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van Dam MA, Crobach ASLP, Boekestijn B, Corssmit EPM, Bonsing BA, Vahrmeijer AL, Mieog JSD. Fluorescence-guided minimally-invasive resection of abdominal paragangliomas using indocyanine green. Sci Rep 2024; 14:3983. [PMID: 38368490 PMCID: PMC10874414 DOI: 10.1038/s41598-024-54718-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/15/2024] [Indexed: 02/19/2024] Open
Abstract
This retrospective study explores the utility of near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) in enhancing the intraoperative identification and guidance for the resection of abdominal paragangliomas. They can be challenging to detect during minimally invasive surgery, due to their anatomical location, varying size and similar appearance in regard to their surrounding tissue. Patients with suspected abdominal paragangliomas planned for a minimally-invasive resection were included. As part of standard of care they received single intravenous dose of 5 mg ICG after abdominal exploration. NIR fluorescence imaging of the anatomical region of the suspected lesion was performed immediately following intravenous administration, to assess fluorescence signals, intraoperative identification, and histopathological correlation. Out of five resected suspicious lesions, four were imaged with NIR fluorescence, pathology confirming four as paragangliomas, the latter turned out to be an adrenal adenoma. NIR fluorescence identified all four lesions, surpassing the limitations of white-light visualization. Homogeneous fluorescence signals appeared 30-60 s post-ICG administration, which lasted up to 30 min. The study demonstrates the feasibility and potential clinical value of fluorescence-guided minimally-invasive resections of abdominal paragangliomas using a single intravenous ICG dose. These findings support the scientific basis for routine use of ICG-fluorescence-guided surgery in challenging anatomical cases, providing valuable assistance in lesion detection and resection.
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Affiliation(s)
- M A van Dam
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - A S L P Crobach
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - B Boekestijn
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - E P M Corssmit
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - B A Bonsing
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - A L Vahrmeijer
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - J S D Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Feijen M, Palmen M, Lamb HJ, Corssmit EPM, Antoni ML. A case report of an intracardiac paraganglioma attached to the left main coronary artery in a patient with a succinate dehydrogenase complex subunit D mutation. Eur Heart J Case Rep 2023; 7:ytad418. [PMID: 37811153 PMCID: PMC10551059 DOI: 10.1093/ehjcr/ytad418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/03/2023] [Accepted: 08/16/2023] [Indexed: 10/10/2023]
Abstract
Background Cardiac paragangliomas are extremely rare neuroendocrine tumours derived from neural crest cells that represent <2% of all paragangliomas. Approximately 35-40% of all paragangliomas are associated with inherited syndromes such as mutation in the succinate dehydrogenase (SDH) enzyme. Case summary A 44-year-old male with an SDH complex subunit D (SDHD) mutation was diagnosed with an intracardiac paraganglioma attached to the left main coronary artery. Multimodality imaging, including gallium dotatate positron emission tomography computed tomography, cardiac magnetic resonance imaging, and coronary computed tomography angiography (CCTA) confirmed the suspected intracardiac paraganglioma. During follow-up with a CCTA, the mass showed growth, and surgical removal was recommended to anticipate on the risk of compression of the left main coronary artery. Prior to surgery, coronary angiography was performed, which showed no coronary calcifications. The highly vascularized paraganglioma was visible near the left main and proximal left anterior descending artery. The intracardiac paraganglioma was successfully removed through a median sternotomy with cardiopulmonary bypass, without any complications. The post-operative course was uneventful, and histological examination confirmed the diagnosis of a paraganglioma. Discussion Intracardiac paragangliomas in the vicinity of the left main coronary artery are rare, and surgical removal may be challenging. Therefore, screening and the use of multiple imaging modalities in patients with SDHD mutations prior to surgery is of major importance.
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Affiliation(s)
- Michelle Feijen
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
| | - Meindert Palmen
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Eleonora P M Corssmit
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Maria Louisa Antoni
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
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Taïeb D, Wanna GB, Ahmad M, Lussey-Lepoutre C, Perrier ND, Nölting S, Amar L, Timmers HJLM, Schwam ZG, Estrera AL, Lim M, Pollom EL, Vitzthum L, Bourdeau I, Casey RT, Castinetti F, Clifton-Bligh R, Corssmit EPM, de Krijger RR, Del Rivero J, Eisenhofer G, Ghayee HK, Gimenez-Roqueplo AP, Grossman A, Imperiale A, Jansen JC, Jha A, Kerstens MN, Kunst HPM, Liu JK, Maher ER, Marchioni D, Mercado-Asis LB, Mete O, Naruse M, Nilubol N, Pandit-Taskar N, Sebag F, Tanabe A, Widimsky J, Meuter L, Lenders JWM, Pacak K. Clinical consensus guideline on the management of phaeochromocytoma and paraganglioma in patients harbouring germline SDHD pathogenic variants. Lancet Diabetes Endocrinol 2023; 11:345-361. [PMID: 37011647 PMCID: PMC10182476 DOI: 10.1016/s2213-8587(23)00038-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 04/05/2023]
Abstract
Patients with germline SDHD pathogenic variants (encoding succinate dehydrogenase subunit D; ie, paraganglioma 1 syndrome) are predominantly affected by head and neck paragangliomas, which, in almost 20% of patients, might coexist with paragangliomas arising from other locations (eg, adrenal medulla, para-aortic, cardiac or thoracic, and pelvic). Given the higher risk of tumour multifocality and bilaterality for phaeochromocytomas and paragangliomas (PPGLs) because of SDHD pathogenic variants than for their sporadic and other genotypic counterparts, the management of patients with SDHD PPGLs is clinically complex in terms of imaging, treatment, and management options. Furthermore, locally aggressive disease can be discovered at a young age or late in the disease course, which presents challenges in balancing surgical intervention with various medical and radiotherapeutic approaches. The axiom-first, do no harm-should always be considered and an initial period of observation (ie, watchful waiting) is often appropriate to characterise tumour behaviour in patients with these pathogenic variants. These patients should be referred to specialised high-volume medical centres. This consensus guideline aims to help physicians with the clinical decision-making process when caring for patients with SDHD PPGLs.
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Affiliation(s)
- David Taïeb
- Department of Nuclear Medicine, Aix-Marseille University, La Timone University Hospital, Marseille, France
| | - George B Wanna
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maleeha Ahmad
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Charlotte Lussey-Lepoutre
- Université Paris Cité, Inserm, PARCC, Equipe Labellisée par la Ligue contre le Cancer, Paris, France; Department of Nuclear Medicine, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Nancy D Perrier
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Svenja Nölting
- Svenja Nölting, Department of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Laurence Amar
- Université Paris Cité, Inserm, PARCC, Equipe Labellisée par la Ligue contre le Cancer, Paris, France; Unité d'hypertension artérielle, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Henri J L M Timmers
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Zachary G Schwam
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anthony L Estrera
- Department of Cardiothoracic and Vascular Surgery, UTHealth Houston, McGovern Medical School, Memorial Hermann Hospital Heart and Vascular Institute, Houston, TX, USA
| | - Michael Lim
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Erqi Liu Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Lucas Vitzthum
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Isabelle Bourdeau
- Division of Endocrinology, Department of Medicine and Research Center, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Ruth T Casey
- Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cancer Research UK Cambridge Centre, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Frédéric Castinetti
- Department of Endocrinology, Aix-Marseille University, Conception University Hospital, Marseille, France; INSERM U1251, Aix-Marseille University, Conception University Hospital, Marseille, France
| | - Roderick Clifton-Bligh
- Department of Endocrinology, Royal North Shore Hospital, Sydney, NSW, Australia; Cancer Genetics Laboratory, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Eleonora P M Corssmit
- Department of Endocrinology, Center of Endocrine Tumors Leiden, Leiden University Medical Centre, Leiden, Netherlands
| | - Ronald R de Krijger
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Jaydira Del Rivero
- Developmental Therapeutics Branch, Rare Tumor Initiative, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Graeme Eisenhofer
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Hans K Ghayee
- Division of Endocrinology and Metabolism, Department of Medicine, Malcom Randall VA Medical Center, University of Florida, Gainesville, FL, USA
| | - Anne-Paule Gimenez-Roqueplo
- Université Paris Cité, Inserm, PARCC, Equipe Labellisée par la Ligue contre le Cancer, Paris, France; Département de Médecine Génomique des Tumeurs et des Cancers, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ashley Grossman
- Green Templeton College, University of Oxford, Oxford, UK; NET Unit, Royal Free Hospital, London, UK
| | - Alessio Imperiale
- Department of Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe, IPHC, UMR 7178, CNRS, University of Strasbourg, Strasbourg, France
| | - Jeroen C Jansen
- Department of Otorhinolaryngology, Leiden University Medical Centre, Leiden, Netherlands
| | - Abhishek Jha
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Michiel N Kerstens
- Department of Endocrinology, University Medical Center Groningen, Groningen, Netherlands
| | - Henricus P M Kunst
- Department of Otolaryngology and Head & Neck Surgery, Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Nijmegen, Netherlands; Department of Otolaryngology and Head & Neck Surgery, Dutch Academic Alliance Skull Base Pathology, Maastricht University Medical Center, Maastricht, Netherlands
| | - James K Liu
- Department of Neurosurgical Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Eamonn R Maher
- Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cancer Research UK Cambridge Centre, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Daniele Marchioni
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Verona, Verona, Italy
| | - Leilani B Mercado-Asis
- Section of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine & Surgery, University of Santo Tomas Hospital, University of Santo Tomas, Manila, Philippines
| | - Ozgur Mete
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Endocrine Pathology Society, Toronto, ON, Canada
| | - Mitsuhide Naruse
- Medical Center and Endocrine Center, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Naris Nilubol
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Neeta Pandit-Taskar
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Frédéric Sebag
- Department of Endocrine Surgery, Aix-Marseille University, Conception University Hospital, Marseille, France
| | - Akiyo Tanabe
- Division of Diabetes, Endocrinology, and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan
| | - Jiri Widimsky
- Third Department of Medicine, Department of Endocrinology and Metabolism of the First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Leah Meuter
- Department of Physician Assistant Studies, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jacques W M Lenders
- Department of Medicine ΙΙI, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
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4
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Reichert AD, Nies M, Tissing WJE, Muller Kobold AC, Klein Hesselink MS, Brouwers AH, Havekes B, van den Heuvel-Eibrink MM, van der Pal HJH, Plukker JTM, van Santen HM, Corssmit EPM, Netea-Maier RT, Peeters RP, van Dam EWCM, Burgerhof JGM, van der Meer P, Bocca G, Links TP. Progressive diastolic dysfunction in survivors of pediatric differentiated thyroid carcinoma. Eur J Endocrinol 2022; 187:497-505. [PMID: 35947635 DOI: 10.1530/eje-22-0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/10/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Pediatric differentiated thyroid cancer (DTC) has an excellent prognosis but unknown late effects of treatment. The initial cardiac evaluation showed subclinical diastolic dysfunction in 20% of adult survivors. The objective of this follow-up study was to determine the clinical course of this finding. METHODS This multicenter study, conducted between 2018 and 2020, re-evaluated survivors after 5 years. The primary endpoint was echocardiographic diastolic cardiac function (depicted by the mean of the early diastolic septal and early diastolic lateral tissue velocity (e' mean)). Secondary endpoints were other echocardiographic parameters and plasma biomarkers. RESULTS Follow-up evaluation was completed in 47 (71.2%) of 66 survivors who had completed their initial evaluation. Of these 47 survivors, 87.2% were women. The median age was 39.8 years (range: 18.8-60.3), and the median follow-up after the initial diagnosis was 23.4 years (range: 10.2-48.8). Between the first and second evaluation, the e' mean significantly decreased by 2.1 cm/s (s.d. 2.3 cm/s, P < 0.001). The median left ventricular ejection fraction did not significantly change (58.0% vs 59.0%, P= NS). In the best explanatory model of e' mean, multivariate linear regression analysis showed that BMI and age were significantly associated with e' mean (β coefficient: -0.169, 95% CI: -0.292; -0.047, P = 0.008 and β coefficient: -0.177, 95% CI: -0.240; -0.113, P < 0.001, respectively). CONCLUSIONS AND RELEVANCE In these relatively young survivors of pediatric DTC, diastolic function decreased significantly during 5-year follow-up and is possibly more pronounced than in normal aging. This finding requires further follow-up to assess clinical consequences.
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Affiliation(s)
- Antoinette D Reichert
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Internal Medicine, Groningen, the Netherlands
| | - Marloes Nies
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Internal Medicine, Groningen, the Netherlands
| | - Wim J E Tissing
- University of Groningen, Beatrix Children's Hospital, Paediatric Oncology, University Medical Center Groningen, Groningen, Groningen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Anneke C Muller Kobold
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Mariëlle S Klein Hesselink
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Internal Medicine, Groningen, the Netherlands
| | - Adrienne H Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bas Havekes
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Pediatric Oncology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Helena J H van der Pal
- Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Medical Oncology, Academic Medical Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - John T M Plukker
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Hanneke M van Santen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Eleonora P M Corssmit
- Leiden University Medical Center, Division of Endocrinology, Department of Internal Medicine, Leiden, the Netherlands
| | - Romana T Netea-Maier
- Radboud University Medical Center, Division of Endocrinology, Department of Internal Medicine, Nijmegen, the Netherlands
| | - Robin P Peeters
- Erasmus Medical Center, Department of Internal Medicine and Erasmus MC Academic Center for Thyroid Disease, Rotterdam, the Netherlands
| | - Eveline W C M van Dam
- Department of Endocrinology, Internal Medicine, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Johannes G M Burgerhof
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Peter van der Meer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gianni Bocca
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Pediatric Endocrinology, Groningen, the Netherlands
| | - Thera P Links
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Internal Medicine, Groningen, the Netherlands
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5
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Dekker BL, Muller Kobold AC, Brouwers AH, Williams GR, Nies M, Klein Hesselink MS, van der Horst-Schrivers ANA, Havekes B, van den Heuvel-Eibrink MM, van der Pal HJH, Plukker JTM, Ronckers CM, van Santen HM, Burgerhof JGM, Corssmit EPM, Netea-Maier RT, Peeters RP, van Dam EWCM, Boot AM, Tissing WJE, Bocca G, Links TP. Bone Mineral Density in Adult Survivors of Pediatric Differentiated Thyroid Carcinoma: A Longitudinal Follow-Up Study. Thyroid 2021; 31:1707-1714. [PMID: 34514857 DOI: 10.1089/thy.2021.0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Survivors of pediatric differentiated thyroid carcinoma (DTC) receive thyrotropin-suppressive therapy to minimize disease recurrence. However, knowledge about long-term effects of subclinical hyperthyroidism on bone mineral density (BMD) in pediatric DTC survivors is scarce, as is the information regarding long-term consequences of permanent hypoparathyroidism on BMD. We evaluated BMD in pediatric DTC survivors and investigated if BMD was affected by subclinical hyperthyroidism and/or permanent hypoparathyroidism during long-term follow-up. Methods: In this nationwide longitudinal study, we determined BMD in the lumbar spine and femur by dual energy X-ray absorptiometry in 65 pediatric DTC survivors. Measurements were repeated after minimal 5 years of follow-up in 46 pediatric DTC survivors. BMD results were evaluated according to the recommendations of the International Society for Clinical Densitometry (ISCD) and WHO. At both visits, we determined biochemical parameters and markers of bone resorption (C-terminal telopeptide of type I collagen [β-CTX]) and formation (N-propeptide of type I collagen [PINP] and osteocalcin). Results: First and second BMD measurements were done after a median follow-up of 17.0 (interquartile range [IQR] 8.0-25.0) and 23.5 (IQR 14.0-30.0) years after diagnosis, respectively. Median age at diagnosis was 15 years (IQR 13.0-17.0). Twenty-nine percent of the survivors had subclinical hyperthyroidism. In most survivors, BMD T- and Z-scores were within the reference range during both BMD evaluations. However, after 23.5 years of follow-up, a low BMD was found in 13.0%. In the 13 survivors with permanent hypoparathyroidism, BMD values did not differ after 5 years of follow-up compared with baseline values or in comparison with the 33 survivors without permanent hypoparathyroidism. During follow-up, turnover markers β-CTX and PINP remained stable. Conclusions: This longitudinal study of pediatric DTC survivors demonstrated normal and stable median lumbar spine and femur BMD values after a median time of 17 and 23.5 years after diagnosis. However, compared with controls, a lower BMD was still found in 13.0% after prolonged follow-up despite intensive follow-up. Based on the studied follow-up period, these data do not provide convincing evidence in support of standard monitoring of bone mass among DTC survivors, but may be restricted to individual cases at low frequency. Trial Registration: This follow-up study was registered in The Netherlands Trial Register under no. NL3280 (www.trialregister.nl/trial/3280).
