1
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Goudet P, Cadiot G, Barlier A, Baudin E, Borson-Chazot F, Brunaud L, Caiazzo R, Cardot-Bauters C, Castinetti F, Chanson P, Cuny T, Dansin E, Gaujoux S, Giraud S, Groussin L, Le Bras M, Lifante JC, Mathonnet M, de Mestier L, Mirallié E, Pattou F, Romanet P, Sebag F, Tresallet C, Vezzosi D, Walter T, Tabarin A. French guidelines from the GTE, AFCE and ENDOCAN-RENATEN (Groupe d'étude des Tumeurs Endocrines/Association Francophone de Chirurgie Endocrinienne/Reseau national de prise en charge des tumeurs endocrines) for the screening, diagnosis and management of Multiple Endocrine Neoplasia Type 1. ANNALES D'ENDOCRINOLOGIE 2024; 85:2-19. [PMID: 37739121 DOI: 10.1016/j.ando.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Affiliation(s)
- Pierre Goudet
- Department of Digestive and Endocrine Surgery, Dijon University Hospital, Dijon, France; INSERM, U1231, EPICAD Team UMR "Lipids, Nutrition, Cancer", Dijon, France; INSERM, CIC1432, Clinical epidemiology Dijon, Dijon, France.
| | - Guillaume Cadiot
- Department of Hepato-Gastro-Enterology and Digestive Oncology, Robert Debré Hospital, Reims, France.
| | - Anne Barlier
- Aix Marseille Univ, APHM, INSERM, MMG, Laboratory of Molecular Biology Hospital La Conception, Marseille, France.
| | - Eric Baudin
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy Cancer Campus, Villejuif, France.
| | - Françoise Borson-Chazot
- Federation of Endocrinology, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon1 University and INSERM U1290, Lyon, France.
| | - Laurent Brunaud
- Department of Gastrointestinal, Visceral, Metabolic, and Cancer Surgery (CVMC), University Hospital of Nancy (CHRU Nancy), University of Lorraine, 54511 Vandoeuvre-les-Nancy, France; INSERM U1256 NGERE, Lorraine University, 11, allée du Morvan, 54511 Vandoeuvre-les-Nancy, France.
| | - Robert Caiazzo
- General and Endocrine Surgery Department, University Hospital Center of Lille, Lille, France.
| | | | - Frédéric Castinetti
- Aix Marseille University, Marseille Medical Genetics, INSERM U1251 and Assistance Publique Hopitaux de Marseille, La Conception Hospital, Department of Endocrinology, Marseille, France.
| | - Philippe Chanson
- University Paris-Saclay, INSERM, Endocrine Physiology and Pathophysiology, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Service of Endocrinology and Reproductive Diseases, National Reference Center for Rare Pituitary Diseases, 94275 Le Kremlin-Bicêtre, France.
| | - Thomas Cuny
- APHM, Marseille Medical Genetics, INSERM U1251, Conception Hospital, Endocrinology Department, Aix Marseille University, Marseille, France.
| | - Eric Dansin
- Department of Medical Oncology, Oscar Lambret Center, 59000 Lille, France.
| | - Sébastien Gaujoux
- Department of Endocrine and Pancreatic Surgery, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.
| | - Sophie Giraud
- Cancer Genetics Unit, Institut Bergonié, Bordeaux, France.
| | - Lionel Groussin
- Department of Endocrinology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Institut Cochin, INSERM U1016, CNRS UMR8104, Université Paris Cité, 75014 Paris, France.
| | - Maëlle Le Bras
- Department of Endocrinology, Nantes University Hospital, Nantes, France.
| | - Jean-Christophe Lifante
- Department of Digestive and Endocrine Surgery, University Hospital of Lyon Sud, Lyon, France; EA 7425 HESPER, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France.
| | - Muriel Mathonnet
- Department of Surgery, Dupuytren University Hospital of Limoges, Limoges, France.
| | - Louis de Mestier
- Paris-Cité University, Department of Pancreatology and Digestive Oncology, Beaujon Hospital (AP-HP-Nord), Clichy, France.
| | - Eric Mirallié
- Department of Oncological, Digestive and Endocrine Surgery (CCDE) Hôtel Dieu, CIC-IMAD, Nantes, France.
| | - François Pattou
- Department of General and Endocrine Surgery, University Hospital. Lille, INSERM U1190, Lille, France.
| | - Pauline Romanet
- Aix Marseille University, APHM, INSERM, MMG, Laboratory of Molecular Biology, La Conception Hospital, Marseille, France.
| | - Frédéric Sebag
- Department of General Endocrine and Metabolic Surgery, Conception University Hospital, APHM, Aix Marseille University, Marseille, France.
| | - Christophe Tresallet
- Department of Digestive, Bariatric and Endocrine Surgery, Avicenne University Hospital, Sorbonne Paris Nord Universty, Assistance Pubique des Hôpitaux de Paris (APHP), Paris, France.
| | - Delphine Vezzosi
- Department of Endocrinology and Metabolic Diseases, CHU Larrey, 24 chemin de Pouvourville, TSA 30030, 31059 Toulouse Cedex, France.
| | - Thomas Walter
- Medical Oncology Department, Edouard-Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
| | - Antoine Tabarin
- Endocrinology Department, INSERM Unit 1215, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France.
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2
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Kann PH. Relevance of Endoscopic Ultrasound in Endocrinology Today: Multiple Endocrine Neoplasia Type 1, Insulinoma, Primary Aldosteronism-An Expert's Perspective Based on Three Decades of Scientific and Clinical Experience. Cancers (Basel) 2023; 15:3494. [PMID: 37444604 DOI: 10.3390/cancers15133494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
In endocrinology, endoscopic ultrasound (EUS) may be used to image the adrenals, the endocrine pancreas, and other organs where endocrine neoplasms may occur. During the recent decades, EUS has been established predominantly to assess multiple endocrine neoplasia type 1, to localize insulinomas, and to identify aldosterone-producing adenomas. EUS in endocrinology requires special skills and individual experience in order to provide reliable diagnostic information.
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Affiliation(s)
- Peter Herbert Kann
- German Center for Endocrine Care DEVZ, Düsseldorfer Strasse 1-7, 60329 Frankfurt am Main, Germany
- Faculty of Medicine, Philipp's University, Baldinger Strasse, 35033 Marburg, Germany
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3
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Chronic Treatment with Somatostatin Analogues in Recurrent Type 1 Gastric Neuroendocrine Tumors. Biomedicines 2023; 11:biomedicines11030872. [PMID: 36979851 PMCID: PMC10045480 DOI: 10.3390/biomedicines11030872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023] Open
Abstract
Background: Type 1 gastric neuroendocrine tumors (GC-1) represent an uncommon subtype of neoplasms. Endoscopic resection has been proposed as the treatment of choice; active surveillance may be performed in those smaller than 1 cm, while gastric surgery may be performed for those with frequent recurrences. The antiproliferative effect of somatostatin analogues (SSA) is well known, and their action on GC-1s has been postulated as a chronic treatment to reduce recurrence. Methods: A two-centered, retrospective, observational study that included nine patients (55.6% women) diagnosed with GC-1, receiving long-term treatment with SSA, with a median follow-up from baseline of 22 months, was undertaken. Endoscopic follow-up, extension study, and analytical values of chromogranin A (Cg A) and gastrin were collected. Results: In total, 88.9% of patients presented partial or complete response. Treatment with SSA was the only independent factor with a trend to prevent tumor recurrence (Odds Ratio 0.054; p = 0.005). A nonsignificant tendency toward a decrease in CgA and gastrin was observed; lack of significance was probably related to concomitant treatment with proton pump inhibitors in some patients. Conclusions: Chronic treatment with SSA is a feasible option for recurrent GC-1s that are difficult to manage using endoscopy or gastrectomy. Randomized clinical trials to provide more scientific evidence are still needed.
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4
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Ramachandran A, Madhusudhan KS. Advances in the imaging of gastroenteropancreatic neuroendocrine neoplasms. World J Gastroenterol 2022; 28:3008-3026. [PMID: 36051339 PMCID: PMC9331531 DOI: 10.3748/wjg.v28.i26.3008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/30/2021] [Accepted: 06/20/2022] [Indexed: 02/06/2023] Open
Abstract
Gastroenteropancreatic neuroendocrine neoplasms comprise a heterogeneous group of tumors that differ in their pathogenesis, hormonal syndromes produced, biological behavior and consequently, in their requirement for and/or response to specific chemotherapeutic agents and molecular targeted therapies. Various imaging techniques are available for functional and morphological evaluation of these neoplasms and the selection of investigations performed in each patient should be customized to the clinical question. Also, with the increased availability of cross sectional imaging, these neoplasms are increasingly being detected incidentally in routine radiology practice. This article is a review of the various imaging modalities currently used in the evaluation of neuroendocrine neoplasms, along with a discussion of the role of advanced imaging techniques and a glimpse into the newer imaging horizons, mostly in the research stage.
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Affiliation(s)
- Anupama Ramachandran
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Kumble Seetharama Madhusudhan
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, India
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5
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Abstract
OBJECTIVE. The purpose of this article is to review the clinical manifestations, endocrine tumors types, and multimodality diagnostic tools available to physicians involved in the management of patients with multiple endocrine neoplasia (MEN) syndrome, in addition to discussing relevant imaging findings and appropriate imaging follow-up. CONCLUSION. Thorough knowledge of the spectrum of tumors associated with MEN gene mutations aids in the screening, diagnostic workup, and posttreatment monitoring of patients with MEN-related gene mutations.
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6
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Brandi ML, Agarwal SK, Perrier ND, Lines KE, Valk GD, Thakker RV. Multiple Endocrine Neoplasia Type 1: Latest Insights. Endocr Rev 2021; 42:133-170. [PMID: 33249439 PMCID: PMC7958143 DOI: 10.1210/endrev/bnaa031] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Indexed: 02/06/2023]
Abstract
Multiple endocrine neoplasia type 1 (MEN1), a rare tumor syndrome that is inherited in an autosomal dominant pattern, is continuing to raise great interest for endocrinology, gastroenterology, surgery, radiology, genetics, and molecular biology specialists. There have been 2 major clinical practice guidance papers published in the past 2 decades, with the most recent published 8 years ago. Since then, several new insights on the basic biology and clinical features of MEN1 have appeared in the literature, and those data are discussed in this review. The genetic and molecular interactions of the MEN1-encoded protein menin with transcription factors and chromatin-modifying proteins in cell signaling pathways mediated by transforming growth factor β/bone morphogenetic protein, a few nuclear receptors, Wnt/β-catenin, and Hedgehog, and preclinical studies in mouse models have facilitated the understanding of the pathogenesis of MEN1-associated tumors and potential pharmacological interventions. The advancements in genetic diagnosis have offered a chance to recognize MEN1-related conditions in germline MEN1 mutation-negative patients. There is rapidly accumulating knowledge about clinical presentation in children, adolescents, and pregnancy that is translatable into the management of these very fragile patients. The discoveries about the genetic and molecular signatures of sporadic neuroendocrine tumors support the development of clinical trials with novel targeted therapies, along with advancements in diagnostic tools and surgical approaches. Finally, quality of life studies in patients affected by MEN1 and related conditions represent an effort necessary to develop a pharmacoeconomic interpretation of the problem. Because advances are being made both broadly and in focused areas, this timely review presents and discusses those studies collectively.
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Affiliation(s)
| | | | - Nancy D Perrier
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Gerlof D Valk
- University Medical Center Utrecht, CX Utrecht, the Netherlands
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7
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Drewitz KP, Grey J, Brügmann P, Pichl J, Sammarco M, Aarts M, van Genechten D, Brandi ML, Schaaf L. Patients' perception on the quality of care for multiple endocrine neoplasia disorders in Europe: an online survey from a patient support group. Endocrine 2021; 71:634-640. [PMID: 33537957 DOI: 10.1007/s12020-021-02637-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE European Patient Advocacy Groups (ePAGs) within the Endo-ERN identified a lack of knowledge about quality of care (QoC) of patients with multiple endocrine neoplasia (MEN). The aim of this study was to identify inequalities in care and to encourage improvements. METHODS The European MEN Alliance (EMENA) developed and conducted a survey, using the European Commissions' EUSurvey platform. Patient groups and healthcare professionals (HCPs) distributed the survey. RESULTS A total of 288 participants completed the survey (MEN1 n = 203, MEN2 n = 67, MEN3 n = 18) from 18 European countries. The majority of respondents were recruited via patient groups (58%), aged between 41 and 60 years (53%) and were female (67%). All participants reported having been diagnosed on average 5.58 years (95%-CI: 4.45-6.60) after first symptoms occurred. This timeframe was lower in the group with MEN2 (2.97 years, 95%-CI: 1.37-4.57). Most of the participants (67%) received their diagnosis by a positive gene test after presenting with one or more MEN-related tumours. Overall QoC was rated as either "good" (43%) or "excellent" (36%). CONCLUSION The results of this unique Europe-wide, patient-driven survey on QoC of patients with MEN show that ratings for overall QoC were lower than ratings for different aspects of care. This may be because of the complex nature of care for genetic syndromes. Furthermore, patients who connect with patient groups may be deemed "expert patients" whose answers are not representative of the overall MEN patient community. We hope that Endo-ERN can support further education and training for HCPs based on these results.
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Affiliation(s)
- Karl Philipp Drewitz
- European Multiple Endocrine Neoplasia Alliance (EMENA), Munich, Germany.
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany.
- German Network of Pituitary and Adrenal Diseases, Fürth, Germany.
| | - Jo Grey
- European Multiple Endocrine Neoplasia Alliance (EMENA), Munich, Germany
- Association for Multiple Endocrine Neoplasia Disorders (AMEND), Kent, UK
- European Patient Advocacy Group (ePAG), Main Thematic Group 4 (Genetic Endocrine Tumour Syndromes), European Reference Network on Rare Endocrine Conditions (Endo-ERN), Leiden, The Netherlands
| | - Petra Brügmann
- European Multiple Endocrine Neoplasia Alliance (EMENA), Munich, Germany
- German Network of Pituitary and Adrenal Diseases, Fürth, Germany
- European Patient Advocacy Group (ePAG), Main Thematic Group 4 (Genetic Endocrine Tumour Syndromes), European Reference Network on Rare Endocrine Conditions (Endo-ERN), Leiden, The Netherlands
| | - Josef Pichl
- European Multiple Endocrine Neoplasia Alliance (EMENA), Munich, Germany
- German Network of Pituitary and Adrenal Diseases, Fürth, Germany
| | - Martina Sammarco
- European Multiple Endocrine Neoplasia Alliance (EMENA), Munich, Germany
- Associazione Italiana Neoplasie Endocrine Multiple di tipo 1 e 2 (AIMEN 1 e 2), Torino, Italy
| | - Monique Aarts
- European Multiple Endocrine Neoplasia Alliance (EMENA), Munich, Germany
- Belangengroep MEN, Utrecht, The Netherlands
| | - Dirk van Genechten
- European Multiple Endocrine Neoplasia Alliance (EMENA), Munich, Germany
- vzw NET & MEN Kanker, Blankenberge, Belgium
| | - Maria-Luisa Brandi
- European Multiple Endocrine Neoplasia Alliance (EMENA), Munich, Germany
- Donatello Bone Clinic, Florence, Italy
- Endo-ERN Reference Center, University Hospital Careggi, Florence, Italy
| | - Ludwig Schaaf
- European Multiple Endocrine Neoplasia Alliance (EMENA), Munich, Germany
- Department of Endocrinology, München Klinik Schwabing, Munich, Germany
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8
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Niederle B, Selberherr A, Bartsch DK, Brandi ML, Doherty GM, Falconi M, Goudet P, Halfdanarson TR, Ito T, Jensen RT, Larghi A, Lee L, Öberg K, Pavel M, Perren A, Sadowski SM, Tonelli F, Triponez F, Valk GD, O'Toole D, Scott-Coombes D, Thakker RV, Thompson GB, Treglia G, Wiedenmann B. Multiple Endocrine Neoplasia Type 1 and the Pancreas: Diagnosis and Treatment of Functioning and Non-Functioning Pancreatic and Duodenal Neuroendocrine Neoplasia within the MEN1 Syndrome - An International Consensus Statement. Neuroendocrinology 2021; 111:609-630. [PMID: 32971521 DOI: 10.1159/000511791] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/18/2020] [Indexed: 11/19/2022]
Abstract
The better understanding of the biological behavior of multiple endocrine neoplasia type 1 (MEN1) organ manifestations and the increase in clinical experience warrant a revision of previously published guidelines. Duodenopancreatic neuroendocrine neoplasias (DP-NENs) are still the second most common manifestation in MEN1 and, besides NENs of the thymus, remain a leading cause of death. DP-NENs are thus of main interest in the effort to reevaluate recommendations for their diagnosis and treatment. Especially over the last 2 years, more clinical experience has documented the follow-up of treated and untreated (natural-course) DP-NENs. It was the aim of the international consortium of experts in endocrinology, genetics, radiology, surgery, gastroenterology, and oncology to systematically review the literature and to present a consensus statement based on the highest levels of evidence. Reviewing the literature published over the past decade, the focus was on the diagnosis of F- and NF-DP-NENs within the MEN1 syndrome in an effort to further standardize and improve treatment and follow-up, as well as to establish a "logbook" for the diagnosis and treatment of DP-NENs. This shall help further reduce complications and improve long-term treatment results in these rare tumors. The following international consensus statement builds upon the previously published guidelines of 2001 and 2012 and attempts to supplement the recommendations issued by various national and international societies.
