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Profile of Pituitary Adenomas in Senegal: Epidemiological, Clinical and Therapeutic Aspects about 241 Collected Cases

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Open Journal of Internal Medicine 2023年第3期13卷 144-154页

作者： Diédhiou Demba Diallo Ibrahima Mané Mbaye Maguette Sow Djiby ndiaye fama Mody Ndour Michel Assane Dieng Mouhamed Gadji Fatou Kiné Thioye Elhadj Mamadou Halim Charles Ndao Cheikh Matar ndiaye Boun Khatab Diouf Sarr Anna Ndour Mbaye Maimouna Medical Clinic II AbassNdao Hospital Center Cheikh Anta Diop University Dakar Senegal Department of Neurosurgery Fann Hospital Center Cheikh Anta Diop University Dakar Senegal

Introduction: in adults, adenomas are the most frequent causes of pituitary tumours. The objective was to characterize its epidemiological and clinical aspects, as well as its therapeutic modalities in Senegal. Methodology: this was a multicenter, retrospective, descriptive and analytical study carried out from the Senegalese register of pituitary adenomas (2008-2022). Results: 242 patients were collected with an average age of 42.4 ± 13 years and a sex ratio (M/F) of 0.91. The mean consultation time was 19.7 ± 23 months. The circumstances of discovery were pituitary apoplexy (11 cases, 4.54%), tumor syndrome (176 cases, 72.72%), gonadal manifestations (103 cases, 42.56%), dysmorphic syndrome (21 cases, 8.68%), hypercorticism (15 cases, 6.19%). Morphologically, it was a macroadenoma (197 cases, 81.40%), an extensive adenoma (22 cases, 9.10%). The hormonal profile was lactotropic hypersecretion (80 cases, 33.05%), somatotropic (13 cases, 5.39%), corticotropic (14 cases, 5.78%), mixed (9 cases, 3.71%). The factors significantly associated with prolactinoma were young age (p = 0.000), female sex (p = 0.000), long consultation delay (p = 0.000) and microadenoma (p = 0.001). Only arterial hypertension was associated with acromegaly (p = 0.000). We found a significant correlation between Cushing’s disease and microadenomas (p = 0.000). Non-secreting adenomas were significantly associated with advanced age (p = 0.000), long delay in consultation (p = 0.000), male gender (p = 0.000), tumor syndrome (p = 0.001) and macroadenomas (p = 0.000). Pituitary surgery was effective in 173 patients (71.49%) including 166 cases (68.59%) by transphenoidal approach. Postoperative incidents were transient diabetes insipidus in 82 cases (47.39%), cerebrospinal fluid leak (20 cases, 11.56%). Death was observed in 18 patients in the entire series (7.44%). The latter had a tumor syndrome (88.88%), a macroadenoma (83.33%) and had undergone pituitary surgery (72.22%). Conclusion: pituitary path

关键词： Pituitary Adenoma Prognosis Management Senegal

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Bisecreting Pituitary Neuroendocrine Tumors: About 9 Cases at the Abass Ndao Hospital Center in Dakar

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Open Journal of Endocrine and Metabolic Diseases 2024年第10期14卷 179-189页

作者： Demba Diedhiou Elhadji M. M. Thioye Matar ndiaye Djiby Sow Michel Assane Ndour fama Mody ndiaye Charles Mouhamed Abdallah Halim Mouhamed Dieng Omar Boun Khatab Diouf Muriel Diembou Boundia Djiba Anna Sarr Maïmouna Ndour Mbaye Department of Internal Medicine II University Hospital Center of Dakar Cheikh Anta Diop University Dakar Senegal

