F. Harzallah

La Rabta Hospital Tunis, Tunis-Ville, Tūnis, Tunisia

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Publications (39)19.25 Total impact

  • F Harzallah, R Waghlani, A Amouri
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    ABSTRACT: In order to illustrate a particular clinical presentation of premature ovarian failure, we report the case of a 16-year-old girl, who presented with primary amenorrhea. Physical examination discovered central obesity and an extent acanthosis nigricans in the neck and in the axillae. Pubertal stage was quoted S3P3 and external genitalia were normal. Oral glucose test revealed glucose intolerance and hormonal investigation discovered hyperinsulinemia and elevated level of FSH. Pelvic echography found infantile internal genitalia and genetic analysis discovered a deletion in the long arm of one of X chromosomes.
    Gynécologie Obstétrique & Fertilité 01/2011; 39(2):e34-6. · 0.55 Impact Factor
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    ABSTRACT: We aimed to characterize the different subgroups of ketosis-prone diabetes (KPD) in a sample of Tunisian patients using the Aβ scheme based on the presence or absence of β-cell autoantibodies (A+ or A-) and β-cell functional reserve (β+ or β-) and we investigated whether HLA class II alleles could contribute to distinct KPD phenotypes. We enrolled 43 adult patients with a first episode of ketosis. For all patients we evaluated clinical parameters, β-cell autoimmunity, β-cell function and HLA class II alleles. Frequency distribution of the 4 subgroups was 23.3% A+β-, 23.3% A-β-, 11.6% A+β+ and 41.9% A-β+. Patients from the group A+β- were significantly younger than those from the group A-β- (P = .002). HLA susceptibility markers were significantly more frequent in patients with autoantibodies (P = .003). These patients also had resistance alleles but they were more frequent in A+β+ than A+β- patients (P = .04). Insulin requirement was not associated to the presence or the absence of HLA susceptibility markers. HLA class II alleles associated with susceptibility to autoimmune diabetes have not allowed us to further define Tunisian KPD groups. However, high prevalence of HLA resistance alleles in our patients may reflect a particular genetic background of Tunisian KPD population.
    Experimental Diabetes Research 01/2011; 2011:964160. · 1.89 Impact Factor
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    ABSTRACT: Good blood pressure control is one of the recommended targets in diabetic patient's management. To evaluate blood pressure (BP) control in hypertensive treated diabetic patients using ambulatory blood pressure measurement (ABPM). Two hundred and six hypertensive treated diabetic patients were enrolled in this study (83 men and 123 women). Mean age were 60.3±9.6 years-old with mean diabetic duration of 9.1±8.2 years. All of them underwent 24 hours ABPM. Intervals between measurements were 20 minutes at diurnal period and 30 minutes at nocturnal period. 28 patients (13.6%) only were at recommended target levels of blood pressure control (mean diurnal BP<130/80 mmHg and nocturnal BP<115/65 mmHg) and 137 patients were at the most bed control levels (mean diurnal BP ? 140/90 mmHg or nocturnal BP ? 125/75 mmHg). Bed controlled patients had mildly higher waist circumference (p=0.08). Poor BP control was associated with non dipper character (p<0.001), diabetic nephropathy (p<0.01) and diabetic retinopathy (p<0.01). Our hypertensive treated diabetic patients were far from good blood pressure control. ABPM showed that the loss of nocturnal blood pressure fall was the most associated abnormality with poor BP control. Diabetic microangiopathy were more frequent in poor controlled patients.
    La Tunisie médicale 12/2010; 88(12):885-9.
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    ABSTRACT: The aim of this study in Tunisia was to classify ketosis-onset diabetes in adult patients. All patients aged > 30 years without known diabetes, presenting with ketosis and admitted to our department were studied. Patients with secondary or gestational diabetes and those on corticoid therapy or with coinciding infection were excluded. The data included clinical characteristics, immunological markers and beta-cell function. Of the 63 patients, islet-cell antibodies were present in 27.0%, glutamic acid decarboxylase antibodies in 25.4% and thyrosin phosphatase antibodies in 19.0%. Beta-cell functional reserve was preserved in 54.0%. Our results confirm that patients with ketosis-onset diabetes mellitus in adulthood are a heterogeneous group.
