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Herrera-Martínez AD, Rebollo Román Á, Pascual Corrales E, Idrobo C, Parra Ramírez P, Martín Rojas-Marcos P, Robles Lázaro C, Marginean DL, Araujo-Castro M. Adrenal Incidentalomas and Other Endocrine-Related Adenomas: How Much Does Cortisol Secretion Matter? Cancers (Basel) 2023; 15:4735. [PMID: 37835429 PMCID: PMC10572012 DOI: 10.3390/cancers15194735] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
Background: Adrenal incidentalomas (AI) are frequent findings in clinical practice. About 40% of AIs are associated with hypercortisolism of variable severity. Although mild autonomous cortisol secretion (MACS) has been associated with the impaired clinical outcome of several diseases, its effect on the development of benign neoplasms is unknown. Aim: To compare the prevalence of adenomas (thyroid, parathyroid, pituitary and other locations) in patients with nonfunctioning AIs (NFAIs) and MACS. Methods: A multicenter, retrospective study of patients with AIs evaluated in four tertiary hospitals was performed. Results: A total of 923 patients were included. Most patients were male (53.6%), with a mean age at diagnosis of 62.4 ± 11.13 years; 21.7% presented with bilateral AIs. MACS was observed in 29.9% (n = 276) of patients, while 69.9% (n = 647) were NFAIs. Adenomas in locations other than the adrenal gland were observed in 36% of the studied population, with a similar distribution in patients with MACS and NFAIs (33% vs. 32%; p > 0.05). There were no statistically significant differences in the prevalence of pituitary, thyroid, parathyroid or other endocrine-related adenomas between both groups, but the prevalence of metabolic comorbidities and mortality was increased in patients with MACS, specifically in patients with thyroid and other endocrine-related adenomas (p < 0.05). Conclusions: Adenomas in locations other than the adrenal glands occur in one third of patients with AIs. Mild autonomous hypercortisolism does not affect the prevalence of other endocrine-related adenomas but is associated with increased metabolic comorbidities and mortality, especially in patients with thyroid adenomas and adenomas in other locations.
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Affiliation(s)
- Aura D. Herrera-Martínez
- Endocrinology & Nutrition Department, Hospital Reina Sofia, 14004 Córdoba, Spain; (Á.R.R.); (D.L.M.)
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Córdoba, Spain
| | - Ángel Rebollo Román
- Endocrinology & Nutrition Department, Hospital Reina Sofia, 14004 Córdoba, Spain; (Á.R.R.); (D.L.M.)
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Córdoba, Spain
| | - Eider Pascual Corrales
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain (C.I.)
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), 28034 Madrid, Spain
| | - Cindy Idrobo
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain (C.I.)
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), 28034 Madrid, Spain
| | - Paola Parra Ramírez
- Endocrinology & Nutrition Department, Hospital La Paz, 28034 Madrid, Spain (P.M.R.-M.)
| | | | | | - Delia Lavinia Marginean
- Endocrinology & Nutrition Department, Hospital Reina Sofia, 14004 Córdoba, Spain; (Á.R.R.); (D.L.M.)
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Córdoba, Spain
| | - Marta Araujo-Castro
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain (C.I.)
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), 28034 Madrid, Spain
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Mamedova EO, Lisina DV, Belaya ZE. [Rare forms of hereditary endocrine neoplasia: co-existence of pituitary adenoma and pheochromocytoma/paraganglioma]. PROBLEMY ENDOKRINOLOGII 2023; 69:24-30. [PMID: 37448268 DOI: 10.14341/probl13196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 07/15/2023]
Abstract
Functioning pituitary adenomas and pheochromocytomas/paragangliomas are rare in the general population. Pituitary adenomas occur in the familial setting in approximately 5% of cases, whereas pheochromocytomas/paragangliomas can be hereditary in 30-40% of cases. Hereditary syndromes associated with pituitary adenomas include multiple endocrine neoplasia types 1 and 4, familial isolated pituitary adenomas, and Carney complex. Hereditary syndromes associated with pheochromocytomas/paragangliomas and genes, mutations in which predispose to their development, are more numerous. The first clinical descriptions of the co-occurrence of pituitary adenoma and pheochromocytoma/paraganglioma in one patient date back to the mid 20th century, however delineating such a co-occurrence into a particular syndrome («3PAs» (pituitary adenoma, pheochromocytoma, paraganglioma)) was suggested only in 2015. To date, approximately 100 cases of such a co-occurrence have been described in the literature. Mutations in genes encoding subunits of succinate dehydrogenase complex II (SDHx) are revealed in the majority of cases, much less common are mutations in MAX, MEN1 and some other genes. This review summarizes the current information on the «3PAs» syndrome.