Introduction: Pituitary neuroendocrine tumor (PitNET) may present multisecreting forms. Identifying its forms helps to guide management. This management is a real challenge, given the limited resources in our regions. In view of advances in the management of these multisecreting pituitary neuroendocrine tumors and the lack of published data in Africa, and in Senegal particularly, this survey was carried out with the aim of describing the epidemiological, clinical and therapeutic aspects of multisecreting PitNETs. Patients and Method: It was a multicenter, retrospective, descriptive and analytical study carried out on files collected from 1st January 2008 to 31 December 2022 in the neurosurgery departments of the Fann and Principal hospitals in Dakar and the endocrinology department of the Abass Ndao hospital in Dakar. Results: Of the 242 patients treated for PitNET, 09 presented (the mean age of our patients was 41.7 ± 11 years) with bihormonal PitNET, i.e. a proportion of 3.71%. Two types of association were found: 08 tumors with GH (Growth Hormon) + PRL (prolactin) secretion and 01 PitNET with ACTH (Adreno Corticotropic Homon) + prolactin secretion. Clinically, gonadotropic insufficiency was found in all patients (100%). Dysmorphic syndrome was found in 6 patients (66.7%) and tumor syndrome in 7 patients (77.8%). Ophthalmological evaluation revealed a decrease in visual acuity in 66.6% of patients. All had macroadenomas, with extension noted in 02 patients. All patients underwent transsphenoidal surgery with complications such as transient diabetes insipidus (3 patients, 33.3%), followed by cerebrospinal fluid leaks (1 patient, 11.1%). Remission was noted in all 5 patients tested. A comparison between the different secretory forms did not reveal any significant difference in the frequency of postoperative complications. Conclusion: Despite the lack of immunohistochemistry, two types of association were found: ACTH-PRL and GH-PRL. All were macroadenomas, the majori

关键词： Pituitary Adenoma Pituitary Neuroendocrine Tumor Multisecreting Adenoma Cushing’s Disease Acromegaly

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Profile of Female Hyperandrogenism at the Medical Clinic II: About 19 Cases

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Open Journal of Endocrine and Metabolic Diseases 2023年第5期13卷 63-74页

作者： Michel Assane Ndour Demba Diédhiou Djiby Sow Ibrahima Mané Diallo Mouhamed Dieng Fatou Gueye Astou Mbodj Julie Borges Preira Fatou Kiné Gadji Muriel Diembou fama ndiaye El Hadj Mouhamadou Moustapha Thioye Charles Halim Anna Sarr Maïmouna Ndour Mbaye Internal Medicine Department Abass Ndao Hospital Cheikh Anta Diop University of Dakar Dakar Senegal

Introduction: Female hyperandrogenism is essentially manifested by hirsutism. It is present in Senegal but not yet elucidated for lack of data. This is why we proposed to study the profile of hyperandrogenism in our context. Patients and Methods: This was an observational, cross-sectional cohort study of 19 patients of reproductive age followed for hyperandrogenism at the Medical Clinic II of Abass Ndao Hospital, from November 1st, 2019 to August 31st, 2021. Results: Our cohort consisted of women with an average age of 25.3 years, single (73.7%), with a low socioeconomic level (42.1%). A family history of hirsutism was found in 31.6% of cases. The main reasons for consultation were a menstrual cycle disorder in 94.7% of cases, and hirsutism in 78.9% of cases. The latter was post-pubertal (66.7%), with a slow or progressive evolution. The physical examination revealed: hirsutism (100%) with an average modified Ferriman Gallwey score (mFG) of 8.9 ± 5.8, acne (36.8%), hyperseborrhea (57.9%), major signs of virilization (10.5%), acanthosis nigricans (47.4%) and galactorrhea (5.3%). Hormonal explorations revealed an elevation of: testosterone (31.6%), 17-hydroxyprogesterone (5.3%), dihydrotestosterone (31.6%), and prolactin (10.5%). The ovarian morphology was micropolycystic (84.2%). The etiological profile corresponded to polycystic ovarian syndrome or PCOS (68.4%), ovarian hyperthecosis (10.5%), hyperprolactinemia (10.5%), congenital adrenal hyperplasia or CAH (5.3%). Idiopathic hirsutism was found in 5.3% of cases. Conclusion: Female hyperandrogenism is a less frequent reason for consultation in endocrinology. It deserves to be further evaluated in a large-scale study focused on epidemiological, clinico-biological and etiological investigation, in order to assess its prevalence and better define its profile in our context.

