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During pregnancy, maternal thyroid function must adapt to physiological steroid (high estrogen) and hormonal (placental hCG secretion) variations to maintain euthyroidism. The reference values of TSH and free T4 levels must be known by the clinician to diagnose accurately thyroid dysfunctions in pregnant women. Primary hypothyroidism, most often secondary to autoimmune thyroiditis, is diagnosed by an increase in TSH level, and can be responsible for maternal, obstetric and fetal complications. It requires substitutive treatment with levothyroxine. The diagnosis of subclinical hypothyroidism (moderate increase in TSH level with normal free T4 concentration) and the benefit of levothyroxine treatment are discussed in the most recent publications. Graves' disease, autoimmune hyperthyroidism linked to anti-TSH receptor antibodies, must be recognized and diagnosed in pregnant patients with thyrotoxicosis. It is associated with maternal and fetal complications, and requires treatment with synthetic antithyroid drugs: propylthiouracil is the first line therapy in pre-conception and during the first trimester of pregnancy due to the risk of more frequent and more severe embryopathies observed with methimazole/carbimazole treatment in pregnant women. Medical treatment with levothyroxine of hypothyroidism and antithyroid drugs in Graves' disease are not contraindicated during breastfeeding. [ABSTRACT FROM AUTHOR]

Introduction. Nodular goiters are clinically recognizable enlargements of the thyroid gland characterized by structural and/or functional transformation of one or several areas within the normal thyroid tissue. In the absence of thyroid dysfunction, autoimmune thyroid disease, thyroiditis, and thyroid malignancy, they constitute an entity described as simple nodular goiter. The objective of the study was to determine the scope of surgery in patients with unilateral nodular goiter with autoimmune thyroiditis (NGAIT) with compression syndrome and predict the long-term results of surgical treatment, based on the study of proliferation of apoptosis and autoimmune disorders. Materials and methods. Long-term results of hemithyroidectomy were analysed in 101 women aged between 23-72 years, with unilateral NGAIT. We analysed the volume of the gland lobe and the echo structure variant before surgery, blood levels of thyroid-stimulating hormone (TSH), free thyroxine and triiodothyronine, thyroid peroxidase antibodies (TPOab), apoptosis and proliferation indicators showing satisfactory or unsatisfactory treatment results. Results. In 75 patients, three years after hemithyroidectomy, no thyroid dysfunction was detected. At ultrasound, in the remaining thyroid the signs of autoimmune thyroiditis (AIT) did not progress. Twenty-six patients showed an increase in the remaining thyroid gland and progression of the autoimmune disease, with hypothyroidism. Conclusions. Hemithyroidectomy can be performed in patients with NGAIT and compression syndrome in conditions of preserved gland function, activation of proliferation and apoptosis, and pseudo micronodular parenchymal echo structure.

Introduction. The main treatment of autoimmune thyroiditis (AIT) is conservative. However, there are patients with AIT in whom surgical treatment is mandatory. The growing experience and reports of surgical intervention with newer indications challenges this traditional view of AIT. The objective of the study was to determine the choice of surgery volume in patients with nodular goiter and AIT, taking into account the activity of apoptosis, index of proliferative activity and polymorphisms of cytotoxic T-lymphocyte antigen-4 (CTLA-4) gene. Material and methods. 95 patients with nodular goiter and autoimmune thyroiditis (NGAIT) were included in the study. We determined the activity of the apoptosis index of proliferative activity and gene polymorphism of CTLA-4. Results. The correlation analysis of markers used to optimize surgical treatment, namely the choice of the surgery volume in patients with NGAIT, showed that the studied tests are objective and reliable for the long-term results of surgical treatment: the volume of the thyroid gland not affected by the nodes less than 10 cm3, the level of antibodies to thyroid peroxidase (TPO Ab) 43%, IIRC Bcl-2 50%; AA and AG-genotype of the CTLA-4 gene. Conclusions. The study allowed to determine new criteria for selecting the volume of surgery in patients with NGAIT.