    Eastern Mediterranean health journal = La revue de santé de la Méditerranée orientale = al-Majallah al-ṣiḥḥīyah li-sharq al-mutawassiṭ 01/2010; 16(1):70-4.
  • Medecine sciences: M/S 01/2010; 26(hors série 1):85. · 0.56 Impact Factor
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    ABSTRACT: With the purpose of illustrating a particular circumstance of giant macroprolactinoma diagnosis, we report the case of a 54-year-old woman who was seen in the Endocrinology department with the suspected diagnosis of hyperthyroidism in presence of unilateral exophthalmos. The patient reported headaches during the last year and secondary amenorrhea since she was 38 years old. The ophthalmologic examination confirmed the unilateral left exophthalmos, which was associated with oculomotor paralysis and vision loss. The computed tomography demonstrated a great mass of the sella extending in all directions and destroying the bone. The hormonal investigation confirmed the diagnosis of prolactinoma, with a level of 8723 ng/ml, and revealed hypopituitarism. The start of bromocriptin treatment was followed by a fall in the prolactin level to less then 200 ng/ml in 1 month. This case is particular regarding the giant macroprolactinoma in a woman discovered by an unusual visual complication.
    Journal francais d'ophtalmologie 02/2009; 32(2):133.e1-3. · 0.51 Impact Factor
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    ABSTRACT: With the purpose of illustrating a particular circumstance of giant macroprolactinoma diagnosis, we report the case of a 54-year-old woman who was seen in the Endocrinology department with the suspected diagnosis of hyperthyroidism in presence of unilateral exophthalmos. The patient reported headaches during the last year and secondary amenorrhea since she was 38 years old. The ophthalmologic examination confirmed the unilateral left exophthalmos, which was associated with oculomotor paralysis and vision loss. The computed tomography demonstrated a great mass of the sella extending in all directions and destroying the bone. The hormonal investigation confirmed the diagnosis of prolactinoma, with a level of 8723 ng/ml, and revealed hypopituitarism. The start of bromocriptin treatment was followed by a fall in the prolactin level to less then 200 ng/ml in 1 month. This case is particular regarding the giant macroprolactinoma in a woman discovered by an unusual visual complication.
    Journal Francais D Ophtalmologie - J FR OPHTALMOL. 01/2009; 32(2).
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    ABSTRACT: The aim of this paper is to report an atypical presentation of MEN2A, in a patient carrying the C634R mutation of the RET-protooncogene. A 41-year-old Tunisian woman was admitted to our department with newly diagnosed hyperglycemia. She had a history of bilateral urinary stone recurrence, managed successfully on two occasions. On physical examination a thyroid node of 1cm on the left side was found. Laboratory evaluation and imaging findings confirmed the diagnosis of primary hyperparathyroidism. During cervicotomy, the parathyroid adenoma was resected and the thyroid node was suspected to be a carcinoma. Total thyroidectomy, with appropriate neck nodal resection, was performed. Histological examination confirmed the diagnosis of parathyroid adenoma and revealed a multifocal and bilateral medullary carcinoma. These findings led to the diagnosis of multiple endocrine neoplasia. DNA-analysis demonstrated a germline Cys634Arg mutation in the RET-protooncogene. During the postoperative follow-up, blood pressure as well as the level of urinary methoxylated metabolites increased progressively. Imaging findings were compatible with the diagnosis of bilateral pheochromocytoma. In conclusion, this case report of MEN 2A linked to a 634 RET mutation was peculiar by its revelation mode (1) hyperparathyroidism moreover linked to an adenoma and (2) associated with diabetes, mechanisms of which are probably multifactorial (familial type 2 diabetes, hypercalcemia, catecholamines excess).
