Mitotane is a steroidogenesis inhibitor and adrenolytic drug used for treatment of adrenocortical cancer (ACC). Mitotane therapy causes adrenal insufficiency requiring glucocorticoid replacement in all patients. However, it is unclear whether chronic therapy with mitotane induces complete destruction of zona fasciculata and whether hypothalamic-pituitary-adrenal (HPA) axis can recover after treatment cessation. Our objective was to assess the HPA axis recovery in a cohort of patients after cessation of adjuvant mitotane therapy for ACC. We retrospectively reviewed patient files with stage I-II-III ACC in two referral centers in Canada and Italy. Data on demographics, tumor characteristics, hormonal profile, and HPA axis were collected. Data from 23 patients with pathologically proven ACC treated with adjuvant mitotane for a minimum of two years were analyzed. Eight patients were males and 15 were females and the median age was 41 years old (range 18 to 73). After mitotane cessation, 18/23 (78.3%) patients achieved a complete HPA axis recovery while 3/23 (13.0%) were unable to tolerate glucocorticoid withdrawal despite having normal hormonal test values and 2/23 (8.7%) never achieved recovery. The mean time interval between mitotane cessation and HPA axis recovery was 2.7 years. A high proportion of patients achieved HPA axis recovery following cessation of mitotane adjuvant therapy. However, complete recovery was often delayed up to 2.5 years and regular assessment of the hormonal profile is required.

Primary aldosteronism (PA) is a frequent cause of secondary hypertension. Studies on the prevalence of PA are lacking in the Middle East region. To determine the proportion of patients with high aldosterone-to-renin ratio (ARR) among Lebanese patients with hypertension screened for PA and to compare their clinical and biological characteristics with patients with essential hypertension. A retrospective review of medical charts of patients with hypertension undergoing sampling of serum aldosterone and plasma renin concentration at a tertiary care center between October 2022 and 2023 was conducted. Of 144 patients with hypertension screened for PA, 23 (16%) had an ARR higher than 3.7 ng/dL/mU/L and serum aldosterone above 15 ng/dL. The mean age of the screened population was 51 ± 15 years, 56% were men. The median duration of hypertension was 4 years and the median number was 2 of antihypertensive medications. Patients with a positive screening test were mostly men (88%, P = .0001), and more frequently had diabetes (50%, P < .0001) than those with essential hypertension. Only 22% had hypokalemia. Of the 23 patients, 11 underwent intravenous saline suppression testing; PA was confirmed in all of them. The high frequency of PA in our center is comparable to other countries. More studies are needed to determine how to reduce healthcare disparities and overcome the barriers to appropriate diagnosis and treatment.

Introduction: Adrenal incidentalomas (AI) are being more frequently reported with the advent of medical imaging. Studies on their prevalence, characteristics and functional status are lacking in the Middle East.Objective: To determine the prevalence of AI as well as their clinical and radiological characteristics and referral rates to endocrinologists for hormonal testing.Methods: We prospectively evaluated unselected adult patients who underwent an abdominal computed tomography (CT) between November 2022 and June 2023 at a Lebanese tertiary teaching hospital. An experienced radiologist carefully reviewed 4,464 CT. Patients with known or suspected malignancy or adrenal disease were excluded. Main outcome measures included prevalence of AI and referral rates to endocrinologists during a one-year follow-up.Results: 3168 CT were retained for analysis, 222 had an AI, with an overall prevalence of 7%. There was no significant difference in prevalence according to gender (8% in women, 6% in men p = .06.). The prevalence increased with age from 0.9% in young adults (18–30 years) to 10.8% in patients older than 70. Mean age of patients with AI was 69 ± 14 years. 46% were males. Median size of AI was 1.7 cm (1.2-2.5). 45% had a density <10 Hounsfield Unit (HU) and 17% were bilateral. Patients with an AI were significantly older (p <.0001), had a higher Body mass index (BMI) (p = .0021), more hypertension (p = .023), dyslipidemia (p = .002), and cardiovascular diseases (CVD) (p = .0056). No difference according to sex was noted. The referral rate of AI to endocrinologists was only 5.4%.Conclusion: The prevalence of AI in Lebanon is comparable to the worldwide prevalence and is linked to age, BMI, hypertension, dyslipidemia and CVD but not to gender. Despite this high prevalence, the rate of referral for appropriate investigations is poor. Raising awareness among clinicians is therefore essential for a better evaluation of these patients.

The impact of COVID-19 pandemic on diabetes management and control is controversial and has never been studied in Middle Eastern countries. The aim of this study is to assess recent trends in HbA1c and fasting blood glucose (FBG) in Lebanon. Data related to all the HbA1c tests performed between 2018 and 2022 were extracted from the large laboratory database of our hospital. Data related to fasting plasma glucose when measured at the same time then HbA1c were also collected. The variation in the number and values of HbA1c and FBG were analyzed according to age, gender, pandemic, sampling year and patient status (in/outpatient). The total number of HbA1c and FBG tests performed was 44,043 and 37,193 respectively. The median (interquartile) values for HbA1c and FBG were 5.55% (IQR:5.24–6.02) and 5.4 mmol/L (IQR:4.98–6.13) respectively. During the pandemic, a significant decrease in the number of HbA1c tests by 26.2% and FBG tests by 25.6% was noted, as well as a significant increase in their values (from 5.53%–5.56% and from 5.35 mmol/L to 5.43 mmol/L respectively). Median HbA1c values were higher in men than in women (5.61% vs 5.5%), in elderly subjects (5.86%) than in adults and children (5.42%, 5.16% respectively), and in inpatient than in outpatient settings (5.98% vs 5.53%), P < .001, for all comparisons. During the COVID-19 outbreak, the number of HbA1c and FBG tests performed decreased, but their values increased. Further studies are needed to look if this trend will last and to assess the long-term impact of these changes.