关键词： Female Hyperandrogenism Hirsutism Senegal

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Profile of Autoimmune Polyendocrinopathies at the Medical Clinic II of the Abass Ndao Hospital: About 40 Cases

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Open Journal of Internal Medicine 2024年第1期14卷 74-82页

作者： Michel Assane Ndour Djiby Sow Mouhamed Dieng Ibrahima Mané Diallo Boundia Djiba Mélaine Honorine Olympio Julie Borges Preira Muriel Diembou Fatou Kiné Gadji fama ndiaye El Hadj Mamadou Moussa Thioye Charles Halim Demba Diédhiou Anna Sarr Maïmouna Ndour Mbaye Abass Ndao Hospital Internal Medicine Department Cheikh Anta Diop University Dakar Senegal Aristide Le Dantec Hospital Internal Medicine Department Cheikh Anta Diop University Dakar Senegal

Introduction: Autoimmune polyendocrinopathies (AP) represent a group of rare concomitant pathologies, making them underdiagnosed. The objective was to study their profile at the Medical Clinic II of the Abass Ndao Hospital. Patients and Methods: This was an observational, descriptive and analytical study, lasting 24 months, from January 1, 2020 to December 31, 2022. We assessed the epidemiological, clinical and paraclinical characteristics of the patients and classified the APs found. Results: We included 40 patients divided into type III (38 cases) and IV (2 cases). A female predominance was noted with a sex ratio of 0.21. The mean age was 38.6 years. A family history of component diseases of autoimmune polyendocrine syndrome (APS) was found in 62.5%. Goiter (80%) was the main clinical sign present. All 38 patients with ISAP-3 had autoimmune thyroiditis, including 29 cases of Graves’ disease (72.5%) and 9 cases of Hashimoto’s thyroiditis (22.5%). They were associated with either type 1 diabetes (57.9%), Biermer’s disease (21.1%), vitiligo + alopecia (18.4%), lupus (2.6%). The 2 patients with AP-4 had Biermer’s disease associated with either Addison’s disease or type 1 diabetes. Management depended on the pathologies present and their possible complications. The immunological phenomena were also controlled. Conclusion: This series is globally similar to the literature. The polymorphous character of the clinical pictures requires a better collaboration between specialists leading to a clinical and holistic synthesis.

关键词： APS Biermer Graves’ Disease Hashimoto’s Addison’s Vitiligo Senegal

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Prolactin Adenomas in Senegal: Epidemiological, Diagnostic and Therapeutic Aspects of 89 Cases

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Open Journal of Internal Medicine 2023年第3期13卷 209-217页

作者： Michel Assane Ndour Demba Diédhiou Djiby Sow Boundia Djiba Mouhamed Dieng Ibrahima Mané Diallo Fatou Kiné Gadji Julie Borges Muriel Diembou fama Mody ndiaye El Hadj Mouhamadou Moustapha Thioye Charles Halim Philippe Moreira Anna Sarr Maïmouna Ndour Mbaye Medical Clinic II Abass Ndao Hospital Center Cheikh Anta Diop University Dakar Senegal

Introduction: In Senegal, there is very little data on prolactinomas despite their negative impact on couples fertility. Patients and methods: This was a multicentre, retrospective, descriptive, analytical study conducted from 1 January 2008 to 31 December 2022 in the neurosurgery departments of the Fann and Principal hospitals and the endocrinology department of the Abass Ndao Hospital. Results: We included 89 patients, representing a prevalence of 36.7% among all cases of pituitary adenoma. The mean age was 35.6 ± 10 years and the sex ratio was 0.34. The mean time to consultation was 27.1 ± 29 months. Clinical symptoms were dominated by gonadotropic disorders represented by galactorrhoea (71 cases, 79.8%), amenorrhoea (61 cases, 68.5%), and infertility in the couple (31 cases, 34.8%). Fifty-seven (58) patients presented with a tumour syndrome (65.2%, including 57 cases of headache (64%), 34 cases of visual disorders (38.2%) and 8 patients with a dysmorphic syndrome (8.9%). Imaging revealed a macroadenoma in 68.5% (61 cases) and extension of the adenoma in 11 patients (12.4%). The hormonal profile was isolated lactotropic hypersecretion (80 cases, 89.9%) and mixed in 9 cases (including concomitant secretion of GH in 8 cases and ACTH in 1 case). All patients had initially benefited? from dopaminergic agonist-based medical treatment. Pituitary surgery was effective in 45 patients (50.6%), including 44 cases by transsphenoidal approach. Postoperative incidents included transient diabetes insipidus (77.7%) and cerebrospinal fluid leakage (20%). We noted 7 cases (7.9%) of death presenting with a tumour syndrome (100%), a macro-adenoma (85.7%), having undergone pituitary surgery (42.9%). The factors significantly associated with prolactinoma were young age (p Conclusion: This series also demonstrates the impact of prolactin adenomas on reproductive function. Delayed diagnosis explains the predominance of macroadenomas, which are a source of pre- and post-operative compli