    Annales d Endocrinologie 09/2008; 69(6):523-5. · 1.02 Impact Factor
  • Diabetes & Metabolism - DIABETES METAB. 01/2008; 34.
  • Diabetes & Metabolism - DIABETES METAB. 01/2008; 34.
  • Diabetes & Metabolism - DIABETES METAB. 01/2008; 34.
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    ABSTRACT: The aim of our retrospective study was to explore the clinical and metabolic characteristics of newly diagnosed diabetes patients over the age of 30 years. Study participants were consecutive, newly diagnosed patients with diabetes, over the age of 30 years, presenting to our university hospital department between January 1999 and June 2003. Clinical and metabolic data were collected retrospectively by medical record review. Three hundred seventy patients were included; mean age was 54.1+/-14.0 years; 49% were women and a family history of diabetes was reported in 52% of patients. Patients presented with acute complications in 40% of cases. Symptoms of polyuria-polydipsia and weight loss were present at diagnosis in 87% and 76% of cases respectively. 58% of our patients were obese or overweight (BMI> or =25 kg/m(2)), hypertension was present in 22%, hypertriglyceridemia in 27% and high LDL cholesterol in 27%. Neuropathy was diagnosed in 24%, nephropathy in 13%, coronary heart disease in 9%, retinopathy in 8% of cases, stroke in 3% and peripheral arterial disease in 2%. Insulin was prescribed initially in 47% of cases. Our results demonstrate that clinical symptoms and acute ketosis are the most common presenting features of diabetes mellitus in adults at the hospital level. Associated chronic complications are frequent.
    Diabetes & Metabolism 01/2007; 32(6):632-5. · 2.39 Impact Factor
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    ABSTRACT: Hemangioma is a benign vascular tumor composed of angioblastic cells. The adrenal gland localization is very rare, with only fifty cases reported in literature. We report a case of adrenal gland hemangioma diagnosed in a 55-year-old woman who presented a cervical neoplasm. The non-specific imaging features, the tumor size and the clinical context led to mandatory surgical resection. The pathological examination established the diagnosis of adrenal gland hemangioma.
    Annales d Endocrinologie 01/2007; 67(6):624-7. · 1.02 Impact Factor
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    ABSTRACT: In order to illustrate a particular circumstance of diagnosis of celiac disease, we report the case of 54-year-old women with a history of thyroid enlargement with normal thyroid function and positive anti-peroxidase antibodies. Immediately after total thyroidectomy with preservation of the parathyroid glands, she developed tetany with total serum calcium level at 50mg/l. Intravenous calcium infusion increased the calcium level and led to resolution of hypocalcemia-induced signs but there was no result when calcium and vitamin D were taken orally. The diagnosis of malabsorption was very probable in light of the family history of celiac disease, the anemia and the hypoalbuminemia. The diagnosis was confirmed by antibodies assay and endoscopy. The PTH level was less than 1 pg/l and radiography showed signs of hyperparathyroidism. Gluten-free diet, calcium and vitamin D led to an improvement of serum calcium.
    Annales d Endocrinologie 10/2006; 67(4):357-9. · 1.02 Impact Factor
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    ABSTRACT: Pituitary is the most important gland of the organism which can be affected by many diseases, especially by adenomatous processes. Classically macroadenoma, microadenoma and picoadenoma are described, according to the size of the pituitary adenoma. The diagnosis of microadenoma was long considered a highly difficult task and that of picoadenoma was impossible by computed tomography. Recently, the high resolution of multiplanar MRI has enabled the diagnosis of microadenomas measuring less than 3 mm (picoadenoma). For macroadenoma, MRI not only contributes to diagnosis but is particularly important to assess the extension and to detect possible complications. The aim of our study is to illustrate MRI features in pituitary adenoma.