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Affiliation(s)
- Bruno Niederle
- Department of Surgery, Medical University of Vienna, Vienna, Austria,
| | | | - Detlef K Bartsch
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Marburg, Germany
| | - Maria L Brandi
- Firmo Lab, Fondazione F.I.R.M.O. and University Florence, Florence, Italy
| | - Gerard M Doherty
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Massimo Falconi
- Pancreatic Surgery, San Raffaele Scientific Institute, "Vita-Salute" University, Milan, Italy
| | - Pierre Goudet
- Service de Chirurgie Viscérale et Endocrinienne, Centre Hospitalier Universitaire François Mitterand, Dijon, France
| | | | - Tetsuhide Ito
- Neuroendocrine Tumor Centre, Fukuoka Sanno Hospital and Department of Gastroenterology, Graduate School of Medical Sciences, International University of Health and Welfare, Sawara-ku, Fukuoka, Japan
| | - Robert T Jensen
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico A. Gemelli IRCCS and Center for Endoscopic Research, Therapeutics and Training, Catholic University, Rome, Italy
| | - Lingaku Lee
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Kjell Öberg
- Endocrine Oncology, Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Marianne Pavel
- Endocrinology and Diabetology, Department of Medicine 1, University Clinic of Erlangen, Erlangen, Germany
| | - Aurel Perren
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Samira M Sadowski
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Francesco Tonelli
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Frédéric Triponez
- Thoracic and Endocrine Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Gerlof D Valk
- Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dermot O'Toole
- Department of Clinical Medicine, St. James's Hospital and St Vincent's University Hospital and Trinity College, Dublin, Ireland
| | - David Scott-Coombes
- Department of Endocrine Surgery, University Hospital of Wales, Cardiff, United Kingdom
| | - Rajesh V Thakker
- Academic Endocrine Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, University of Oxford, Oxford, United Kingdom
| | - Geoffrey B Thompson
- Section of Endocrine Surgery, Department of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Giorgio Treglia
- Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Bertram Wiedenmann
- Department of Gastroenterology and Hepatology, Campus Virchow-Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
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9
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van Beek DJ, Verkooijen HM, Nell S, Bonsing BA, van Eijck CH, van Goor H, Hoogwater FJH, Nieveen van Dijkum EJM, Kazemier G, Dejong CHC, Brosens LAA, Wessels FJ, Borel Rinkes IHM, Valk GD, Vriens MR. Reliability and Agreement of Radiological and Pathological Tumor Size in Patients with Multiple Endocrine Neoplasia Type 1-Related Pancreatic Neuroendocrine Tumors: Results from a Population-Based Cohort. Neuroendocrinology 2021; 111:705-717. [PMID: 32721974 PMCID: PMC8491507 DOI: 10.1159/000510514] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/07/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pancreatic neuroendocrine tumors (pNETs) have a high prevalence in patients with multiple endocrine neoplasia type 1 (MEN1) and are the leading cause of death. Tumor size is still regarded as the main prognostic factor and therefore used for surgical decision-making. We assessed reliability and agreement of radiological and pathological tumor size in a population-based cohort of patients with MEN1-related pNETs. METHODS Patients were selected from the Dutch MEN1 database if they had undergone a resection for a pNET between 2003 and 2018. Radiological (MRI, CT, and endoscopic ultrasonography [EUS]) and pathological tumor size were collected from patient records. Measures of agreement (Bland-Altman plots with limits of agreement [LoA] and absolute agreement) and reliability (intraclass correlation coefficients [ICC] and unweighted kappa) were calculated for continuous and categorized (< or ≥2 cm) pNET size. RESULTS In 73 included patients, the median radiological and pathological tumor sizes measured were 22 (3-160) and 21 (4-200) mm, respectively. Mean bias between radiological and pathological tumor size was -0.2 mm and LoA ranged from -12.9 to 12.6 mm. For the subgroups of MRI, CT, and EUS, LoA of radiological and pathological tumor size ranged from -9.6 to 10.9, -15.9 to 15.8, and -13.9 to 11.0, respectively. ICCs for the overall cohort, MRI, CT, and EUS were 0.80, 0.86, 0.75, and 0.76, respectively. Based on the 2 cm criterion, agreement was 81.5%; hence, 12 patients (18.5%) were classified differently between imaging and pathology. Absolute agreement and kappa values of MRI, CT, and EUS were 88.6, 85.7, and 75.0%, and 0.77, 0.71, and 0.50, respectively. CONCLUSION Within a population-based cohort, MEN1-related pNET size was not systematically over- or underestimated on preoperative imaging. Based on agreement and reliability measures, MRI is the preferred imaging modality.
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Affiliation(s)
- Dirk-Jan van Beek
- Department of Endocrine Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Helena M Verkooijen
- Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sjoerd Nell
- Department of Endocrine Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bert A Bonsing
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Casper H van Eijck
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frederik J H Hoogwater
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elisabeth J M Nieveen van Dijkum
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Center location Academic Medical Center, Amsterdam, The Netherlands
| | - Geert Kazemier
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Center location VUmc University Medical Center, Amsterdam, The Netherlands
| | - Cornelis H C Dejong
- Department of Surgery, Maastricht University Medical Center, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
- Department of Surgery, Universitätsklinikum Aachen, Aachen, Germany
| | - Lodewijk A A Brosens
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank J Wessels
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Inne H M Borel Rinkes
- Department of Endocrine Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gerlof D Valk
- Department of Endocrine Oncology, University Medical Center, Utrecht, The Netherlands
| | - Menno R Vriens
- Department of Endocrine Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands,
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10
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Olpin J, Fine GC, Shaaban A. Imaging of Gastrointestinal Neuroendocrine Tumors. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-00371-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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11
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Oleinikov K, Uri I, Jacob H, Epshtein J, Benson A, Ben-Haim S, Atlan K, Tal I, Meirovitz A, Maimon O, Lev-Cohain N, Mazeh H, Glaser B, Gross DJ, Grozinsky-Glasberg S. Long-term outcomes in MEN-1 patients with pancreatic neuroendocrine neoplasms: an Israeli specialist center experience. Endocrine 2020; 68:222-229. [PMID: 32036501 DOI: 10.1007/s12020-020-02217-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 01/29/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE The decreased life expectancy of MEN-1 patients is mainly related to pancreatic neuroendocrine tumors (pNETs). At best, limited data is available on the natural history of MEN-1-associated pNETs, as these tumors are rare and have a wide range of biologic behavior. Our study aims to explore the clinical course of patients with MEN-1-associated pNETs and the long-term outcomes. METHODS This longitudinal study was conducted on the MEN-1 cohort treated at our referral center over a 22-year period (1996-2018). Relevant clinical data were retrospectively analysed. RESULTS Among the 33 MEN-1 patients included in our study, pNETs were identified in 21 subjects with a penetrance of 48% by the age of 50. Non-functioning and functioning pNETs were diagnosed in sixteen (76%) and five (24%) patients, respectively. Two-thirds of the patients had multifocal tumors. The median number of pancreatic macroscopic lesions per individual was 4.0 ± 3.9 (range 1-8) with a mean size of 1.3 ± 2.1 cm (range 0.5-10). The metastatic rate according to the dominant pNET lesion reached 100%, 62% and 6% for tumors sized > 4 cm, 2.1-4 cm, and 1-2 cm, respectively. Over the study period, one or more therapeutic interventions for pNETs were required in 20 out of the 21 patients. pNET-related metastatic complication was the main cause of death within this MEN-1 cohort. The overall survival rate for the pNETs patients was 86% during a mean follow-up period of 8.0 ± 4.6 years. CONCLUSIONS In our MEN-1 cohort, non-functioning pNETs were the most frequent type of pancreaticoduodenal tumor, and the tumor size correlated with the risks of metastasis and death. Increased awareness, early diagnosis, and a multidisciplinary approach may improve the associated morbidity and mortality in these patients.
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Affiliation(s)
- Kira Oleinikov
- Neuroendocrine Tumor Unit, Department of Endocrinology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Inbal Uri
- Neuroendocrine Tumor Unit, Department of Endocrinology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Harold Jacob
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Advanced Endoscopy Unit, Department of Gastroenterology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Julia Epshtein
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Advanced Endoscopy Unit, Department of Gastroenterology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ariel Benson
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Advanced Endoscopy Unit, Department of Gastroenterology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Simona Ben-Haim
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Department of Nuclear Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Institute of Nuclear Medicine, University College Hospitals, NHS Trust, London, UK
| | - Karine Atlan
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Department of Pathology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ilanit Tal
- Neuroendocrine Tumor Unit, Department of Endocrinology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Amichay Meirovitz
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ofra Maimon
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Naama Lev-Cohain
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Haggi Mazeh
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Benjamin Glaser
- Neuroendocrine Tumor Unit, Department of Endocrinology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David J Gross
- Neuroendocrine Tumor Unit, Department of Endocrinology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Simona Grozinsky-Glasberg
- Neuroendocrine Tumor Unit, Department of Endocrinology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
- ENETS Center of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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12
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Lourenço DM, de Herder WW. Editorial: Early Genetic and Clinical Diagnosis in MEN1. Front Endocrinol (Lausanne) 2020; 11:218. [PMID: 32351454 PMCID: PMC7174644 DOI: 10.3389/fendo.2020.00218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/26/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Delmar M. Lourenço
- Endocrine Genetics Unit (LIM-25), Endocrinology Division, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
- Endocrine Oncology Division, Institute of Cancer of the State of São Paulo, São Paulo, Brazil
- *Correspondence: Delmar M. Lourenço Jr. ; ;
| | - Wouter W. de Herder
- Sector Endocrinology, Department of Internal Medicine, ENETS Centre of Excellence, Erasmus MC Cancer Institute, Erasmus MC - University Medical Center, Rotterdam, Netherlands
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13
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Tamagno G, Scherer V, Caimo A, Bergmann SR, Kann PH. Endoscopic Ultrasound Features of Multiple Endocrine Neoplasia Type 1-Related versus Sporadic Pancreatic Neuroendocrine Tumors: A Single-Center Retrospective Study. Digestion 2018; 98:112-118. [PMID: 29698969 DOI: 10.1159/000487939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 02/25/2018] [Indexed: 02/04/2023]
Abstract
AIM Pancreatic neuroendocrine tumors (pNETs) can occur in patients with a familial syndrome either as multiple endocrine neoplasia type 1 (MEN-1) or as sporadic tumors. Endoscopic ultrasound (EUS) has become one of the first-line investigations for pNET characterization. The ultrasonographic features of pNETs may differ depending on the familial versus sporadic pathogenesis of the tumor. Therefore, the EUS findings could help and direct the definition of a pNET with an impact on the most appropriate diagnostic and therapeutic patient management. METHODS In this single-center retrospective study, we reviewed the EUS features of 94 pNETs from 37 MEN-1 patients and 15 pNETs from 11 sporadic disease patients at the time of their first EUS assessment. We analyzed the most relevant morphological and ultrasonographic characteristics of the tumors and compared the findings between the 2 patient groups. RESULTS Patients with MEN-1 more likely present with multiple pNETs than patients with sporadic disease. Sporadic pNETs are usually much bigger than those due to MEN-1. Moreover, pNETs are more heterogeneous in patients with sporadic disease than in those with MEN-1. No statistical difference with regard to definition of the margins, morphology, and vascularization of the pNETs appears between the 2 groups. CONCLUSIONS Patients with sporadic disease usually present with bigger and more heterogeneous pNETs than patients with MEN-1, who tend to present with a higher number of lesions. EUS can facilitate the precise characterization of a pNET, and the ultrasonographic features of the lesion can help and distinguish MEN-1-related versus sporadic disease.
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Affiliation(s)
- Gianluca Tamagno
- Division of Endocrinology and Diabetology, University Hospital, Philipp's University, Marburg, Germany.,Department of Endocrinology/Diabetes Mellitus, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Vanessa Scherer
- Division of Endocrinology and Diabetology, University Hospital, Philipp's University, Marburg, Germany
| | - Alberto Caimo
- School of Mathematical Sciences, Dublin Institute of Technology, Dublin, Ireland
| | - Simona R Bergmann
- Division of Endocrinology and Diabetology, University Hospital, Philipp's University, Marburg, Germany
| | - Peter H Kann
- Division of Endocrinology and Diabetology, University Hospital, Philipp's University, Marburg, Germany
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14
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Marini F, Giusti F, Fossi C, Cioppi F, Cianferotti L, Masi L, Boaretto F, Zovato S, Cetani F, Colao A, Davì MV, Faggiano A, Fanciulli G, Ferolla P, Ferone D, Loli P, Mantero F, Marcocci C, Opocher G, Beck-Peccoz P, Persani L, Scillitani A, Guizzardi F, Spada A, Tomassetti P, Tonelli F, Brandi ML. Multiple endocrine neoplasia type 1: analysis of germline MEN1 mutations in the Italian multicenter MEN1 patient database. Endocrine 2018; 62:215-233. [PMID: 29497973 DOI: 10.1007/s12020-018-1566-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 02/08/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Multiple endocrine neoplasia type 1 (MEN1) is caused by germline inactivating mutations of the MEN1 gene. Currently, no direct genotype-phenotype correlation is identified. We aim to analyze MEN1 mutation site and features, and possible correlations between the mutation type and/or the affected menin functional domain and clinical presentation in patients from the Italian multicenter MEN1 database, one of the largest worldwide MEN1 mutation series published to date. METHODS The study included the analysis of MEN1 mutation profile in 410 MEN1 patients [370 familial cases from 123 different pedigrees (48 still asymptomatic at the time of this study) and 40 single cases]. RESULTS We identified 99 different mutations: 41 frameshift [small intra-exon deletions (28) or insertions (13)], 13 nonsense, 26 missense and 11 splicing site mutations, 4 in-frame small deletions, and 4 intragenic large deletions spanning more than one exon. One family had two different inactivating MEN1 mutations on the same allele. Gastro-entero-pancreatic tumors resulted more frequent in patients with a nonsense mutation, and thoracic neuroendocrine tumors in individuals bearing a splicing-site mutation. CONCLUSIONS Our data regarding mutation type frequency and distribution are in accordance with previously published data: MEN1 mutations are scattered through the entire coding region, and truncating mutations are the most common in MEN1 syndrome. A specific direct correlation between MEN1 genotype and clinical phenotype was not found in all our families, and wide intra-familial clinical variability and variable disease penetrance were both confirmed, suggesting a role for modifying, still undetermined, factors, explaining the variable MEN1 tumorigenesis.
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Affiliation(s)
- Francesca Marini
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Francesca Giusti
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Caterina Fossi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Federica Cioppi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Luisella Cianferotti
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Laura Masi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Francesca Boaretto
- Familial Cancer Clinic, Veneto Institute of Oncology IRCCS, Padua, Italy
| | - Stefania Zovato
- Familial Cancer Clinic, Veneto Institute of Oncology IRCCS, Padua, Italy
| | - Filomena Cetani
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy
| | - Annamaria Colao
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maria Vittoria Davì
- Internal Medicine, Section of Endocrinology, Department of Medicine, University of Verona, Verona, Italy
| | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppe Fanciulli
- NET Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Piero Ferolla
- Multidisciplinar NET Center, Umbria Regional Cancer Network, Azienda Ospedaliera di Perugia and University of Perugia, Perugia, Italy
| | - Diego Ferone
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Paola Loli
- Department of Endocrinology, Hospital Niguarda Ca' Granda, Milan, Italy
| | - Franco Mantero
- Division of Endocrinology, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy
| | - Giuseppe Opocher
- Familial Cancer Clinic, Veneto Institute of Oncology IRCCS, Padua, Italy
| | | | - Luca Persani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Alfredo Scillitani
- Unit of Endocrinology 'Casa Sollievo della Sofferenza' Hospital, IRCCS, San Giovanni Rotondo, Foggia, Italy
| | - Fabiana Guizzardi
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Anna Spada
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paola Tomassetti
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Francesco Tonelli
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Maria Luisa Brandi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
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15
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Polenta V, Slater EP, Kann PH, Albers MB, Manoharan J, Ramaswamy A, Mahnken AH, Bartsch DK. Preoperative Imaging Overestimates the Tumor Size in Pancreatic Neuroendocrine Neoplasms Associated with Multiple Endocrine Neoplasia Type 1. World J Surg 2018; 42:1440-1447. [PMID: 29075857 DOI: 10.1007/s00268-017-4317-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Radiological tumor size of non-functioning pancreatic neuroendocrine neoplasms (Nf-pNENs) associated with multiple endocrine neoplasia type 1 (MEN1) is a crucial parameter to indicate surgery. The aim of this study was to compare radiological size (RS) and pathologic size (PS) of MEN1 associated with pNENs. METHODS Prospectively collected data of MEN1 patients who underwent pancreatic resections for pNENs were retrospectively analyzed. RS was defined as the largest tumor diameter measured on endoscopic ultrasound (EUS), magnetic resonance imaging (MRI) or computed tomography (CT). PS was defined as the largest tumor diameter on pathological analysis. Student's t test and linear regression analysis were used to compare the median RS and PS. p < 0.05 was considered significant. RESULTS Forty-four patients with a median age of 37 (range 10-68) years underwent primary pancreatic resections for pNENs. Overall, the median RS (20 mm, range 3-100 mm) was significantly larger than the PS (13 mm, range 4-110 mm) (p = 0.001). In patients with pNENs < 20 mm (n = 27), the size difference (median RS 15 mm vs PS 12 mm) was also significant (p = 0.003). However, the only modality that significantly overestimated the PS was EUS (median RS 14 mm vs 11 mm; p = 0.0002). RS overestimated the PS in 21 patients (21 of 27 patients, 78%). Five of 11 patients (12%) with a Nf-pNEN and a RS > 20 mm had in reality a PS < 20 mm. MRI was the imaging technique that best correlated with PS in the total cohort (r = 0.8; p < 0.0001), whereas EUS was the best correlating imaging tool in pNENs < 20 mm (r = 0.5; p = 0.0001). CONCLUSION Preoperative imaging, especially EUS, frequently overestimates the size of MEN1-pNENs, especially those with a PS < 20 mm. This should be considered when indicating surgery in MEN1 patients with small Nf-pNENs.
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Affiliation(s)
- V Polenta
- Department of Visceral, Thoracic and Vascular Surgery, Philipps-University Marburg, Marburg, Germany. .,Department of General Surgery, Ospedali Riuniti Ancona, Conca 71, Torrette, 60020, Ancona, Italy.
| | - E P Slater
- Department of Visceral, Thoracic and Vascular Surgery, Philipps-University Marburg, Marburg, Germany
| | - P H Kann
- Division Endocrinology, Philipps-University Marburg, Marburg, Germany
| | - M B Albers
- Department of Visceral, Thoracic and Vascular Surgery, Philipps-University Marburg, Marburg, Germany
| | - J Manoharan
- Department of Visceral, Thoracic and Vascular Surgery, Philipps-University Marburg, Marburg, Germany
| | - A Ramaswamy
- Institute of Pathology, Philipps-University Marburg, Marburg, Germany
| | - A H Mahnken
- Department of Radiology, Philipps-University Marburg, Marburg, Germany
| | - D K Bartsch
- Department of Visceral, Thoracic and Vascular Surgery, Philipps-University Marburg, Marburg, Germany
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16
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van Treijen MJC, van Beek DJ, van Leeuwaarde RS, Vriens MR, Valk GD. Diagnosing Nonfunctional Pancreatic NETs in MEN1: The Evidence Base. J Endocr Soc 2018; 2:1067-1088. [PMID: 30202829 PMCID: PMC6125714 DOI: 10.1210/js.2018-00087] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 07/26/2018] [Indexed: 02/07/2023] Open
Abstract
In multiple endocrine neoplasia type 1 (MEN1), nonfunctional pancreatic neuroendocrine tumors (NF-pNETs) are the most frequently diagnosed NETs and a leading cause of MEN1-related death. The high prevalence and malignant potential of NF-pNETs outline the need for an evidence-based screening program, as early diagnosis and timely intervention could reduce morbidity and mortality. Controversies exist regarding the value of several diagnostic tests. This systematic review aims to evaluate current literature and amplify an up-to-date evidence-based approach to NF-pNET diagnosis in MEN1. Three databases were systematically searched on the diagnostic value of biomarkers and imaging modalities. Twenty-seven studies were included and critically appraised (modified Quality Assessment of Diagnostic Accuracy Studies). Another 12 studies, providing data on age-related penetrance and tumor growth, were included to assess the optimal frequency and timing of screening. Based on current literature, biomarkers should no longer play a role in the diagnostic process for NF-pNETs, as accuracies are too low. Studies evaluating the diagnostic value of imaging modalities are heterogeneous with varying risks of bias. For the detection of NF-pNETs, endoscopic ultrasound (EUS) has the highest sensitivity. A combined strategy of EUS and MRI seems to be the most useful. Gallium 68 octreotate-DOTA positron emission tomography-CT could be added if NF-pNETs are diagnosed to identify metastasis. Reported growth rates were generally low, and two distinct phenotypes were observed. Surveillance programs should focus on and be adapted to the presence of substantial growth in NF-pNETs. The optimal age to start screening must yet be determined, as insufficient evidence for an evidence-based recommendation was available.