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Affiliation(s)
- Bernadette L Dekker
- Internal Medicine, Department of Endocrinology; Departments of University Medical Center Groningen, Groningen, The Netherlands
| | | | - Adrienne H Brouwers
- Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Graham R Williams
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Marloes Nies
- Internal Medicine, Department of Endocrinology; Departments of University Medical Center Groningen, Groningen, The Netherlands
| | - Mariëlle S Klein Hesselink
- Internal Medicine, Department of Endocrinology; Departments of University Medical Center Groningen, Groningen, The Netherlands
| | - Anouk N A van der Horst-Schrivers
- Internal Medicine, Department of Endocrinology; Departments of University Medical Center Groningen, Groningen, The Netherlands
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bas Havekes
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Sophia Children's Hospital; Rotterdam, The Netherlands
| | | | - John Th M Plukker
- Surgical Oncology, and University Medical Center Groningen, Groningen, The Netherlands
| | - Cecile M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Brandenburg Medical School, Institute of Biostatistics and Registry Research, Neuruppin, Germany
| | - Hanneke M van Santen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes G M Burgerhof
- Epidemiology; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eleonora P M Corssmit
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Romana T Netea-Maier
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine; Erasmus Medical Center, Rotterdam, The Netherlands
- Erasmus MC Academic Center for Thyroid Disease, Rotterdam, The Netherlands
| | - Eveline W C M van Dam
- Division of Endocrinology, Department of Internal Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Annemieke M Boot
- Pediatric Endocrinology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Paediatric Oncology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Gianni Bocca
- Pediatric Endocrinology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Thera P Links
- Internal Medicine, Department of Endocrinology; Departments of University Medical Center Groningen, Groningen, The Netherlands
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6
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Nies M, Arts EGJM, van Velsen EFS, Burgerhof JGM, Muller Kobold AC, Corssmit EPM, Netea-Maier RT, Peeters RP, van der Horst-Schrivers ANA, Cantineau AEP, Links TP. Long-term male fertility after treatment with radioactive iodine for differentiated thyroid carcinoma. Eur J Endocrinol 2021; 185:775-782. [PMID: 34582359 DOI: 10.1530/eje-21-0315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 09/28/2021] [Indexed: 11/08/2022]
Abstract
CONTEXT Whilst radioactive iodine (RAI) is often administered in the treatment for differentiated thyroid carcinoma (DTC), long-term data on male fertility after RAI are scarce. OBJECTIVE To evaluate long-term male fertility after RAI for DTC, and to compare semen quality before and after RAI. DESIGN, SETTING, AND PATIENTS Multicenter study including males with DTC ≥2 years after their final RAI treatment with a cumulative activity of ≥3.7 GBq. MAIN OUTCOME MEASURE(S) Semen analysis, hormonal evaluation, and a fertility-focused questionnaire. Cut-off scores for 'low semen quality' were based on reference values of the general population as defined by the World Health Organization (WHO). RESULTS Fifty-one participants had a median age of 40.5 (interquartile range (IQR): 34.0-49.6) years upon evaluation and a median follow-up of 5.8 (IQR: 3.0-9.5) years after their last RAI administration. The median cumulative administered activity of RAI was 7.4 (range: 3.7-23.3) GBq. The proportion of males with a low semen volume, concentration, progressive motility, or total motile sperm count did not differ from the 10th percentile cut-off of a general population (P = 0.500, P = 0.131, P = 0.094, and P = 0.500, respectively). Cryopreserved semen was used by 1 participant of the 20 who had preserved semen. CONCLUSIONS Participants had a normal long-term semen quality. The proportion of participants with low semen quality parameters scoring below the 10th percentile did not differ from the general population. Cryopreservation of semen of males with DTC is not crucial for conceiving a child after RAI administration but may be considered in individual cases.
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Affiliation(s)
| | - Eus G J M Arts
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Evert F S van Velsen
- Department of Internal Medicine and Erasmus MC Academic Center for Thyroid Disease, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Johannes G M Burgerhof
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anneke C Muller Kobold
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Eleonora P M Corssmit
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Romana T Netea-Maier
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Robin P Peeters
- Department of Internal Medicine and Erasmus MC Academic Center for Thyroid Disease, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Anouk N A van der Horst-Schrivers
- Department of Endocrinology, Internal Medicine
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Astrid E P Cantineau
- Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Meijs AC, Schroijen MA, Snel M, Corssmit EPM. Interleukin-6 producing pheochromocytoma/paraganglioma: case series from a tertiary referral centre for pheochromocytomas and paragangliomas. J Endocrinol Invest 2021; 44:2253-2259. [PMID: 33715142 PMCID: PMC8421286 DOI: 10.1007/s40618-021-01532-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 02/10/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION In addition to catecholamines, pheochromocytomas and paragangliomas (PPGL) may secrete interleukin-6 (IL-6). IL-6 contributes to the development of unusual symptoms, which may hinder the diagnosis. PATIENTS AND METHODS We report the clinical course and subsequent treatment of IL-6 producing PPGL in three patients from a single tertiary referral centre for PPGL patients in the Netherlands. CONCLUSION PPGL combined with persistent elevated inflammatory markers, either in the presence or absence of pyrexia, raised suspicion of IL-6 overproduction in these three patients. Although surgical resection of the tumour is the only curative treatment option, our case series adds to the accumulating evidence that alpha-blockers might be effective in these patients.
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Affiliation(s)
- A C Meijs
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
- Centre for Endocrine Tumours Leiden (CETL), Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - M A Schroijen
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Centre for Endocrine Tumours Leiden (CETL), Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - M Snel
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Centre for Endocrine Tumours Leiden (CETL), Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - E P M Corssmit
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Centre for Endocrine Tumours Leiden (CETL), Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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Berends AMA, Buitenwerf E, Riphagen IJ, Lenders JWM, Timmers HJLM, Kruijff S, Links TP, van der Horst-Schrivers ANA, Stegeman CA, Eekhoff EMW, Feelders RA, Corssmit EPM, Groote Veldman R, Haak HR, Muller Kobold AC, Kerstens MN. Circulating adrenomedullin and B-type natriuretic peptide do not predict blood pressure fluctuations during pheochromocytoma resection: a cross-sectional study. Eur J Endocrinol 2021; 185:507-514. [PMID: 34324433 DOI: 10.1530/eje-20-1452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/28/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Despite adequate presurgical management, blood pressure fluctuations are common during resection of pheochromocytoma or sympathetic paraganglioma (PPGL). To a large extent, the variability in blood pressure control during PPGL resection remains unexplained. Adrenomedullin and B-type natriuretic peptide, measured as MR-proADM and NT-proBNP, respectively, are circulating biomarkers of cardiovascular dysfunction. We investigated whether plasma levels of MR-proADM and NT-proBNP are associated with blood pressure fluctuations during PPGL resection. METHODS Study subjects participated in PRESCRIPT, a randomized controlled trial in patients undergoing PPGL resection. MR-proADM and NT-proBNP were determined in a single plasma sample drawn before surgery. Multivariable linear and logistic regression analyses were used to explore associations between these biomarkers and blood pressure fluctuations, use of vasoconstrictive agents during surgery as well as the occurrence of perioperative cardiovascular events. RESULTS A total of 126 PPGL patients were included. Median plasma concentrations of MR-proADM and NT-proBNP were 0.51 (0.41-0.63) nmol/L and 68.7 (27.9-150.4) ng/L, respectively. Neither MR-proADM nor NT-proBNP were associated with blood pressure fluctuations. There was a positive correlation between MR-proADM concentration and the cumulative dose of vasoconstrictive agents (03B2 0.44, P =0.001). Both MR-proADM and NT-proBNP were significantly associated with perioperative cardiovascular events (OR: 5.46, P =0.013 and OR: 1.54, P =0.017, respectively). CONCLUSIONS plasma MR-proADM or NT-proBNP should not be considered as biomarkers for the presurgical risk assessment of blood pressure fluctuations during PPGL resection. Future studies are needed to explore the potential influence of these biomarkers on the intraoperative requirement of vasoconstrictive agents and the perioperative cardiovascular risk.
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Affiliation(s)
| | | | - Ineke J Riphagen
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jacques W M Lenders
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Medicine III, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Henri J L M Timmers
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Thera P Links
- Department of Endocrinology, Groningen, The Netherlands
| | | | - Coen A Stegeman
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elisabeth M W Eekhoff
- Department of Internal Medicine Section Endocrinology, Amsterdam University Medical Centers location VUmc, Amsterdam, The Netherlands
| | - Richard A Feelders
- Department of Endocrinology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eleonora P M Corssmit
- Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Harm R Haak
- Department of Internal Medicine, Máxima Medical Center, Eindhoven/Veldhoven, The Netherlands
- Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht, The Netherlands
- Division of General Internal Medicine, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Anneke C Muller Kobold
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Meijs AC, Snel M, Corssmit EPM. Pheochromocytoma/paraganglioma crisis: case series from a tertiary referral center for pheochromocytomas and paragangliomas. Hormones (Athens) 2021; 20:395-403. [PMID: 33575936 PMCID: PMC8110488 DOI: 10.1007/s42000-021-00274-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/25/2021] [Indexed: 12/22/2022]
Abstract
Pheochromocytoma/paraganglioma (PPGL)-induced catecholamine crisis is a rare endocrine emergency leading to life-threatening hemodynamic instability causing end-organ damage or dysfunction. As it is associated with a significant mortality rate of approximately 15%, recognizing the signs and symptoms and making the appropriate diagnosis are critical. For this purpose, we report the clinical course of the crisis in four out of a total of six patients with a PPGL crisis from a cohort of 199 PPGL patients of a single tertiary referral center for PPGL patients in the Netherlands diagnosed between 2002 and 2020. Successful treatment of a PPGL crisis demands prompt diagnosis, vigorous pharmacological therapy, and emergency tumor removal if the patient continues to deteriorate.
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Affiliation(s)
- Anouk C Meijs
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Marieke Snel
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Eleonora P M Corssmit
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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10
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Buffet A, Zhang J, Rebel H, Corssmit EPM, Jansen JC, Hensen EF, Bovée JVMG, Morini A, Gimenez-Roqueplo AP, Hes FJ, Devilee P, Favier J, Bayley JP. Germline DLST Variants Promote Epigenetic Modifications in Pheochromocytoma-Paraganglioma. J Clin Endocrinol Metab 2021; 106:459-471. [PMID: 33180916 DOI: 10.1210/clinem/dgaa819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Indexed: 02/02/2023]
Abstract
CONTEXT Pheochromocytomas and paragangliomas (PPGLs) are neuroendocrine tumors in which altered central metabolism appears to be a major driver of tumorigenesis, and many PPGL genes encode proteins involved in the tricarboxylic acid (TCA) cycle. OBJECTIVE/DESIGN While about 40% of PPGL cases carry a variant in a known gene, many cases remain unexplained. In patients with unexplained PPGL showing clear evidence of a familial burden or multiple tumors, we aimed to identify causative factors using genetic analysis of patient DNA and functional analyses of identified DNA variants in patient tumor material and engineered cell lines. PATIENTS AND SETTING Patients with a likely familial cancer burden of pheochromocytomas and/or paragangliomas and under investigation in a clinical genetic and clinical research setting in university hospitals. RESULTS While investigating unexplained PPGL cases, we identified a novel variant, c.1151C>T, p.(Pro384Leu), in exon 14 of the gene encoding dihydrolipoamide S-succinyltransferase (DLST), a component of the multi-enzyme complex 2-oxoglutarate dehydrogenase. Targeted sequence analysis of further unexplained cases identified a patient carrying a tumor with compound heterozygous variants in DLST, consisting of a germline variant, c.1121G>A, p.(Gly374Glu), together with a somatic missense variant identified in tumor DNA, c.1147A>G, p.(Thr383Ala), both located in exon 14. Using a range of in silico and functional assays we show that these variants are predicted to be pathogenic, profoundly impact enzyme activity, and result in DNA hypermethylation. CONCLUSIONS The identification and functional analysis of these DLST variants further validates DLST as an additional PPGL gene involved in the TCA cycle.
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Affiliation(s)
- Alexandre Buffet
- Université de Paris, PARCC, INSERM, Equipe Labellisée par la Ligue contre le Cancer, F-75015 Paris, France
- Genetic department, Adrenal Referral Center, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, F-75015 Paris, France
| | - Juan Zhang
- Department of Human Genetics, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - Heggert Rebel
- Department of Human Genetics, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - Eleonora P M Corssmit
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - Jeroen C Jansen
- Department of Otorhinolaryngology, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - Erik F Hensen
- Department of Otorhinolaryngology, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - Judith V M G Bovée
- Department of Pathology, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - Aurélien Morini
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Département d'anatomo-pathologie, F-75015 Paris, France
| | - Anne-Paule Gimenez-Roqueplo
- Université de Paris, PARCC, INSERM, Equipe Labellisée par la Ligue contre le Cancer, F-75015 Paris, France
- Genetic department, Adrenal Referral Center, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, F-75015 Paris, France
| | - Frederik J Hes
- Department of Clinical Genetics, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - Peter Devilee
- Department of Human Genetics, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
- Department of Pathology, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - Judith Favier
- Genetic department, Adrenal Referral Center, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, F-75015 Paris, France
| | - Jean-Pierre Bayley
- Department of Human Genetics, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
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Nies M, Cantineau AEP, Arts EGJM, van den Berg MH, van Leeuwen FE, Muller Kobold AC, Klein Hesselink MS, Burgerhof JGM, Brouwers AH, van Dam EWCM, Havekes B, van den Heuvel-Eibrink MM, Corssmit EPM, Kremer LCM, Netea-Maier RT, van der Pal HJH, Peeters RP, Plukker JTM, Ronckers CM, van Santen HM, van der Horst-Schrivers ANA, Tissing WJE, Bocca G, van Dulmen-den Broeder E, Links TP. Long-Term Effects of Radioiodine Treatment on Female Fertility in Survivors of Childhood Differentiated Thyroid Carcinoma. Thyroid 2020; 30:1169-1176. [PMID: 32079487 DOI: 10.1089/thy.2019.0560] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: Differentiated thyroid carcinoma (DTC) during childhood is a rare disease. Its excellent survival rate requires a focus on possible long-term adverse effects. This study aimed to evaluate fertility in female survivors of childhood DTC by assessing various reproductive characteristics combined with anti-Müllerian hormone (AMH) levels (a marker of ovarian reserve). Methods: Female survivors of childhood DTC, diagnosed at ≤18 years of age between 1970 and 2013, were included. Survivors were excluded when follow-up time was less than five years or if they developed other malignancies before or after diagnosis of DTC. Survivors filled out a questionnaire regarding reproductive characteristics (e.g., age at menarche and menopause, pregnancies, pregnancy outcomes, need for assisted reproductive therapy). Survivors aged <18 years during evaluation received an altered questionnaire without questions regarding pregnancy and pregnancy outcomes. These data were combined with information from medical records. AMH levels were measured in serum samples and were compared with AMH levels from 420 women not treated for cancer. Results: Fifty-six survivors with a median age of 31.0 (interquartile range, IQR, 25.1-39.6) years were evaluated after a median follow-up of 15.4 (IQR 8.3-24.7) years. The median cumulative dose of 131I administered was 7.4 (IQR 3.7-13.0) GBq/200.0 (IQR 100.0-350.0) mCi. Twenty-five of the 55 survivors aged 18 years or older during evaluation reported 64 pregnancies, 45 of which resulted in live birth. Of these 55, 10.9% visited a fertility clinic. None of the survivors reported premature menopause. Age at AMH evaluation did not differ between DTC survivors and the comparison group (p = 0.268). Median AMH levels did not differ between DTC survivors and the comparison group [2.0 (IQR 1.0-3.7) μg/L vs. 1.6 (IQR 0.6-3.1) μg/L, respectively, p = 0.244]. The cumulative dose of 131I was not associated with AMH levels in DTC survivors (rs = 0.210, p = 0.130). Conclusions: Female survivors of DTC who received 131I treatment during childhood do not appear to have major abnormalities in reproductive characteristics nor in predictors of ovarian failure.