Introduction. Autoimmune thyroiditis is one of the most important problems of modern endocrinology, with inadequately studied etiological and pathogenic mechanisms of development. It is characterized by the lack of objective and reliable diagnostic methods, effective treatment methods, uncertain therapy or indications for the choice of treatment methods. The aim of the study. Determination of markers for prediction of clinical course and choice of surgery’ volume in patients with nodular goiter and autoimmune thyroiditis, taking into account the oxidative, autoimmune and apoptotic processes. Material and methods. A total of 95 patients who were operated for a nodular endemic goiter on the background of autoimmune thyroiditis were examined. The status of pro- and antioxidant systems, the activity of proinflammatory cytokines, hormonal function of thyroid gland, the level of antibodies to thyroperoxidase, thyroglobulin antibodies and ultrasound structural changes in the thyroid gland have been evaluated in all patients, before and after surgery. Results. In patients with nodular endemic goiter and autoimmune thyroiditis, in the remote period after surgical treatment, there is a significant increase in the peroxide oxidation index and a decrease in the activity of antioxidant defense systems, against the suppression of apoptotic processes and the activation of pro-inflammatory cytokines. These processes lead to functional failure, hyperplasia and the progression of structural thyroid abnormalities, with progression of the functional incapacity of the thyroid gland and inadequate long-term outcome of treatment. Conclusions. The study allowed to clarify the indications and contraindications of different methods of treatment in patients with NGAIT, taking into account the parameters of severity of peroxide oxidation processes, the activity of apoptosis and functional capacity of the gland.

Background. Autoimmune thyroiditis (AIT) is one of the unsolved problems of modern endocrinology, the etiology and pathogenesis being still insufficiently known. Objectives. To study the effects of substitution, antioxidant and lymph-drainage ther­apy on the structure and function of the thyroid gland in patients with AIT and hypothyroidism. Methods. We have identified 2 groups of patients with AIT and subclinical hypothyroid­ism. The first group – control group – included 20 patients who received substitution therapy with thyroxine. The second group included 33 patients who received a comprehensive treatment with thyroxine, alpha lipoic acid and Lymphomyosot. Results. The use of substitution therapy with thyroxine and the proposed an­tioxidant and lymph drainage therapy in patients with AIT led to the improve­ment of the structure of the gland, reduced the activity of peroxide oxidation pro­cesses and the activity of pro-inflammatory cytokines, increased the level of anti­oxidant defense enzymes, normalized the number of aniline-positive lymphocytes, improved the lymphatic drainage function of the gland. Our results sustain the effectiveness of the proposed method of complex treatment in patients with autoimmune thy­roiditis.

Chronic autoimmune thyroiditis (Hashimoto’s thyroiditis) is the most common cause of hypothyroidism which may associate weight increase and changes in serum lipid levels. There is still controversy over the link between obesity and autoimmune hypothyroidism. The paper aims to assess obesity and lipid metabolism in patients with Hashimoto’s thyroiditis, and to establish a correlation between TSH (thyroid-stimulating hormone), FT4 (free thyroxine) levels, and the titer of antithyroid antibodies.

Several disorders of immunological origin, in particular thyroid disorders have been reported in patients with myasthenia. This relationship has been little elucidated but in patients with myasthenia and Graves’ disease was found an immunological cross-reaction between the neuromuscular junction and thyroid components. It is generally accepted that the association between hyperthyroidism and myasthenia is much more common than between myasthenia and hypothyroidism. However, there has been no clear explanation for this difference. We here report the case of a 53-year old patient treated for hypothyroidism due to suspected Hashimoto's disease well balanced under replacement therapy and whose evolution was marked by the detection of myasthenia during the follow up period. Myasthenia responded well to treatment based on neostigmine. [ABSTRACT FROM AUTHOR]

Lichen planus pigmentosus (LPP) is an autoimmune, chronic and rare variant of lichen planus of unknown etiology that progresses with pigmentation. The condition is rarely observed concurrently with autoimmune diseases. In this case report, a diabetic male patient with speckled lentiginous lesions on the face, also diagnosed with concurrent autoimmune thyroiditis is presented due to the rarity of the condition and the morphological character of the lesions.