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Affiliation(s)
- Mark J C van Treijen
- Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Dirk-Jan van Beek
- Department of Endocrine Surgical Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Menno R Vriens
- Department of Endocrine Surgical Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Gerlof D Valk
- Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, Netherlands
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17
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So A, Pointon O, Hodgson R, Burgess J. An assessment of 18 F-FDG PET/CT for thoracic screening and risk stratification of pulmonary nodules in multiple endocrine neoplasia type 1. Clin Endocrinol (Oxf) 2018; 88:683-691. [PMID: 29446832 DOI: 10.1111/cen.13573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 02/03/2018] [Accepted: 02/06/2018] [Indexed: 12/21/2022]
Abstract
CONTEXT Bronchopulmonary neuroendocrine tumours (bpNETs) and thymic carcinoid (ThC) are features of multiple endocrine neoplasia type 1 (MEN 1), and surveillance guidelines recommend periodic thoracic imaging. The optimal thoracic imaging modality and screening frequency remain uncertain as does the prognosis of small lung nodules when identified. OBJECTIVES To evaluate fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG PET/CT) for identification and prognostic assessment of thoracic lesions in MEN 1. DESIGN Retrospective observational study. SETTING AND PARTICIPANTS Fifty consecutive MEN 1 patients undergoing screening with 18 F-FDG PET/CT at a tertiary referral hospital between July 2011 and December 2016. INTERVENTIONS 18 F-FDG PET/CT. OUTCOME MEASURES Pulmonary and thymic lesion prevalence, size, functional characteristics and behaviour. RESULTS Thirteen patients (26.0%) exhibited pulmonary nodules with multiple nodules identified in nine (18.0%). An asymptomatic 31 mm FDG-avid ThC was identified in one patient (2%). Of the 13 patients with pulmonary nodules, four (8.0%) exhibited 13 FDG-avid nodules (mean size 10.1 ± 9.1 mm), and nine (18.0%) demonstrated 26 FDG nonavid nodules (mean size 6.9 ± 5.8 mm). All FDG-avid lesions increased in size vs 11 (42.3%) FDG nonavid lesions (P = .0004). For FDG-avid and nonavid nodules, the median doubling time was 24.2 months (IQR 11.4-40.7) and 48.6 months (IQR 37.0-72.2), respectively. Nodule resection was undertaken in two patients, typical bronchial carcinoid diagnosed in one (FDG nonavid) and metastatic renal cell carcinoma in the second (FDG avid). CONCLUSION Thoracic imaging with 18 F-FDG PET/CT effectively identifies pulmonary nodules and ThC. FDG-avid pulmonary lesions are significantly more likely to progress than nonavid lesions.
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Affiliation(s)
- Alvin So
- Department of Medical Imaging, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Owen Pointon
- Department of Nuclear Medicine, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Richard Hodgson
- Department of Medical Imaging, Royal Hobart Hospital, Hobart, TAS, Australia
| | - John Burgess
- Department of Diabetes & Endocrinology, Royal Hobart Hospital, Hobart, TAS, Australia
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
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18
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Giudici F, Cavalli T, Giusti F, Gronchi G, Batignani G, Tonelli F, Brandi ML. Natural History of MEN1 GEP-NET: Single-Center Experience After a Long Follow-Up. World J Surg 2018; 41:2312-2323. [PMID: 28429092 DOI: 10.1007/s00268-017-4019-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The multiple endocrine neoplasia type 1 syndrome (MEN1) natural history is poorly evaluated, and few single-institution experiences about hereditary gastroenteropancreatic neuroendocrine tumors (GEP-NET) are reported. Our purpose is to analyze the role of GEP-NET in MEN1-related death, as well as the behavior of these lesions during follow-up. METHODS The study population consists of 77 patients diagnosed with MEN1 GEP-NET, regularly followed up since 1990. Extensive clinical data were prospectively recorded. Statistical analysis was performed both on the whole population of 77 patients and on two subgroups including patients who, during the long lasting study period, underwent GEP-NET surgery (50 pts) and who did not (27 pts), respectively. RESULTS Twenty-five males (32.5%) and 52 females (67.5%) were enrolled. Sixty-four patients had MEN1 family history (83.1%), and genetic mutation was detected in 67 cases (87%). The mean age at GEP-NET diagnosis was 41.4 years (SD = 13.6); 16 patients (20.8%) had GEP-NET diagnosed before age 30 and 12 cases (15.6%) before 1996. The mean interval time between MEN1 diagnosis and GEP-NET detection was 5.7 years (range -11/37; SD = 8.1 years). Overall, the mean follow-up time from MEN1 diagnosis was 15.8 years (SD = 9.7 years) and from GEP-NET diagnosis was 9.6 years (SD = 6.9 years). Gastrinoma was the most frequent functioning GEP-NET and pancreatoduodenectomy the most adopted surgery. GEP-NET progression affected 12 patients within the non-surgical group, while 18 subjects developed progression after surgery. CONCLUSIONS Our single-center data provide information on epidemiologic, clinical and pathological features of GEP-NET in MEN1 making possible to clarify their natural history.
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Affiliation(s)
- Francesco Giudici
- Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50139, Florence, Italy.
| | - Tiziana Cavalli
- Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50139, Florence, Italy
| | - Francesca Giusti
- Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50139, Florence, Italy
| | - Giorgio Gronchi
- Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50139, Florence, Italy
| | - Giacomo Batignani
- Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50139, Florence, Italy
| | - Francesco Tonelli
- Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50139, Florence, Italy
| | - Maria Luisa Brandi
- Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50139, Florence, Italy
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19
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Manoharan J, Raue F, Lopez CL, Albers MB, Bollmann C, Fendrich V, Slater EP, Bartsch DK. Is Routine Screening of Young Asymptomatic MEN1 Patients Necessary? World J Surg 2018; 41:2026-2032. [PMID: 28321559 DOI: 10.1007/s00268-017-3992-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Recent clinical practice guidelines recommend that routine screening of MEN1 mutation carriers should start at the age of 5 years. The occurrence of clinically relevant MEN1 organ manifestations in children (≤18 years) was evaluated. METHODS Two prospective collected databases of MEN1 patients (n = 166) who underwent annual screening were retrospectively analyzed for organ manifestations in MEN1 patients ≤18 years. The follow-up was based on the most recent screening examination until December 2015. RESULTS Twenty [11 females, 9 males, (12%)] of 166 MEN1 patients were diagnosed with at least one organ manifestation at age ≤18 years. The most frequent manifestation was mild asymptomatic pHPT (n = 9, 45%, age range 8-18 years). Eight (40%) young patients had pNENs (three non-functioning pNENs, five insulinomas, age range 9-18 years). All five insulinomas were diagnosed based on hypoglycemic symptoms. The other organ manifestations were asymptomatic pituitary adenomas in six patients (30%, age range 15-18 years) and a bronchial carcinoid in one 15-year-old patient. Only six (30%) patients ≤18 years had clinically relevant organ manifestations. CONCLUSION Symptomatic or severe manifestations in MEN1 patients rarely occur below the age of 16 years. With regard to psychological burden and cost-effectiveness, routine screening of asymptomatic MEN1 patients should be postponed at least until the age of 16 years.
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Affiliation(s)
- Jerena Manoharan
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Baldingerstrasse, 35041, Marburg, Germany.
| | - Friedhelm Raue
- Practice and Molecular Laboratory, Brueckenstrasse 21, 69120, Heidelberg, Germany
| | - Caroline L Lopez
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Baldingerstrasse, 35041, Marburg, Germany
| | - Max B Albers
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Baldingerstrasse, 35041, Marburg, Germany
| | - Carmen Bollmann
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Baldingerstrasse, 35041, Marburg, Germany
| | - Volker Fendrich
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Baldingerstrasse, 35041, Marburg, Germany
| | - Emily P Slater
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Baldingerstrasse, 35041, Marburg, Germany
| | - Detlef K Bartsch
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Baldingerstrasse, 35041, Marburg, Germany
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Limited Value of Ga-68-DOTATOC-PET-CT in Routine Screening of Patients with Multiple Endocrine Neoplasia Type 1. World J Surg 2018; 41:1521-1527. [PMID: 28138732 DOI: 10.1007/s00268-017-3907-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Routine screening is recommended for patients with multiple endocrine neoplasia type 1 (MEN1) to enable early detection and treatment of associated neuroendocrine neoplasms (NEN). Gallium68-DOTATOC-Positron emission tomography combined with computed tomography (Ga-68-DOTATOC-PET-CT) is a very sensitive and specific imaging technique for the detection of sporadic neuroendocrine tumors. The present study evaluated the value of Ga-68-DOTATOC-PET-CT in routine screening of patients with MEN1. METHODS Between January 2014 and March 2016, all MEN1 patients underwent Ga-68-DOTATOC-PET-CT in addition to conventional imaging (computed tomography of the thorax, magnetic resonance imaging of the abdomen and pituitary, endoscopic ultrasonography). The diagnostic yield of conventional imaging and Ga-68-DOTATOC-PET-CT was prospectively documented and compared, and treatment changes caused by the addition of Ga-68-DOTATOC-PET-CT were recorded. RESULTS Conventional imaging detected 145 NENs, mainly pancreaticoduodenal NENs (n = 117, 81%), in 31 of 33 MEN1 patients. Ga-68-DOTATOC-PET-CT detected 55 NENs in 23 of the 33 patients (p = 0.0001). Ninety (62%) NENs detected by conventional imaging were missed by DOTATOC-PET-CT. The majority of missed lesions were pNEN (n = 68; 74%). The sensitivity of Ga-68-DOTATOC-PET-CT for NENs <5, 5-9, 10-19 and ≥20 mm was 0, 29, 81 and 100%, respectively. However, Ga-68-DOTATOC-PET-CT detected more liver and lymph node metastases in patients with known metastatic disease, which did not lead to a change of patients' management. In one patient (3%), Ga-68-DOTATOC-PET-CT was the only imaging modality that detected a small intestine NEN and led to potentially curative surgery. CONCLUSION Ga-68-DOTATOC-PET-CT cannot be recommended for routine screening of MEN1 patients. It might provide important additional information in patients with suspected or known metastatic disease.
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Giusti F, Cianferotti L, Boaretto F, Cetani F, Cioppi F, Colao A, Davì MV, Faggiano A, Fanciulli G, Ferolla P, Ferone D, Fossi C, Giudici F, Gronchi G, Loli P, Mantero F, Marcocci C, Marini F, Masi L, Opocher G, Beck-Peccoz P, Persani L, Scillitani A, Sciortino G, Spada A, Tomassetti P, Tonelli F, Brandi ML. Multiple endocrine neoplasia syndrome type 1: institution, management, and data analysis of a nationwide multicenter patient database. Endocrine 2017; 58:349-359. [PMID: 28132167 DOI: 10.1007/s12020-017-1234-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 01/13/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The aim of this study was to integrate European epidemiological data on patients with multiple endocrine neoplasia type 1 by creating an Italian registry of this syndrome, including clinical and genetic characteristics and therapeutic management. METHODS Clinical, familial and genetic data of patients with multiple endocrine neoplasia type 1, diagnosed, treated, and followed-up for a mean time of 11.3 years, in 14 Italian referral endocrinological centers, were collected, over a 3-year course (2011-2013), to build a national electronic database. RESULTS The Italian multiple endocrine neoplasia type 1 database includes 475 patients (271 women and 204 men), of whom 383 patients (80.6%) were classified as familial cases (from 136 different pedigrees), and 92 (19.4%) patients were sporadic cases. A MEN1 mutation was identified in 92.6% of familial cases and in 48.9% of sporadic cases. Four hundred thirty-six patients were symptomatic, presenting primary hyperparathyroidism, gastroenteropancreatic neuroendocrine tumors and pituitary tumors in 93, 53, and 41% of cases, respectively. Thirty-nine subjects, belonging to affected pedigrees positive for a MEN1 mutation, were asymptomatic at clinical and biochemical screening. Age at diagnosis of multiple endocrine neoplasia type 1 probands was similar for both familial and simplex cases (mean age 47.2 ± 15.3 years). In familial cases, diagnosis of multiple endocrine neoplasia type 1 in relatives of affected probands was made more than 10 years in advance (mean age at diagnosis 36.5 ± 17.6 years). CONCLUSIONS The analysis of Italian registry of multiple endocrine neoplasia type 1 patients revealed that clinical features of Italian multiple endocrine neoplasia type 1 patients are similar to those of other western countries, and confirmed that the genetic test allowed multiple endocrine neoplasia type 1 diagnosis 10 years earlier than biochemical or clinical diagnosis.
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Affiliation(s)
- Francesca Giusti
- Department of Surgery and Translational Medicine, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Luisella Cianferotti
- Department of Surgery and Translational Medicine, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Francesca Boaretto
- Familial Tumor Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Filomena Cetani
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy
| | - Federica Cioppi
- Department of Surgery and Translational Medicine, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Annamaria Colao
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maria Vittoria Davì
- Internal Medicine, Section of Endocrinology, Department of Medicine, University of Verona, Verona, Italy
| | - Antongiulio Faggiano
- Thyroid and Parathyroid Surgery Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy
| | - Giuseppe Fanciulli
- NET Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Piero Ferolla
- Department of Internal Medicine and Endocrine Sciences, University of Perugia, Perugia, Italy
| | - Diego Ferone
- Endocrinology Units, Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa, Italy
| | - Caterina Fossi
- Department of Surgery and Translational Medicine, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Francesco Giudici
- Department of Surgery and Translational Medicine, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Giorgio Gronchi
- Department of Surgery and Translational Medicine, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Paola Loli
- Department of Endocrinology, Hospital Niguarda Ca' Granda, Milan, Italy
| | - Franco Mantero
- Division of Endocrinology, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy
| | - Francesca Marini
- Department of Surgery and Translational Medicine, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Laura Masi
- Department of Surgery and Translational Medicine, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Giuseppe Opocher
- Familial Tumor Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - Luca Persani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Alfredo Scillitani
- Unit of Endocrinology 'Casa Sollievo della Sofferenza' Hospital, IRCCS, San Giovanni Rotondo, Foggia, Italy
| | - Giovanna Sciortino
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Anna Spada
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paola Tomassetti
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Francesco Tonelli
- Department of Surgery and Translational Medicine, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Maria Luisa Brandi
- Department of Surgery and Translational Medicine, University of Florence, Largo Palagi 1, 50139, Florence, Italy.
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Manoharan J, Albers MB, Bartsch DK. The future: diagnostic and imaging advances in MEN1 therapeutic approaches and management strategies. Endocr Relat Cancer 2017; 24:T209-T225. [PMID: 28790162 DOI: 10.1530/erc-17-0231] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 08/08/2017] [Indexed: 12/13/2022]
Abstract
Prospective randomized data are lacking, but current clinical expert guidelines recommend annual screening examinations, including laboratory assessments and various imaging modalities (e.g. CT, MRI, scintigraphy and EUS) for patients with multiple endocrine neoplasia type 1 (MEN1). Routine screening is proposed to detect and localize neuroendocrine manifestations as early as possible. The goal is timely intervention to improve quality of life and to increase life expectancy by preventing the development of life-threatening hormonal syndromes and/or metastatic disease. In recent years, some studies compared different and new imaging methods regarding their sensitivity and utility in MEN1 patients. This present article reviews the proposed diagnostic tools for MEN1 screening as well as potential future perspectives.
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Affiliation(s)
- Jerena Manoharan
- Department of VisceralThoracic and Vascular Surgery, Philipps University Marburg, Marburg, Germany
| | - Max B Albers
- Department of VisceralThoracic and Vascular Surgery, Philipps University Marburg, Marburg, Germany
| | - Detlef K Bartsch
- Department of VisceralThoracic and Vascular Surgery, Philipps University Marburg, Marburg, Germany
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Pieterman CRC, de Laat JM, Twisk JWR, van Leeuwaarde RS, de Herder WW, Dreijerink KMA, Hermus ARMM, Dekkers OM, van der Horst-Schrivers ANA, Drent ML, Bisschop PH, Havekes B, Borel Rinkes IHM, Vriens MR, Valk GD. Long-Term Natural Course of Small Nonfunctional Pancreatic Neuroendocrine Tumors in MEN1-Results From the Dutch MEN1 Study Group. J Clin Endocrinol Metab 2017; 102:3795-3805. [PMID: 28938468 DOI: 10.1210/jc.2017-00372] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 08/01/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pancreatic neuroendocrine tumors (pNETs) are highly prevalent in patients with multiple endocrine neoplasia type 1 (MEN1), and metastatic disease is an important cause of MEN1-related mortality. Especially small nonfunctional (NF) pNETs pose a challenge to the treating physician and more information is needed regarding their natural course. We assessed long-term natural history of small NF-pNETs and its modifiers in the Dutch MEN1 population. PATIENTS AND METHODS Retrospective longitudinal observational cohort study of patients with small (<2 cm) NF-pNETs from the Dutch national MEN1 database, which includes >90% of the Dutch MEN1 population. Modifiers of long-term natural course were analyzed using linear mixed-models analysis. RESULTS Growth rate of the 115 included small NF-pNETs from 99 patients was slow (0.4 mm/y; 95% confidence interval, 0.15 to 0.59). Seventy percent of the tumors was stable and a subgroup of 30% of the tumors was growing (1.6 mm/y; 95% confidence interval, 1.1 to 2.0). No differences in clinical characteristics were identified between growing and stable tumors. Within the subgroup of growing tumors, germline missense mutations were significantly associated with accelerated growth compared with nonsense and frameshift mutations. CONCLUSION The majority of small NF-pNETs are stable at long-term follow-up, irrespective of the underlying MEN1 genotype. A subgroup of tumors is slowly growing but cannot be identified on clinical grounds. In this subgroup, tumors with missense mutations exhibited faster growth. Additional events appear necessary for pNETs to progress. Future studies should be aimed at identifying these molecular driving events, which could be used as potential biomarkers.