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Affiliation(s)
- Marloes Nies
- Department of Endocrinology, Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Astrid E P Cantineau
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eus G J M Arts
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marleen H van den Berg
- Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Anneke C Muller Kobold
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mariëlle S Klein Hesselink
- Department of Endocrinology, Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johannes G M Burgerhof
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adrienne H Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eveline W C M van Dam
- Department of Internal Medicine, VU University Medical Center Amsterdam UMC, Amsterdam, The Netherlands
| | - Bas Havekes
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eleonora P M Corssmit
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Leontien C M Kremer
- Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Romana T Netea-Maier
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Helena J H van der Pal
- Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Oncology, Academic Medical Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Rotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - John T M Plukker
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Cécile M Ronckers
- Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Medical University Brandenburg, Neuruppin, Germany
| | - Hanneke M van Santen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anouk N A van der Horst-Schrivers
- Department of Endocrinology, Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Paediatric Oncology and Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gianni Bocca
- Department of Pediatric Endocrinology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eline van Dulmen-den Broeder
- Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Thera P Links
- Department of Endocrinology, Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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12
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Buitenwerf E, Osinga TE, Timmers HJLM, Lenders JWM, Feelders RA, Eekhoff EMW, Haak HR, Corssmit EPM, Bisschop PHLT, Valk GD, Veldman RG, Dullaart RPF, Links TP, Voogd MF, Wietasch GJKG, Kerstens MN. Efficacy of α-Blockers on Hemodynamic Control during Pheochromocytoma Resection: A Randomized Controlled Trial. J Clin Endocrinol Metab 2020; 105:5622983. [PMID: 31714582 PMCID: PMC7261201 DOI: 10.1210/clinem/dgz188] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/27/2020] [Indexed: 12/14/2022]
Abstract
CONTEXT Pretreatment with α-adrenergic receptor blockers is recommended to prevent hemodynamic instability during resection of a pheochromocytoma or sympathetic paraganglioma (PPGL). OBJECTIVE To determine which type of α-adrenergic receptor blocker provides the best efficacy. DESIGN Randomized controlled open-label trial (PRESCRIPT; ClinicalTrials.gov NCT01379898). SETTING Multicenter study including 9 centers in The Netherlands. PATIENTS 134 patients with nonmetastatic PPGL. INTERVENTION Phenoxybenzamine or doxazosin starting 2 to 3 weeks before surgery using a blood pressure targeted titration schedule. Intraoperative hemodynamic management was standardized. MAIN OUTCOME MEASURES Primary efficacy endpoint was the cumulative intraoperative time outside the blood pressure target range (ie, SBP >160 mmHg or MAP <60 mmHg) expressed as a percentage of total surgical procedure time. Secondary efficacy endpoint was the value on a hemodynamic instability score. RESULTS Median cumulative time outside blood pressure targets was 11.1% (interquartile range [IQR]: 4.3-20.6] in the phenoxybenzamine group compared to 12.2% (5.3-20.2)] in the doxazosin group (P = .75, r = 0.03). The hemodynamic instability score was 38.0 (28.8-58.0) and 50.0 (35.3-63.8) in the phenoxybenzamine and doxazosin group, respectively (P = .02, r = 0.20). The 30-day cardiovascular complication rate was 8.8% and 6.9% in the phenoxybenzamine and doxazosin group, respectively (P = .68). There was no mortality after 30 days. CONCLUSIONS The duration of blood pressure outside the target range during resection of a PPGL was not different after preoperative treatment with either phenoxybenzamine or doxazosin. Phenoxybenzamine was more effective in preventing intraoperative hemodynamic instability, but it could not be established whether this was associated with a better clinical outcome.
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Affiliation(s)
- Edward Buitenwerf
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Correspondence and Reprint Requests: Edward Buitenwerf, MD, Department of Endocrinology (AA31), University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands. E-mail:
| | - Thamara E Osinga
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henri J L M Timmers
- Department of Internal Medicine, Section of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jacques W M Lenders
- Department of Internal Medicine, Section of Vascular Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Richard A Feelders
- Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Elisabeth M W Eekhoff
- Department of Internal Medicine, Endocrinology Section, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Harm R Haak
- Department of Internal Medicine, Máxima Medical Center, Eindhoven, The Netherlands
- Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Eleonora P M Corssmit
- Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter H L T Bisschop
- Department of Endocrinology and Metabolism, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Gerlof D Valk
- Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Robin P F Dullaart
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Thera P Links
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Magiel F Voogd
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Götz J K G Wietasch
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel N Kerstens
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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13
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Dreijerink KMA, Rijken JA, Compaijen CJ, Timmers HJLM, van der Horst-Schrivers ANA, van Leeuwaarde RS, van Dam PS, Leemans CR, van Dam EWCM, Dickhoff C, Dommering CJ, de Graaf P, Zwezerijnen GJC, van der Valk P, Menke-Van der Houven van Oordt CW, Hensen EF, Corssmit EPM, Eekhoff EMW. Biochemically Silent Sympathetic Paraganglioma, Pheochromocytoma, or Metastatic Disease in SDHD Mutation Carriers. J Clin Endocrinol Metab 2019; 104:5421-5426. [PMID: 31194241 DOI: 10.1210/jc.2019-00202] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/07/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT Current guidelines do not consistently recommend imaging beyond the head and neck region in succinate dehydrogenase subunit D (SDHD) mutation carriers as long as catecholamine metabolite levels are within the reference range. PARTICIPANTS We report a series of 10 patients carrying pathogenic variants in the SDHD gene from five tertiary referral centers for paraganglioma (PGL) in the Netherlands, who presented with a sympathetic PGL (sPGL), pheochromocytoma (PHEO), or metastases outside the head and neck region in the absence of excessive catecholamine production. Two of six patients with a biochemically silent sPGL/PHEO developed metastatic disease. Additionally, four patients were found to have metastases outside the head and neck region from head and neck PGL. The average interval between the initial diagnosis and discovery of the silent lesions was 10 (range, 0 to 32) years. CONCLUSIONS The absence of excessive catecholamine production does not exclude the presence of manifestations of SDHD outside the head and neck region. These findings suggest that a more extensive imaging strategy in SDHD mutation carriers may be warranted for detection of biochemically silent lesions.
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Affiliation(s)
- Koen M A Dreijerink
- Department of Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, HV Amsterdam, Netherlands
| | - Johannes A Rijken
- Department of Otolaryngology/Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, HZ Amsterdam, Netherlands
| | - C J Compaijen
- Department of Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, HV Amsterdam, Netherlands
| | - Henri J L M Timmers
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, GA Nijmegen, Netherlands
| | | | - Rachel S van Leeuwaarde
- Department of Endocrine Oncology, University Medical Center Utrecht, GA Utrecht, Netherlands
| | - P Sytze van Dam
- Department of Internal Medicine, OLVG Hospital, AC Amsterdam, Netherlands
| | - C René Leemans
- Department of Otolaryngology/Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, HZ Amsterdam, Netherlands
| | - Eveline W C M van Dam
- Department of Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, HV Amsterdam, Netherlands
| | - Chris Dickhoff
- Department of Surgery and Cardiothoracic Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, HV Amsterdam, Netherlands
| | - Charlotte J Dommering
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, HV Amsterdam, Netherlands
| | - Pim de Graaf
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, HV Amsterdam, Netherlands
| | - G J C Zwezerijnen
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, HV Amsterdam, Netherlands
| | - Paul van der Valk
- Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, HV Amsterdam, Netherlands
| | | | - Erik F Hensen
- Department of Otolaryngology/Head and Neck Surgery, Leiden University Medical Center, ZA Leiden, Netherlands
| | - Eleonora P M Corssmit
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, ZA Leiden, Netherlands
| | - E Marelise W Eekhoff
- Department of Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, HV Amsterdam, Netherlands
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Bayley JP, Bausch B, Rijken JA, van Hulsteijn LT, Jansen JC, Ascher D, Pires DEV, Hes FJ, Hensen EF, Corssmit EPM, Devilee P, Neumann HPH. Variant type is associated with disease characteristics in SDHB, SDHC and SDHD-linked phaeochromocytoma-paraganglioma. J Med Genet 2019; 57:96-103. [PMID: 31492822 DOI: 10.1136/jmedgenet-2019-106214] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/09/2019] [Accepted: 07/24/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Pathogenic germline variants in subunits of succinate dehydrogenase (SDHB, SDHC and SDHD) are broadly associated with disease subtypes of phaeochromocytoma-paraganglioma (PPGL) syndrome. Our objective was to investigate the role of variant type (ie, missense vs truncating) in determining tumour phenotype. METHODS Three independent datasets comprising 950 PPGL and head and neck paraganglioma (HNPGL) patients were analysed for associations of variant type with tumour type and age-related tumour risk. All patients were carriers of pathogenic germline variants in the SDHB, SDHC or SDHD genes. RESULTS Truncating SDH variants were significantly over-represented in clinical cases compared with missense variants, and carriers of SDHD truncating variants had a significantly higher risk for PPGL (p<0.001), an earlier age of diagnosis (p<0.0001) and a greater risk for PPGL/HNPGL comorbidity compared with carriers of missense variants. Carriers of SDHB truncating variants displayed a trend towards increased risk of PPGL, and all three SDH genes showed a trend towards over-representation of missense variants in HNPGL cases. Overall, variant types conferred PPGL risk in the (highest-to-lowest) sequence SDHB truncating, SDHB missense, SDHD truncating and SDHD missense, with the opposite pattern apparent for HNPGL (p<0.001). CONCLUSIONS SDHD truncating variants represent a distinct group, with a clinical phenotype reminiscent of but not identical to SDHB. We propose that surveillance and counselling of carriers of SDHD should be tailored by variant type. The clinical impact of truncating SDHx variants is distinct from missense variants and suggests that residual SDH protein subunit function determines risk and site of disease.
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Affiliation(s)
- Jean Pierre Bayley
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Birke Bausch
- Department of Medicine II, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Johannes Adriaan Rijken
- Department of Otorhinolaryngology - Head & Neck Surgery, Free University Medical Center, Amsterdam, The Netherlands
| | | | - Jeroen C Jansen
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands
| | - David Ascher
- Department of Biochemistry and Molecular Biology, The University of Melbourne Bio21 Molecular Science and Biotechnology Institute, Parkville, Victoria, Australia
| | | | - Frederik J Hes
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Erik F Hensen
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands
| | - Eleonora P M Corssmit
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter Devilee
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hartmut P H Neumann
- Section for Preventive Medicine, Faculty of Medicine, Albert-Ludwigs-University, Freiburg, Germany
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Neumann HPH, Tsoy U, Bancos I, Amodru V, Walz MK, Tirosh A, Kaur RJ, McKenzie T, Qi X, Bandgar T, Petrov R, Yukina MY, Roslyakova A, van der Horst-Schrivers ANA, Berends AMA, Hoff AO, Castroneves LA, Ferrara AM, Rizzati S, Mian C, Dvorakova S, Hasse-Lazar K, Kvachenyuk A, Peczkowska M, Loli P, Erenler F, Krauss T, Almeida MQ, Liu L, Zhu F, Recasens M, Wohllk N, Corssmit EPM, Shafigullina Z, Calissendorff J, Grozinsky-Glasberg S, Kunavisarut T, Schalin-Jäntti C, Castinetti F, Vlček P, Beltsevich D, Egorov VI, Schiavi F, Links TP, Lechan RM, Bausch B, Young WF, Eng C. Comparison of Pheochromocytoma-Specific Morbidity and Mortality Among Adults With Bilateral Pheochromocytomas Undergoing Total Adrenalectomy vs Cortical-Sparing Adrenalectomy. JAMA Netw Open 2019; 2:e198898. [PMID: 31397861 PMCID: PMC6692838 DOI: 10.1001/jamanetworkopen.2019.8898] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Large studies investigating long-term outcomes of patients with bilateral pheochromocytomas treated with either total or cortical-sparing adrenalectomies are needed to inform clinical management. OBJECTIVE To determine the association of total vs cortical-sparing adrenalectomy with pheochromocytoma-specific mortality, the burden of primary adrenal insufficiency after bilateral adrenalectomy, and the risk of pheochromocytoma recurrence. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from a multicenter consortium-based registry for 625 patients treated for bilateral pheochromocytomas between 1950 and 2018. Data were analyzed from September 1, 2018, to June 1, 2019. EXPOSURES Total or cortical-sparing adrenalectomy. MAIN OUTCOMES AND MEASURES Primary adrenal insufficiency, recurrent pheochromocytoma, and mortality. RESULTS Of 625 patients (300 [48%] female) with a median (interquartile range [IQR]) age of 30 (22-40) years at diagnosis, 401 (64%) were diagnosed with synchronous bilateral pheochromocytomas and 224 (36%) were diagnosed with metachronous pheochromocytomas (median [IQR] interval to second adrenalectomy, 6 [1-13] years). In 505 of 526 tested patients (96%), germline mutations were detected in the genes RET (282 patients [54%]), VHL (184 patients [35%]), and other genes (39 patients [7%]). Of 849 adrenalectomies performed in 625 patients, 324 (52%) were planned as cortical sparing and were successful in 248 of 324 patients (76.5%). Primary adrenal insufficiency occurred in all patients treated with total adrenalectomy but only in 23.5% of patients treated with attempted cortical-sparing adrenalectomy. A third of patients with adrenal insufficiency developed complications, such as adrenal crisis or iatrogenic Cushing syndrome. Of 377 patients who became steroid dependent, 67 (18%) developed at least 1 adrenal crisis and 50 (13%) developed iatrogenic Cushing syndrome during median (IQR) follow-up of 8 (3-25) years. Two patients developed recurrent pheochromocytoma in the adrenal bed despite total adrenalectomy. In contrast, 33 patients (13%) treated with successful cortical-sparing adrenalectomy developed another pheochromocytoma within the remnant adrenal after a median (IQR) of 8 (4-13) years, all of which were successfully treated with another surgery. Cortical-sparing surgery was not associated with survival. Overall survival was associated with comorbidities unrelated to pheochromocytoma: of 63 patients who died, only 3 (5%) died of metastatic pheochromocytoma. CONCLUSIONS AND RELEVANCE Patients undergoing cortical-sparing adrenalectomy did not demonstrate decreased survival, despite development of recurrent pheochromocytoma in 13%. Cortical-sparing adrenalectomy should be considered in all patients with hereditary pheochromocytoma.
