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

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 pathology has become a reality with clinical and secretory polymorphism. The diagnostic delay explains the predominance of macroadenomas which are sources of pre and post-operative complications.

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

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 complications.

Prognostic utility of global longitudinal strain in myocardial infarction

Cardiovascular magnetic resonance(CMR) represents the reference standard for cardiac morphology and function assessment. Since introduction in 2009, CMR feature tracking(CMR-FT) has become a frequently used tool in the assessment of myocardial deformation and wall motion on the basis of routinely acquired b-SSFP cine images. Extensive validation has led to excellent intra-and inter-observer as well as inter-study reproducibility. CMR-FT derived myocardial deformation indices such as left ventricular(LV) strain have been shown to be impaired in cardiac diseases such as cardiomyopathies as well as myocardial infarction. Although LV ejection fraction(LVEF) is the routinely and frequently utilized parameter for systolic myocardial function assessment and major adverse clinical event(MACE) prediction, it fails to assess regional differences. Recently, LV strain has emerged as a superior measure for risk assessment and MACE prediction as compared to the established markers e.g., LVEF. This editorial aims to elucidate current discussions in the field of strain assessment in myocardial infarction in the light of recent data from a large prospective multicentre CMR study.

Low Socio-Economic Level: A Major Obstacle to Therapeutic Observation (Survey of 125 Diabetic Patients)

Introduction: Diabetic patients adhering to their treatment are less likely to face complication from their disease. For this reason, we studied the compliance of diabetics with their treatment. Materials and Method: This was a comprehensive cross-sectional study of adherence in diabetic patients. All patients meeting the inclusion criteria were enrolled in the study. This study took place at a private pharmacy called “pharmacy Elhadj Seydou Nourou Tall” located in the city of Pikine during the period from April 1 to September 30, 2019. Results: In total, the study population was composed of 125 diabetics;frequency of 8.47%. The average age was 62.5 years and there were more women (58.4%). Of the patients, 87% had a low socioeconomic level and 72% a low educational level. Only 65.6% of the patients knew their diabetes type. Even though 97.6% of the patients were confident in the treatment but due to financial reasons 20.8% did not adhere to the prescribed treatment and 16.8% to their diets. Moreover, 15.2% of the patients had changed the dosage of the prescribed medication, 44.4% had forgotten to take their medication regularly. 78.4% of them thought they were taking too much medication. No factors were found to be statistically associated with poor adherence, but the proportion of poor adherence patients was higher in patients over 60 years of age, with low socio-economic status and low education. Conclusion: Low socio-economic status is the main barrier to good adherence. Recommendations have been formulated to improve this adherence.

Diabetes Mellitus and COVID-19 at Abass Ndao Hospital Epidemic Treatment Center (ETC)

Introduction: SARS-COV2 infection is a major public health problem and diabetes mellitus is a serious factor. The objective was to determine the characteristics of COVID-19 in diabetics at the Epidemic Treatment Center (ETC) of the Abass Ndao Hospital Center. Observation: This was a retrospective, descriptive and analytical study carried out at Abass Ndao Hospital from March 01, 2021 to September 31, 2021. We evaluated the epidemiological, clinical and evolutionary characteristics. Results: Among 333 patients infected with COVID-19, 203 were diabetic (60.96%). The sex ratio was 0.70 and the mean age 60.18 years. Diabetes was type 2 (84.2%) and inaugural (15.8%). Arterial hypertension was the main comorbidity (86.96% of cases). The RT-PCR test was positive in 86.21% of cases. The main clinical signs were: asthenia (90.14%), dyspnea (78.81%), cough (52.21%) and body aches (52.21%). Oxygen saturation was alanced in 71.43% with an average blood sugar of 2.02 ± 4 g/l. At the paraclinical, the D dimer was ≥1000 ng/l (71.52%) and the C-reactive protein ≥100 mg/l (32.01%). Chest CT scan found mild to moderate (55.17%), severe (21.67%) and critical (17.24%) lung lesions. Pulmonary embolism was found in 4 diabetics. The treatment of diabetes was represented by insulin therapy (85.82%) and oral antidiabetics (24.11%). Anti-COVID-19 treatment was dominated by azithromycin (89.11%), corticosteroid therapy (92.11%), anticoagulants (99%), hydroxychloroquine (21.29%). Mortality was found in 14.36% (n = 29) and significantly correlated with age ≥ 60 years (OR = 3.013 [1.266 - 7.173], P = 0.005), short duration of hospitalization (OR = 3.154 [1.149 - 8.663], P = 0.009), C-reactive protein > 100 mg/l (OR = 6.370 [2.704 - 15.006], P < 0.001), lung saturation < 90% (OR = 6.331 [2.633 - 15.222], P [3.367 - 18.322], P Conclusion: Diabetes is one of the most important comorbidities linked to the severity of SARS-CoV-2 infection. The seriousness factors in this field remain age ≥ 60 years, lung damage ≥ 50%, CRP ≥ 100 mg/l, and oxygen saturation at 90%.