    Annales d Endocrinologie 10/2006; 67(4):325-30. · 1.02 Impact Factor
  • F Harzallah, H Alberti, F Ben Khalifa
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    ABSTRACT: To report the prevalence of the metabolic syndrome in Arab men and women using the new International Diabetes Federation (IDF) criteria, and to compare this with the prevalence using the 1999 World Health Organization (WHO) and 2001 National Cholesterol Education Program Adult Treatment Panel III (NECP ATPIII) definitions. The study involved 863 subjects (343 men and 520 women) aged > or = 40 years living in Tunis, Tunisia, taken from an initially randomized, population sample. The prevalence of the metabolic syndrome using the IDF criteria was found to be 45.5%; 55.8% in women and 30.0% in men (P < 0.001), higher than the rates of 28.7% (WHO) and 24.3% (NECP ATPIII) using the previous definitions. Using all the definitions, the prevalence was higher in women than in men predominantly because of significant differences in central obesity and high-density lipoprotein (HDL) cholesterol and, to a lesser extent, hypertension. The increased prevalence using the IDF criteria compared with the 1999 WHO criteria and the 2001 NCEP ATPIII definitions is striking and has huge implications for public health worldwide. The major reason for the higher rate using the new definition seems to be the predominant focus placed on central obesity. Using tighter criteria for fasting glycaemia has also played a factor. The question remains as yet unanswered as to whether the new IDF criteria are better at predicting hard outcomes such as diabetes mellitus and cardiovascular diseases.
    Diabetic Medicine 05/2006; 23(4):441-4. · 3.24 Impact Factor
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    ABSTRACT: In order to illustrate a particular circumstance of diagnosis of celiac disease, we report the case of 54-year-old women with a history of thyroid enlargement with normal thyroid function and positive anti-peroxidase antibodies. Immediately after total thyroidectomy with preservation of the parathyroid glands, she developed tetany with total serum calcium level at 50mg/l. Intravenous calcium infusion increased the calcium level and led to resolution of hypocalcemia-induced signs but there was no result when calcium and vitamin D were taken orally. The diagnosis of malabsorption was very probable in light of the family history of celiac disease, the anemia and the hypoalbuminemia. The diagnosis was confirmed by antibodies assay and endoscopy. The PTH level was less than 1 pg/l and radiography showed signs of hyperparathyroidism. Gluten-free diet, calcium and vitamin D led to an improvement of serum calcium.
    Annales D Endocrinologie - ANN ENDOCRINOL. 01/2006; 67(4):357-359.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Pituitary is the most important gland of the organism which can be affected by many diseases, especially by adenomatous processes. Classically macroadenoma, microadenoma and picoadenoma are described, according to the size of the pituitary adenoma. The diagnosis of microadenoma was long considered a highly difficult task and that of picoadenoma was impossible by computed tomography. Recently, the high resolution of multiplanar MRI has enabled the diagnosis of microadenomas measuring less than 3 mm (picoadenoma). For macroadenoma, MRI not only contributes to diagnosis but is particularly important to assess the extension and to detect possible complications. The aim of our study is to illustrate MRI features in pituitary adenoma.
    Annales D Endocrinologie - ANN ENDOCRINOL. 01/2006; 67(4):325-330.
  • F. Harzallah, F. Kanoun, F. Elhouch, H. Slimane
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    ABSTRACT: We assessed the quality of care provided to non-insulin treated diabetic patients by ex- amining the medical records of 248 such patients attending our outpatient department in 2002. The mean age was 59.5 (SD 10.1) years, 62.1% were women and known duration of diabetes was 8.6 (SD 5.9) years. The majority of patients were treated with a combination of sulfonylurea and metformin. Glycaemic control was assessed using fasting blood glucose in 96.8% of patients, post-prandial blood glucose in 31.9% and glycated haemoglobin in 52.4%. Weight was measured at least once for 88.7% of patients, blood pressure for 91.1% of patients and lipid levels for 64.9%. Body mass index was less than 25 kg/m 2 in 12.3% of patients and blood pressure less than 140/90 mmHg in 40.3%. Foot examination was noted in only 2% of records, electrocardiography was performed for 25% of patients and fundoscopy for 21%. Proteinuria was
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  • Diabetes & Metabolism - DIABETES METAB. 01/2006; 32(6):632-635.