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Affiliation(s)
- Hartmut P. H. Neumann
- Section of Preventive Medicine, Medical Center–University of Freiburg, Faculty of Medicine, Albert-Ludwig-University Freiburg, Freiburg, Germany
| | - Uliana Tsoy
- Neuroendocrinology Laboratory, Endocrinology Institute, Almazov National Medical Research Centre, St Petersburg, Russia
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Vincent Amodru
- Aix Marseille University, INSERM, Marseille Medical Genetics, Department of Endocrinology, Assistance Publique Hopitaux de Marseille, Marseille, France
| | - Martin K. Walz
- Department of Surgery, Huyssens Foundation Clinics, Essen, Germany
| | - Amit Tirosh
- Neuroendocrine Tumors Service, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ravinder Jeet Kaur
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Travis McKenzie
- Division of General Surgery, Mayo Clinic, Rochester, Minnesota
| | - Xiaoping Qi
- Department of Oncologic and Urologic Surgery, the 903rd PLA Hospital, Wenzhou Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Tushar Bandgar
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Roman Petrov
- Department of Surgical Oncology, Bakhrushin Brothers Moscow City Hospital, Moscow, Russia
| | - Marina Y. Yukina
- Department of Surgery, Endocrinology Research Center, Moscow, Russia
| | - Anna Roslyakova
- Department of Surgery, Endocrinology Research Center, Moscow, Russia
| | | | - Annika M. A. Berends
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ana O. Hoff
- Instituto do Cancer do Estado de São Paulo (ICESP), Serviço de Endocrinologia, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luciana Audi Castroneves
- Instituto do Cancer do Estado de São Paulo (ICESP), Serviço de Endocrinologia, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Silvia Rizzati
- Familial Cancer Clinic and Oncoendocrinology, Veneto Institute of Oncology IOV–IRCCS, Padua, Italy
| | - Caterina Mian
- Operative Unit of the Endocrinology Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Sarka Dvorakova
- Department of Molecular Endocrinology, Institute of Endocrinology, Prague, Czech Republic
| | - Kornelia Hasse-Lazar
- Department of Endocrine Oncology and Nuclear Medicine, Maria Sklodowska-Curie Institute–Oncology Center, Gliwice Branch, Gliwice, Poland
| | - Andrey Kvachenyuk
- Institute of Endocrinology and Metabolism NAMS of Ukraine, Kiev, Ukraine
| | | | - Paola Loli
- Department of Endocrinology, Ospedale Niguarda Cà Granda, Milan, Italy
| | - Feyza Erenler
- Department of Medicine, Division of Endocrinology, Tufts Medical Center, Boston, Massachusetts
| | - Tobias Krauss
- Department of Radiology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Madson Q. Almeida
- Instituto do Cancer do Estado de São Paulo (ICESP), Serviço de Endocrinologia, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Longfei Liu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Feizhou Zhu
- Department of Biochemistry and Molecular Biology, School of Life Sciences, Central South University, Changsha, China
| | - Mònica Recasens
- Hospital Universitari de Girona, Gerencia Territorial Girona, Institut Català de la Salut, Girona, Spain
| | - Nelson Wohllk
- Endocrine Section, Hospital del Salvador, Santiago de Chile, Department of Medicine University of Chile, Santiago, Chile
| | - Eleonora P. M. Corssmit
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Zulfiya Shafigullina
- Department of Endocrinology, E.E. Eichwald Clinic, I.I. Mechnikov Northwestern State Medical University, St Petersburg, Russia
| | - Jan Calissendorff
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Simona Grozinsky-Glasberg
- Neuroendocrine Tumor Unit, Endocrinology and Metabolism Service, Department of Medicine, ENETS Centre of Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Tada Kunavisarut
- Division of Endocrinology and Metabolism, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Camilla Schalin-Jäntti
- Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Frederic Castinetti
- Aix Marseille University, INSERM, Marseille Medical Genetics, Department of Endocrinology, Assistance Publique Hopitaux de Marseille, Marseille, France
| | - Petr Vlček
- Department of Nuclear Medicine and Endocrinology, Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Dmitry Beltsevich
- Department of Surgery, Endocrinology Research Center, Moscow, Russia
| | - Viacheslav I. Egorov
- Department of Surgical Oncology, Bakhrushin Brothers Moscow City Hospital, Moscow, Russia
| | - Francesca Schiavi
- Familial Cancer Clinic and Oncoendocrinology, Veneto Institute of Oncology IOV–IRCCS, Padua, Italy
| | - Thera P. Links
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ronald M. Lechan
- Department of Medicine, Division of Endocrinology, Tufts Medical Center, Boston, Massachusetts
| | - Birke Bausch
- Department of Medicine II, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - William F. Young
- Department of Oncologic and Urologic Surgery, the 903rd PLA Hospital, Wenzhou Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Charis Eng
- Genomic Medicine Institute, Lerner Research Institute and Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
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van der Tuin K, Ventayol Garcia M, Corver WE, Khalifa MN, Ruano Neto D, Corssmit EPM, Hes FJ, Links TP, Smit JWA, Plantinga TS, Kapiteijn E, van Wezel T, Morreau H. Targetable gene fusions identified in radioactive iodine refractory advanced thyroid carcinoma. Eur J Endocrinol 2019; 180:235-241. [PMID: 30668525 DOI: 10.1530/eje-18-0653] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/21/2019] [Indexed: 12/12/2022]
Abstract
Objective Gene alterations leading to activation of the MAPK pathway are of interest for targeted therapy in patients with advanced radioactive iodine refractory (RAI-R) thyroid carcinoma. Due to technical reasons gene fusion analysis in RNA isolated from formalin-fixed tumor tissues has till now been limited. The objective of the present study was to identify targetable gene rearrangements in RNA isolated from formalin-fixed RAI-R thyroid carcinomas. Design Retrospective study in 132 patients with RAI-R thyroid carcinoma (59 papillary-, 24 follicular-, 35 Hürthle cell- and 14 anaplastic thyroid carcinoma). Methods Total nucleic acid (undivided DNA and RNA) was isolated from formalin-fixed tissue. Extensive gene fusion analysis was performed in all samples that tested negative for pathogenic BRAF, NRAS, HRAS and KRAS variants. Results Seven targetable gene fusions were identified in the remaining 60 samples without known DNA variants. This includes frequently reported gene fusions such as CCDC6/RET (PTC1), PRKAR1A/RET (PTC2) and ETV6/NTRK3 , and gene fusions that are less common in thyroid cancer (TPM3/NTRK1, EML4/ALK and EML4/NTRK3). Of note, most gene fusions were detected in papillary thyroid carcinoma and MAPK-associated alterations in Hürthle cell carcinomas are rare (2/35). Conclusion Targetable gene fusions were found in 12% of RAI-R thyroid carcinoma without DNA variants and can be effectively identified in formalin-fixed tissue. These gene fusions might provide a preclinical rationale to include specific kinase inhibitors in the treatment regimen for these patients. The latter intends to restore iodine transport and/or take advantage of the direct effect on tumor cell vitality once progressive disease is seen.
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Affiliation(s)
- K van der Tuin
- Department of Clinical Genetics, Division of Endocrinology, Leiden University Medical Centre, Leiden, the Netherlands
| | - M Ventayol Garcia
- Department of Pathology, Division of Endocrinology, Leiden University Medical Centre, Leiden, the Netherlands
| | - W E Corver
- Department of Pathology, Division of Endocrinology, Leiden University Medical Centre, Leiden, the Netherlands
| | - M N Khalifa
- Department of Pathology, Division of Endocrinology, Leiden University Medical Centre, Leiden, the Netherlands
| | - D Ruano Neto
- Department of Pathology, Division of Endocrinology, Leiden University Medical Centre, Leiden, the Netherlands
| | - E P M Corssmit
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Leiden, the Netherlands
| | - F J Hes
- Department of Clinical Genetics, Division of Endocrinology, Leiden University Medical Centre, Leiden, the Netherlands
| | - T P Links
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - J W A Smit
- Department of Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - T S Plantinga
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - E Kapiteijn
- Department of Oncology, Leiden University Medical Centre, Leiden, the Netherlands
| | - T van Wezel
- Department of Pathology, Division of Endocrinology, Leiden University Medical Centre, Leiden, the Netherlands
| | - H Morreau
- Department of Pathology, Division of Endocrinology, Leiden University Medical Centre, Leiden, the Netherlands
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Nederstigt C, Uitbeijerse BS, Janssen LGM, Corssmit EPM, de Koning EJP, Dekkers OM. Associated auto-immune disease in type 1 diabetes patients: a systematic review and meta-analysis. Eur J Endocrinol 2019; 180:135-144. [PMID: 30508413 DOI: 10.1530/eje-18-0515] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/30/2018] [Indexed: 12/29/2022]
Abstract
Introduction The association between type 1 diabetes (T1D) and other auto-immune diseases is well known. However, a quantitative overview of all associated auto-immune diseases and their prevalence in T1D is lacking. Methods We searched PubMed, Web of Science, EMBASE and Cochrane library in September 2018 to identify relevant articles about the prevalence of the following associated auto-immune diseases in T1D cohorts: auto-immune thyroid disease, celiac disease, gastric autoimmunity including pernicious anemia, vitiligo and adrenal gland insufficiency. A meta-analysis was performed to estimate pooled prevalence using a random-effects model. Furthermore, random-effects meta-regression analysis was performed to assess the association between prevalence and mean age or diabetes duration. Results One hundred eighty articles were eligible including a total of 293 889 type 1 diabetes patients. Hypothyroidism (65 studies) was prevalent in 9.8% (95% CI: 7.5-12.3) of patients. Meta-regression showed that for every 10-year age increase, hypothyroidism prevalence increased 4.6% (95% CI: 2.6-6.6, P < 0.000, 54 studies). Weighted prevalence of celiac disease was 4.5% (95% CI: 4.0-5.5, 87 studies). Gastric autoimmunity was found in 4.3% of patients (95% CI: 1.6-8.2, 8 studies) and vitiligo in 2.4% (95% CI: 1.2-3.9, 14 studies) of patients. The prevalence of adrenal insufficiency was 0.2% (95% CI: 0.0-0.4, 14 studies) and hyperthyroidism was found in 1.3 percent (95% CI: 0.9-1.8, 45 studies) of type 1 diabetes patients. For all analyses, statistical heterogeneity between studies was moderate to high. Conclusions The prevalence of antibody-mediated auto-immune disease is high among type 1 diabetes patients. Especially hypothyroidism and celiac disease are frequently found.
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Affiliation(s)
- C Nederstigt
- Department of Internal Medicine, Section Endocrinology & Metabolism
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - B S Uitbeijerse
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - L G M Janssen
- Department of Internal Medicine, Section Endocrinology & Metabolism
| | - E P M Corssmit
- Department of Internal Medicine, Section Endocrinology & Metabolism
| | - E J P de Koning
- Department of Internal Medicine, Section Endocrinology & Metabolism
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - O M Dekkers
- Department of Internal Medicine, Section Endocrinology & Metabolism
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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18
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Selvakumar T, Nies M, Klein Hesselink MS, Brouwers AH, van der Horst-Schrivers ANA, Klein Hesselink EN, Tissing WJE, Vissink A, Links TP, Bocca G, Burgerhof JGM, van Dam EWCM, Havekes B, van den Heuvel-Eibrink MM, Corssmit EPM, Kremer LCM, Netea-Maier RT, van der Pal HJH, Peeters RP, Smit JWA, Plukker JTM, Ronckers CM, van Santen HM. Long-term effects of radioiodine treatment on salivary gland function in adult survivors of pediatric differentiated thyroid carcinoma. J Nucl Med 2018; 60:jnumed.118.212449. [PMID: 30504138 DOI: 10.2967/jnumed.118.212449] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/18/2018] [Indexed: 01/17/2023] Open
Abstract
Pediatric differentiated thyroid cancer (DTC) is a rare disease. Initial treatment of DTC consists of a (near) total thyroidectomy and radioactive iodine (131I) therapy. Previous studies in adults showed that 131I treatment may result in a reduced salivary gland function. Studies regarding salivary gland function in children treated for DTC are sparse. Our aim was to assess long-term effects of 131I treatment on salivary gland function in survivors of pediatric DTC. Methods: In a nationwide cross-sectional study, salivary gland function of patients treated for pediatric DTC between 1970 and 2013 (>5 years after diagnosis, ≥18 years old at time of evaluation) was studied. Salivary gland function was assessed by sialometry, sialochemistry and a xerostomia inventory. Salivary gland dysfunction was defined as unstimulated whole saliva flow ≤0.2mL/min and/or a stimulated whole saliva flow ≤0.7 mL/min. Results: Sixty-five patients (median age at evaluation 33 [IQR, 25-40] years, 86.2% female, median follow-up period 11 [IQR, 6-22] years) underwent 131I treatment. Median cumulative 131I activity was 5.88 [IQR, 2.92-12.95] GBq, 47.7% underwent multiple 131I administrations. Salivary gland dysfunction was present in 30 (47.6%) patients. Levels of amylase and total protein in saliva were reduced. Moderate to severe xerostomia was present in 22 (35.5%) patients. Stimulated salivary secretion was lower and severity of xerostomia complaints higher in patients treated with higher cumulative 131I activity. Conclusion: In survivors of pediatric DTC, clinically significant salivary gland dysfunction was found in 35.5% and was related to the cumulative 131I activity of the treatment.
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Affiliation(s)
- Tharsana Selvakumar
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Netherlands
| | - Marloes Nies
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Netherlands
| | | | - Adrienne H Brouwers
- Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Netherlands
| | | | - Esther N Klein Hesselink
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Netherlands
| | - Wim J E Tissing
- Department of Pediatric Oncology, University of Groningen, University Medical Center Groningen, Netherlands
| | - Arjan Vissink
- Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Netherlands
| | - Thera P Links
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Netherlands
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Heesterman BL, Bokhorst JM, de Pont LMH, Verbist BM, Bayley JP, van der Mey AGL, Corssmit EPM, Hes FJ, van Benthem PPG, Jansen JC. Mathematical Models for Tumor Growth and the Reduction of Overtreatment. J Neurol Surg B Skull Base 2018; 80:72-78. [PMID: 30733904 DOI: 10.1055/s-0038-1667148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 06/13/2018] [Indexed: 01/22/2023] Open
Abstract
Background To improve our understanding of the natural course of head and neck paragangliomas (HNPGL) and ultimately differentiate between cases that benefit from early treatment and those that are best left untreated, we studied the growth dynamics of 77 HNPGL managed with primary observation. Methods Using digitally available magnetic resonance images, tumor volume was estimated at three time points. Subsequently, nonlinear least squares regression was used to fit seven mathematical models to the observed growth data. Goodness of fit was assessed with the coefficient of determination ( R 2 ) and root-mean-squared error. The models were compared with Kruskal-Wallis one-way analysis of variance and subsequent post-hoc tests. In addition, the credibility of predictions (age at onset of neoplastic growth and estimated volume at age 90) was evaluated. Results Equations generating sigmoidal-shaped growth curves (Gompertz, logistic, Spratt and Bertalanffy) provided a good fit (median R 2 : 0.996-1.00) and better described the observed data compared with the linear, exponential, and Mendelsohn equations ( p < 0.001). Although there was no statistically significant difference between the sigmoidal-shaped growth curves regarding the goodness of fit, a realistic age at onset and estimated volume at age 90 were most often predicted by the Bertalanffy model. Conclusions Growth of HNPGL is best described by decelerating tumor growth laws, with a preference for the Bertalanffy model. To the best of our knowledge, this is the first time that this often-neglected model has been successfully fitted to clinically obtained growth data.