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Affiliation(s)
- Carolina R C Pieterman
- Department of Endocrine Oncology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Joanne M de Laat
- Department of Endocrine Oncology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Jos W R Twisk
- Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, 1007 MB Amsterdam, The Netherlands
- Department of Health Sciences, VU University, 1007 MB Amsterdam, The Netherlands
| | - Rachel S van Leeuwaarde
- Department of Endocrine Oncology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Wouter W de Herder
- Department of Internal Medicine, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Koen M A Dreijerink
- Department of Endocrine Oncology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Ad R M M Hermus
- Department of Endocrinology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Olaf M Dekkers
- Departments of Endocrinology and Metabolism and Clinical Epidemiology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | | | - Madeleine L Drent
- Department of Internal Medicine, Section of Endocrinology, VU University Medical Center, 1007 MB Amsterdam, The Netherlands
| | - Peter H Bisschop
- Department of Endocrinology and Metabolism, Academic Medical Center, 1100 DD Amsterdam, The Netherlands
| | - Bastiaan Havekes
- Department of Internal Medicine, Division of Endocrinology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
| | - Inne H M Borel Rinkes
- Department of Endocrine Surgical Oncology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Menno R Vriens
- Department of Endocrine Surgical Oncology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Gerlof D Valk
- Department of Endocrine Oncology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
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van Leeuwaarde RS, de Laat JM, Pieterman CRC, Dreijerink K, Vriens MR, Valk GD. The future: medical advances in MEN1 therapeutic approaches and management strategies. Endocr Relat Cancer 2017; 24:T179-T193. [PMID: 28768698 DOI: 10.1530/erc-17-0225] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 12/21/2022]
Abstract
Multiple endocrine neoplasia type 1 is a rare autosomal inherited disorder associated with a high risk for patients to simultaneously develop tumors of the parathyroid glands, duodenopancreatic neuroendocrine tumors and tumors of the anterior pituitary gland. Early identification of MEN1 in patients enables presymptomatic screening of manifestations, which makes timely interventions possible with the intention to prevent morbidity and mortality. Causes of death nowadays have shifted toward local or metastatic progression of malignant neuroendocrine tumors. In early cohorts, complications like peptic ulcers in gastrinoma, renal failure in hyperparathyroidism, hypoglycemia and acute hypercalcemia were the primary causes of early mortality. Improved medical treatments of these complications led to a significantly improved life expectancy. The MEN1 landscape is still evolving, considering the finding of breast cancer as a new MEN1-related manifestation and ongoing publications on follow-up and medical care for patients with MEN1. This review aims at summarizing the most recent insights into the follow-up and medical care for patients with MEN1 and identifying the gaps for future research.
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Affiliation(s)
| | - Joanne M de Laat
- Department of Endocrine OncologyUniversity Medical Center Utrecht, Utrecht, The Netherlands
| | - Carolina R C Pieterman
- Department of Endocrine OncologyUniversity Medical Center Utrecht, Utrecht, The Netherlands
| | - Koen Dreijerink
- Department of Endocrine OncologyUniversity Medical Center Utrecht, Utrecht, The Netherlands
| | - Menno R Vriens
- Department of Endocrine SurgeryUniversity Medical Center Utrecht, Utrecht, The Netherlands
| | - Gerlof D Valk
- Department of Endocrine OncologyUniversity Medical Center Utrecht, Utrecht, The Netherlands
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Frey MK, Sandler G, Sobolev R, Kim SH, Chambers R, Bassett RY, Martineau J, Sapra KJ, Boyd L, Curtin JP, Pothuri B, Blank SV. Multigene panels in Ashkenazi Jewish patients yield high rates of actionable mutations in multiple non-BRCA cancer-associated genes. Gynecol Oncol 2017; 146:123-128. [PMID: 28495237 DOI: 10.1016/j.ygyno.2017.04.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/11/2017] [Accepted: 04/14/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the results of multigene panel testing among Ashkenazi Jewish compared with non-Ashkenazi Jewish patients. METHODS We reviewed the medical records for all patients who underwent multigene panel testing and targeted BRCA1/2 testing at a single institution between 6/2013-1/2015. Clinical actionability for identified pathogenic mutations was characterized based on the National Comprehensive Cancer Network (NCCN) guidelines and consensus statements and expert opinion for genes not addressed by these guidelines. RESULTS Four hundred and fifty-four patients underwent multigene panel screening, including 138 Ashkenazi Jewish patients. The median patient age was fifty-two years. Three hundred and fifty-four patients (78%) had a personal history of cancer. Two hundred and fifty-one patients had breast cancer, 49, ovarian cancer, 26, uterine cancer and 20, colorectal cancer. We identified 62 mutations in 56 patients and 291 variants of uncertain significance in 196 patients. Among the 56 patients with mutations, 51 (91%) had actionable mutations. Twenty mutations were identified by multigene panels among Ashkenazi Jewish patients, 18 of which were in genes other than BRCA1/2. A review of targeted BRCA1/2 testing performed over the same study period included 103 patients and identified six mutations in BRCA1/2, all of which occurred in Ashkenazi Jewish patients. Among all Ashkenazi Jewish patients undergoing genetic testing, 25/183 (14%) had a mutation, 24/25 of which were actionable (96%) and 17/25 patients (68%) had mutations in non BRCA1/2 genes. CONCLUSIONS With the rapid acceptance of multigene panels there is a pressing need to understand how this testing will affect patient management. While traditionally many Ashkenazi Jewish patients have undergone targeted BRCA1/2 testing, our data suggest consideration of multigene panels in this population as the majority of the results are clinically actionable and often in genes other than BRCA1/2.
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Affiliation(s)
| | - Gabriella Sandler
- New York University Langone Medical Center, New York, NY, United States
| | - Rachel Sobolev
- New York University Langone Medical Center, New York, NY, United States
| | - Sarah H Kim
- New York University Langone Medical Center, New York, NY, United States
| | - Rachelle Chambers
- New York University Langone Medical Center, New York, NY, United States
| | - Rebecca Y Bassett
- New York University Langone Medical Center, New York, NY, United States
| | - Jessica Martineau
- New York University Langone Medical Center, New York, NY, United States
| | | | - Leslie Boyd
- New York University Langone Medical Center, New York, NY, United States
| | - John P Curtin
- New York University Langone Medical Center, New York, NY, United States
| | - Bhavana Pothuri
- New York University Langone Medical Center, New York, NY, United States
| | - Stephanie V Blank
- Icahn School of Medicine at Mount Sinai, New York, NY, United States.
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Complicated Case Presentation: Management of Pancreatic Neuroendocrine Tumors in Multiple Endocrine Neoplasia Type 1. Pancreas 2017; 46:416-426. [PMID: 28187108 DOI: 10.1097/mpa.0000000000000770] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Multiple endocrine neoplasia type 1 (MEN1) is an inherited predisposition to tumors of the parathyroid glands, anterior pituitary, and pancreatic islet cells. In this review, we discuss the clinical case of a 45-year-old woman with MEN1 that was presented at the 2015 North American Neuroendocrine Tumor Society Symposium. In our review of this patient's complicated clinical course and subsequent operative management, we highlight controversies in the diagnosis and management of pancreatic neuroendocrine tumors in MEN1. In particular, this case illustrates the lack of consensus regarding the optimal biochemical and radiologic screening for pancreatic neuroendocrine tumors and absence of guidelines about the appropriate surgical approach for treatment. We review these controversies and discuss possible approaches to management.
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Keutgen XM, Nilubol N, Agarwal S, Welch J, Cochran C, Marx SJ, Weinstein LS, Simonds WF, Kebebew E. Reoperative Surgery in Patients with Multiple Endocrine Neoplasia Type 1 Associated Primary Hyperparathyroidism. Ann Surg Oncol 2016; 23:701-707. [PMID: 27464610 DOI: 10.1245/s10434-016-5467-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Persistent/recurrent primary hyperparathyroidism (pHPT) occurs frequently in multiple endocrine neoplasia type 1 (MEN1). We assessed the usefulness of intraoperative PTH (IOPTH) and preoperative localizing studies based on the outcome of patients with MEN1-associated pHPT undergoing reoperative surgery. METHODS A retrospective analysis identified MEN1 patients with persistent/recurrent pHPT. Patient outcome was defined as postoperative serum calcium and PTH levels (cured, persistent or recurrent) at last follow-up. Positive predictive value (PPV) was calculated for imaging studies and IOPTH. RESULTS Thirty patients with MEN1-associated recurrent/persistent pHPT underwent 69 reoperative parathyroidectomies. Median follow-up time was 33 months. Persistent pHPT occurred in four (13 %) patients. IOPTH had a 92 % PPV for postoperative eucalcemia. Ultrasound and Tc99m-sestamibi had sensitivities of 100 and 85 % for localizing an enlarged parathyroid gland. However, five (17 %) patients had additional enlarged glands, not visualized preoperatively that were removed after IOPTH did not drop appropriately. Bone mineral density scores did not improve after reoperation (p = 0.60), but the rate of postoperative nephrocalcinosis did (p = 0.046). Patients with pancreatic neuroendocrine tumors had significantly higher rates of persistent/recurrent pHPT compared with those without (40 vs. 0 %, p = 0.021). Intraoperative and delayed parathyroid autotransplantation was performed in nine (30 %) and four (14 %) patients, respectively. CONCLUSIONS Although preoperative localizing studies are helpful for guiding reoperative strategy in MEN1 with persistent/recurrent pHPT, additional enlarged glands may be missed by conventional imaging. IOPTH should therefore be employed routinely in this setting. Routine cryopreservation should be considered in all patients. Pancreatic manifestation may be associated with earlier recurrence or persistent disease.
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Affiliation(s)
- Xavier M Keutgen
- Endocrine Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Naris Nilubol
- Endocrine Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sunita Agarwal
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - James Welch
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Craig Cochran
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Steve J Marx
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Lee S Weinstein
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - William F Simonds
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Electron Kebebew
- Endocrine Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Minimally Invasive Versus Open Pancreatic Surgery in Patients with Multiple Endocrine Neoplasia Type 1. World J Surg 2016; 40:1729-36. [DOI: 10.1007/s00268-016-3456-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Ito T, Jensen RT. Imaging in multiple endocrine neoplasia type 1: recent studies show enhanced sensitivities but increased controversies. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2016; 3:53-66. [PMID: 26834963 DOI: 10.2217/ije.15.29] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
In multiple endocrine neoplasia type 1 (MEN1) patients, a number of recent studies compare the ability of different, new imaging modalities to existing modalities to localize the important neuroendocrine tumors (NETs) that contribute to their decreased life expectancy (pancreatic NETs [pNETs] and thymic carcinoids). These included the use of 68Ga-DOTATOC-PET/CT, endoscopic ultrasound and MRI. The current paper analyzes these results in light of current guidelines and controversies involved in the treatment/management of MEN1 patients. Particular attention is paid to results in these studies with thymic carcinoids and nonfunctional pNETs/gastrinomas, which recent studies show are particularly important in determining long-term survival. These studies show a number of promising imaging results but also raise a number of controversies, which will need to be addressed both in their use initially and for serial studies in these patients.
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Affiliation(s)
- Tetsuhide Ito
- Department of Medicine & Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Robert T Jensen
- Digestive Diseases Branch, NIDDK, NIH, Bethesda, MD 20817, USA
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Buzzola R, Kurukulasuriya LR, Touza M, Litofsky NS, Brietzke S, Sowers JR. A Possible New Multiple Endocrine Neoplasia Mutation in a Patient with a Prototypic Multiple Endocrine Neoplasia Presentation. Cardiorenal Med 2016; 6:129-34. [PMID: 26989398 DOI: 10.1159/000440985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 08/08/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Multiple endocrine neoplasia (MEN) type 1 syndrome is an uncommon inherited disorder characterized by the occurrence of tumors involving two or more endocrine glands. These tumors include pheochromocytoma, adrenal cortical and neuroendocrine tumors including (bronchopulmonary, thymic, gastric), lipomas, angiofibromas, collagenomas, and meningiomas. MEN-4 is very rare and has been characterized by the occurrence of parathyroid and anterior pituitary tumors in association with tumors of the adrenals, kidneys, and reproductive organs. SUMMARY We report the case of a 40-year-old male without significant family history of endocrine disease who was found to have primary hyperparathyroidism, a pituitary tumor causing acromegaly, thyroid cancer, renal cell carcinoma, and pancreatic cysts. We posit that this represents a new version of MEN-4. While renal tumors (angiomyolipoma) have been reported as part of the MEN-4 phenotype, to our knowledge, this is the first case reported of the association of MEN-1 and/or MEN-4 phenotype with this unique constellation of tumors, including renal cell carcinoma. Interestingly, this patient tested negative (DNA sequencing/deletion) for MEN-1 (menin), MEN-4 (CDKN1B) and VHL genes. KEY MESSAGE Thus, while this case has clinical characteristics consistent with either MEN-1 or MEN-4, it may represent a unique genetic variant.
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Affiliation(s)
- Rino Buzzola
- Diabetes and Cardiovascular Center, University of Missouri, Mo., USA
| | | | - Mariana Touza
- Diabetes and Cardiovascular Center, University of Missouri, Mo., USA
| | | | - Stephen Brietzke
- Diabetes and Cardiovascular Center, University of Missouri, Mo., USA
| | - James R Sowers
- Diabetes and Cardiovascular Center, University of Missouri, Mo., USA; Departments of Medicine and Physiology, University of Missouri, Mo., USA; Harry S. Truman VA Hospital, Columbia, Mo., USA
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31
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Singh Ospina N, Maraka S, Montori V, Thompson GB, Young WF. When and how should patients with multiple endocrine neoplasia type 1 be screened for thymic and bronchial carcinoid tumours? Clin Endocrinol (Oxf) 2016; 84:13-6. [PMID: 26562483 DOI: 10.1111/cen.12972] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 10/22/2015] [Accepted: 11/05/2015] [Indexed: 02/04/2023]
Abstract
Patients with multiple endocrine neoplasia type 1 (MEN1) are commonly evaluated for clinical manifestations of this syndrome with the rationale that early diagnosis and adequate treatment will result in improved survival and quality of life. Thymic and bronchial carcinoid tumours are uncommon but important manifestations of MEN1. Current practice guidelines recommend evaluation with computed tomography or magnetic resonance imaging scan of the chest every 1-2 years to detect these neoplasms. However, the certainty that patients will be better off (increased survival or quality of life) as a result of this case detection strategy is based on evidence at moderate-high risk of bias that yields only imprecise results of indirect relevance to these patients. In order to improve the care that patients with MEN1 receive, co-ordinated efforts from different stakeholders are required so that large, prospective, multicentre studies evaluating patient important outcomes are carried out.
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Affiliation(s)
- Naykky Singh Ospina
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Spyridoula Maraka
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Victor Montori
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - William F Young
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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32
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Bartsch DK, Albers MB, Lopez CL, Apitzsch JC, Walthers EM, Fink L, Fendrich V, Slater EP, Waldmann J, Anlauf M. Bronchopulmonary Neuroendocrine Neoplasms and Their Precursor Lesions in Multiple Endocrine Neoplasia Type 1. Neuroendocrinology 2016; 103:240-7. [PMID: 26113081 DOI: 10.1159/000435921] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 06/10/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The prevalence and clinical behavior of bronchopulmonary neuroendocrine tumors (bNET) associated with multiple endocrine neoplasia type 1 (MEN1) are not well defined. This study aimed to determine the prevalence, potential precursor lesions and prognosis of bNET in patients with MEN1. METHODS A database of 75 prospectively collected MEN1 cases was retrospectively analyzed for bNET. Patient characteristics, imaging and treatment were evaluated. Resection specimens of operated patients were reassessed by two specialized pathologists. Available CT scans of the whole cohort were reviewed to determine the prevalence of bronchopulmonary nodules. RESULTS Five of the 75 MEN1 patients (6.6%; 2 male, 3 female) developed histologically confirmed bNET after a median follow-up of 134 months. The median age at diagnosis of bNET was 47 years (range 31-67), and all patients were asymptomatic. Four patients underwent anatomic lung resections with lymphadenectomy; the remaining patient with multiple lesions had only a wedge resection of the largest bNET. Tumor sizes ranged from 7 to 32 mm in diameter, and all bNET were well differentiated. Two patients had lymph node metastases. Two of 4 reevaluated resection specimens revealed multifocal bNET, and 3 specimens showed tumorlets (up to 3) associated with multifocal areas of a neuroendocrine cell hyperplasia within the subsegmental bronchi. One bNET-related death (1.3%) occurred during long-term follow-up. Review of the available CT scans of the patients without proven bNET revealed small bronchopulmonary lesions (≥3 mm) in 16 of 53 cases (30.2%). CONCLUSIONS bNET in MEN1 might be more common than previously recognized. Their natural course seems to be rather benign. Multifocal tumorlets and multifocal neuroendocrine cell hyperplasia might represent their precursor lesions.
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Affiliation(s)
- Detlef K Bartsch
- Department of Visceral, Thoracic and Vascular Surgery, Philipps-Universitx00E4;t Marburg, Marburg, Germany
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33
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Yates CJ, Newey PJ, Thakker RV. Challenges and controversies in management of pancreatic neuroendocrine tumours in patients with MEN1. Lancet Diabetes Endocrinol 2015; 3:895-905. [PMID: 26165399 DOI: 10.1016/s2213-8587(15)00043-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 03/03/2015] [Indexed: 01/05/2023]
Abstract
Multiple endocrine neoplasia type 1 (MEN1), an autosomal dominant disorder, is characterised by the occurrence of pancreatic neuroendocrine tumours (P-NETs) in association with parathyroid and pituitary tumours. P-NETs, which include gastrinomas, insulinomas, and non-functioning tumours, occur in more than 80% of MEN1 patients and account for 50% of disease-specific deaths. However, there is no consensus about the optimal methods for detecting and treating P-NETs in MEN1 patients, and extrapolations from approaches used in patients with non-familial (sporadic) P-NETs require caution because of differences, such as the younger age of onset, multi-focality of P-NETs, and concomitant presence of other tumours in MEN1 patients. Thus, the early detection of P-NETs by circulating biomarkers and imaging modalities, and their appropriate treatments by surgical approaches and/or radionuclide therapy, chemotherapy, and biotherapy pose challenges and controversies. These challenges and controversies will be reviewed and possible approaches proposed.
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Affiliation(s)
- Christopher J Yates
- Academic Endocrine Unit, Radcliffe Department of Clinical Medicine, University of Oxford, Oxford, UK; Department of Diabetes and Endocrinology, Melbourne Health, Melbourne, VIC, Australia; Department of Diabetes and Endocrinology, Western Health, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Paul J Newey
- Academic Endocrine Unit, Radcliffe Department of Clinical Medicine, University of Oxford, Oxford, UK; Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Rajesh V Thakker
- Academic Endocrine Unit, Radcliffe Department of Clinical Medicine, University of Oxford, Oxford, UK.
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34
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Norton JA, Krampitz G, Jensen RT. Multiple Endocrine Neoplasia: Genetics and Clinical Management. Surg Oncol Clin N Am 2015; 24:795-832. [PMID: 26363542 DOI: 10.1016/j.soc.2015.06.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Early diagnosis of multiple endocrine neoplasia (MEN) syndromes is critical for optimal clinical outcomes; before the MEN syndromes can be diagnosed, they must be suspected. Genetic testing for germline alterations in both the MEN type 1 (MEN1) gene and RET proto-oncogene is crucial to identifying those at risk in affected kindreds and directing timely surveillance and surgical therapy to those at greatest risk of potentially life-threatening neoplasia. Pancreatic, thymic, and bronchial neuroendocrine tumors are the leading cause of death in patients with MEN1 and should be aggressively considered by at least biannual computed tomography imaging.
