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Resume Introduction L’histiocytose est une maladie systemique rare. L’atteinte hypothalamo-hypophysaire est le plus souvent retardee et rarement etudiee chez l’adulte. Observations Nous rapportons les particularites cliniques et paracliniques chez 4 patientes avec histiocytose multifocale. Le diabete insipide a ete la manifestation de decouverte dans tous les cas. Un panhypopituitarisme est present chez 2 patientes et a ete inaugural dans 1 cas. L’insuffisance antehypophysaire s’installe dans un delai de 6 mois a 4 ans apres la decouverte du diabete insipide et les atteintes systemiques sont retardees de 3 a 6 ans par rapport a l’atteinte hypothalamo-hypophysaire. L’imagerie par resonance magnetique nucleaire a trouve un processus tumoral hypthalmo-hypophysaire chez 2 patientes et un epaississement de la tige pituitaire chez les 2 autres. Une patiente a une selle turcique partiellement vide. Discussion L’atteinte antehypophysaire semble predominante chez la femme adulte. Un panhypopituitarisme est possible des le debut de la maladie. Le polymorphisme clinique de cette maladie rend le diagnostic souvent difficile et retarde.

Resume Introduction. – Lˈhistiocytose langerhansienne est une maladie rare, de cause indeterminee, caracterisee par une heterogeneite clinique, evolutive et therapeutique. Le diabete insipide est une manifestation classique au cours de l’histiocytose. La coexistence d’un diabete insipide et d’un diabete sucre associee a une histiocytose est une eventualite tres rare. Seuls trois cas ont ete rapportes dans la litterature. Exegese. – Nous rapportons lˈobservation dˈune femme atteinte dˈune histiocytose disseminee (hypophyse, osseuse) associee a un diabete sucre qui illustre les difficultes diagnostiques et therapeutiques que pose cette association. Conclusion. – Les differents mecanismes etiopathogeniques pouvant expliquer la survenue dˈun diabete sucre au cours de lˈhistiocytose langerhansienne sont discutes.

To assess the effectiveness of bromocriptine (BRC) as primary therapy in reducing the size of PRL-secreting macroadenomas with extra-sellar extension, we conducted a multicenter study in 29 patients without prior radiotherapy. Clinical presentation, response to medical treatment and long term follow-up of 29 patients with macroprolactinoma (pituitary mass more than 10 mm in diameter) were analysed. There were 19 women for 10 men. Mean age was 33 years. An hypogonadism was present in 94% of women vs 57% for men. Headaches and or visual abnormalities were present in 68% of women vs 90% of men. The mean basal serum prolactin level before treatment was 1 501 ng/ml: 202 ng/ml for women (range: 70-478 ng/ml) and 3 870 ng/ml for men (range: 100-20 476 ng/ml) and was correlated to tumoral size. 25 patients were treated with BRC as primary therapy with a mean dose of 9,7 mg/day (13 mg/day in men and 8 mg/day in women). BRC no malized serum PRL levels in all men and in 17/19 women over a mean period of 6 months, ranging from 3 to 72 months in both sexes. Tumor size was reduced by more than 50% in 18/29 patients (62%) with secondary empty sella in 5 patients and by less than 50% in 11 patients. Visual field improved in most of the patients in whom it was initially abnormal. Reduction in size was quite fast in most of patients but slower in some of them. The cumulative radiological response to BRC increased with time. Therefore, it appears that prolonged medical therapy is effective and safe in macroprolactinomas.

Langerhans' cell histiocytosis is a rare disorder of unknown etiology characterized by a wide clinical spectrum and varied behavior. Diabetes insipidus is a relatively common feature in Langerhans' cell histiocytosis. The presence of both diabetes insipidus and mellitus associated with histiocytosis in an adult is rare. To our knowledge, only three previous cases have been reported.We report the clinical presentation, pathologic findings and clinical progress in an adult female who had disseminated Langerhans' cell histiocytosis (hypothalamic infiltration, multifocal bone involvement) associated with both diabetes insipidus and mellitus.The pathogenesis of diabetes mellitus in such an association will be discussed.

Levels of plasma low density lipoproteins (LDL) are positively, and high density lipoproteins (HDL) are negatively correlated with an increased risk for atherosclerosis. The frequencies of restriction fragment length polymorphism (RFLP) of the genes for apoB, a major LDL apolipoprotein, and apoAII, a major HDL apolipoprotein, were studied in 45 Tunisian diabetics and an equal number of sex and age matched controls. Southern blot analysis of an EcoR1 apoB polymorphism and an Msp1 apo AII polymorphism indicates that there was no statistically significant difference in the incidence of different genotypes or alleles among diabetics compared to controls.

To the Editor.— Sheehan's syndrome is still frequently seen in Tunisia. We have previously reported its association with a small sella turcica, the average volume being 330 mm3in Sheehan's syndrome compared with 556 mm3in normal adult women.1 To our knowledge, HLA typing has not been studied in Sheehan's syndrome, we therefore obtained HLA antigens in a group of 48 women presenting with hypopituitarism in the setting of typical Sheehan's syndrome. Their mean age was 37.6 years ( ± 9.3) and the mean age when they had their last (often hemorragic) delivery was 29.2 years (±6.1). The diagnosis was made 7.5 years ( ± 5.7) after the onset of the disease. HLA typing was performed using acomplement-dependent microlymphocytotoxicity assay, as described previously.2The results in the 48 women with Sheehan's syndrome were compared with those of a control group of 109 normal Tunisians unrelated to the