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Branzoli F, Salgues B, Marjańska M, Laloi-Michelin M, Herman P, Le Collen L, Delemer B, Riancho J, Kuhn E, Jublanc C, Burnichon N, Amar L, Favier J, Gimenez-Roqueplo AP, Buffet A, Lussey-Lepoutre C. SDHx mutation and pituitary adenoma: can in vivo 1H-MR spectroscopy unravel the link? Endocr Relat Cancer 2023; 30:ERC-22-0198. [PMID: 36449569 PMCID: PMC9885742 DOI: 10.1530/erc-22-0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022]
Abstract
Germline mutations in genes encoding succinate dehydrogenase (SDH) are frequently involved in pheochromocytoma/paraganglioma (PPGL) development and were implicated in patients with the '3PAs' syndrome (associating pituitary adenoma (PA) and PPGL) or isolated PA. However, the causality link between SDHx mutation and PA remains difficult to establish, and in vivo tools for detecting hallmarks of SDH deficiency are scarce. Proton magnetic resonance spectroscopy (1H-MRS) can detect succinate in vivo as a biomarker of SDHx mutations in PGL. The objective of this study was to demonstrate the causality link between PA and SDH deficiency in vivo using 1H-MRS as a novel noninvasive tool for succinate detection in PA. Three SDHx-mutated patients suffering from a PPGL and a macroprolactinoma and one patient with an apparently sporadic non-functioning pituitary macroadenoma underwent MRI examination at 3 T. An optimized 1H-MRS semi-LASER sequence (TR = 2500 ms, TE = 144 ms) was employed for the detection of succinate in vivo. Succinate and choline-containing compounds were identified in the MR spectra as single resonances at 2.44 and 3.2 ppm, respectively. Choline compounds were detected in all the tumors (three PGL and four PAs), while a succinate peak was only observed in the three macroprolactinomas and the three PGL of SDHx-mutated patients, demonstrating SDH deficiency in these tumors. In conclusion, the detection of succinate by 1H-MRS as a hallmark of SDH deficiency in vivo is feasible in PA, laying the groundwork for a better understanding of the biological link between SDHx mutations and the development of these tumors.
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Affiliation(s)
- Francesca Branzoli
- Paris Brain Institute - Institut du Cerveau (ICM), Center for Neuroimaging Research (CENIR), Paris, France
- Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, ICM, Paris, France
| | - Betty Salgues
- Sorbonne University, nuclear medicine department, Pitié-Salpêtrière Hospital, Assistance -Publique Hôpitaux de Paris, Paris, France
- Paris Cardiovascular Research Center (PARCC), Inserm, Paris, France
| | - Małgorzata Marjańska
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Marie Laloi-Michelin
- Endocrinology department, Lariboisière Hospital, Assistance -Publique Hôpitaux de Paris, Paris, France
| | - Philippe Herman
- ENT unit, Lariboisière Hospital, Assistance -Publique Hôpitaux de Paris, Paris-Cité University, INSERM U1141, Paris, France
| | - Lauriane Le Collen
- Inserm/CNRS UMR 1283/8199, Pasteur Institute of Lille, EGID, University of Lille, Lille, France
- Department of Endocrinology Diabetology, University Hospital Center of Reims, Reims, France
- Department of Genetic, University Hospital Center of Reims, Reims, France
| | - Brigitte Delemer
- Department of Endocrinology Diabetology, University Hospital Center of Reims, Reims, France
- CRESTIC EA 3804, University of Reims Champagne Ardenne, UFR Sciences Exactes et Naturelles, Moulin de La Housse, BP 1039, Reims, France
| | - Julien Riancho
- AP-HP, Hôpital Européen Georges Pompidou, Hypertension Unit, and Reference centre for rare adrenal diseases, Paris, France
| | - Emmanuelle Kuhn
- Pituitary Unit, Pitié-Salpêtrière Hospital APHP, Sorbonne University, Paris, France
| | - Christel Jublanc
- Pituitary Unit, Pitié-Salpêtrière Hospital APHP, Sorbonne University, Paris, France
| | - Nelly Burnichon
- Département de médecine génomique des tumeurs et des cancers, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
- Université Paris Cité, Inserm, PARCC, Paris, France
| | - Laurence Amar
- AP-HP, Hôpital Européen Georges Pompidou, Hypertension Unit, and Reference centre for rare adrenal diseases, Paris, France
- Université Paris Cité, Inserm, PARCC, Paris, France
| | | | - Anne-Paule Gimenez-Roqueplo