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Affiliation(s)
- Berdine L Heesterman
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands
| | - John-Melle Bokhorst
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisa M H de Pont
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands
| | - Berit M Verbist
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean-Pierre Bayley
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Andel G L van der Mey
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands
| | - Eleonora P M Corssmit
- Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frederik J Hes
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jeroen C Jansen
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands
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20
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Abstract
SummaryInterferons (IFNs) are used for a variety of disorders. It has been postulated that part of the effects of IFN may be mediated by IFN-induced modulation of endothelial cells. Since the principal activating and inhibiting factors of the fibrinolytic system are synthesized and stored in endothelial cells, we have studied the effects on fibrinolysis and coagulation of the administration of recombinant IFN-α (5 × 106U/m2) to healthy human subjects (n = 8) in a randomized controlled cross-over study. IFN-α significantly increased plasma levels of tissue-type plasminogen activator (t-PA) and urokinase-type plasminogen activator (u-PA). Simultaneously, plasma levels of the inhibitor of plasminogen activation, PAI-1, sharply increased. The net effect on plasma plasminogen activator activity (PA-activity) was a modest increase to 116% of baseline, however without a significant effect on plasmin generation, as reflected by plasma levels of plasmin-α2-antiplasmin complexes. IFN-α had no effect on the plasma levels of thrombin-antithrombin III (TAT) complexes.We conclude that despite considerable effects on endothelial cells, IFN-α does not significantly alter the coagulant-fibrinolytic balance, although the occurrence of such changes under pathological circumstances is not excluded.
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Affiliation(s)
- E P M Corssmit
- The Department of Internal Medicine, University of Amsterdam, The Netherlands
| | - M Levi
- The Department of Internal Medicine, University of Amsterdam, The Netherlands
- The Center for Haemostasis, Thrombosis, Atherosclerosis and Inflammation Research, University of Amsterdam, The Netherlands
| | - C E Hack
- The Department of Autoimmune Diseases and Inflammation, Central Laboratory of the Netherlands Red Cross Blood Transfusion Service (CLB), Amsterdam, The Netherlands
| | - J W ten Cate
- The Center for Haemostasis, Thrombosis, Atherosclerosis and Inflammation Research, University of Amsterdam, The Netherlands
| | - H P Sauerwein
- The Department of Internal Medicine, University of Amsterdam, The Netherlands
| | - J A Romijn
- The Department of Intensive Care, Academic Medical Center, University of Amsterdam, The Netherlands
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21
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Buitenwerf E, Korteweg T, Visser A, Haag CMSC, Feelders RA, Timmers HJLM, Canu L, Haak HR, Bisschop PHLT, Eekhoff EMW, Corssmit EPM, Krak NC, Rasenberg E, van den Bergh J, Stoker J, Greuter MJW, Dullaart RPF, Links TP, Kerstens MN. Unenhanced CT imaging is highly sensitive to exclude pheochromocytoma: a multicenter study. Eur J Endocrinol 2018; 178:431-437. [PMID: 29467230 DOI: 10.1530/eje-18-0006] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 02/20/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND A substantial proportion of all pheochromocytomas is currently detected during the evaluation of an adrenal incidentaloma. Recently, it has been suggested that biochemical testing to rule out pheochromocytoma is unnecessary in case of an adrenal incidentaloma with an unenhanced attenuation value ≤10 Hounsfield Units (HU) at computed tomography (CT). OBJECTIVES We aimed to determine the sensitivity of the 10 HU threshold value to exclude a pheochromocytoma. METHODS Retrospective multicenter study with systematic reassessment of preoperative unenhanced CT scans performed in patients in whom a histopathologically proven pheochromocytoma had been diagnosed. Unenhanced attenuation values were determined independently by two experienced radiologists. Sensitivity of the 10 HU threshold was calculated, and interobserver consistency was assessed using the intraclass correlation coefficient (ICC). RESULTS 214 patients were identified harboring a total number of 222 pheochromocytomas. Maximum tumor diameter was 51 (39-74) mm. The mean attenuation value within the region of interest was 36 ± 10 HU. Only one pheochromocytoma demonstrated an attenuation value ≤10 HU, resulting in a sensitivity of 99.6% (95% CI: 97.5-99.9). ICC was 0.81 (95% CI: 0.75-0.86) with a standard error of measurement of 7.3 HU between observers. CONCLUSION The likelihood of a pheochromocytoma with an unenhanced attenuation value ≤10 HU on CT is very low. The interobserver consistency in attenuation measurement is excellent. Our study supports the recommendation that in patients with an adrenal incidentaloma biochemical testing for ruling out pheochromocytoma is only indicated in adrenal tumors with an unenhanced attenuation value >10 HU.
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Affiliation(s)
- Edward Buitenwerf
- Departments of EndocrinologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tijmen Korteweg
- Departments of RadiologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anneke Visser
- Departments of EndocrinologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Charlotte M S C Haag
- Departments of RadiologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Richard A Feelders
- Department of EndocrinologyErasmus Medical Center, Rotterdam, The Netherlands
| | - Henri J L M Timmers
- Section of EndocrinologyDepartment of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Letizia Canu
- Section of EndocrinologyDepartment of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Experimental and Clinical Biomedical SciencesUniversity of Florence, Florence, Italy
| | - Harm R Haak
- Department of Internal MedicineMáxima Medical Center, Eindhoven, The Netherlands
- Division of General Internal MedicineDepartment of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Maastricht UniversityCAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Peter H L T Bisschop
- Department of Endocrinology and MetabolismAcademic Medical Center, Amsterdam, The Netherlands
| | - Elisabeth M W Eekhoff
- Endocrinology SectionDepartment of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Eleonora P M Corssmit
- Department of EndocrinologyLeiden University Medical Center, Leiden, The Netherlands
| | - Nanda C Krak
- Department of RadiologyErasmus Medical Center, Rotterdam, The Netherlands
| | - Elise Rasenberg
- Department of RadiologyMáxima Medical Center, Eindhoven, The Netherlands
| | | | - Jaap Stoker
- Department of Radiology and Nuclear MedicineAcademic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel J W Greuter
- Departments of RadiologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robin P F Dullaart
- Departments of EndocrinologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Thera P Links
- Departments of EndocrinologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel N Kerstens
- Departments of EndocrinologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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22
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de Koster EJ, de Geus-Oei LF, Dekkers OM, van Engen-van Grunsven I, Hamming J, Corssmit EPM, Morreau H, Schepers A, Smit J, Oyen WJG, Vriens D. Diagnostic Utility of Molecular and Imaging Biomarkers in Cytological Indeterminate Thyroid Nodules. Endocr Rev 2018; 39:154-191. [PMID: 29300866 DOI: 10.1210/er.2017-00133] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 12/27/2017] [Indexed: 12/21/2022]
Abstract
Indeterminate thyroid cytology (Bethesda III and IV) corresponds to follicular-patterned benign and malignant lesions, which are particularly difficult to differentiate on cytology alone. As ~25% of these nodules harbor malignancy, diagnostic hemithyroidectomy is still custom. However, advanced preoperative diagnostics are rapidly evolving.This review provides an overview of additional molecular and imaging diagnostics for indeterminate thyroid nodules in a preoperative clinical setting, including considerations regarding cost-effectiveness, availability, and feasibility of combining techniques. Addressed diagnostics include gene mutation analysis, microRNA, immunocytochemistry, ultrasonography, elastosonography, computed tomography, sestamibi scintigraphy, [18F]-2-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET), and diffusion-weighted magnetic resonance imaging.The best rule-out tests for malignancy were the Afirma® gene expression classifier and FDG-PET. The most accurate rule-in test was sole BRAF mutation analysis. No diagnostic had both near-perfect sensitivity and specificity, and estimated cost-effectiveness. Molecular techniques are rapidly advancing. However, given the currently available techniques, a multimodality stepwise approach likely offers the most accurate diagnosis, sequentially applying one sensitive rule-out test and one specific rule-in test. Geographical variations in cytology (e.g., Hürthle cell neoplasms) and tumor genetics strongly influence local test performance and clinical utility. Multidisciplinary collaboration and implementation studies can aid the local decision for one or more eligible diagnostics.
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Affiliation(s)
- Elizabeth J de Koster
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Olaf M Dekkers
- Department of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Jaap Hamming
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Eleonora P M Corssmit
- Department of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Abbey Schepers
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan Smit
- Department of Endocrinology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wim J G Oyen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.,Division of Radiotherapy and Imaging, Institute of Cancer Research, and Department of Nuclear Medicine, Royal Marsden Hospital, London, United Kingdom
| | - Dennis Vriens
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
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23
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Nies M, Dekker BL, Sulkers E, Huizinga GA, Klein Hesselink MS, Maurice-Stam H, Grootenhuis MA, Brouwers AH, Burgerhof JGM, van Dam EWCM, Havekes B, van den Heuvel-Eibrink MM, Corssmit EPM, Kremer LCM, Netea-Maier RT, van der Pal HJH, Peeters RP, Plukker JTM, Ronckers CM, van Santen HM, van der Horst-Schrivers ANA, Tissing WJE, Bocca G, Links TP. Psychosocial development in survivors of childhood differentiated thyroid carcinoma: a cross-sectional study. Eur J Endocrinol 2018; 178:215-223. [PMID: 29254931 PMCID: PMC5811933 DOI: 10.1530/eje-17-0741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 12/18/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The impact of childhood differentiated thyroid carcinoma (DTC) on psychosocial development has not yet been studied. The aim of this study was to evaluate the achievement of psychosocial developmental milestones in long-term survivors of childhood DTC. DESIGN AND METHODS Survivors of childhood DTC diagnosed between 1970 and 2013 were included. Reasons for exclusion were age <18 or >35 years at follow-up, a follow-up period <5 years or diagnosis with DTC as a second malignant neoplasm. Survivors gathered peer controls of similar age and sex (n = 30). A comparison group non-affected with cancer (n = 508) and other childhood cancer survivors (CCS) were also used to compare psychosocial development. To assess the achievement of psychosocial milestones (social, autonomy and psychosexual development), the course of life questionnaire (CoLQ) was used. RESULTS We included 39 survivors of childhood DTC (response rate 83.0%, mean age at diagnosis 15.6 years, and mean age at evaluation 26.1 years). CoLQ scores did not significantly differ between survivors of childhood DTC and the two non-affected groups. CoLQ scores of childhood DTC survivors were compared to scores of other CCS diagnosed at similar ages (n = 76). DTC survivors scored significantly higher on social development than other CCS, but scores were similar on autonomy and psychosexual developmental scales. CONCLUSIONS Survivors of childhood DTC showed similar development on social, autonomy, and psychosexual domains compared to non-affected individuals. Social development was slightly more favorable in DTC survivors than in other CCS, but was similar on autonomy and psychosexual domains.
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Affiliation(s)
- Marloes Nies
- Division of EndocrinologyDepartment of Internal Medicine
| | | | - Esther Sulkers
- Department of Wenkebach InstituteSchool of Nursing and Health and Beatrix Children’s Hospital
| | - Gea A Huizinga
- Department of Wenkebach InstituteSchool of Nursing and Health and Beatrix Children’s Hospital
- Department of Pediatric OncologyUniversity of Groningen, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | | | | | - Martha A Grootenhuis
- Psychosocial DepartmentAcademic Medical Center, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric OncologyUtrecht, the Netherlands
| | | | - Johannes G M Burgerhof
- Department of EpidemiologyUniversity of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Eveline W C M van Dam
- Division of Endocrinology, Department of Internal MedicineVU University Medical Center, Amsterdam, the Netherlands
| | - Bas Havekes
- Division of Endocrinology, Department of Internal MedicineMaastricht University Medical Center, Maastricht, the Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric OncologyUtrecht, the Netherlands
- Department of Pediatric OncologyRotterdam, the Netherlands
| | - Eleonora P M Corssmit
- Division of Endocrinology, Department of Internal MedicineLeiden University Medical Center, Leiden, the Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric OncologyUtrecht, the Netherlands
- Department of Pediatric OncologyAcademic Medical Center, Amsterdam, the Netherlands
| | - Romana T Netea-Maier
- Division of Endocrinology, Department of Internal MedicineRadboud University Medical Center, Nijmegen, the Netherlands
| | - Heleen J H van der Pal
- Princess Máxima Center for Pediatric OncologyUtrecht, the Netherlands
- Department of Medical Oncology and Emma Children’s Hospital/Academic Medical CenterAmsterdam, the Netherlands
| | - Robin P Peeters
- Department of Internal Medicine and Rotterdam Thyroid Center Erasmus Medical CenterRotterdam, the Netherlands
| | - John T M Plukker
- Department of Surgical OncologyUniversity of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Cécile M Ronckers
- Department of Pediatric OncologyAcademic Medical Center, Amsterdam, the Netherlands
| | - Hanneke M van Santen
- Department of PediatricsUniversity Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, the Netherlands
| | | | - Wim J E Tissing
- Department of Pediatric OncologyUniversity of Groningen, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | - Gianni Bocca
- Department of Pediatric EndocrinologyUniversity of Groningen, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | - Thera P Links
- Division of EndocrinologyDepartment of Internal Medicine
- Correspondence should be addressed to T P Links
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24
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Rijken JA, Niemeijer ND, Leemans CR, Eijkelenkamp K, van der Horst-Schrivers ANA, van Berkel A, Timmers HJLM, Kunst HPM, Bisschop PHLT, van Dooren MF, Hes FJ, Jansen JC, Corssmit EPM, Hensen EF. Nationwide study of patients with head and neck paragangliomas carrying SDHB germline mutations. BJS Open 2018; 2:62-69. [PMID: 29951630 PMCID: PMC5952381 DOI: 10.1002/bjs5.39] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 11/21/2017] [Indexed: 12/26/2022] Open
Abstract
Background Germline mutations in the succinate dehydrogenase B (SDHB) gene predispose to hereditary paraganglioma (PGL) syndrome type 4. The aim of this study was to evaluate the clinical characteristics and outcome of treatment strategies for patients with head and neck paraganglioma (HNPGL) carrying SDHB germline mutations. Methods This was a retrospective evaluation of patients with HNPGL carrying SDHB germline mutations in the Netherlands. Results In a Dutch nationwide cohort study of SDHB germline mutation carriers, 54 patients with a total of 62 HNPGLs were identified. Forty‐one of 54 patients (76 per cent) visited the outpatient clinic because of associated complaints. Eight patients (15 per cent) had multiple PGLs. One patient (2 per cent) developed a phaeochromocytoma and three (6 per cent) developed a malignant PGL. Twenty‐seven patients (50 per cent) had an operation for their HNPGL and 15 (28 per cent) received radiotherapy. Three patients with HNPGL (6 per cent) were diagnosed with additional non‐paraganglionic tumours. Conclusion If an SDHB germline mutation is identified in a patient with HNPGL, the clinician should be aware of the variable manifestations of the SDHB‐linked tumour syndrome, the risk of catecholamine excess, concurrent phaeochromocytoma, and association with non‐paraganglionic tumours.