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Affiliation(s)
- Jeffrey A Norton
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA.
| | - Geoffrey Krampitz
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Robert T Jensen
- Cell Biology Section, Digestive Diseases Branch, National Institute of Arthritis, Diabetes, Digestive and Kidney Disease, National Institutes of Health, Bethesda, MD 20892-2560, USA
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35
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Manuel Vázquez A, Sanz Muñoz P, López López B, Carabias Hernández A, Jover Navalón JM. Diagnostic/therapeutic management of pancreatic neuroendocrine tumours associated with MEN 1 syndrome. Cir Esp 2015; 93:539-41. [PMID: 26051828 DOI: 10.1016/j.ciresp.2015.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 04/24/2015] [Accepted: 04/30/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Alba Manuel Vázquez
- Servicio de Cirugía General y Digestiva, Hospital Universitario de Getafe, Getafe, Madrid, España.
| | - Paloma Sanz Muñoz
- Servicio de Cirugía General y Digestiva, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - Bibiana López López
- Servicio de Cirugía General y Digestiva, Hospital Universitario de Getafe, Getafe, Madrid, España
| | | | - José María Jover Navalón
- Servicio de Cirugía General y Digestiva, Hospital Universitario de Getafe, Getafe, Madrid, España
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36
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Vezzosi D, Cardot-Bauters C, Bouscaren N, Lebras M, Bertholon-Grégoire M, Niccoli P, Levy-Bohbot N, Groussin L, Bouchard P, Tabarin A, Chanson P, Lecomte P, Guilhem I, Carrere N, Mirallié E, Pattou F, Peix JL, Goere D, Borson-Chazot F, Caron P, Bongard V, Carnaille B, Goudet P, Baudin E. Long-term results of the surgical management of insulinoma patients with MEN1: a Groupe d'étude des Tumeurs Endocrines (GTE) retrospective study. Eur J Endocrinol 2015; 172:309-19. [PMID: 25538206 DOI: 10.1530/eje-14-0878] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Management of insulinomas in the context of MEN1 remains poorly studied. The aim of this study was to evaluate long-term results of various surgical approaches in a large cohort of insulinoma-MEN1 patients. DESIGN AND METHODS Consecutive insulinoma-MEN1 patients operated on for a nonmetastatic insulinoma between 1957 and 2010 were retrospectively selected from the MEN1 database of the French Endocrine Tumor Group. The type of surgery was categorized as distal pancreatectomy (DP), total pancreatectomy/cephalic duodenopancreatectomy (TP/CDP), or enucleation (E). Primary endpoint was time until recurrence of hypoglycemia after initial surgery. Secondary endpoints were post-operative complications. RESULTS The study included 73 patients (median age=28 years). Surgical procedures were DP (n=46), TP/CDP (n=9), or E (n=18). After a median post-operative follow-up of 9.0 years (inter-quartile range (IQR): 2.5-16.5 years), 60/73 patients (82.2%) remained hypoglycemia free. E and TP/CDP were associated with a higher risk of recurrent hypoglycemia episodes (unadjusted hazard ratio: 6.18 ((95% CI: 1.54-24.8); P=0.010) for E vs DP and 9.51 ((95% CI: 1.85-48.8); P=0.007) for TP/CDP vs DP. After adjustment for International Union against Cancer pTNM classification, enucleation remained significantly associated with a higher probability of recurrence. Long-term complications had occurred in 20 (43.5%) patients with DP, five (55.6%) with TP/CDP, but in none of the patients who have undergone E (P=0.002). CONCLUSION In the French Endocrine database, DP is associated with a lower risk for recurrent hypoglycemia episodes. Due to lower morbidity, E alone might be considered as an alternative.
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Affiliation(s)
- Delphine Vezzosi
- Service d'EndocrinologieMaladies Métaboliques et Nutrition, Centre Hospitalier Universitaire Rangueil-Larrey, Université Paul Sabatier et INSERM U1037, Toulouse, FranceCHRU de LilleClinique Marc-Linquette, Service d'Endocrinologie-Métabolisme, Lille, FranceService d'EpidémiologieCentre Hospitalier Universitaire, Toulouse, FranceClinique d'EndocrinologieCentre Hospitalier Universitaire, Nantes, FranceService d'EndocrinologieCentre Hospitalier Est, Hospices Civils de Lyon, Université Lyon 1 et INSERM U1052, Lyon, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, Centre Hospitalier Universitaire La Timone, Marseille, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Cochin, Paris, FranceService d'EndocrinologieGroupement Hospitalier Universitaire Est, Hôpital Saint Antoine, Paris, FranceService d'EndocrinologieCentre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, FranceService d'Endocrinologie et des Maladies de la ReproductionHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, FranceUnité ENDCHRU Bretonneau, Tours, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, CHU de Rennes, Hôpital Sud, Rennes, FranceService de Chirurgie digestiveCHU Purpan, Toulouse, FranceClinique de Chirurgie Digestive et EndocrinienneCHU Nantes, Nantes, FranceService de Chirurgie Générale et EndocrinienneCHU Lille, Lille Cedex, FranceService de Chirurgie EndocrinienneHospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, FranceService de Chirurgie OncologiqueInstitut Gustave Roussy, Villejuif, FranceService de Chirurgie EndocrinienneCentre Hospitalier Universitaire de Dijon, Dijon, FranceService de Médecine Nucléaire et de Cancérologie EndocrineInstitut Gustave Roussy, Villejuif, France
| | - Catherine Cardot-Bauters
- Service d'EndocrinologieMaladies Métaboliques et Nutrition, Centre Hospitalier Universitaire Rangueil-Larrey, Université Paul Sabatier et INSERM U1037, Toulouse, FranceCHRU de LilleClinique Marc-Linquette, Service d'Endocrinologie-Métabolisme, Lille, FranceService d'EpidémiologieCentre Hospitalier Universitaire, Toulouse, FranceClinique d'EndocrinologieCentre Hospitalier Universitaire, Nantes, FranceService d'EndocrinologieCentre Hospitalier Est, Hospices Civils de Lyon, Université Lyon 1 et INSERM U1052, Lyon, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, Centre Hospitalier Universitaire La Timone, Marseille, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Cochin, Paris, FranceService d'EndocrinologieGroupement Hospitalier Universitaire Est, Hôpital Saint Antoine, Paris, FranceService d'EndocrinologieCentre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, FranceService d'Endocrinologie et des Maladies de la ReproductionHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, FranceUnité ENDCHRU Bretonneau, Tours, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, CHU de Rennes, Hôpital Sud, Rennes, FranceService de Chirurgie digestiveCHU Purpan, Toulouse, FranceClinique de Chirurgie Digestive et EndocrinienneCHU Nantes, Nantes, FranceService de Chirurgie Générale et EndocrinienneCHU Lille, Lille Cedex, FranceService de Chirurgie EndocrinienneHospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, FranceService de Chirurgie OncologiqueInstitut Gustave Roussy, Villejuif, FranceService de Chirurgie EndocrinienneCentre Hospitalier Universitaire de Dijon, Dijon, FranceService de Médecine Nucléaire et de Cancérologie EndocrineInstitut Gustave Roussy, Villejuif, France
| | - Nicolas Bouscaren
- Service d'EndocrinologieMaladies Métaboliques et Nutrition, Centre Hospitalier Universitaire Rangueil-Larrey, Université Paul Sabatier et INSERM U1037, Toulouse, FranceCHRU de LilleClinique Marc-Linquette, Service d'Endocrinologie-Métabolisme, Lille, FranceService d'EpidémiologieCentre Hospitalier Universitaire, Toulouse, FranceClinique d'EndocrinologieCentre Hospitalier Universitaire, Nantes, FranceService d'EndocrinologieCentre Hospitalier Est, Hospices Civils de Lyon, Université Lyon 1 et INSERM U1052, Lyon, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, Centre Hospitalier Universitaire La Timone, Marseille, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Cochin, Paris, FranceService d'EndocrinologieGroupement Hospitalier Universitaire Est, Hôpital Saint Antoine, Paris, FranceService d'EndocrinologieCentre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, FranceService d'Endocrinologie et des Maladies de la ReproductionHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, FranceUnité ENDCHRU Bretonneau, Tours, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, CHU de Rennes, Hôpital Sud, Rennes, FranceService de Chirurgie digestiveCHU Purpan, Toulouse, FranceClinique de Chirurgie Digestive et EndocrinienneCHU Nantes, Nantes, FranceService de Chirurgie Générale et EndocrinienneCHU Lille, Lille Cedex, FranceService de Chirurgie EndocrinienneHospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, FranceService de Chirurgie OncologiqueInstitut Gustave Roussy, Villejuif, FranceService de Chirurgie EndocrinienneCentre Hospitalier Universitaire de Dijon, Dijon, FranceService de Médecine Nucléaire et de Cancérologie EndocrineInstitut Gustave Roussy, Villejuif, France
| | - Maëlle Lebras
- Service d'EndocrinologieMaladies Métaboliques et Nutrition, Centre Hospitalier Universitaire Rangueil-Larrey, Université Paul Sabatier et INSERM U1037, Toulouse, FranceCHRU de LilleClinique Marc-Linquette, Service d'Endocrinologie-Métabolisme, Lille, FranceService d'EpidémiologieCentre Hospitalier Universitaire, Toulouse, FranceClinique d'EndocrinologieCentre Hospitalier Universitaire, Nantes, FranceService d'EndocrinologieCentre Hospitalier Est, Hospices Civils de Lyon, Université Lyon 1 et INSERM U1052, Lyon, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, Centre Hospitalier Universitaire La Timone, Marseille, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Cochin, Paris, FranceService d'EndocrinologieGroupement Hospitalier Universitaire Est, Hôpital Saint Antoine, Paris, FranceService d'EndocrinologieCentre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, FranceService d'Endocrinologie et des Maladies de la ReproductionHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, FranceUnité ENDCHRU Bretonneau, Tours, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, CHU de Rennes, Hôpital Sud, Rennes, FranceService de Chirurgie digestiveCHU Purpan, Toulouse, FranceClinique de Chirurgie Digestive et EndocrinienneCHU Nantes, Nantes, FranceService de Chirurgie Générale et EndocrinienneCHU Lille, Lille Cedex, FranceService de Chirurgie EndocrinienneHospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, FranceService de Chirurgie OncologiqueInstitut Gustave Roussy, Villejuif, FranceService de Chirurgie EndocrinienneCentre Hospitalier Universitaire de Dijon, Dijon, FranceService de Médecine Nucléaire et de Cancérologie EndocrineInstitut Gustave Roussy, Villejuif, France
| | - Mireille Bertholon-Grégoire
- Service d'EndocrinologieMaladies Métaboliques et Nutrition, Centre Hospitalier Universitaire Rangueil-Larrey, Université Paul Sabatier et INSERM U1037, Toulouse, FranceCHRU de LilleClinique Marc-Linquette, Service d'Endocrinologie-Métabolisme, Lille, FranceService d'EpidémiologieCentre Hospitalier Universitaire, Toulouse, FranceClinique d'EndocrinologieCentre Hospitalier Universitaire, Nantes, FranceService d'EndocrinologieCentre Hospitalier Est, Hospices Civils de Lyon, Université Lyon 1 et INSERM U1052, Lyon, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, Centre Hospitalier Universitaire La Timone, Marseille, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Cochin, Paris, FranceService d'EndocrinologieGroupement Hospitalier Universitaire Est, Hôpital Saint Antoine, Paris, FranceService d'EndocrinologieCentre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, FranceService d'Endocrinologie et des Maladies de la ReproductionHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, FranceUnité ENDCHRU Bretonneau, Tours, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, CHU de Rennes, Hôpital Sud, Rennes, FranceService de Chirurgie digestiveCHU Purpan, Toulouse, FranceClinique de Chirurgie Digestive et EndocrinienneCHU Nantes, Nantes, FranceService de Chirurgie Générale et EndocrinienneCHU Lille, Lille Cedex, FranceService de Chirurgie EndocrinienneHospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, FranceService de Chirurgie OncologiqueInstitut Gustave Roussy, Villejuif, FranceService de Chirurgie EndocrinienneCentre Hospitalier Universitaire de Dijon, Dijon, FranceService de Médecine Nucléaire et de Cancérologie EndocrineInstitut Gustave Roussy, Villejuif, France
| | - Patricia Niccoli
- Service d'EndocrinologieMaladies Métaboliques et Nutrition, Centre Hospitalier Universitaire Rangueil-Larrey, Université Paul Sabatier et INSERM U1037, Toulouse, FranceCHRU de LilleClinique Marc-Linquette, Service d'Endocrinologie-Métabolisme, Lille, FranceService d'EpidémiologieCentre Hospitalier Universitaire, Toulouse, FranceClinique d'EndocrinologieCentre Hospitalier Universitaire, Nantes, FranceService d'EndocrinologieCentre Hospitalier Est, Hospices Civils de Lyon, Université Lyon 1 et INSERM U1052, Lyon, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, Centre Hospitalier Universitaire La Timone, Marseille, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Cochin, Paris, FranceService d'EndocrinologieGroupement Hospitalier Universitaire Est, Hôpital Saint Antoine, Paris, FranceService d'EndocrinologieCentre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, FranceService d'Endocrinologie et des Maladies de la ReproductionHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, FranceUnité ENDCHRU Bretonneau, Tours, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, CHU de Rennes, Hôpital Sud, Rennes, FranceService de Chirurgie digestiveCHU Purpan, Toulouse, FranceClinique de Chirurgie Digestive et EndocrinienneCHU Nantes, Nantes, FranceService de Chirurgie Générale et EndocrinienneCHU Lille, Lille Cedex, FranceService de Chirurgie EndocrinienneHospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, FranceService de Chirurgie OncologiqueInstitut Gustave Roussy, Villejuif, FranceService de Chirurgie EndocrinienneCentre Hospitalier Universitaire de Dijon, Dijon, FranceService de Médecine Nucléaire et de Cancérologie EndocrineInstitut Gustave Roussy, Villejuif, France
| | - Nathalie Levy-Bohbot
- Service d'EndocrinologieMaladies Métaboliques et Nutrition, Centre Hospitalier Universitaire Rangueil-Larrey, Université Paul Sabatier et INSERM U1037, Toulouse, FranceCHRU de LilleClinique Marc-Linquette, Service d'Endocrinologie-Métabolisme, Lille, FranceService d'EpidémiologieCentre Hospitalier Universitaire, Toulouse, FranceClinique d'EndocrinologieCentre Hospitalier Universitaire, Nantes, FranceService d'EndocrinologieCentre Hospitalier Est, Hospices Civils de Lyon, Université Lyon 1 et INSERM U1052, Lyon, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, Centre Hospitalier Universitaire La Timone, Marseille, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Cochin, Paris, FranceService d'EndocrinologieGroupement Hospitalier Universitaire Est, Hôpital Saint Antoine, Paris, FranceService d'EndocrinologieCentre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, FranceService d'Endocrinologie et des Maladies de la ReproductionHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, FranceUnité ENDCHRU Bretonneau, Tours, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, CHU de Rennes, Hôpital Sud, Rennes, FranceService de Chirurgie digestiveCHU Purpan, Toulouse, FranceClinique de Chirurgie Digestive et EndocrinienneCHU Nantes, Nantes, FranceService de Chirurgie Générale et EndocrinienneCHU Lille, Lille Cedex, FranceService de Chirurgie EndocrinienneHospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, FranceService de Chirurgie OncologiqueInstitut Gustave Roussy, Villejuif, FranceService de Chirurgie EndocrinienneCentre Hospitalier Universitaire de Dijon, Dijon, FranceService de Médecine Nucléaire et de Cancérologie EndocrineInstitut Gustave Roussy, Villejuif, France
| | - Lionel Groussin
- Service d'EndocrinologieMaladies Métaboliques et Nutrition, Centre Hospitalier Universitaire Rangueil-Larrey, Université Paul Sabatier et INSERM U1037, Toulouse, FranceCHRU de LilleClinique Marc-Linquette, Service d'Endocrinologie-Métabolisme, Lille, FranceService d'EpidémiologieCentre Hospitalier Universitaire, Toulouse, FranceClinique d'EndocrinologieCentre Hospitalier Universitaire, Nantes, FranceService d'EndocrinologieCentre Hospitalier Est, Hospices Civils de Lyon, Université Lyon 1 et INSERM U1052, Lyon, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, Centre Hospitalier Universitaire La Timone, Marseille, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Cochin, Paris, FranceService d'EndocrinologieGroupement Hospitalier Universitaire Est, Hôpital Saint Antoine, Paris, FranceService d'EndocrinologieCentre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, FranceService d'Endocrinologie et des Maladies de la ReproductionHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, FranceUnité ENDCHRU Bretonneau, Tours, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, CHU de Rennes, Hôpital Sud, Rennes, FranceService de Chirurgie digestiveCHU Purpan, Toulouse, FranceClinique de Chirurgie Digestive et EndocrinienneCHU Nantes, Nantes, FranceService de Chirurgie Générale et EndocrinienneCHU Lille, Lille Cedex, FranceService de Chirurgie EndocrinienneHospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, FranceService de Chirurgie OncologiqueInstitut Gustave Roussy, Villejuif, FranceService de Chirurgie EndocrinienneCentre Hospitalier Universitaire de Dijon, Dijon, FranceService de Médecine Nucléaire et de Cancérologie EndocrineInstitut Gustave Roussy, Villejuif, France
| | - Philippe Bouchard
- Service d'EndocrinologieMaladies Métaboliques et Nutrition, Centre Hospitalier Universitaire Rangueil-Larrey, Université Paul Sabatier et INSERM U1037, Toulouse, FranceCHRU de LilleClinique Marc-Linquette, Service d'Endocrinologie-Métabolisme, Lille, FranceService d'EpidémiologieCentre Hospitalier Universitaire, Toulouse, FranceClinique d'EndocrinologieCentre Hospitalier Universitaire, Nantes, FranceService d'EndocrinologieCentre Hospitalier Est, Hospices Civils de Lyon, Université Lyon 1 et INSERM U1052, Lyon, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, Centre Hospitalier Universitaire La Timone, Marseille, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Cochin, Paris, FranceService d'EndocrinologieGroupement Hospitalier Universitaire Est, Hôpital Saint Antoine, Paris, FranceService d'EndocrinologieCentre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, FranceService d'Endocrinologie et des Maladies de la ReproductionHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, FranceUnité ENDCHRU Bretonneau, Tours, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, CHU de Rennes, Hôpital Sud, Rennes, FranceService de Chirurgie digestiveCHU Purpan, Toulouse, FranceClinique de Chirurgie Digestive et EndocrinienneCHU Nantes, Nantes, FranceService de Chirurgie Générale et EndocrinienneCHU Lille, Lille Cedex, FranceService de Chirurgie EndocrinienneHospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, FranceService de Chirurgie OncologiqueInstitut Gustave Roussy, Villejuif, FranceService de Chirurgie EndocrinienneCentre Hospitalier Universitaire de Dijon, Dijon, FranceService de Médecine Nucléaire et de Cancérologie EndocrineInstitut Gustave Roussy, Villejuif, France
| | - Antoine Tabarin