- Département de médecine génomique des tumeurs et des cancers, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
- Université Paris Cité, Inserm, PARCC, Paris, France
| | - Alexandre Buffet
- Département de médecine génomique des tumeurs et des cancers, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
- Université Paris Cité, Inserm, PARCC, Paris, France
| | - Charlotte Lussey-Lepoutre
- Sorbonne University, nuclear medicine department, Pitié-Salpêtrière Hospital, Assistance -Publique Hôpitaux de Paris, Paris, France
- Paris Cardiovascular Research Center (PARCC), Inserm, Paris, France
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Lanes Iglesias S, Megido Armada A, Castaño González LA, Menéndez Torre EL, Riaño Galán I. Experience in diagnosis and treatment of prolactinomas in pediatric patients and young adults. ENDOCRINOLOGIA, DIABETES Y NUTRICION 2022; 69:911-913. [PMID: 36446712 DOI: 10.1016/j.endien.2022.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/13/2021] [Indexed: 11/27/2022]
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Lanes Iglesias S, Megido Armada A, Castaño González LA, Menéndez Torre EL, Riaño Galán I. Experiencia en el diagnóstico y tratamiento de prolactinomas en pacientes pediátricos y adultos jóvenes. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Guerrero-Pérez F, Fajardo C, Torres Vela E, Giménez-Palop O, Lisbona Gil A, Martín T, González N, Díez JJ, Iglesias P, Robledo M, Villabona C. 3P association (3PAs): Pituitary adenoma and pheochromocytoma/paraganglioma. A heterogeneous clinical syndrome associated with different gene mutations. Eur J Intern Med 2019; 69:14-19. [PMID: 31431315 DOI: 10.1016/j.ejim.2019.08.005] [Citation(s) in RCA: 10] [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: 05/02/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pituitary adenomas (PA) associated with pheochromocytomas/paragangliomas (Pheo/PGL), also known as "the three P association" or "3PAs" could be the results of coincidence, but new evidence supports a common pathogenic mechanism in some patients. Our aim is to report the clinical data, surgical outcome, genetic findings of a large case series and review the current knowledge on this topic. METHODS AND RESULTS In a retrospective multicentre study, we compiled 10 patients with PAs (6 new unreported cases). Six patients were female with mean age of 51.6 ± 18.0 years. PA were: 6 acromegaly, 3 prolactinoma and 1 non-functioning PA (NFPA). Among the Pheo/PGL, 7 patients had a single tumour (4 Pheo and 3 PGL) and 3 patients had multiple or bilateral disease (2 PGL and 1 Pheo). Patients with GH-secreting PA and NFPA underwent surgery, while patients with prolactinoma received medical treatment (one patient required surgery). Unilateral adrenalectomy was carried out in all single Pheo and a bilateral procedure was performed in the patient with bilateral tumour. A single tumour was resected in two patients with multiple PGL. We found 3 germline pathogenic mutations: 2 in SDHB (c.166-170delCCTCA and a gross deletion involving exon 1) and 1 SDHD (p.P81L exon 3). Two variants of uncertain significance: 1 in MEN1 (c.1618C > T; p.Pro540Ser) and 1 in RET (c.2556C > G, p.Ile852Met), and finally a RETM918T somatic mutation in a Pheo tissue. CONCLUSION We actively suggest considering the possibility of hereditary disease in all cases with 3PA and performing a complete genetic study.
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Affiliation(s)
- Fernando Guerrero-Pérez
- Department of Endocrinology, Hospital Universitari de Bellvitge, Carrer de la Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Carmen Fajardo
- Department of Endocrinology, Hospital Universitario de la Ribera, Ctra. Corbera, km 1, 46600 Alcira, Valencia, Spain.
| | - Elena Torres Vela
- Department of Endocrinology, Hospital Universitario San Cecilio, Av. del Conocimiento, s/n, 18016 Granada, Spain
| | - Olga Giménez-Palop
- Department of Endocrinology, Hospital Universitari Parc Taulí, Parc Taulí, 1, 08208 Sabadell, Barcelona, Spain.
| | - Arturo Lisbona Gil
- Department of Endocrinology, Hospital Universitario Central de la Defensa, Glorieta Ejército, 1, 28047 Madrid, Spain.
| | - Tomas Martín
- Department of Endocrinology, Hospital Universitario Virgen Macarena, Calle Dr. Fedriani, 3, 41009 Sevilla, Spain.