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Affiliation(s)
- J A Rijken
- Department of Otorhinolaryngology/Head and Neck Surgery VU University Medical Centre Amsterdam The Netherlands
| | - N D Niemeijer
- Department of Endocrinology and Metabolic Diseases Leiden University Medical Centre Leiden The Netherlands
| | - C R Leemans
- Department of Otorhinolaryngology/Head and Neck Surgery VU University Medical Centre Amsterdam The Netherlands
| | - K Eijkelenkamp
- Department of Endocrinology, University of Groningen University Medical Centre Groningen Groningen The Netherlands
| | | | - A van Berkel
- Division of Endocrinology, Department of Internal Medicine Radboud University Medical Centre Nijmegen The Netherlands
| | - H J L M Timmers
- Division of Endocrinology, Department of Internal Medicine Radboud University Medical Centre Nijmegen The Netherlands
| | - H P M Kunst
- Department of Otorhinolaryngology/Head and Neck Surgery Radboud University Medical Centre Nijmegen The Netherlands
| | - P H L T Bisschop
- Department of Endocrinology and Metabolism, Academic Medical Centre University of Amsterdam Amsterdam The Netherlands
| | - M F van Dooren
- Department of Clinical Genetics, Erasmus MC University Medical Centre Rotterdam Rotterdam The Netherlands
| | - F J Hes
- Department of Clinical Genetics Leiden University Medical Centre Leiden The Netherlands
| | - J C Jansen
- Otorhinolaryngology/Head and Neck Surgery Leiden University Medical Centre Leiden The Netherlands
| | - E P M Corssmit
- Department of Endocrinology and Metabolic Diseases Leiden University Medical Centre Leiden The Netherlands
| | - E F Hensen
- Department of Otorhinolaryngology/Head and Neck Surgery VU University Medical Centre Amsterdam The Netherlands.,Otorhinolaryngology/Head and Neck Surgery Leiden University Medical Centre Leiden The Netherlands
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25
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van der Tuin K, Mensenkamp AR, Tops CMJ, Corssmit EPM, Dinjens WN, van de Horst-Schrivers ANA, Jansen JC, de Jong MM, Kunst HPM, Kusters B, Leter EM, Morreau H, van Nesselrooij BMP, Oldenburg RA, Spruijt L, Hes FJ, Timmers HJLM. Clinical Aspects of SDHA-Related Pheochromocytoma and Paraganglioma: A Nationwide Study. J Clin Endocrinol Metab 2018; 103:438-445. [PMID: 29177515 DOI: 10.1210/jc.2017-01762] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/16/2017] [Indexed: 02/02/2023]
Abstract
CONTEXT Paraganglioma (PGL) has the highest degree of heritability among human neoplasms. Current clinical understanding of germline SDHA mutation carriers is limited. OBJECTIVE To estimate the contribution of SDHA mutations in PGL and to assess clinical manifestations and age-related penetrance. DESIGN Nationwide retrospective cohort study. SETTING Tertiary referral centers in the Netherlands (multicenter). PATIENTS Germline SDHA analysis was performed in 393 patients with genetically unexplained PGL. Subsequently, 30 index SDHA mutation carriers and 56 nonindex carriers were studied. MAIN OUTCOME MEASURES SDHA mutation detection yield, clinical manifestations, and SDHA-related disease penetrance. RESULTS Pathogenic germline SDHA variants were identified in 30 of the 393 referred patients with PGL (7.6%), who had head and neck PGL (21 of 174 [12%]), pheochromocytoma (4 of 191 [2%]), or sympathetic PGL (5 of 28 [18%]). The median age at diagnosis was 43 years (range, 17 to 81 years) in index SDHA mutation carriers compared with 52 years (range, 7 to 90 years) in nonmutation carriers (P = 0.002). The estimated penetrance of any SDHA-related manifestation was 10% at age 70 years (95% confidence interval, 0% to 21%) in nonindex mutation carriers. CONCLUSION Germline SDHA mutations are relatively common (7.6%) in patients with genetically unexplained PGL. Most index patients presented with apparently sporadic PGL. In this SDHA series, the largest assembled so far, we found the lowest penetrance of all major PGL predisposition genes. This suggests that recommendations for genetic counseling of at-risk relatives and stringency of surveillance for SDHA mutation carriers might need to be reassessed.
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Affiliation(s)
- Karin van der Tuin
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Arjen R Mensenkamp
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Carli M J Tops
- Department of Clinical Genetics, Laboratory for Diagnostic Genetic Analysis, Leiden University Medical Center, Leiden, the Netherlands
| | - Eleonora P M Corssmit
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
| | - Winand N Dinjens
- Department of Pathology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Jeroen C Jansen
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mirjam M de Jong
- Department of Clinical Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Henricus P M Kunst
- Department Otorhinolaryngology, Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Benno Kusters
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Edward M Leter
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Rogier A Oldenburg
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Liesbeth Spruijt
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frederik J Hes
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Henri J L M Timmers
- Department of Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, the Netherlands
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26
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Klein Hesselink MS, Bocca G, Hummel YM, Brouwers AH, Burgerhof JGM, van Dam EWCM, Gietema JA, Havekes B, van den Heuvel-Eibrink MM, Corssmit EPM, Kremer LCM, Netea-Maier RT, van der Pal HJH, Peeters RP, Plukker JTM, Ronckers CM, van Santen HM, van der Meer P, Links TP, Tissing WJE. Diastolic Dysfunction is Common in Survivors of Pediatric Differentiated Thyroid Carcinoma. Thyroid 2017; 27:1481-1489. [PMID: 29132262 DOI: 10.1089/thy.2017.0383] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Whether pediatric patients with differentiated thyroid carcinoma (DTC) are at risk of developing treatment-related adverse effects on cardiac function is unknown. We therefore studied in long-term survivors of pediatric DTC the prevalence of cardiac dysfunction and atrial fibrillation in relation to treatment variables, and the association between cardiac dysfunction and plasma biomarkers. METHODS In this nationwide prospective multicenter study, cardiac assessments were performed in 66 adult survivors of pediatric DTC (age at diagnosis ≤18 years and follow-up ≥5 years after diagnosis) treated in the Netherlands between 1970 and 2009. Assessment included echocardiography, plasma biomarkers (N-terminal pro-brain natriuretic peptide, high-sensitive troponin-T, galectin-3), and 24-hour Holter electrocardiography. Echocardiographic measurements were compared with retrospective data of 66 sex- and age-matched unaffected Dutch controls. Diastolic dysfunction was defined as an early diastolic septal and/or lateral tissue velocity (e') less than 2 SD of mean age-adjusted reference data. RESULTS The survivors (86.4% women) had at DTC diagnosis a median age of 16 years. Median follow-up was 17 years. Left ventricular ejection fraction <50% was found in one survivor, and median global longitudinal systolic strain was near normal. Diastolic dysfunction was present in 14 asymptomatic survivors (21.2%). Overall, diastolic function of survivors was lower compared with controls (e'mean 14.5 versus 15.8 cm/s, P = 0.006). Older attained age and higher waist circumference were associated with decreased diastolic function, whereas thyrotropin levels and cumulative administered radioiodine dose were not. In survivors, biomarkers were not associated with diastolic dysfunction; atrial fibrillation was not observed. CONCLUSION While systolic function is unaffected, diastolic dysfunction is frequently observed in asymptomatic long-term survivors of pediatric DTC, which may suggest early cardiac aging.
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Affiliation(s)
- Mariëlle S Klein Hesselink
- 1 Department of Endocrinology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Gianni Bocca
- 2 Department of Pediatric Endocrinology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Yoran M Hummel
- 3 Department of Cardiology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Adrienne H Brouwers
- 4 Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Johannes G M Burgerhof
- 5 Department of Epidemiology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Eveline W C M van Dam
- 6 Department of Internal Medicine, VU University Medical Center , Amsterdam, The Netherlands
| | - Jourik A Gietema
- 7 Department of Medical Oncology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Bas Havekes
- 8 Department of Internal Medicine, Division of Endocrinology, Maastricht University Medical Center , Maastricht, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- 9 Department of Pediatric Oncology, Sophia Children's Hospital, Erasmus Medical Center , Rotterdam, The Netherlands
- 10 Princess Máxima Center for Pediatric Oncology , Utrecht, The Netherlands
| | - Eleonora P M Corssmit
- 11 Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center , Leiden, The Netherlands
| | - Leontien C M Kremer
- 12 Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center , Amsterdam, The Netherlands
| | - Romana T Netea-Maier
- 13 Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center , Nijmegen, The Netherlands
| | - Helena J H van der Pal
- 12 Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center , Amsterdam, The Netherlands
- 14 Department of Medical Oncology, Academic Medical Center , Amsterdam, The Netherlands
| | - Robin P Peeters
- 15 Department of Internal Medicine, Erasmus Medical Center , Rotterdam, The Netherlands
- 16 Rotterdam Thyroid Center, Erasmus Medical Center , Rotterdam, The Netherlands
| | - John T M Plukker
- 17 Department of Surgical Oncology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Cécile M Ronckers
- 12 Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center , Amsterdam, The Netherlands
| | - Hanneke M van Santen
- 18 Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht , Utrecht, The Netherlands
| | - Peter van der Meer
- 3 Department of Cardiology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Thera P Links
- 1 Department of Endocrinology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Wim J E Tissing
- 19 Department of Pediatric Endocrinology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
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Hoekstra AS, Hensen EF, Jordanova ES, Korpershoek E, van der Horst-Schrivers AN, Cornelisse C, Corssmit EPM, Hes FJ, Jansen JC, Kunst HPM, Timmers HJLM, Bateman A, Eccles D, Bovée JVMG, Devilee P, Bayley JP. Loss of maternal chromosome 11 is a signature event in SDHAF2, SDHD, and VHL-related paragangliomas, but less significant in SDHB-related paragangliomas. Oncotarget 2017; 8:14525-14536. [PMID: 28099933 PMCID: PMC5362423 DOI: 10.18632/oncotarget.14649] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 01/04/2017] [Indexed: 12/28/2022] Open
Abstract
Germline mutations in the succinate dehydrogenase (SDHA, SDHB, SDHC, SDHD, SDHAF2) or Von Hippel-Lindau (VHL) genes cause hereditary paraganglioma/pheochromocytoma. While SDHB (1p36) and VHL (3p25) are associated with autosomal dominant disease, SDHD (11q23) and SDHAF2 (11q13) show a remarkable parent-of-origin effect whereby tumor formation is almost completely dependent on paternal transmission of the mutant allele. Loss of the entire maternal copy of chromosome 11 occurs frequently in SDHD-linked tumors, and has been suggested to be the basis for this typical inheritance pattern.Using fluorescent in situ hybridization, microsatellite marker and SNP array analysis, we demonstrate that loss of the entire copy of chromosome 11 is also frequent in SDHAF2-related PGLs, occurring in 89% of tumors. Analysis of two imprinted differentially methylated regions (DMR) in 11p15, H19-DMR and KvDMR, showed that this loss always affected the maternal copy of chromosome 11. Likewise, loss of maternal chromosome 11p15 was demonstrated in 85% of SDHD and 75% of VHL-related PGLs/PCCs. By contrast, both copies of chromosome 11 were found to be retained in 62% of SDHB-mutated PGLs/PCCs, while only 31% showed loss of maternal chromosome 11p15. Genome-wide copy number analysis revealed frequent loss of 1p in SDHB mutant tumors and show greater genomic instability compared to SDHD and SDHAF2.These results show that loss of the entire copy of maternal chromosome 11 is a highly specific and statistically significant event in SDHAF2, SDHD and VHL-related PGLs/PCCs, but is less significant in SDHB-mutated tumors, suggesting that these tumors have a distinct genetic etiology.
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Affiliation(s)
- Attje S Hoekstra
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Erik F Hensen
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Esther Korpershoek
- Department of Pathology, Josephine Nefkens Institute, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Cees Cornelisse
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Eleonora P M Corssmit
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Frederik J Hes
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen C Jansen
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands
| | - Henricus P M Kunst
- Department of Otorhinolaryngology, Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Henri J L M Timmers
- Department of Medicine, Division of Endocrinology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Adrian Bateman
- Department of Cellular Pathology, University Hospital Southampton, Southampton, UK
| | - Diana Eccles
- University of Southampton School of Medicine, Cancer Sciences Division, Somers Cancer Research Building, Southampton, UK
| | - Judith V M G Bovée
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter Devilee
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean-Pierre Bayley
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
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28
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Niemeijer ND, Rijken JA, Eijkelenkamp K, van der Horst-Schrivers ANA, Kerstens MN, Tops CMJ, van Berkel A, Timmers HJLM, Kunst HPM, Leemans CR, Bisschop PH, Dreijerink KMA, van Dooren MF, Bayley JP, Pereira AM, Jansen JC, Hes FJ, Hensen EF, Corssmit EPM. The phenotype of SDHB germline mutation carriers: a nationwide study. Eur J Endocrinol 2017; 177:115-125. [PMID: 28490599 DOI: 10.1530/eje-17-0074] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/24/2017] [Accepted: 05/10/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Succinate dehydrogenase B subunit (SDHB) gene germline mutations predispose to pheochromocytomas, sympathetic paragangliomas, head and neck paragangliomas and non-paraganglionic tumors (e.g. renal cell carcinoma, gastrointestinal stromal tumor and pituitary neoplasia). The aim of this study was to determine phenotypical characteristics of a large Dutch cohort of SDHB germline mutation carriers and assess differences in clinical phenotypes related to specific SDHB mutations. DESIGN Retrospective descriptive study. METHODS Retrospective descriptive study in seven academic centers. RESULTS We included 194 SDHB mutation carriers consisting 65 (33.5%) index patients and 129 (66.5%) relatives. Mean age was 44.8 ± 16.0 years. Median duration of follow-up was 2.6 years (range: 0-36). Sixty persons (30.9%) carried the exon 3 deletion and 46 (23.7%) the c.423 + 1G > A mutation. Fifty-four mutation carriers (27.8%) had one or multiple head and neck paragangliomas, 4 (2.1%) had a pheochromocytoma and 26 (13.4%) had one or more sympathetic paragangliomas. Fifteen patients (7.7%) developed metastatic paraganglioma and 17 (8.8%) developed non-paraganglionic tumors. At study close, there were 111 (57.2%) unaffected mutation carriers. Statistical analyses showed no significant differences in the number and location of head and neck paragangliomas, sympathetic paragangliomas or pheochromocytomas, nor in the occurrence of metastatic disease or other tumors between carriers of the two founder SDHB mutations (exon 3 deletion vs c.423 + 1G > A). CONCLUSIONS In this nationwide study of disease-affected and unaffected SDHB mutation carriers, we observed a lower rate of metastatic disease and a relatively high number of head and neck paragangliomas compared with previously reported referral-based cohorts.