Résumé Les pathologies auto-immunes sont de plus en plus observées, décrites et reconnues chez les enfants et les adolescents, que ce soit des maladies comme le lupus érythémateux disséminé (LED), les thyroïdites auto-immunes, ou les encéphalites auto-immunes dont les formes sont volontiers plus sévères et plus agressives que celle décrites chez l’adulte. L’aspect psychiatrique de ces tableaux cliniques est souvent au premier plan. En effet, les symptômes psychiatriques sont nombreux, aigus, sévères, ubiquitaires et pour la plupart atypiques. En conséquence, de nombreux patients atteints de pathologies auto-immunes sous-jacentes sont pris en charge en pédopsychiatrie devant l’apparition brutale et bruyante de symptômes psychiatriques. Parmi ces symptômes figure la catatonie de l’enfant et l’adolescent qui prend une place particulière. L’objet de cet article est de présenter des exemples de pathologies auto-immunes pouvant conduire à des tableaux psychiatriques chez l’enfant et l’adolescent, à travers une revue de la littérature. Nous détaillerons également le type de symptômes neuropsychiatriques rencontrés dans ces pathologies auto-immunes, ainsi que le rôle important de la catatonie comme symptôme de « porte d’entrée ». Puis enfin nous aborderons les aspects et les enjeux diagnostiques et thérapeutiques de ces pathologies. Notre discussion est illustrée par deux vignettes cliniques. In the last twenty years, autoimmune disorders have been clearly described in child and adolescents, from systemic erythematous lupus, auto-immune thyroiditis to auto-immune encephalitis, which are more aggressive and severe than in adults. The psychiatric features met in these autoimmune conditions are often at the front. Indeed, psychiatric symptoms are likely to be various, acute, severe, random, and for most of them atypical. Hence, many patients suffering from autoimmune conditions end up being taken care by psychiatrist for acute and severe psychiatric presentation. Among these psychiatric symptoms, catatonia takes a specific and important place. The aim of this article is to present a few examples of autoimmune disorders which can lead to psychiatric presentation. We emphasize on the type of neuropsychiatric symptoms, which are likely to appear in autoimmune conditions, and also on the role of catatonia as a key symptom. Then we underline the therapeutic options and challenge of autoimmune disorders. Our discussion is illustrated with two case reports. [ABSTRACT FROM AUTHOR]

Squaric acid dibutylester (SADBE) is frequently used for the treatment of alopecia, but sometimes unwanted side effects occur. Herein we report a case which developed vitiliginous lesions induced by topical SADBE application in a patient with autoimmune thyroiditis. A 60-year-old female visited our department, complaining of diffuse alopecia of the scalp. She was suffering from chronic autoimmune thyroiditis over several years, and taking thyradin (90mg per day).

Abstract: Introduction: Autoimmune manifestations are common in splenic marginal zone lymphoma (SMZL) and are sometimes the presenting feature of the disease. Autoimmune cytopenia (anemia, thrombocytopenia) are the most frequently reported autoimmune conditions. However, other immunological manifestations may be associated with SMZL. Méthodes: We report a retrospective case series of six patients with SMZL associated with autoimmunity. Results: Auto-immune manifestations were the presenting feature of lymphoma in four cases. Auto-immune manifestations included auto-immune cytopenia in three cases (two hemolytic anemia and one pancytopenia), thyroiditis in two cases, systemic lupus and Still''s disease in one case each. Antinuclear antibodies were detected with a titre of 1/250 in three cases, and with a titre of 1/32,000 in the patient with systemic lupus. Testing for DNA antibodies was negative in all cases. Two patients had a circulating lupus anticoagulant, with portal venous thrombosis following splenectomy in one case. One patient had hypogammaglobulinemia. A monoclonal gammopathy was detected in three patients. All patients had spleen enlargement. Immunophenotyping of blood peripheral lymphocyte was typical in five out of the six cases. Bone marrow was infiltrated in five out of the six cases. Diagnosis was obtained by the combination of immunophenotyping and bone marrow histopathology in five cases, and by splenic histopathology in the remaining case. Hepatitis C virus serology was negative in all patient. Conclusion: Autoimmune disease as systemic lupus or Still''s disease may be associated with SMZL before its tumoral manifestations are evident. In this mode of presentation, spleen enlargement, hypogammaglobulinemia, monoclonal gammopathy, and multiple autoimmune diseases, should alert the physician. [Copyright &y& Elsevier]

Abstract: The autoimmune thyroid diseases (AITDs) are multifactorial diseases which result from interplays between predisposing genes and triggering environmental factors. In order to study the genetic susceptibility factors to AITDs, we have followed up 115 control members belonging to a large Tunisian family with a high prevalence of AITDs (Akr family) during 15 years between 1990 to 2005. The follow-up of these control members have showed that 13 subjects (11.3%) developed AITDs (G2). The Hashimoto thyroiditis was the most frequently seen in 77% of the cases, whereas the Graves''s disease was present in 23% of the cases. One hundred and two members remained controls (G1). High female predominance was noted in the two groups. The mean age of the G1 subjects group was slightly higher than that of G2. The prevalence of positive antithyroglobulin antibody (TgAb) and antithyroperoxydase antibody (TPOAb) was more frequent in G2 group (P =0.27 and P =0.23) respectively. The HLA haplotypes was realized in 42% of control members. The most frequent HLA haplotypes that were found were B37, DRB11 and A1. HLA B37 and DRB11 were significantly more frequent for the patients of G2 (P =0.0001 and P =0.034) respectively. Our study confirms the contribution of the genetic factors in the development of AITDs in ‘Akr’ family and suggested that the members of this family share the same genetic inheritance. [Copyright &y& Elsevier]