- Service d'EndocrinologieMaladies Métaboliques et Nutrition, Centre Hospitalier Universitaire Rangueil-Larrey, Université Paul Sabatier et INSERM U1037, Toulouse, FranceCHRU de LilleClinique Marc-Linquette, Service d'Endocrinologie-Métabolisme, Lille, FranceService d'EpidémiologieCentre Hospitalier Universitaire, Toulouse, FranceClinique d'EndocrinologieCentre Hospitalier Universitaire, Nantes, FranceService d'EndocrinologieCentre Hospitalier Est, Hospices Civils de Lyon, Université Lyon 1 et INSERM U1052, Lyon, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, Centre Hospitalier Universitaire La Timone, Marseille, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Cochin, Paris, FranceService d'EndocrinologieGroupement Hospitalier Universitaire Est, Hôpital Saint Antoine, Paris, FranceService d'EndocrinologieCentre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, FranceService d'Endocrinologie et des Maladies de la ReproductionHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, FranceUnité ENDCHRU Bretonneau, Tours, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, CHU de Rennes, Hôpital Sud, Rennes, FranceService de Chirurgie digestiveCHU Purpan, Toulouse, FranceClinique de Chirurgie Digestive et EndocrinienneCHU Nantes, Nantes, FranceService de Chirurgie Générale et EndocrinienneCHU Lille, Lille Cedex, FranceService de Chirurgie EndocrinienneHospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, FranceService de Chirurgie OncologiqueInstitut Gustave Roussy, Villejuif, FranceService de Chirurgie EndocrinienneCentre Hospitalier Universitaire de Dijon, Dijon, FranceService de Médecine Nucléaire et de Cancérologie EndocrineInstitut Gustave Roussy, Villejuif, France
| | - Philippe Chanson
- Service d'EndocrinologieMaladies Métaboliques et Nutrition, Centre Hospitalier Universitaire Rangueil-Larrey, Université Paul Sabatier et INSERM U1037, Toulouse, FranceCHRU de LilleClinique Marc-Linquette, Service d'Endocrinologie-Métabolisme, Lille, FranceService d'EpidémiologieCentre Hospitalier Universitaire, Toulouse, FranceClinique d'EndocrinologieCentre Hospitalier Universitaire, Nantes, FranceService d'EndocrinologieCentre Hospitalier Est, Hospices Civils de Lyon, Université Lyon 1 et INSERM U1052, Lyon, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, Centre Hospitalier Universitaire La Timone, Marseille, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Cochin, Paris, FranceService d'EndocrinologieGroupement Hospitalier Universitaire Est, Hôpital Saint Antoine, Paris, FranceService d'EndocrinologieCentre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, FranceService d'Endocrinologie et des Maladies de la ReproductionHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, FranceUnité ENDCHRU Bretonneau, Tours, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, CHU de Rennes, Hôpital Sud, Rennes, FranceService de Chirurgie digestiveCHU Purpan, Toulouse, FranceClinique de Chirurgie Digestive et EndocrinienneCHU Nantes, Nantes, FranceService de Chirurgie Générale et EndocrinienneCHU Lille, Lille Cedex, FranceService de Chirurgie EndocrinienneHospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, FranceService de Chirurgie OncologiqueInstitut Gustave Roussy, Villejuif, FranceService de Chirurgie EndocrinienneCentre Hospitalier Universitaire de Dijon, Dijon, FranceService de Médecine Nucléaire et de Cancérologie EndocrineInstitut Gustave Roussy, Villejuif, France
| | - Pierre Lecomte
- Service d'EndocrinologieMaladies Métaboliques et Nutrition, Centre Hospitalier Universitaire Rangueil-Larrey, Université Paul Sabatier et INSERM U1037, Toulouse, FranceCHRU de LilleClinique Marc-Linquette, Service d'Endocrinologie-Métabolisme, Lille, FranceService d'EpidémiologieCentre Hospitalier Universitaire, Toulouse, FranceClinique d'EndocrinologieCentre Hospitalier Universitaire, Nantes, FranceService d'EndocrinologieCentre Hospitalier Est, Hospices Civils de Lyon, Université Lyon 1 et INSERM U1052, Lyon, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, Centre Hospitalier Universitaire La Timone, Marseille, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Cochin, Paris, FranceService d'EndocrinologieGroupement Hospitalier Universitaire Est, Hôpital Saint Antoine, Paris, FranceService d'EndocrinologieCentre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, FranceService d'Endocrinologie et des Maladies de la ReproductionHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, FranceUnité ENDCHRU Bretonneau, Tours, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, CHU de Rennes, Hôpital Sud, Rennes, FranceService de Chirurgie digestiveCHU Purpan, Toulouse, FranceClinique de Chirurgie Digestive et EndocrinienneCHU Nantes, Nantes, FranceService de Chirurgie Générale et EndocrinienneCHU Lille, Lille Cedex, FranceService de Chirurgie EndocrinienneHospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, FranceService de Chirurgie OncologiqueInstitut Gustave Roussy, Villejuif, FranceService de Chirurgie EndocrinienneCentre Hospitalier Universitaire de Dijon, Dijon, FranceService de Médecine Nucléaire et de Cancérologie EndocrineInstitut Gustave Roussy, Villejuif, France
| | - Isabelle Guilhem
- Service d'EndocrinologieMaladies Métaboliques et Nutrition, Centre Hospitalier Universitaire Rangueil-Larrey, Université Paul Sabatier et INSERM U1037, Toulouse, FranceCHRU de LilleClinique Marc-Linquette, Service d'Endocrinologie-Métabolisme, Lille, FranceService d'EpidémiologieCentre Hospitalier Universitaire, Toulouse, FranceClinique d'EndocrinologieCentre Hospitalier Universitaire, Nantes, FranceService d'EndocrinologieCentre Hospitalier Est, Hospices Civils de Lyon, Université Lyon 1 et INSERM U1052, Lyon, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, Centre Hospitalier Universitaire La Timone, Marseille, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Cochin, Paris, FranceService d'EndocrinologieGroupement Hospitalier Universitaire Est, Hôpital Saint Antoine, Paris, FranceService d'EndocrinologieCentre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, FranceService d'Endocrinologie et des Maladies de la ReproductionHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, FranceUnité ENDCHRU Bretonneau, Tours, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, CHU de Rennes, Hôpital Sud, Rennes, FranceService de Chirurgie digestiveCHU Purpan, Toulouse, FranceClinique de Chirurgie Digestive et EndocrinienneCHU Nantes, Nantes, FranceService de Chirurgie Générale et EndocrinienneCHU Lille, Lille Cedex, FranceService de Chirurgie EndocrinienneHospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, FranceService de Chirurgie OncologiqueInstitut Gustave Roussy, Villejuif, FranceService de Chirurgie EndocrinienneCentre Hospitalier Universitaire de Dijon, Dijon, FranceService de Médecine Nucléaire et de Cancérologie EndocrineInstitut Gustave Roussy, Villejuif, France
| | - Nicolas Carrere
- Service d'EndocrinologieMaladies Métaboliques et Nutrition, Centre Hospitalier Universitaire Rangueil-Larrey, Université Paul Sabatier et INSERM U1037, Toulouse, FranceCHRU de LilleClinique Marc-Linquette, Service d'Endocrinologie-Métabolisme, Lille, FranceService d'EpidémiologieCentre Hospitalier Universitaire, Toulouse, FranceClinique d'EndocrinologieCentre Hospitalier Universitaire, Nantes, FranceService d'EndocrinologieCentre Hospitalier Est, Hospices Civils de Lyon, Université Lyon 1 et INSERM U1052, Lyon, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, Centre Hospitalier Universitaire La Timone, Marseille, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Cochin, Paris, FranceService d'EndocrinologieGroupement Hospitalier Universitaire Est, Hôpital Saint Antoine, Paris, FranceService d'EndocrinologieCentre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, FranceService d'Endocrinologie et des Maladies de la ReproductionHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, FranceUnité ENDCHRU Bretonneau, Tours, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, CHU de Rennes, Hôpital Sud, Rennes, FranceService de Chirurgie digestiveCHU Purpan, Toulouse, FranceClinique de Chirurgie Digestive et EndocrinienneCHU Nantes, Nantes, FranceService de Chirurgie Générale et EndocrinienneCHU Lille, Lille Cedex, FranceService de Chirurgie EndocrinienneHospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, FranceService de Chirurgie OncologiqueInstitut Gustave Roussy, Villejuif, FranceService de Chirurgie EndocrinienneCentre Hospitalier Universitaire de Dijon, Dijon, FranceService de Médecine Nucléaire et de Cancérologie EndocrineInstitut Gustave Roussy, Villejuif, France
| | - Eric Mirallié
- Service d'EndocrinologieMaladies Métaboliques et Nutrition, Centre Hospitalier Universitaire Rangueil-Larrey, Université Paul Sabatier et INSERM U1037, Toulouse, FranceCHRU de LilleClinique Marc-Linquette, Service d'Endocrinologie-Métabolisme, Lille, FranceService d'EpidémiologieCentre Hospitalier Universitaire, Toulouse, FranceClinique d'EndocrinologieCentre Hospitalier Universitaire, Nantes, FranceService d'EndocrinologieCentre Hospitalier Est, Hospices Civils de Lyon, Université Lyon 1 et INSERM U1052, Lyon, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, Centre Hospitalier Universitaire La Timone, Marseille, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Cochin, Paris, FranceService d'EndocrinologieGroupement Hospitalier Universitaire Est, Hôpital Saint Antoine, Paris, FranceService d'EndocrinologieCentre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, FranceService d'Endocrinologie et des Maladies de la ReproductionHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, FranceUnité ENDCHRU Bretonneau, Tours, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, CHU de Rennes, Hôpital Sud, Rennes, FranceService de Chirurgie digestiveCHU Purpan, Toulouse, FranceClinique de Chirurgie Digestive et EndocrinienneCHU Nantes, Nantes, FranceService de Chirurgie Générale et EndocrinienneCHU Lille, Lille Cedex, FranceService de Chirurgie EndocrinienneHospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, FranceService de Chirurgie OncologiqueInstitut Gustave Roussy, Villejuif, FranceService de Chirurgie EndocrinienneCentre Hospitalier Universitaire de Dijon, Dijon, FranceService de Médecine Nucléaire et de Cancérologie EndocrineInstitut Gustave Roussy, Villejuif, France
| | - François Pattou
- Service d'EndocrinologieMaladies Métaboliques et Nutrition, Centre Hospitalier Universitaire Rangueil-Larrey, Université Paul Sabatier et INSERM U1037, Toulouse, FranceCHRU de LilleClinique Marc-Linquette, Service d'Endocrinologie-Métabolisme, Lille, FranceService d'EpidémiologieCentre Hospitalier Universitaire, Toulouse, FranceClinique d'EndocrinologieCentre Hospitalier Universitaire, Nantes, FranceService d'EndocrinologieCentre Hospitalier Est, Hospices Civils de Lyon, Université Lyon 1 et INSERM U1052, Lyon, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, Centre Hospitalier Universitaire La Timone, Marseille, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Cochin, Paris, FranceService d'EndocrinologieGroupement Hospitalier Universitaire Est, Hôpital Saint Antoine, Paris, FranceService d'EndocrinologieCentre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, FranceService d'Endocrinologie et des Maladies de la ReproductionHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, FranceUnité ENDCHRU Bretonneau, Tours, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, CHU de Rennes, Hôpital Sud, Rennes, FranceService de Chirurgie digestiveCHU Purpan, Toulouse, FranceClinique de Chirurgie Digestive et EndocrinienneCHU Nantes, Nantes, FranceService de Chirurgie Générale et EndocrinienneCHU Lille, Lille Cedex, FranceService de Chirurgie EndocrinienneHospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, FranceService de Chirurgie OncologiqueInstitut Gustave Roussy, Villejuif, FranceService de Chirurgie EndocrinienneCentre Hospitalier Universitaire de Dijon, Dijon, FranceService de Médecine Nucléaire et de Cancérologie EndocrineInstitut Gustave Roussy, Villejuif, France
| | - Jean Louis Peix
- Service d'EndocrinologieMaladies Métaboliques et Nutrition, Centre Hospitalier Universitaire Rangueil-Larrey, Université Paul Sabatier et INSERM U1037, Toulouse, FranceCHRU de LilleClinique Marc-Linquette, Service d'Endocrinologie-Métabolisme, Lille, FranceService d'EpidémiologieCentre Hospitalier Universitaire, Toulouse, FranceClinique d'EndocrinologieCentre Hospitalier Universitaire, Nantes, FranceService d'EndocrinologieCentre Hospitalier Est, Hospices Civils de Lyon, Université Lyon 1 et INSERM U1052, Lyon, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, Centre Hospitalier Universitaire La Timone, Marseille, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Cochin, Paris, FranceService d'EndocrinologieGroupement Hospitalier Universitaire Est, Hôpital Saint Antoine, Paris, FranceService d'EndocrinologieCentre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, FranceService d'Endocrinologie et des Maladies de la ReproductionHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, FranceUnité ENDCHRU Bretonneau, Tours, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, CHU de Rennes, Hôpital Sud, Rennes, FranceService de Chirurgie digestiveCHU Purpan, Toulouse, FranceClinique de Chirurgie Digestive et EndocrinienneCHU Nantes, Nantes, FranceService de Chirurgie Générale et EndocrinienneCHU Lille, Lille Cedex, FranceService de Chirurgie EndocrinienneHospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, FranceService de Chirurgie OncologiqueInstitut Gustave Roussy, Villejuif, FranceService de Chirurgie EndocrinienneCentre Hospitalier Universitaire de Dijon, Dijon, FranceService de Médecine Nucléaire et de Cancérologie EndocrineInstitut Gustave Roussy, Villejuif, France
| | - Diane Goere
- Service d'EndocrinologieMaladies Métaboliques et Nutrition, Centre Hospitalier Universitaire Rangueil-Larrey, Université Paul Sabatier et INSERM U1037, Toulouse, FranceCHRU de LilleClinique Marc-Linquette, Service d'Endocrinologie-Métabolisme, Lille, FranceService d'EpidémiologieCentre Hospitalier Universitaire, Toulouse, FranceClinique d'EndocrinologieCentre Hospitalier Universitaire, Nantes, FranceService d'EndocrinologieCentre Hospitalier Est, Hospices Civils de Lyon, Université Lyon 1 et INSERM U1052, Lyon, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, Centre Hospitalier Universitaire La Timone, Marseille, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Cochin, Paris, FranceService d'EndocrinologieGroupement Hospitalier Universitaire Est, Hôpital Saint Antoine, Paris, FranceService d'EndocrinologieCentre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, FranceService d'Endocrinologie et des Maladies de la ReproductionHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, FranceUnité ENDCHRU Bretonneau, Tours, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, CHU de Rennes, Hôpital Sud, Rennes, FranceService de Chirurgie digestiveCHU Purpan, Toulouse, FranceClinique de Chirurgie Digestive et EndocrinienneCHU Nantes, Nantes, FranceService de Chirurgie Générale et EndocrinienneCHU Lille, Lille Cedex, FranceService de Chirurgie EndocrinienneHospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, FranceService de Chirurgie OncologiqueInstitut Gustave Roussy, Villejuif, FranceService de Chirurgie EndocrinienneCentre Hospitalier Universitaire de Dijon, Dijon, FranceService de Médecine Nucléaire et de Cancérologie EndocrineInstitut Gustave Roussy, Villejuif, France
| | - Françoise Borson-Chazot
- Service d'EndocrinologieMaladies Métaboliques et Nutrition, Centre Hospitalier Universitaire Rangueil-Larrey, Université Paul Sabatier et INSERM U1037, Toulouse, FranceCHRU de LilleClinique Marc-Linquette, Service d'Endocrinologie-Métabolisme, Lille, FranceService d'EpidémiologieCentre Hospitalier Universitaire, Toulouse, FranceClinique d'EndocrinologieCentre Hospitalier Universitaire, Nantes, FranceService d'EndocrinologieCentre Hospitalier Est, Hospices Civils de Lyon, Université Lyon 1 et INSERM U1052, Lyon, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, Centre Hospitalier Universitaire La Timone, Marseille, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Cochin, Paris, FranceService d'EndocrinologieGroupement Hospitalier Universitaire Est, Hôpital Saint Antoine, Paris, FranceService d'EndocrinologieCentre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, FranceService d'Endocrinologie et des Maladies de la ReproductionHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, FranceUnité ENDCHRU Bretonneau, Tours, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, CHU de Rennes, Hôpital Sud, Rennes, FranceService de Chirurgie digestiveCHU Purpan, Toulouse, FranceClinique de Chirurgie Digestive et EndocrinienneCHU Nantes, Nantes, FranceService de Chirurgie Générale et EndocrinienneCHU Lille, Lille Cedex, FranceService de Chirurgie EndocrinienneHospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, FranceService de Chirurgie OncologiqueInstitut Gustave Roussy, Villejuif, FranceService de Chirurgie EndocrinienneCentre Hospitalier Universitaire de Dijon, Dijon, FranceService de Médecine Nucléaire et de Cancérologie EndocrineInstitut Gustave Roussy, Villejuif, France
| | - Philippe Caron
- Service d'EndocrinologieMaladies Métaboliques et Nutrition, Centre Hospitalier Universitaire Rangueil-Larrey, Université Paul Sabatier et INSERM U1037, Toulouse, FranceCHRU de LilleClinique Marc-Linquette, Service d'Endocrinologie-Métabolisme, Lille, FranceService d'EpidémiologieCentre Hospitalier Universitaire, Toulouse, FranceClinique d'EndocrinologieCentre Hospitalier Universitaire, Nantes, FranceService d'EndocrinologieCentre Hospitalier Est, Hospices Civils de Lyon, Université Lyon 1 et INSERM U1052, Lyon, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, Centre Hospitalier Universitaire La Timone, Marseille, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Cochin, Paris, FranceService d'EndocrinologieGroupement Hospitalier Universitaire Est, Hôpital Saint Antoine, Paris, FranceService d'EndocrinologieCentre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, FranceService d'Endocrinologie et des Maladies de la ReproductionHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, FranceUnité ENDCHRU Bretonneau, Tours, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, CHU de Rennes, Hôpital Sud, Rennes, FranceService de Chirurgie digestiveCHU Purpan, Toulouse, FranceClinique de Chirurgie Digestive et EndocrinienneCHU Nantes, Nantes, FranceService de Chirurgie Générale et EndocrinienneCHU Lille, Lille Cedex, FranceService de Chirurgie EndocrinienneHospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, FranceService de Chirurgie OncologiqueInstitut Gustave Roussy, Villejuif, FranceService de Chirurgie EndocrinienneCentre Hospitalier Universitaire de Dijon, Dijon, FranceService de Médecine Nucléaire et de Cancérologie EndocrineInstitut Gustave Roussy, Villejuif, France
| | - Vanina Bongard