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Affiliation(s)
- Nicolasine D Niemeijer
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Johannes A Rijken
- Department of Otorhinolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Karin Eijkelenkamp
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Michiel N Kerstens
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Carli M J Tops
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Henricus P M Kunst
- Department of Otorhinolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C René Leemans
- Department of Otorhinolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Peter H Bisschop
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Koen M A Dreijerink
- Department of Endocrine Oncology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marieke F van Dooren
- Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | | | - Alberto M Pereira
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeroen C Jansen
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frederik J Hes
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Erik F Hensen
- Department of Otorhinolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Eleonora P M Corssmit
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, the Netherlands
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29
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Heesterman BL, de Pont LMH, Verbist BM, van der Mey AGL, Corssmit EPM, Hes FJ, van Benthem PPG, Jansen JC. Age and Tumor Volume Predict Growth of Carotid and Vagal Body Paragangliomas. J Neurol Surg B Skull Base 2017; 78:497-505. [PMID: 29134169 DOI: 10.1055/s-0037-1604347] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 06/08/2017] [Indexed: 01/23/2023] Open
Abstract
Objective Treatment for head and neck paragangliomas (HNGPL) can be more harmful than the disease. After diagnosis, an initial period of surveillance is often indicated, and surgery or radiotherapy is reserved for progressive disease. With the aim to optimize this "wait and scan" strategy, we studied growth and possible predictors. Design A retrospective cohort study was conducted. Setting This study was conducted at a tertiary referral center for patients with HNGPL. Methods Tumor volume was estimated for 184 SDHD -related carotid and vagal body paragangliomas using sequential magnetic resonance imaging. Cox regression was used to study predictors of tumor growth. Results The estimated fraction of growing tumors ranged from 0.42 after 1 year of follow-up to 0.85 after 11 years. A median growth rate of 10.4 and 12.0% per year was observed for carotid and vagal body tumors, respectively. Tumor location, initial volume, and age ( p < 0.05) were included in our prediction model. The probability of growth decreased with increasing age and volume, indicating a decelerating growth pattern. Conclusions We created a prediction model (available online), enabling a more individualized "wait and scan" strategy. The favorable natural course of carotid and vagal body paragangliomas was confirmed; although with long follow-up growth will be observed in most cases.
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Affiliation(s)
- Berdine L Heesterman
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisa M H de Pont
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands
| | - Berit M Verbist
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andel G L van der Mey
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands
| | - Eleonora P M Corssmit
- Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frederik J Hes
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jeroen C Jansen
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands
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30
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Nies M, Klein Hesselink MS, Huizinga GA, Sulkers E, Brouwers AH, Burgerhof JGM, van Dam EWCM, Havekes B, van den Heuvel-Eibrink MM, Corssmit EPM, Kremer LCM, Netea-Maier RT, van der Pal HJH, Peeters RP, Plukker JTM, Ronckers CM, van Santen HM, Tissing WJE, Links TP, Bocca G. Long-Term Quality of Life in Adult Survivors of Pediatric Differentiated Thyroid Carcinoma. J Clin Endocrinol Metab 2017; 102:1218-1226. [PMID: 28001468 DOI: 10.1210/jc.2016-2246] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 12/20/2016] [Indexed: 11/19/2022]
Abstract
CONTEXT Little is known about long-term quality of life (QoL) of survivors of pediatric differentiated thyroid carcinoma. Therefore, this study aimed to evaluate generic health-related QoL (HRQoL), fatigue, anxiety, and depression in these survivors compared with matched controls, and to evaluate thyroid cancer-specific HRQoL in survivors only. DESIGN Survivors diagnosed between 1970 and 2013 at age ≤18 years, were included. Exclusion criteria were a follow-up <5 years, attained age <18 years, or diagnosis of DTC as a second malignant neoplasm (SMN). Controls were matched by age, sex, and socioeconomic status. Survivors and controls were asked to complete 3 questionnaires [Short-Form 36 (HRQoL), Multidimensional Fatigue Inventory 20 (fatigue), and Hospital Anxiety and Depression Scale (anxiety/depression)]. Survivors completed a thyroid cancer-specific HRQoL questionnaire. RESULTS Sixty-seven survivors and 56 controls. Median age of survivors at evaluation was 34.2 years (range, 18.8 to 61.7). Median follow-up was 17.8 years (range, 5.0 to 44.7). On most QoL subscales, scores of survivors and controls did not differ significantly. However, survivors had more physical problems (P = 0.031), role limitations due to physical problems (P = 0.021), and mental fatigue (P = 0.016) than controls. Some thyroid cancer-specific complaints (e.g., sensory complaints and chilliness) were present in survivors. Unemployment and more extensive disease or treatment characteristics were most frequently associated with worse QoL. CONCLUSIONS Overall, long-term QoL in survivors of pediatric DTC was normal. Survivors experienced mild impairment of QoL in some domains (physical problems, mental fatigue, and various thyroid cancer-specific complaints). Factors possibly affecting QoL need further exploration.
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Affiliation(s)
| | | | - Gea A Huizinga
- Wenkebach Institute, School of Nursing and Health, Departments of
- Pediatric Oncology and
| | - Esther Sulkers
- Wenkebach Institute, School of Nursing and Health, Departments of
| | | | | | - Eveline W C M van Dam
- Department of Internal Medicine, VU University Medical Center, 1007 MB Amsterdam, The Netherlands
| | - Bas Havekes
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Department of Pediatric Oncology, Sophia Children's Hospital, Erasmus Medical Center, 3000 CB Rotterdam, The Netherlands
| | - Eleonora P M Corssmit
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | | | - Romana T Netea-Maier
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Heleen J H van der Pal
- Department of Pediatric Oncology, Emma Children's Hospital, and
- Department of Medical Oncology, Academic Medical Center, 1100 DD Amsterdam, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine and Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands
| | | | | | - Hanneke M van Santen
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | | | | | - Gianni Bocca
- Pediatric Endocrinology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
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31
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Hoekstra AS, Addie RD, Ras C, Seifar RM, Ruivenkamp CA, Briaire-de Bruijn IH, Hes FJ, Jansen JC, Corssmit EPM, Corver WE, Morreau H, Bovée JVMG, Bayley JP, Devilee P. Parent-of-origin tumourigenesis is mediated by an essential imprinted modifier in SDHD-linked paragangliomas: SLC22A18 and CDKN1C are candidate tumour modifiers. Hum Mol Genet 2016; 25:3715-3728. [PMID: 27402879 DOI: 10.1093/hmg/ddw218] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 12/11/2022] Open
Abstract
Mutations in SDHD and SDHAF2 (both located on chromosome 11) give rise to hereditary paraganglioma almost exclusively after paternal transmission of the mutation, and tumours often show loss of the entire maternal copy of chromosome 11. The 'Hensen' model postulates that a tumour modifier gene located on chromosome 11p15, a region known to harbour a cluster of imprinted genes, is essential to tumour formation. We observed decreased protein expression of the 11p15 candidate genes CDKN1C, SLC22A18 and ZNF215 evaluated in 60 SDHD-mutated tumours compared to normal carotid body tissue and non-SDH mutant tumours.We then created stable knockdown in vitro models, reasoning that the simultaneous knockdown of SDHD and a maternally expressed 11p15 modifier gene would enhance paraganglioma-related cellular characteristics compared to SDHD knockdown alone. Knockdown of SDHD in SNB19 and SHSY5Y cells resulted in the accumulation of succinate, the stabilization of HIF1 protein and a reduction in cell proliferation.Compared to single knockdown of SDHD, knockdown of SDHD together with SLC22A18 or with CDKN1C led to small but significant increases in cell proliferation and resistance to apoptosis, and to a gene expression profile closely related to the known transcriptional profile of SDH-deficient tumours. Of the 60 SDHD tumours investigated, four tumours showing retention of chromosome 11 showed SLC22A18 and CDKN1C expression levels comparable to levels in tumours showing loss of chromosome 11, suggesting loss of protein expression despite chromosomal retention.Our data strongly suggest that SLC22A18 and/or CDKN1C are tumour modifier genes involved in the tumourigenesis of SDHD-linked paraganglioma.
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Affiliation(s)
| | - Ruben D Addie
- Center for Proteomics and Metabolomics
- Department of Pathology
| | - Cor Ras
- Department of Biotechnology, Delft University of Technology, Delft, The Netherlands
| | - Reza M Seifar
- Department of Biotechnology, Delft University of Technology, Delft, The Netherlands
| | | | | | | | | | - Eleonora P M Corssmit
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, The Netherlands
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32
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Klein Hesselink MS, Nies M, Bocca G, Brouwers AH, Burgerhof JGM, van Dam EWCM, Havekes B, van den Heuvel-Eibrink MM, Corssmit EPM, Kremer LCM, Netea-Maier RT, van der Pal HJH, Peeters RP, Schmid KW, Smit JWA, Williams GR, Plukker JTM, Ronckers CM, van Santen HM, Tissing WJE, Links TP. Pediatric Differentiated Thyroid Carcinoma in The Netherlands: A Nationwide Follow-Up Study. J Clin Endocrinol Metab 2016; 101:2031-9. [PMID: 26963949 DOI: 10.1210/jc.2015-3290] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Treatment for differentiated thyroid carcinoma (DTC) in pediatric patients is based mainly on evidence from adult series due to lack of data from pediatric cohorts. Our objective was to evaluate presentation, treatment-related complications, and long-term outcome in patients with pediatric DTC in The Netherlands. PATIENTS AND METHODS In this nationwide study, presentation, complications, and outcome of patients with pediatric DTC (age at diagnosis ≤18 y) treated in The Netherlands between 1970 and 2013 were assessed using medical records. RESULTS We identified 170 patients. Overall survival was 99.4% after a median follow-up of 13.5 years (range 0.3-44.7 y). Extensive follow-up data were available for 105 patients (83.8% women), treated in 39 hospitals. Median age at diagnosis was 15.6 years (range 5.8-18.9 y). At initial diagnosis, 43.8% of the patients had cervical lymph node metastases; 13.3% had distant metastases. All patients underwent total thyroidectomy. Radioiodine was administered to 97.1%, with a median cumulative activity of 5.66 GBq (range 0.74-35.15 GBq). Life-long postoperative complications (permanent hypoparathyroidism and/or recurrent laryngeal nerve injury) were present in 32.4% of the patients. At last known follow-up, 8.6% of the patients had persistent disease and 7.6% experienced a recurrence. TSH suppression was not associated with recurrences (odds ratio 2.00, 95% confidence interval 0.78-5.17, P = .152). CONCLUSIONS Survival of pediatric DTC is excellent. Therefore, minimizing treatment-related morbidity takes major priority. Our study shows a frequent occurrence of life-long postoperative complications. Adverse effects may be reduced by the centralization of care, which is crucial for children with DTC.
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Affiliation(s)
- Mariëlle S Klein Hesselink
- Departments of Endocrinology (M.S.K.H., M.N., T.P.L.), Nuclear Medicine and Molecular Imaging (A.H.B.), Epidemiology (J.G.M.B.), and Surgical Oncology (J.T.M.P.), University of Groningen, University Medical Center Groningen, and Departments of Pediatric Endocrinology (G.B.) and Pediatric Oncology (W.J.E.T.), Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Internal Medicine (E.W.C.M.v.D.), VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (B.H.), Division of Endocrinology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands; Department of Pediatric Oncology (M.M.v.d.H.-E.), Sophia Children's Hospital, Erasmus Medical Center, 3000 CB Rotterdam, The Netherlands; Department of Internal Medicine (E.P.M.C.), Division of Endocrinology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pediatric Oncology (L.C.M.K., H.J.H.v.d.P., C.M.R.), Emma Children's Hospital, Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.T.N.-M., J.W.A.S.), Division of Endocrinology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; Department of Medical Oncology (H.J.H.v.d.P.), Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.P.P.) and Rotterdam Thyroid Center (R.P.P.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Institute of Pathology (K.W.S.), University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; Department of Medicine (G.R.W.), Imperial College London, London SW7 2AZ, United Kingdom; and Department of Pediatrics (H.M.v.S.), Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Marloes Nies
- Departments of Endocrinology (M.S.K.H., M.N., T.P.L.), Nuclear Medicine and Molecular Imaging (A.H.B.), Epidemiology (J.G.M.B.), and Surgical Oncology (J.T.M.P.), University of Groningen, University Medical Center Groningen, and Departments of Pediatric Endocrinology (G.B.) and Pediatric Oncology (W.J.E.T.), Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Internal Medicine (E.W.C.M.v.D.), VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (B.H.), Division of Endocrinology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands; Department of Pediatric Oncology (M.M.v.d.H.-E.), Sophia Children's Hospital, Erasmus Medical Center, 3000 CB Rotterdam, The Netherlands; Department of Internal Medicine (E.P.M.C.), Division of Endocrinology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pediatric Oncology (L.C.M.K., H.J.H.v.d.P., C.M.R.), Emma Children's Hospital, Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.T.N.-M., J.W.A.S.), Division of Endocrinology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; Department of Medical Oncology (H.J.H.v.d.P.), Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.P.P.) and Rotterdam Thyroid Center (R.P.P.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Institute of Pathology (K.W.S.), University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; Department of Medicine (G.R.W.), Imperial College London, London SW7 2AZ, United Kingdom; and Department of Pediatrics (H.M.v.S.), Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Gianni Bocca
- Departments of Endocrinology (M.S.K.H., M.N., T.P.L.), Nuclear Medicine and Molecular Imaging (A.H.B.), Epidemiology (J.G.M.B.), and Surgical Oncology (J.T.M.P.), University of Groningen, University Medical Center Groningen, and Departments of Pediatric Endocrinology (G.B.) and Pediatric Oncology (W.J.E.T.), Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Internal Medicine (E.W.C.M.v.D.), VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (B.H.), Division of Endocrinology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands; Department of Pediatric Oncology (M.M.v.d.H.-E.), Sophia Children's Hospital, Erasmus Medical Center, 3000 CB Rotterdam, The Netherlands; Department of Internal Medicine (E.P.M.C.), Division of Endocrinology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pediatric Oncology (L.C.M.K., H.J.H.v.d.P., C.M.R.), Emma Children's Hospital, Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.T.N.-M., J.W.A.S.), Division of Endocrinology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; Department of Medical Oncology (H.J.H.v.d.P.), Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.P.P.) and Rotterdam Thyroid Center (R.P.P.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Institute of Pathology (K.W.S.), University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; Department of Medicine (G.R.W.), Imperial College London, London SW7 2AZ, United Kingdom; and Department of Pediatrics (H.M.v.S.), Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Adrienne H Brouwers
- Departments of Endocrinology (M.S.K.H., M.N., T.P.L.), Nuclear Medicine and Molecular Imaging (A.H.B.), Epidemiology (J.G.M.B.), and Surgical Oncology (J.T.M.P.), University of Groningen, University Medical Center Groningen, and Departments of Pediatric Endocrinology (G.B.) and Pediatric Oncology (W.J.E.T.), Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Internal Medicine (E.W.C.M.v.D.), VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (B.H.), Division of Endocrinology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands; Department of Pediatric Oncology (M.M.v.d.H.-E.), Sophia Children's Hospital, Erasmus Medical Center, 3000 CB Rotterdam, The Netherlands; Department of Internal Medicine (E.P.M.C.), Division of Endocrinology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pediatric Oncology (L.C.M.K., H.J.H.v.d.P., C.M.R.), Emma Children's Hospital, Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.T.N.-M., J.W.A.S.), Division of Endocrinology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; Department of Medical Oncology (H.J.H.v.d.P.), Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.P.P.) and Rotterdam Thyroid Center (R.P.P.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Institute of Pathology (K.W.S.), University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; Department of Medicine (G.R.W.), Imperial College London, London SW7 2AZ, United Kingdom; and Department of Pediatrics (H.M.v.S.), Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Johannes G M Burgerhof