Copyright of IBS, Immuno-analyse & Biologie Specialisee is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of IBS, Immuno-analyse & Biologie Specialisee is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of IBS, Immuno-analyse & Biologie Specialisee is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A variety of rheumatic manifestations have been described in association with autoimmune thyroiditis. In the past, most of these manifestations were attributed to the underlying thyroid dysfunction, in particular hypothyroidism. However, a responsibility of the mechanisms involved in the autoimmunity rather than a direct action of thyroid hormones seems supported by the evidences that some rheumatic manifestations may occur even in euthyroid patients, or that they are more frequent in hypothyroid patient with autoimmune thyroiditis than in those without this disease. Rheumatic manifestations could be sometimes attributable to the autoimmune rheumatic diseases frequently associated with autoimmune thyroiditis, such as Sjögren’s syndrome, rheumatoid arthritis, systemic lupus erythematosus, or scleroderma. Among the most important or frequent rheumatic manifestations there are a mild non erosive variety of arthritis, polyarthralgia, myalgia, and sicca syndrome without a true Sjögren’s syndrome. Although the possible pathogenesis of these manifestations is not completely established, some hypotheses may be proposed, including a role of autoantibodies characteristics of autoimmune thyroiditis, a possible overlap between autoimmune thyroiditis and some autoimmune rheumatic diseases, and a systemic inflammatory reaction associated with thyroiditis. [Copyright &y& Elsevier]

This review focuses on auto-immune diseases which frequently affect women and can have interactions with pregnancy: lupus erythematosus (LES), antiphospholipide syndrome (SAPL), Sjögren's syndrome (GS), rhumatoid arthritis (PR) and auto-immune thyroiditis. LES may flare at the end of a pregnancy and during post-partum. Its biological monitoring during pregnancy is well established. SAPL is at risk of sterility, prematurity, Hellp syndrome, eclampsia and retroplacental hematoma. The main risk, actually risk is fœtal loss by placental ischemia, which has to be well known as 2 randomised studies have proven the efficacy of treatments with aspirin ± subcutaneus heparin. LES, GS and PR can both be associated with anti SS-A ± anti SS-B antibodies linked to a risk of congenital auriculo-ventricular block, which is fortunately low (less than 5% of the cases). Auto-immune thyroiditis are often revealed during pregnancy and may be enhanced during the six first months of post-partum. [ABSTRACT FROM AUTHOR]

The whole of the lesions associated with Crohn's disease affecting the anal canal, the skin of the perineum, the bottom-rectum and the recto vaginal septum are referred to as anoperineal lesions of Crohn's disease. The main types of primary lesions include ulcerations, suppurations and stenoses. Crohn's disease-like anoperineal lesions are often suspected in patients with severe inflammatory process, peri-anal skin thickening, œdematous marisques, multiple lesions and lesions extending above pectineal line. Fistulas usually originate from an ulceration or a scar rather than the crypts of the anal canal. Elementary lesions of Crohn's disease are rarely isolated and they are, in most cases, combined lesions. The presence of a stenosis of the anal canal or of the rectum is very often associated with an inflammatory and suppurative process. Anal ulcerations are complicated with suppuration in half of the cases. We report the case of 45-year old woman treated for autoimmune thyroiditis and vitiligo who presented with knife-cut painful perineal ulcerations. The patient reported episodes of diarrhea during interview. Histological examination of skin lesions showed epitheliogigantocellular granuloma without caseous necrosis and digestive exploration suggested Crohn's disease which was confirmed with histology [ABSTRACT FROM AUTHOR]

Copyright of IBS, Immuno-analyse & Biologie Specialisee is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Introduction. – The oncovirus HTLV-1 is aetiologically associated with uveitis and autoimmune thyroiditis in endemic areas. The association of uveitis with autoimmune thyroiditis in HTLV-1 carriers is less common moreover in non-endemic area. Exégèse. – We report two original cases of simultaneous uveitis and autoimmune thyroiditis in HTLV-1 carriers, without other disease due to HTLV-1. The visual outcome was favorable in both cases. Conclusion. – A significant correlation exists between hyperthyroidism, uveitis and HTLV-1, but still needs to be confirmed. The autoimmune or immune mediated mecanism of HTLV-1 may be involved in the uveitis and the thyroidits. [Copyright &y& Elsevier]