| | - Natividad González
- Department of Endocrinology, Hospital Universitario Virgen Macarena, Calle Dr. Fedriani, 3, 41009 Sevilla, Spain
| | - Juan José Díez
- Department of Endocrinology, Hospital Universitario Ramón y Cajal, Ctra. Colmenar Viejo, km. 9, 100, 28034 Madrid, Spain.
| | - Pedro Iglesias
- Department of Endocrinology, Hospital Universitario Ramón y Cajal, Ctra. Colmenar Viejo, km. 9, 100, 28034 Madrid, Spain
| | - Mercedes Robledo
- Spanish National Cancer Research Centre (CNIO) & Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Calle de Melchor Fernández Almagro, 3, 28029 Madrid, Spain.
| | - Carles Villabona
- Department of Endocrinology, Hospital Universitari de Bellvitge, Carrer de la Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
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Xekouki P, Brennand A, Whitelaw B, Pacak K, Stratakis CA. The 3PAs: An Update on the Association of Pheochromocytomas, Paragangliomas, and Pituitary Tumors. Horm Metab Res 2019; 51:419-436. [PMID: 30273935 PMCID: PMC7448524 DOI: 10.1055/a-0661-0341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pituitary adenomas (PA) and pheochromocytomas/paragangliomas (PHEO/PGL) are rare tumors. Although they may co-exist by coincidence, there is mounting evidence that genes predisposing in PHEO/PGL development, may play a role in pituitary tumorigenesis. In 2012, we described a GH-secreting PA caused by an SDHD mutation in a patient with familial PGLs and found loss of heterozygosity at the SDHD locus in the pituitary tumor, along with increased hypoxia-inducible factor 1α (HIF-1α) levels. Additional patients with PAs and SDHx defects have since been reported. Overall, prevalence of SDHx mutations in PA is very rare (0.3-1.8% in unselected cases) but we and others have identified several cases of PAs with PHEOs/PGLs, like our original report, a condition which we termed the 3 P association (3PAs). Interestingly, when 3PAs is found in the sporadic setting, no SDHx defects were identified, whereas in familial PGLs, SDHx mutations were identified in 62.5-75% of the reported cases. Hence, pituitary surveillance is recommended among patients with SDHx defects. It is possible that the SDHx germline mutation-negative 3PAs cases may be due to another gene, epigenetic changes, mutations in modifier genes, mosaicism, somatic mutations, pituitary hyperplasia due to ectopic hypothalamic hormone secretion or a coincidence. PA in 3PAs are mainly macroadenomas, more aggressive, more resistant to somatostatin analogues, and often require surgery. Using the Sdhb +/- mouse model, we showed that hyperplasia may be the first abnormality in tumorigenesis as initial response to pseudohypoxia. We also propose surveillance and follow-up approach of patients presenting with this association.
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Affiliation(s)
- Paraskevi Xekouki
- Department of Endocrinology, King’s College Hospital, London, UK
- Division of Diabetes & Nutritional Sciences, King’s College London, London, UK
| | - Ana Brennand
- Division of Diabetes & Nutritional Sciences, King’s College London, London, UK
| | - Ben Whitelaw
- Department of Endocrinology, King’s College Hospital, London, UK
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Constantine A. Stratakis
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
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Abstract
The knowledge on the molecular and genetic causes of Cushing's syndrome (CS) has greatly increased in the recent years. Somatic mutations leading to overactive 3',5'-cyclic adenosine monophosphate/protein kinase A and wingless-type MMTV integration site family/beta-catenin pathways are the main molecular mechanisms underlying adrenocortical tumorigenesis. Corticotropinomas are characterized by resistance to glucocorticoid negative feedback, impaired cell cycle control and overexpression of pathways sustaining ACTH secretion. Recognizing the genetic defects behind corticotroph and adrenocortical tumorigenesis proves crucial for tailoring the clinical management of CS patients and for designing strategies for genetic counseling and clinical screening to be applied in routine medical practice.
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Affiliation(s)
- Laura C Hernández-Ramírez
- Section on Endocrinology and Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), 10 Center Drive, CRC, Room 1E-3216, Bethesda, MD 20892-1862, USA
| | - Constantine A Stratakis
- Section on Endocrinology and Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), 10 Center Drive, CRC, Room 1E-3216, Bethesda, MD 20892-1862, USA.
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An unusual case of mediastinal paraganglioma and pituitary adenoma. Surgery 2017; 162:1338-1339. [PMID: 28438335 DOI: 10.1016/j.surg.2017.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 11/23/2022]
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