- Service d'EndocrinologieMaladies Métaboliques et Nutrition, Centre Hospitalier Universitaire Rangueil-Larrey, Université Paul Sabatier et INSERM U1037, Toulouse, FranceCHRU de LilleClinique Marc-Linquette, Service d'Endocrinologie-Métabolisme, Lille, FranceService d'EpidémiologieCentre Hospitalier Universitaire, Toulouse, FranceClinique d'EndocrinologieCentre Hospitalier Universitaire, Nantes, FranceService d'EndocrinologieCentre Hospitalier Est, Hospices Civils de Lyon, Université Lyon 1 et INSERM U1052, Lyon, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, Centre Hospitalier Universitaire La Timone, Marseille, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Cochin, Paris, FranceService d'EndocrinologieGroupement Hospitalier Universitaire Est, Hôpital Saint Antoine, Paris, FranceService d'EndocrinologieCentre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, FranceService d'Endocrinologie et des Maladies de la ReproductionHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, FranceUnité ENDCHRU Bretonneau, Tours, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, CHU de Rennes, Hôpital Sud, Rennes, FranceService de Chirurgie digestiveCHU Purpan, Toulouse, FranceClinique de Chirurgie Digestive et EndocrinienneCHU Nantes, Nantes, FranceService de Chirurgie Générale et EndocrinienneCHU Lille, Lille Cedex, FranceService de Chirurgie EndocrinienneHospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, FranceService de Chirurgie OncologiqueInstitut Gustave Roussy, Villejuif, FranceService de Chirurgie EndocrinienneCentre Hospitalier Universitaire de Dijon, Dijon, FranceService de Médecine Nucléaire et de Cancérologie EndocrineInstitut Gustave Roussy, Villejuif, France
| | - Bruno Carnaille
- Service d'EndocrinologieMaladies Métaboliques et Nutrition, Centre Hospitalier Universitaire Rangueil-Larrey, Université Paul Sabatier et INSERM U1037, Toulouse, FranceCHRU de LilleClinique Marc-Linquette, Service d'Endocrinologie-Métabolisme, Lille, FranceService d'EpidémiologieCentre Hospitalier Universitaire, Toulouse, FranceClinique d'EndocrinologieCentre Hospitalier Universitaire, Nantes, FranceService d'EndocrinologieCentre Hospitalier Est, Hospices Civils de Lyon, Université Lyon 1 et INSERM U1052, Lyon, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, Centre Hospitalier Universitaire La Timone, Marseille, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Cochin, Paris, FranceService d'EndocrinologieGroupement Hospitalier Universitaire Est, Hôpital Saint Antoine, Paris, FranceService d'EndocrinologieCentre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, FranceService d'Endocrinologie et des Maladies de la ReproductionHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, FranceUnité ENDCHRU Bretonneau, Tours, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, CHU de Rennes, Hôpital Sud, Rennes, FranceService de Chirurgie digestiveCHU Purpan, Toulouse, FranceClinique de Chirurgie Digestive et EndocrinienneCHU Nantes, Nantes, FranceService de Chirurgie Générale et EndocrinienneCHU Lille, Lille Cedex, FranceService de Chirurgie EndocrinienneHospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, FranceService de Chirurgie OncologiqueInstitut Gustave Roussy, Villejuif, FranceService de Chirurgie EndocrinienneCentre Hospitalier Universitaire de Dijon, Dijon, FranceService de Médecine Nucléaire et de Cancérologie EndocrineInstitut Gustave Roussy, Villejuif, France
| | - Pierre Goudet
- Service d'EndocrinologieMaladies Métaboliques et Nutrition, Centre Hospitalier Universitaire Rangueil-Larrey, Université Paul Sabatier et INSERM U1037, Toulouse, FranceCHRU de LilleClinique Marc-Linquette, Service d'Endocrinologie-Métabolisme, Lille, FranceService d'EpidémiologieCentre Hospitalier Universitaire, Toulouse, FranceClinique d'EndocrinologieCentre Hospitalier Universitaire, Nantes, FranceService d'EndocrinologieCentre Hospitalier Est, Hospices Civils de Lyon, Université Lyon 1 et INSERM U1052, Lyon, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, Centre Hospitalier Universitaire La Timone, Marseille, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Cochin, Paris, FranceService d'EndocrinologieGroupement Hospitalier Universitaire Est, Hôpital Saint Antoine, Paris, FranceService d'EndocrinologieCentre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, FranceService d'Endocrinologie et des Maladies de la ReproductionHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, FranceUnité ENDCHRU Bretonneau, Tours, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, CHU de Rennes, Hôpital Sud, Rennes, FranceService de Chirurgie digestiveCHU Purpan, Toulouse, FranceClinique de Chirurgie Digestive et EndocrinienneCHU Nantes, Nantes, FranceService de Chirurgie Générale et EndocrinienneCHU Lille, Lille Cedex, FranceService de Chirurgie EndocrinienneHospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, FranceService de Chirurgie OncologiqueInstitut Gustave Roussy, Villejuif, FranceService de Chirurgie EndocrinienneCentre Hospitalier Universitaire de Dijon, Dijon, FranceService de Médecine Nucléaire et de Cancérologie EndocrineInstitut Gustave Roussy, Villejuif, France
| | - Eric Baudin
- Service d'EndocrinologieMaladies Métaboliques et Nutrition, Centre Hospitalier Universitaire Rangueil-Larrey, Université Paul Sabatier et INSERM U1037, Toulouse, FranceCHRU de LilleClinique Marc-Linquette, Service d'Endocrinologie-Métabolisme, Lille, FranceService d'EpidémiologieCentre Hospitalier Universitaire, Toulouse, FranceClinique d'EndocrinologieCentre Hospitalier Universitaire, Nantes, FranceService d'EndocrinologieCentre Hospitalier Est, Hospices Civils de Lyon, Université Lyon 1 et INSERM U1052, Lyon, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, Centre Hospitalier Universitaire La Timone, Marseille, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, FranceService d'EndocrinologieCentre Hospitalier Universitaire de Cochin, Paris, FranceService d'EndocrinologieGroupement Hospitalier Universitaire Est, Hôpital Saint Antoine, Paris, FranceService d'EndocrinologieCentre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, FranceService d'Endocrinologie et des Maladies de la ReproductionHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, FranceUnité ENDCHRU Bretonneau, Tours, FranceService d'EndocrinologieDiabète et Maladies Métaboliques, CHU de Rennes, Hôpital Sud, Rennes, FranceService de Chirurgie digestiveCHU Purpan, Toulouse, FranceClinique de Chirurgie Digestive et EndocrinienneCHU Nantes, Nantes, FranceService de Chirurgie Générale et EndocrinienneCHU Lille, Lille Cedex, FranceService de Chirurgie EndocrinienneHospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, FranceService de Chirurgie OncologiqueInstitut Gustave Roussy, Villejuif, FranceService de Chirurgie EndocrinienneCentre Hospitalier Universitaire de Dijon, Dijon, FranceService de Médecine Nucléaire et de Cancérologie EndocrineInstitut Gustave Roussy, Villejuif, France
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Bartsch DK, Slater EP, Albers M, Knoop R, Chaloupka B, Lopez CL, Fendrich V, Kann PH, Waldmann J. Higher risk of aggressive pancreatic neuroendocrine tumors in MEN1 patients with MEN1 mutations affecting the CHES1 interacting MENIN domain. J Clin Endocrinol Metab 2014; 99:E2387-91. [PMID: 25210877 DOI: 10.1210/jc.2013-4432] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Sixty to 80% of multiple endocrine neoplasia type 1 (MEN1) patients develop pancreatic neuroendocrine neoplasias (pNENs), which reveal an aggressive behavior in 10%-20% of patients. Causative MEN1 mutations in the interacting domains of the encoded Menin protein directly alter its regulation abilities and may influence the phenotype. OBJECTIVE The objective of the study was the evaluation of an association between MEN1 mutations in different interacting domains of Menin and the phenotype of pNENs. DESIGN This was a retrospective analysis of a prospectively collected cohort of 71 genetically confirmed MEN1 patients at a tertiary referral center. MAIN OUTCOME MEASURES Analysis of patients' characteristics and clinical phenotype of pNENs regarding the mutation type and its location in Menin interacting domains was measured. RESULTS Sixty-seven patients (93%) developed pNENs after a median follow-up of 134 months. Patients with mutations leading to loss of interaction (LOI) with the checkpoint kinase 1 (CHES1) interacting domain codons (428-610) compared with patients with mutations resulting in LOI with other domains (eg, JunD, Smad3) had significantly higher rates of functioning pNENs (70% vs 34%), malignant pNENs (59% vs 16%), and aggressive pNENs (37% vs 9%), respectively. Patients with CHES1-LOI also had an increased pNEN-related mortality (20% vs 4.5%). Neither gender, age, nor the ABO blood types were associated with the phenotype of pNENs. CONCLUSIONS MEN1 patients with MEN1 mutations leading to CHES1-LOI have a higher risk of malignant pNENs with an aggressive course of disease and disease-related death.
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Affiliation(s)
- Detlef K Bartsch
- Departments of Visceral, Thoracic, and Vascular Surgery (D.K.B., E.P.S., M.A., R.K., B.C., C.L.L., V.F., J.W.) and Gastroenterology (P.H.K.), Division of Endocrinology and Diabetology, University Hospital Giessen and Marburg, Campus Marburg, 35041 Marburg, Germany
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38
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Fendrich V, Lopez CL, Manoharan J, Maschuw K, Wichmann S, Baier A, Holler JP, Ramaswamy A, Bartsch DK, Waldmann J. Enalapril and ASS inhibit tumor growth in a transgenic mouse model of islet cell tumors. Endocr Relat Cancer 2014; 21:813-24. [PMID: 25121552 DOI: 10.1530/erc-14-0175] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Accumulating evidence suggests a role for angiotensin-converting enzymes involving the angiotensin II-receptor 1 (AT1-R) and the cyclooxygenase pathway in carcinogenesis. The effects of ASS and enalapril were assessed in vitro and in a transgenic mouse model of pancreatic neuroendocrine neoplasms (pNENs). The effects of enalapril and ASS on proliferation and expression of the AGTR1A and its target gene vascular endothelial growth factor (Vegfa) were assessed in the neuroendocrine cell line BON1. Rip1-Tag2 mice were treated daily with either 0.6 mg/kg bodyweight of enalapril i.p., 20 mg/kg bodyweight of ASS i.p., or a vehicle in a prevention (weeks 5-12) and a survival group (week 5 till death). Tumor surface, weight of pancreatic glands, immunostaining for AT1-R and nuclear factor kappa beta (NFKB), and mice survival were analyzed. In addition, sections from human specimens of 20 insulinomas, ten gastrinomas, and 12 non-functional pNENs were evaluated for AT1-R and NFKB (NFKB1) expression and grouped according to the current WHO classification. Proliferation was significantly inhibited by enalapril and ASS in BON1 cells, with the combination being the most effective. Treatment with enalapril and ASS led to significant downregulation of known target genes Vegf and Rela at RNA level. Tumor growth was significantly inhibited by enalapril and ASS in the prevention group displayed by a reduction of tumor size (84%/67%) and number (30%/45%). Furthermore, daily treatment with enalapril and ASS prolonged the overall median survival compared with vehicle-treated Rip1-Tag2 (107 days) mice by 9 and 17 days (P=0.016 and P=0.013). The AT1-R and the inflammatory transcription factor NFKB were abolished completely upon enalapril and ASS treatment. AT1-R and NFKB expressions were observed in 80% of human pNENs. Enalapril and ASS may provide an approach for chemoprevention and treatment of pNENs.
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Affiliation(s)
- V Fendrich
- Department of General SurgeryEndocrine Center, University Hospital Giessen and Marburg, Campus Marburg, Baldingerstrasse, 35043 Marburg, GermanyDepartment of General SurgeryUniversity Hospital Giessen and Marburg, Campus Giessen, Rudolf-Buchheim-Strasse 7, 35385 Giessen, Germany
| | - C L Lopez
- Department of General SurgeryEndocrine Center, University Hospital Giessen and Marburg, Campus Marburg, Baldingerstrasse, 35043 Marburg, GermanyDepartment of General SurgeryUniversity Hospital Giessen and Marburg, Campus Giessen, Rudolf-Buchheim-Strasse 7, 35385 Giessen, Germany
| | - J Manoharan
- Department of General SurgeryEndocrine Center, University Hospital Giessen and Marburg, Campus Marburg, Baldingerstrasse, 35043 Marburg, GermanyDepartment of General SurgeryUniversity Hospital Giessen and Marburg, Campus Giessen, Rudolf-Buchheim-Strasse 7, 35385 Giessen, Germany
| | - K Maschuw
- Department of General SurgeryEndocrine Center, University Hospital Giessen and Marburg, Campus Marburg, Baldingerstrasse, 35043 Marburg, GermanyDepartment of General SurgeryUniversity Hospital Giessen and Marburg, Campus Giessen, Rudolf-Buchheim-Strasse 7, 35385 Giessen, Germany
| | - S Wichmann
- Department of General SurgeryEndocrine Center, University Hospital Giessen and Marburg, Campus Marburg, Baldingerstrasse, 35043 Marburg, GermanyDepartment of General SurgeryUniversity Hospital Giessen and Marburg, Campus Giessen, Rudolf-Buchheim-Strasse 7, 35385 Giessen, Germany
| | - A Baier
- Department of General SurgeryEndocrine Center, University Hospital Giessen and Marburg, Campus Marburg, Baldingerstrasse, 35043 Marburg, GermanyDepartment of General SurgeryUniversity Hospital Giessen and Marburg, Campus Giessen, Rudolf-Buchheim-Strasse 7, 35385 Giessen, Germany
| | - J P Holler
- Department of General SurgeryEndocrine Center, University Hospital Giessen and Marburg, Campus Marburg, Baldingerstrasse, 35043 Marburg, GermanyDepartment of General SurgeryUniversity Hospital Giessen and Marburg, Campus Giessen, Rudolf-Buchheim-Strasse 7, 35385 Giessen, Germany
| | - A Ramaswamy
- Department of General SurgeryEndocrine Center, University Hospital Giessen and Marburg, Campus Marburg, Baldingerstrasse, 35043 Marburg, GermanyDepartment of General SurgeryUniversity Hospital Giessen and Marburg, Campus Giessen, Rudolf-Buchheim-Strasse 7, 35385 Giessen, Germany
| | - D K Bartsch
- Department of General SurgeryEndocrine Center, University Hospital Giessen and Marburg, Campus Marburg, Baldingerstrasse, 35043 Marburg, GermanyDepartment of General SurgeryUniversity Hospital Giessen and Marburg, Campus Giessen, Rudolf-Buchheim-Strasse 7, 35385 Giessen, Germany
| | - J Waldmann
- Department of General SurgeryEndocrine Center, University Hospital Giessen and Marburg, Campus Marburg, Baldingerstrasse, 35043 Marburg, GermanyDepartment of General SurgeryUniversity Hospital Giessen and Marburg, Campus Giessen, Rudolf-Buchheim-Strasse 7, 35385 Giessen, Germany
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Grimaldi F, Fazio N, Attanasio R, Frasoldati A, Papini E, Angelini F, Baldelli R, Berretti D, Bianchetti S, Bizzarri G, Caputo M, Castello R, Cremonini N, Crescenzi A, Davì MV, D’Elia AV, Faggiano A, Pizzolitto S, Versari A, Zini M, Rindi G, Öberg K. Italian Association of Clinical Endocrinologists (AME) position statement: a stepwise clinical approach to the diagnosis of gastroenteropancreatic neuroendocrine neoplasms. J Endocrinol Invest 2014; 37:875-909. [PMID: 25038902 PMCID: PMC4159596 DOI: 10.1007/s40618-014-0119-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 03/29/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Franco Grimaldi
- Endocrinology and Metabolic Disease Unit, Azienda Ospedaliero-Universitaria “S. Maria della Misericordia”, P.le S.M. della Misericordia, 15-33100, Udine, Italy
| | - Nicola Fazio
- Unit of Gastrointestinal and Neuroendocrine Tumors, European Institute of Oncology, Milan, Italy
| | | | - Andrea Frasoldati
- Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy
| | - Enrico Papini
- Endocrinology Unit, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
| | - Francesco Angelini
- Oncology and Hematology Unit, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
| | - Roberto Baldelli
- Endocrinology Section, Regina Elena National Cancer Institute, Rome, Italy
| | - Debora Berretti
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria “S. Maria della Misericordia”, Udine, Italy
| | - Sara Bianchetti
- Oncology and Hematology Unit, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
| | - Giancarlo Bizzarri
- Diagnostic Imaging Unit, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
| | - Marco Caputo
- Dipartimento Servizi di Diagnosi e Cura, AUSL 22 Regione Veneto, Bussolengo, VR Italy
| | - Roberto Castello
- Medicina Interna ad indirizzo Endocrinologico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Nadia Cremonini
- Endocrinology Unit, Maggiore and Bellaria Hospital, Bologna, Italy
| | - Anna Crescenzi
- Pathology Unit, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
| | - Maria Vittoria Davì
- Medicina Interna D, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Angela Valentina D’Elia
- Genetic Service, Azienda Ospedaliero-Universitaria “S. Maria della Misericordia”, Udine, Italy
| | - Antongiulio Faggiano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Stefano Pizzolitto
- Pathology Unit, Azienda Ospedaliero-Universitaria “S. Maria della Misericordia”, Udine, Italy
| | - Annibale Versari
- Nuclear Medicine Service, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy
| | - Michele Zini
- Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy
| | - Guido Rindi
- Institute of Pathology, Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Kjell Öberg
- Department of Endocrine Oncology, University Hospital, Uppsala, Sweden
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40
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de Laat JM, Pieterman CR, van den Broek MF, Twisk JW, Hermus AR, Dekkers OM, de Herder WW, van der Horst-Schrivers AN, Drent ML, Bisschop PH, Havekes B, Vriens MR, Valk GD. Natural course and survival of neuroendocrine tumors of thymus and lung in MEN1 patients. J Clin Endocrinol Metab 2014; 99:3325-33. [PMID: 24915123 DOI: 10.1210/jc.2014-1560] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT The natural course and survival of neuroendocrine tumors (NETs) of thymus (Th) and lung in multiple endocrine neoplasia type 1 (MEN1) patients are still unknown. OBJECTIVE Our objective was to assess prevalence, tumor growth, and survival of Th and lung NETs in an unselected MEN1 population with long-term follow-up. DESIGN This was an observational study. PATIENTS AND METHODS A longitudinal study was performed using the Dutch national MEN1 database, including >90% of the Dutch MEN1 population >16 years of age. Patients under care of the Dutch University Medical Centers (1990-2011) (n = 323) were included. MAIN OUTCOME MEASURES The prevalence and survival of Th and lung NETs were assessed. Linear mixed-models analysis was applied to assess tumor growth with age as a possible confounder and gender, genotype and baseline tumor size as possible effect modifiers. RESULTS Th NETs occurred in 3.4% of patients, almost exclusively in males with a 10-year survival of 25% (95% confidence interval = 8%-80%). A thoracic computed tomography scan was available in 188 patients (58.2%). A lung NET was identified in 42 patients (13.0%) with a 10-year survival of 71.1% (95% confidence interval = 51%-100%). Tumor volume of lung NETs increased 17% per year (P < .001) (tumor doubling time 4.5 years). Tumor doubling time in males was 2.5 vs 5.5 years in females (P = .05). Lung NET growth was not associated with genotype or with baseline tumor size (<1 vs ≥1 cm). CONCLUSION In MEN1 patients, Th NETs almost exclusively occurred in males and had a very low prevalence and a high mortality. Lung NETs occurred more often than previously thought, had an indolent course, and occurred equally in both sexes. Tumor growth in males was double compared with female patients.