Introduction: L’association d’une ou plusieurs maladies auto-immunes (MAI), chez le diabétique de type 1 (DT1) est plus fréquente que dans l’ensemble de la population. La thyroïdite auto-immune (TAI) est parmi les MAI les plus fréquemment associées au diabète de type 1. L’intérêt de notre étude est de démontrer que le dépistage systématique de la TAI est justifié au cours du suivi des patients diabétiques de type 1. Patients et méthodes: Analyse rétrospective concernant 50 patients DT 1, suivis à l’Hôpital Militaire de Rabat, âgés entre 10 et 22 ans. Résultats: 31,5 % de nos DT1 avaient des anticorps antithyroïdiens (AAT) positifs. La majorité de ces patients (28,6 %) avaient aussi des anticorps anti glutamic acid decarboxylase (Ac GAD) positifs. La durée moyenne du diabète était de 6,9 ans chez les patients avec AAT positifs contre 2,2 ans chez les patients avec des AAT négatifs. L’âge moyen des patients ayant les AAT positifs est de 18,9 ans, comparé à âge moyen de 13,6 ans chez les patients avec des AAT négatifs. La fréquence des AAT augmentait régulièrement avec l’âge : 5,2 % entre 10 et 13 ans, 17,9 % entre 14 et 18 ans et 31,5 % entre 20 et 22 ans : 23,6 % filles et 7,8 % garçons Conclusion: l’âge des patients, l’ancienneté du diabète, la positivité des anticorps anti GAD sont tous des facteurs qui augmentent le risque de la survenue d’une TAA chez un DT 1. Ces données devraient conduire à une stratégie de dépistage adaptée de la TAI chez le DT 1, tenant compte de ces différents facteurs. Des études de l’histoire de la TAA chez le DT1 restent à mener permettrait ainsi de mieux définir la stratégie de son dépistage. [ABSTRACT FROM AUTHOR]

Introduction: Les causes de l’hypothyroïdie périphérique sont multiples dominées par les thyroïdites auto-immunes. Le but de notre étude et de décrire les différents aspects étiologiques de l’hypothyroïdie périphérique dans notre contexte et de rapporter notre expérience. Matériels et méthodes: Étude rétrospective menée sur 18 mois (novembre 2008 à avril 2010), portant sur 65 patients (56 femmes et 9 hommes) présentant une hypothyroïdie périphérique, suivis en consultation externe d’endocrinologie de l’hôpital de Mostaganem. Nous avons relevé pour chaque patient les paramètres suivants: âge, sexe, circonstances de découvertes, TSHus, antiTPO, aspect échographique. Nous avons défini l’hypothyroïdie par un niveau de TSHus > 4μUI/ml avec une FT4 normal ou diminué. Résultats: L’âge moyen est de 44,81 ans (17–74), le sexe ratio H/F=0,16, le BMI moyen=25,74kg/m2. L’ancienneté de l’hypothyroïdie, lors de la première consultation à notre niveau, était en moyenne de 18 mois. Les circonstances de découvertes étaient dominées par le goitre dans 43,07 % des cas et les signes fonctionnels dans 35,38 % des cas. Il s’agissait d’une hypothyroïdie avérée dans 78,46 % des cas et fruste dans 21,53 % des cas, avec une TSHus moyenne 21,08μUI/ml. Parmi les 30 patients qui ont réalisé un dosage des antiTPO 19 soit 63,33 % des cas étaient positifs. La répartition selon les causes montre la grande fréquence des séquelles de thyroïdectomie dans 38,46 % des cas suivis par les thyroïdites auto-immunes dans 35, 38 % des cas avec 26, 15 % des cas de thyroïdite d’Hashimoto et 6,15 % des cas de thyroïdite atrophique et 3,07 % des cas de thyroïdite du postpartum. Nous avons relevé 2 cas (3,07 %) de surcharge iodée par amiodarone, 1 cas (1,53 %) d’hypothyroïdie post radique. Dans 21,53 % des cas la cause était imprécise. Conclusion: Malgré la prédominance légère des hypothyroïdies postopératoires dans notre série, les thyroïdites auto-immunes restent une étiologie importante à rechercher en se basant sur les données cliniques, échographiques et hormonales notamment les anticorps antithyroïdiens [Copyright &y& Elsevier]

