Endocrine Abstracts

Introduction: The prevalence of megaloblastic anemia in the adult population is poorly documented, but in the elderly, it has been clearly shown that the prevalence of macrocytic anemia increases after the age of 65 years especially in men. The most frequent etiology of vitamin B12 and folate deficiency is malabsorption. They have an action in the conversion of homocysteine to methionine: an increase in homocysteinaemia is currently considered a cardiovascular risk factor. Stroke can result from traditional cardiovascular risk factors, as well as from cancer-induced factors, including hypercoagulability. Case ReportWe report the case of a 65-year-old patient, without any pathological history, diagnosed with a left adrenal cortical mass in the left adrenal space, irregular in shape, fairly well limited, isodense with spontaneous contrast (33UH), measuring 9 cm, with an absolute wash out of 25% and relative to 11%. Associated with an alteration of the general state. With a broken cortisol cycle in the biological assessment with a midnight cortisol level of 12, a negative minute braking and a FU of 4 times normal. The patient presented macrocytic anemia and thrombocytopenia with vitamin B12 deficiency. In our case, the etiology of vitamin B12 deficiency was nutritional deficiency. After 4 days, the patient presented an ischemic stroke of the right middle cerebral artery. The patient was put on anticoagulant treatment and intramuscular hydroxocobalamin treatment at the rate of one ampoule per day for one week, then one ampoule per week for one month, then one ampoule per month continuously. The evolution was marked by an improvement of the anemia and thrombocytopenia and the progressive resumption of the motricity of the left hemisphere and speech. The patient was scheduled for left adrenalectomy after medical preparation.

Discussion: Cobalamin deficiency is common in adults, especially in elderly subjects (more than 20%), but is often unknown or even unexplored, mainly because of frustrating clinical manifestations. Nevertheless, the potential seriousness of its complications, particularly neuropsychiatric, but also hematological, invites to systematically search for it. Moreover the diagnosis of cancer increases the risk of stroke in some cases. This has been found to occur over time after a cancer diagnosis, and is more common in people with cancer.

Conclusion: Hyperhomocysteinemia may be a modifiable risk factor for cardiovascular disease, independent of other risk factors, but its direct causality remains controversial. Megaloblastic anemia associated with a neoplastic context constitutes a criterion for suspicion of thromboembolic pathology or ischemic stroke.