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Affiliation(s)
- Joanne M de Laat
- Departments of Internal Medicine (J.M.d.L., C.R.P., M.F.v.d.B., G.D.V.) and Surgery (M.R.V.), University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands; Department of Clinical Epidemiology and Biostatistics (J.W.T.), VU University Medical Center, 1007 MB, Amsterdam, The Netherlands; Department of Endocrinology (A.R.H.), Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; Departments of Endocrinology and Metabolism and Clinical Epidemiology (O.M.D.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Internal Medicine (W.W.d.H.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Endocrinology (A.N.v.d.H.-S.), University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Internal Medicine (M.L.D.), Section of Endocrinology, VU University Medical Center, 6202 AZ Amsterdam, The Netherlands; Department of Endocrinology and Metabolism (P.H.B.), Academic Medical Center, 1100 DD Amsterdam, The Netherlands; and Department of Internal Medicine (B.H.), Division of Endocrinology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
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41
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Pieterman CRC, Conemans EB, Dreijerink KMA, de Laat JM, Timmers HTM, Vriens MR, Valk GD. Thoracic and duodenopancreatic neuroendocrine tumors in multiple endocrine neoplasia type 1: natural history and function of menin in tumorigenesis. Endocr Relat Cancer 2014; 21:R121-42. [PMID: 24389729 DOI: 10.1530/erc-13-0482] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Mutations of the multiple endocrine neoplasia type 1 (MEN1) gene lead to loss of function of its protein product menin. In keeping with its tumor suppressor function in endocrine tissues, the majority of the MEN1-related neuroendocrine tumors (NETs) show loss of heterozygosity (LOH) on chromosome 11q13. In sporadic NETs, MEN1 mutations and LOH are also reported, indicating common pathways in tumor development. Prevalence of thymic NETs (thNETs) and pulmonary carcinoids in MEN1 patients is 2-8%. Pulmonary carcinoids may be underreported and research on natural history is limited, but disease-related mortality is low. thNETs have a high mortality rate. Duodenopancreatic NETs (dpNETs) are multiple, almost universally found at pathology, and associated with precursor lesions. Gastrinomas are usually located in the duodenal submucosa while other dpNETs are predominantly pancreatic. dpNETs are an important determinant of MEN1-related survival, with an estimated 10-year survival of 75%. Survival differs between subtypes and apart from tumor size there are no known prognostic factors. Natural history of nonfunctioning pancreatic NETs needs to be redefined because of increased detection of small tumors. MEN1-related gastrinomas seem to behave similar to their sporadic counterparts, while insulinomas seem to be more aggressive. Investigations into the molecular functions of menin have led to new insights into MEN1-related tumorigenesis. Menin is involved in gene transcription, both as an activator and repressor. It is part of chromatin-modifying protein complexes, indicating involvement of epigenetic pathways in MEN1-related NET development. Future basic and translational research aimed at NETs in large unbiased cohorts will clarify the role of menin in NET tumorigenesis and might lead to new therapeutic options.
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Affiliation(s)
- C R C Pieterman
- Division of Internal Medicine and Dermatology, Department of Internal Medicine, University Medical Center Utrecht, Internal post number L.00.408, PO Box 85500, 3508 GA Utrecht, The Netherlands Division of Biomedical Genetics, Department of Molecular Cancer Research Division of Surgical Specialties, Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Raymond VM, Everett JN, Furtado LV, Gustafson SL, Jungbluth CR, Gruber SB, Hammer GD, Stoffel EM, Greenson JK, Giordano TJ, Else T. Adrenocortical carcinoma is a lynch syndrome-associated cancer. J Clin Oncol 2013; 31:3012-8. [PMID: 23752102 DOI: 10.1200/jco.2012.48.0988] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Adrenocortical carcinoma (ACC) is an endocrine malignancy with a poor prognosis. The association of adult-onset ACC with inherited cancer predisposition syndromes is poorly understood. Our study sought to define the prevalence of Lynch syndrome (LS) among patients with ACC. PATIENTS AND METHODS One hundred fourteen patients with ACC were evaluated in a specialized endocrine oncology clinic and were prospectively offered genetic counseling and clinical genetics risk assessment (group 1). In addition, families with known mismatch repair (MMR) gene mutations that were recorded in the University of Michigan Cancer Genetics Registry were retrospectively reviewed for the presence of ACC (group 2). ACC tumors from patients with LS were tested for microsatellite instability and immunohistochemistry (IHC) to evaluate for MMR deficiency. RESULTS Ninety-four (82.5%) of 114 patients with ACC underwent genetic counseling (group 1). Three individuals (3.2%) had family histories suggestive of LS. All three families were found to have MMR gene mutations. Retrospective review of an additional 135 MMR gene-positive probands identified two with ACC (group 2). Four ACC tumors were available (group 1, 3; group 2, 1). All four tumors were microsatellite stable; three had IHC staining patterns consistent with germline mutation status. CONCLUSION The prevalence of LS among patients with ACC is 3.2%, which is comparable to the prevalence of LS in colorectal and endometrial cancer. Patients with ACC and a personal or family history of LS tumors should be strongly considered for genetic risk assessment. IHC screening of all ACC tumors may be an effective strategy for identifying patients with LS.
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López CL, Langer P, Waldmann J, Fendrich V, Sitter H, Nies C, Bartsch DK. Shortness: an unknown phenotype of multiple endocrine neoplasia type 1. Eur J Endocrinol 2013; 169:133-7. [PMID: 23828958 DOI: 10.1530/eje-13-0126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE An observation of shortness among the female participants of a regular screening program in multiple endocrine neoplasia type 1 (MEN1) patients has raised the question as to whether shortness represents a phenotype characteristic of the disease. METHODS The body height (cm) of genetically confirmed MEN1 patients at the time of diagnosis was compared with the body height of their unaffected relatives (parents, siblings, and children), the midparental body height, and the body height of the age-matched German population. Univariate analysis of the clinical variables was performed using the t-test, Mann–Whitney U test, and ANOVA as appropriate, and multivariate analysis was performed as a logistic regression analysis. P values <0.05 were considered statistically significant. RESULTS The mean body height of 22 female MEN1 patients (mean age 33.5 years) was 161 +/- 5 cm and thus significantly lesser than the body heights of their unaffected female relatives (mean 165.5 +/- 7.3 cm, P=0.027) and the age-matched German female population (mean 167 cm, P=0.0001) and mid-parental height (177.5 cm, P<0.0001). The mean body height of 24 male MEN1 patients (mean age 34.8 years) was also lesser (177 +/- 6.5 cm) than the average body height of German males in this age group (180 cm, P=0.031) and tended to be lesser than that of their unaffected male relatives (178.5 +/- 5.8 cm, P=0.0915) and the mid-parental body height (177.5 cm, P=0.124). CONCLUSIONS Small body height is a yet unrecognized phenotype characteristic of MEN1 patients, especially in women. The mechanisms behind this phenotypical characteristic warrant further investigation.
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Affiliation(s)
- Caroline L López
- Department of Surgery, University Hospital Giessen and Marburg, Marburg, Germany.
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Partial pancreaticoduodenectomy can provide cure for duodenal gastrinoma associated with multiple endocrine neoplasia type 1. Ann Surg 2013; 257:308-14. [PMID: 22580937 DOI: 10.1097/sla.0b013e3182536339] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the outcome of pancreaticoduodenectomy (PD) versus non-PD resections for the treatment of gastrinoma in multiple endocrine neoplasia type 1. BACKGROUND Gastrinoma in MEN1 is considered a rarely curable disease and its management is highly controversial both for timing and extent of surgery. METHODS Clinical characteristics, complications and outcomes of 27 prospectively collected MEN1 patients with biochemically proven gastrinoma, who underwent surgery, were analyzed with special regard to the gastrinoma type and the initial operative procedure. RESULTS Twenty-two (81%) patients with gastrinoma in MEN1 had duodenal gastrinomas and 5 patients (19%) had pancreatic gastrinomas. At the time of diagnosis, 21 (77%) gastrinomas were malignant (18 duodenal, 3 pancreatic), but distant metastases were only present in 4 (15%) patients. Patients with pancreatic gastrinomas underwent either distal pancreatic resections or gastrinoma enucleation with lymphadenectomy, 2 patients also had synchronous resections of liver metastases. One of these patients was biochemically cured after a median of 136 (77-312) months. Thirteen patients with duodenal gastrinomas underwent PD resections (group 1, partial PD [n = 11], total PD [n = 2]), whereas 9 patients had no-PD resections (group 2) as initial operative procedure. Perioperative morbidity and mortality, including postoperative diabetes, differed not significantly between groups (P > 0.5). All patients of group 1 and 5 of 9 (55%) patients of group 2 had a negative secretin test at hospital discharge. However, after a median follow-up of 136 (3-276) months, 12 (92%) patients of group 1 were still normogastrinemic compared to only 3 of 9 (33%) patients of group 2 (P = 0.023). Three (33%) patients of group 2 had to undergo up to 3 reoperations for recurrent or metastatic disease compared to none of group 1. CONCLUSIONS Duodenal gastrinoma in MEN1 should be considered a surgically curable disease. PD seems to be the adequate approach to this disease, providing a high cure rate and acceptable morbidity compared to non-PD resections.
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Sahani DV, Bonaffini PA, Fernández-Del Castillo C, Blake MA. Gastroenteropancreatic neuroendocrine tumors: role of imaging in diagnosis and management. Radiology 2013; 266:38-61. [PMID: 23264526 DOI: 10.1148/radiol.12112512] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are a heterogeneous group of neoplasms that arise from cells of the diffuse neuroendocrine system and are characterized by a wide spectrum of clinical manifestations. All NETs are potentially malignant but differ in their biologic characteristics and the probability of metastatic disease. The pathologic classification of these tumors relies on their proliferation and differentiation. In the past decades, several nomenclatures have been proposed to stratify neuroendocrine tumors, but the World Health Organization classification is the one that is most widely accepted and used. The diagnosis of neuroendocrine tumor relies on clinical manifestation, laboratory parameters, imaging features, and tissue biomarkers in a biopsy specimen. With improved understanding of the natural history and lesion biology, management of GEP-NETs has also evolved. Although surgery remains the only potentially curative therapy for patients with primary GEP-NETs, other available treatments include chemotherapy, interferon, somatostatin analogs, and targeted therapies. Recent improvements in both morphologic and functional imaging methods have contributed immensely to patient care. Morphologic imaging with contrast agent-enhanced multidetector computed tomography and magnetic resonance imaging is most widely used for initial evaluation and staging of disease in these patients, whereas functional imaging techniques are useful both for detection and prognostic evaluation and can change treatment planning.
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Affiliation(s)
- Dushyant V Sahani
- Department of Radiology, Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA 02114, USA.
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Bartsch DK, Albers M, Knoop R, Kann PH, Fendrich V, Waldmann J. Enucleation and limited pancreatic resection provide long-term cure for insulinoma in multiple endocrine neoplasia type 1. Neuroendocrinology 2013; 98:290-8. [PMID: 24356648 DOI: 10.1159/000357779] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 12/06/2013] [Indexed: 12/25/2022]
Abstract
AIM To assess the characteristics and long-term outcome after surgery in patients with multiple endocrine neoplasia type 1 (MEN1)-associated insulinoma. METHODS Retrospective analysis of prospectively collected data of MEN1 patients with organic hyperinsulinism at a tertiary referral center. RESULTS Thirteen (17%) of 74 patients with MEN1 had organic hyperinsulinism. The median age at diagnosis was 27 (range 9-48) years. In 7 patients insulinoma was the first manifestation of the syndrome. All patients had at least one pancreatic neuroendocrine neoplasm (pNEN) upon imaging, including CT, MRI or endoscopic ultrasonography. Seven patients had solitary lesions upon imaging, 4 patients had one dominant tumor with coexisting multiple small pNENs, and 2 patients had multiple lesions without dominance. Eight patients had limited resections (1 segmental resection, 7 enucleations), 4 subtotal distal pancreatectomies, and 1 patient a partial duodenopancreatectomy. There was no postoperative mortality. Six patients experienced complications, including pancreatic fistula in 5 patients. Pathological examination revealed median three (range 1-14) macro-pNENs sized between 6 and 40 mm, and a total of 14 potentially benign insulinomas were detected in the 13 patients. After median follow-up of 156 months, only 1 patient developed recurrent hyperinsulinism after initial enucleation. Twelve patients developed new pNENs in the pancreatic remnant and 4 patients underwent reoperations (3 for metastatic ZES, 1 for recurrent hyperinsulinism). One of 5 patients with an initial extended pancreatic resection developed insulin-dependent diabetes mellitus. CONCLUSION Enucleation and limited resection provide long-term cure for MEN1 insulinoma in patients with solitary or dominant tumors. Subtotal distal pancreatectomy should thus be preserved for patients with multiple pNENs without dominance given the risk of exocrine and endocrine pancreas insufficiency in the mostly young patients.
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Affiliation(s)
- Detlef K Bartsch
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Marburg, Germany
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Abstract
BACKGROUND Many serologic and radiographic modalities are used for monitoring multiple endocrine neoplasia type 1 (MEN 1) patients for pancreaticoduodenal neuroendocrine tumors (PNETs). We compared serum markers and imaging studies obtained preoperatively with the gross pathology and immunohistochemical findings and correlated preoperative testing with postoperative outcome. METHODS From 2000 to 2008, 52 MEN 1 patients [32 (62%) female; median age = 43 years, range 19-74 years] underwent 56 pancreatic operations [49 (88%) distal pancreatectomies] for suspected PNETs. Preoperative serum markers [human pancreatic polypeptide (HPP), gastrin, and glucagon] and imaging [CT, (111)In pentetreotide scintigraphy, and endoscopic ultrasound (EUS)] were compared to the pathologic findings. Postoperative serum markers and survival were followed. RESULTS Human pancreatic polypeptide had the highest agreement between an elevated serum level and positive tumor immunostaining (83% vs. 50% agreement for gastrin vs. 67% agreement for glucagon). Preoperative CT had 81% sensitivity and positive predictive value (PPV) of 97% for PNETs. (111)In pentetreotide scintigraphy had 84% sensitivity and PPV of 96%. Preoperative endoscopic ultrasonography (EUS) had 100% sensitivity and PPV, with close correlation (r (s) = 0.93) between the largest lesion seen on EUS and pathology. Median follow-up was 4.3 years (range = 0.1-10.9 years). Overall survival was 89% at 5-year follow-up. CONCLUSIONS Our study substantiates EUS as providing the highest preoperative sensitivity and PPV in assessing the presence of PNETs in MEN 1 patients. CT and octreotide scintigraphy can yield both false-positive and false-negative results. HPP, gastrin, and glucagon were the most commonly measured tumor markers in our series but did not always correlate with immunostaining. With an aggressive surgical approach, satisfactory rates of biochemical improvement and long-term survival were observed.
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Kann PH, Bartsch D, Langer P, Waldmann J, Hadji P, Pfützner A, Klüsener J. Peripheral bone mineral density in correlation to disease-related predisposing conditions in patients with multiple endocrine neoplasia type 1. J Endocrinol Invest 2012; 35:573-9. [PMID: 21791969 DOI: 10.3275/7880] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIM Patients with multiple endocrine neoplasia type 1 (MEN1) often have low bone mineral density (BMD) attributed to primary hyperparathyroidism (pHPT). However, in MEN1 patients, other endocrine dysfunctions and conditions such as hypercortisolism, hypogonadism, and GH deficiency due to pituitary manifestation, and surgery on the upper gastrointestinal tract may affect BMD. SUBJECTS AND METHODS In 23 patients with MEN1 (10 females, 13 males; 46±12 yr), BMD was determined by quantitative computed tomography at the forearm (pqCT), compared to a reference population and related to different conditions suspected to affect bone metabolism in MEN1. RESULTS In this cohort, Z-score for trabecular BMD was -0.85±1.18 and for total BMD -1.16±1.04. There was a similar trend towards lower BMD in uncontrolled hyperparathyroidism, hypercortisolism, hypogonadism/GH deficiency and the state after surgery at the upper gastrointestinal tract. CONCLUSIONS These data while confirming previous observations on reduced BMD in patients with MEN1, however, challenge its only or even predominant association with pHPT. Other conditions such as hypercortisolism, somatotrophic/ gonadotrophic pituitary insufficiency, and previous upper gastrointestinal surgery seem to be factors contributing to the risk of developing osteoporosis.
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Affiliation(s)
- P H Kann
- Division of Endocrinology and Diabetology, Faculty of Medicine and University Hospital, Philipp's University, Marburg, Germany.
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Tonelli F, Giudici F, Giusti F, Brandi ML. Gastroenteropancreatic neuroendocrine tumors in multiple endocrine neoplasia type 1. Cancers (Basel) 2012; 4:504-22. [PMID: 24213321 PMCID: PMC3712700 DOI: 10.3390/cancers4020504] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 04/10/2012] [Accepted: 04/18/2012] [Indexed: 12/21/2022] Open
Abstract
We reviewed the literature about entero-pancreatic neuroendocrine tumors in Multiple Endocrine Neoplasia type 1 syndrome (MEN1) to clarify their demographic features, localization imaging, practice, and appropriate therapeutical strategies, analyzing the current approach to entero-pancreatic neuroendocrine tumors in MEN1. Despite the fact that hyperparathyroidism is usually the first manifestation of MEN1, the penetrance of these tumors is similar. They are characterized by multiplicity of lesions, variable expression of the tumors, and propensity for malignant degeneration. Both the histological type and the size of MEN1 neuroendocrine tumors correlate with malignancy. Monitoring of pancreatic peptides and use of imaging exams allow early diagnosis and prompt surgical treatment, resulting in prevention of metastatic disease and improvement of long-term survival. Surgery is often the treatment of choice for MEN1-neuroendocrine tumors. The rationale for surgical approach is to curtail malignant progression of the disease, and to cure the associated biochemical syndrome, should it be present.
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Affiliation(s)
- Francesco Tonelli
- Department of Clinical Physiopathology, Surgical Unit, Medical School, University of Florence, Largo Brambilla n° 3, Florence 50134, Italy; E-Mail:
| | - Francesco Giudici
- Department of Clinical Physiopathology, Surgical Unit, Medical School, University of Florence, Largo Brambilla n° 3, Florence 50134, Italy; E-Mail:
| | - Francesca Giusti
- Department of Internal Medicine, Medical School and Regional Centre for Hereditary Endocrine Tumors, University of Florence, Largo Brambilla n° 3, Florence 50134, Italy; E-Mails: (F.G.); (M.L.B.)
| | - Maria Luisa Brandi
- Department of Internal Medicine, Medical School and Regional Centre for Hereditary Endocrine Tumors, University of Florence, Largo Brambilla n° 3, Florence 50134, Italy; E-Mails: (F.G.); (M.L.B.)
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