Introduction: L’association du diabète de type 1 avec d’autres maladies auto-immunes est une situation fréquente surtout pour la thyroïdite d’Hashimoto (TH) et la maladie cœliaque (MC). La reconnaissance de ces pathologies est particulièrement intéressante du fait du retentissement qu’elles peuvent avoir sur l’équilibre glycémique. L’objectif de cette étude est d’estimer la séroprévalence de la MC et de la TH chez des diabétiques de type 1 tunisiens, asymptomatiques pour ces 2 affections. Patients et méthodes: Il s’agit d’une étude rétrospective incluant 96 diabétiques de type 1. Tous les malades ont un dosage systématique des anticorps anti-thyro peroxydase (ATPO) et des anticorps de la maladie cœliaque. L’ancienneté moyenne du diabète est de 4,9 ans ± 7,35 ans lors de la pratique du bilan immunologique. Résultats: Concernant la MC : 14,5 % des malades ont au moins un anticorps positif pour la MC. Parmi ces patients, 85,7 % ont une FOGD ainsi qu’une biopsie duodénale, et l’histologie a confirmé la MC dans 30 % des cas. Concernant la TH, le dosage des ATPO est positif dans 14 % des cas; parmi ces malades : 50 % sont en euthyroidie biologique, 28,6 % sont en hypothyroïdie fruste et 21,5 % sont en hypothyroïdie patente. Conclusion: Nos résultats confirment l’importance du dépistage systématique de la MC et de la TH chez les diabétiques de type 1. En fait, le risque de développer une MC est 20 fois plus élevé chez ces patients et, en cas d’ATPO positifs, le risque de développer une hypothyroïdie patente est multiplié par 18. [Copyright &y& Elsevier]

Abstract: Tubulopathy can complicate autoimmune diseases. It is usually a distal tubular acidosis, but Fanconi syndrome or Bartter syndrome has been exceptionally reported. We report a case of acquired Gitelman syndrome in a 32-year-old male who also presented diffuse scleroderma autoimmune thyroiditis, and Sjögren''s syndrome. Only three cases of Sjögren syndrome associated with Gitelman syndrome have been previously reported in literature. The absence of other cases in the family and absence of mutation SLC12A3 emphasise the relation between autoimmune disease and this tubulopathy. [Copyright &y& Elsevier]

Introduction: La polyendocrinopathie auto-immune de type II (PEAI II) est définie, selon la classification de Neufeld, par l’association d’une maladie d’Addison à une maladie thyroïdienne auto-immune et/ou un diabète. Elles répondent à un modèle physiopathologique particulier que schématise le concept de maladies auto-immunes spécifiques d’organes. Matériels et méthodes: Nous avons mené une étude rétrospective de 39 cas de PEAI II, ainsi qu’une étude cas témoins du polymorphisme des gènes HLA classe II, qui inclut 13 cas de patients ayant une PEAI II et de 120 témoins sains, afin d’identifier les allèles de prédisposition. Résultats: La maladie d’Addison était découverte à un âge moyen de 39 ans. Une prédominance féminine était notée. Les thyréopathies auto-immunes étaient les plus fréquemment associées à la maladie d’Addison dans 82 % des cas : 16 cas de thyroïdite de Hashimoto dans sa forme atrophique, 12 cas dans sa forme goitreuse et 4 cas de maladie de Basedow. Le diabète était associé à la maladie d’Addison dans 25,6 % des cas. L’étude immunologique montrait une positivité des anticorps anti-thyropéroxydase dans 54 % des cas, anticorps anti-GAD dans 28,5 % des cas et les anticorps anti-cortex surrénalien dans 21,8 % des cas. L’étude du polymorphisme des gènes HLA classe II, réalisée pour 13 cas, montrait que l’allèle DRB1*03 était significativement associé aux PEAI type II (p = 0,00004 ; RR = 3,48). Une association moins forte avec l’allèle DRB1*04 était retrouvée (p = 0,05 ; RR = 1.8), devenant non significative après correction de Bontferroni. De même, une association significative de l’allèle DQB1*0302 était observée (p = 0,002 ; RR = 2,27) dans notre population. On n’a pas noté d’association négative d’un ou plusieurs allèles avec la PEAI II. Conclusion: À travers cette étude, nous avons pu mettre en relief les caractéristiques épidémiologiques, cliniques et immunologiques de la maladie d’Addisson au cours de la PEAI et nous avons prouvé l’association entre cette entité et le polymorphisme des gènes du système HLA. [Copyright &y& Elsevier]