关键词： Prolactinoma Fertility Disorders Tumour Syndrome Pituitary Adenomas

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Primary Hyperparathyroidia at the Abass Ndao Hospital Center: About 29 Cases

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Open Journal of Internal Medicine 2023年第4期13卷 427-435页

作者： Demba Diédhiou Michel Assane Ndour Mouhamed Dieng Charles Halim Ibrahima Mané Diallo Djiby Sow Fatou Kiné Gadji Ndeye Déthié Beye fama Mody ndiaye El Hadj M. M. Thioye Boundia Djiba Boucar Ndong Awa Cheikh Ndao Anna Sarr Maïmouna Ndour Mbaye Service de Médecine Interne Centre Hospitalier Abass Ndao Université Cheikh Anta Diop Dakar Sénégal Service de Médecine Nucléaire et de Biophysique Faculté de Médecine Pharmacie et d’Odontologie Université Cheikh Anta Diop Dakar Sénégal Service de Médecine Interne Centre Hospitalier Aristide Le Dantec Université Cheikh Anta Diop Dakar Sénégal

Introduction: In Senegal, there is very little data on primary hyperparathyroidism despite an overall upward epidemiological trend. The objective was to describe its epidemiological, clinical, therapeutic and evolutionary aspects. Materials and Methods: This was a cross-sectional, descriptive study, conducted over 5 years (from January 01, 2018 to December 31, 2022) at the National Abass Ndao Hospital Center and including all confirmed cases of primary hyperparathyroidism. Results: Twenty-nine patients were included with a female predominance (86.20%) and an average age of 48.10 ± 18.93 years. The discovery of hyperparathyroidism was fortuitous in 79.31% of cases. The main clinical manifestations were osteoarticular (62%) and urinary (34.5%). On average, serum calcium measured was 109.2 ± 7.92 mg/l, corrected serum calcium 111.3 ± 6.25 mg/l, urinary calcium 421.9 ± 96.45 mg/24h and parathormone at 145 ± 159.71 pg/ml. Among the patients, 25 had hypercalcemia (86.2%) and all had 24-hour hypercalciuria. The diagnosis was retained in view of the elevated parathyroid hormone (PTH) values in all patients. Cervical ultrasound objectified a parathyroid adenoma in 27.58% of cases and 12 patients or 46.2% had presented a scintigraphy in favor of a parathyroid adenoma. We found 01 cases of multiple endocrine neoplasia type 2. Bone densitometry performed in 10 patients found osteoporosis in 60% of cases (6 patients) and osteopenia in 40% of cases (4 patients). Surgical treatment was performed in 12 patients (41.4%). The histology of the surgical specimens was in favor of a parathyroid adenoma in all cases. Among the operated patients, the evolution was marked by a cure rate of 100%. Conclusion: The symptomatology of primary hyperparathyroidism remains mainly osteoarticular and urinary. Surgery has proven its effectiveness in our series. We insist on the systematic dosage of calcemia especially in women over 50 years and the promotion of morphological explorations.

关键词： Primary Hyperparathyroidism Hypercalcemia Parathormone Osteoporosis Dakar

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