- Departments of Endocrinology (M.S.K.H., M.N., T.P.L.), Nuclear Medicine and Molecular Imaging (A.H.B.), Epidemiology (J.G.M.B.), and Surgical Oncology (J.T.M.P.), University of Groningen, University Medical Center Groningen, and Departments of Pediatric Endocrinology (G.B.) and Pediatric Oncology (W.J.E.T.), Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Internal Medicine (E.W.C.M.v.D.), VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (B.H.), Division of Endocrinology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands; Department of Pediatric Oncology (M.M.v.d.H.-E.), Sophia Children's Hospital, Erasmus Medical Center, 3000 CB Rotterdam, The Netherlands; Department of Internal Medicine (E.P.M.C.), Division of Endocrinology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pediatric Oncology (L.C.M.K., H.J.H.v.d.P., C.M.R.), Emma Children's Hospital, Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.T.N.-M., J.W.A.S.), Division of Endocrinology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; Department of Medical Oncology (H.J.H.v.d.P.), Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.P.P.) and Rotterdam Thyroid Center (R.P.P.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Institute of Pathology (K.W.S.), University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; Department of Medicine (G.R.W.), Imperial College London, London SW7 2AZ, United Kingdom; and Department of Pediatrics (H.M.v.S.), Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Eveline W C M van Dam
- Departments of Endocrinology (M.S.K.H., M.N., T.P.L.), Nuclear Medicine and Molecular Imaging (A.H.B.), Epidemiology (J.G.M.B.), and Surgical Oncology (J.T.M.P.), University of Groningen, University Medical Center Groningen, and Departments of Pediatric Endocrinology (G.B.) and Pediatric Oncology (W.J.E.T.), Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Internal Medicine (E.W.C.M.v.D.), VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (B.H.), Division of Endocrinology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands; Department of Pediatric Oncology (M.M.v.d.H.-E.), Sophia Children's Hospital, Erasmus Medical Center, 3000 CB Rotterdam, The Netherlands; Department of Internal Medicine (E.P.M.C.), Division of Endocrinology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pediatric Oncology (L.C.M.K., H.J.H.v.d.P., C.M.R.), Emma Children's Hospital, Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.T.N.-M., J.W.A.S.), Division of Endocrinology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; Department of Medical Oncology (H.J.H.v.d.P.), Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.P.P.) and Rotterdam Thyroid Center (R.P.P.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Institute of Pathology (K.W.S.), University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; Department of Medicine (G.R.W.), Imperial College London, London SW7 2AZ, United Kingdom; and Department of Pediatrics (H.M.v.S.), Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Bas Havekes
- Departments of Endocrinology (M.S.K.H., M.N., T.P.L.), Nuclear Medicine and Molecular Imaging (A.H.B.), Epidemiology (J.G.M.B.), and Surgical Oncology (J.T.M.P.), University of Groningen, University Medical Center Groningen, and Departments of Pediatric Endocrinology (G.B.) and Pediatric Oncology (W.J.E.T.), Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Internal Medicine (E.W.C.M.v.D.), VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (B.H.), Division of Endocrinology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands; Department of Pediatric Oncology (M.M.v.d.H.-E.), Sophia Children's Hospital, Erasmus Medical Center, 3000 CB Rotterdam, The Netherlands; Department of Internal Medicine (E.P.M.C.), Division of Endocrinology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pediatric Oncology (L.C.M.K., H.J.H.v.d.P., C.M.R.), Emma Children's Hospital, Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.T.N.-M., J.W.A.S.), Division of Endocrinology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; Department of Medical Oncology (H.J.H.v.d.P.), Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.P.P.) and Rotterdam Thyroid Center (R.P.P.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Institute of Pathology (K.W.S.), University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; Department of Medicine (G.R.W.), Imperial College London, London SW7 2AZ, United Kingdom; and Department of Pediatrics (H.M.v.S.), Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Departments of Endocrinology (M.S.K.H., M.N., T.P.L.), Nuclear Medicine and Molecular Imaging (A.H.B.), Epidemiology (J.G.M.B.), and Surgical Oncology (J.T.M.P.), University of Groningen, University Medical Center Groningen, and Departments of Pediatric Endocrinology (G.B.) and Pediatric Oncology (W.J.E.T.), Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Internal Medicine (E.W.C.M.v.D.), VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (B.H.), Division of Endocrinology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands; Department of Pediatric Oncology (M.M.v.d.H.-E.), Sophia Children's Hospital, Erasmus Medical Center, 3000 CB Rotterdam, The Netherlands; Department of Internal Medicine (E.P.M.C.), Division of Endocrinology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pediatric Oncology (L.C.M.K., H.J.H.v.d.P., C.M.R.), Emma Children's Hospital, Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.T.N.-M., J.W.A.S.), Division of Endocrinology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; Department of Medical Oncology (H.J.H.v.d.P.), Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.P.P.) and Rotterdam Thyroid Center (R.P.P.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Institute of Pathology (K.W.S.), University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; Department of Medicine (G.R.W.), Imperial College London, London SW7 2AZ, United Kingdom; and Department of Pediatrics (H.M.v.S.), Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Eleonora P M Corssmit
- Departments of Endocrinology (M.S.K.H., M.N., T.P.L.), Nuclear Medicine and Molecular Imaging (A.H.B.), Epidemiology (J.G.M.B.), and Surgical Oncology (J.T.M.P.), University of Groningen, University Medical Center Groningen, and Departments of Pediatric Endocrinology (G.B.) and Pediatric Oncology (W.J.E.T.), Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Internal Medicine (E.W.C.M.v.D.), VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (B.H.), Division of Endocrinology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands; Department of Pediatric Oncology (M.M.v.d.H.-E.), Sophia Children's Hospital, Erasmus Medical Center, 3000 CB Rotterdam, The Netherlands; Department of Internal Medicine (E.P.M.C.), Division of Endocrinology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pediatric Oncology (L.C.M.K., H.J.H.v.d.P., C.M.R.), Emma Children's Hospital, Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.T.N.-M., J.W.A.S.), Division of Endocrinology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; Department of Medical Oncology (H.J.H.v.d.P.), Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.P.P.) and Rotterdam Thyroid Center (R.P.P.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Institute of Pathology (K.W.S.), University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; Department of Medicine (G.R.W.), Imperial College London, London SW7 2AZ, United Kingdom; and Department of Pediatrics (H.M.v.S.), Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Leontien C M Kremer
- Departments of Endocrinology (M.S.K.H., M.N., T.P.L.), Nuclear Medicine and Molecular Imaging (A.H.B.), Epidemiology (J.G.M.B.), and Surgical Oncology (J.T.M.P.), University of Groningen, University Medical Center Groningen, and Departments of Pediatric Endocrinology (G.B.) and Pediatric Oncology (W.J.E.T.), Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Internal Medicine (E.W.C.M.v.D.), VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (B.H.), Division of Endocrinology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands; Department of Pediatric Oncology (M.M.v.d.H.-E.), Sophia Children's Hospital, Erasmus Medical Center, 3000 CB Rotterdam, The Netherlands; Department of Internal Medicine (E.P.M.C.), Division of Endocrinology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pediatric Oncology (L.C.M.K., H.J.H.v.d.P., C.M.R.), Emma Children's Hospital, Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.T.N.-M., J.W.A.S.), Division of Endocrinology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; Department of Medical Oncology (H.J.H.v.d.P.), Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.P.P.) and Rotterdam Thyroid Center (R.P.P.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Institute of Pathology (K.W.S.), University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; Department of Medicine (G.R.W.), Imperial College London, London SW7 2AZ, United Kingdom; and Department of Pediatrics (H.M.v.S.), Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Romana T Netea-Maier
- Departments of Endocrinology (M.S.K.H., M.N., T.P.L.), Nuclear Medicine and Molecular Imaging (A.H.B.), Epidemiology (J.G.M.B.), and Surgical Oncology (J.T.M.P.), University of Groningen, University Medical Center Groningen, and Departments of Pediatric Endocrinology (G.B.) and Pediatric Oncology (W.J.E.T.), Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Internal Medicine (E.W.C.M.v.D.), VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (B.H.), Division of Endocrinology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands; Department of Pediatric Oncology (M.M.v.d.H.-E.), Sophia Children's Hospital, Erasmus Medical Center, 3000 CB Rotterdam, The Netherlands; Department of Internal Medicine (E.P.M.C.), Division of Endocrinology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pediatric Oncology (L.C.M.K., H.J.H.v.d.P., C.M.R.), Emma Children's Hospital, Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.T.N.-M., J.W.A.S.), Division of Endocrinology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; Department of Medical Oncology (H.J.H.v.d.P.), Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.P.P.) and Rotterdam Thyroid Center (R.P.P.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Institute of Pathology (K.W.S.), University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; Department of Medicine (G.R.W.), Imperial College London, London SW7 2AZ, United Kingdom; and Department of Pediatrics (H.M.v.S.), Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Heleen J H van der Pal
- Departments of Endocrinology (M.S.K.H., M.N., T.P.L.), Nuclear Medicine and Molecular Imaging (A.H.B.), Epidemiology (J.G.M.B.), and Surgical Oncology (J.T.M.P.), University of Groningen, University Medical Center Groningen, and Departments of Pediatric Endocrinology (G.B.) and Pediatric Oncology (W.J.E.T.), Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Internal Medicine (E.W.C.M.v.D.), VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (B.H.), Division of Endocrinology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands; Department of Pediatric Oncology (M.M.v.d.H.-E.), Sophia Children's Hospital, Erasmus Medical Center, 3000 CB Rotterdam, The Netherlands; Department of Internal Medicine (E.P.M.C.), Division of Endocrinology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pediatric Oncology (L.C.M.K., H.J.H.v.d.P., C.M.R.), Emma Children's Hospital, Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.T.N.-M., J.W.A.S.), Division of Endocrinology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; Department of Medical Oncology (H.J.H.v.d.P.), Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.P.P.) and Rotterdam Thyroid Center (R.P.P.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Institute of Pathology (K.W.S.), University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; Department of Medicine (G.R.W.), Imperial College London, London SW7 2AZ, United Kingdom; and Department of Pediatrics (H.M.v.S.), Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Robin P Peeters
- Departments of Endocrinology (M.S.K.H., M.N., T.P.L.), Nuclear Medicine and Molecular Imaging (A.H.B.), Epidemiology (J.G.M.B.), and Surgical Oncology (J.T.M.P.), University of Groningen, University Medical Center Groningen, and Departments of Pediatric Endocrinology (G.B.) and Pediatric Oncology (W.J.E.T.), Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Internal Medicine (E.W.C.M.v.D.), VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (B.H.), Division of Endocrinology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands; Department of Pediatric Oncology (M.M.v.d.H.-E.), Sophia Children's Hospital, Erasmus Medical Center, 3000 CB Rotterdam, The Netherlands; Department of Internal Medicine (E.P.M.C.), Division of Endocrinology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pediatric Oncology (L.C.M.K., H.J.H.v.d.P., C.M.R.), Emma Children's Hospital, Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.T.N.-M., J.W.A.S.), Division of Endocrinology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; Department of Medical Oncology (H.J.H.v.d.P.), Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.P.P.) and Rotterdam Thyroid Center (R.P.P.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Institute of Pathology (K.W.S.), University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; Department of Medicine (G.R.W.), Imperial College London, London SW7 2AZ, United Kingdom; and Department of Pediatrics (H.M.v.S.), Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Kurt W Schmid
- Departments of Endocrinology (M.S.K.H., M.N., T.P.L.), Nuclear Medicine and Molecular Imaging (A.H.B.), Epidemiology (J.G.M.B.), and Surgical Oncology (J.T.M.P.), University of Groningen, University Medical Center Groningen, and Departments of Pediatric Endocrinology (G.B.) and Pediatric Oncology (W.J.E.T.), Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Internal Medicine (E.W.C.M.v.D.), VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (B.H.), Division of Endocrinology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands; Department of Pediatric Oncology (M.M.v.d.H.-E.), Sophia Children's Hospital, Erasmus Medical Center, 3000 CB Rotterdam, The Netherlands; Department of Internal Medicine (E.P.M.C.), Division of Endocrinology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pediatric Oncology (L.C.M.K., H.J.H.v.d.P., C.M.R.), Emma Children's Hospital, Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.T.N.-M., J.W.A.S.), Division of Endocrinology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; Department of Medical Oncology (H.J.H.v.d.P.), Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.P.P.) and Rotterdam Thyroid Center (R.P.P.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Institute of Pathology (K.W.S.), University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; Department of Medicine (G.R.W.), Imperial College London, London SW7 2AZ, United Kingdom; and Department of Pediatrics (H.M.v.S.), Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Johannes W A Smit
- Departments of Endocrinology (M.S.K.H., M.N., T.P.L.), Nuclear Medicine and Molecular Imaging (A.H.B.), Epidemiology (J.G.M.B.), and Surgical Oncology (J.T.M.P.), University of Groningen, University Medical Center Groningen, and Departments of Pediatric Endocrinology (G.B.) and Pediatric Oncology (W.J.E.T.), Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Internal Medicine (E.W.C.M.v.D.), VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (B.H.), Division of Endocrinology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands; Department of Pediatric Oncology (M.M.v.d.H.-E.), Sophia Children's Hospital, Erasmus Medical Center, 3000 CB Rotterdam, The Netherlands; Department of Internal Medicine (E.P.M.C.), Division of Endocrinology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pediatric Oncology (L.C.M.K., H.J.H.v.d.P., C.M.R.), Emma Children's Hospital, Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.T.N.-M., J.W.A.S.), Division of Endocrinology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; Department of Medical Oncology (H.J.H.v.d.P.), Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.P.P.) and Rotterdam Thyroid Center (R.P.P.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Institute of Pathology (K.W.S.), University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; Department of Medicine (G.R.W.), Imperial College London, London SW7 2AZ, United Kingdom; and Department of Pediatrics (H.M.v.S.), Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Graham R Williams
- Departments of Endocrinology (M.S.K.H., M.N., T.P.L.), Nuclear Medicine and Molecular Imaging (A.H.B.), Epidemiology (J.G.M.B.), and Surgical Oncology (J.T.M.P.), University of Groningen, University Medical Center Groningen, and Departments of Pediatric Endocrinology (G.B.) and Pediatric Oncology (W.J.E.T.), Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Internal Medicine (E.W.C.M.v.D.), VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (B.H.), Division of Endocrinology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands; Department of Pediatric Oncology (M.M.v.d.H.-E.), Sophia Children's Hospital, Erasmus Medical Center, 3000 CB Rotterdam, The Netherlands; Department of Internal Medicine (E.P.M.C.), Division of Endocrinology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pediatric Oncology (L.C.M.K., H.J.H.v.d.P., C.M.R.), Emma Children's Hospital, Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.T.N.-M., J.W.A.S.), Division of Endocrinology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; Department of Medical Oncology (H.J.H.v.d.P.), Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.P.P.) and Rotterdam Thyroid Center (R.P.P.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Institute of Pathology (K.W.S.), University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; Department of Medicine (G.R.W.), Imperial College London, London SW7 2AZ, United Kingdom; and Department of Pediatrics (H.M.v.S.), Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - John T M Plukker
- Departments of Endocrinology (M.S.K.H., M.N., T.P.L.), Nuclear Medicine and Molecular Imaging (A.H.B.), Epidemiology (J.G.M.B.), and Surgical Oncology (J.T.M.P.), University of Groningen, University Medical Center Groningen, and Departments of Pediatric Endocrinology (G.B.) and Pediatric Oncology (W.J.E.T.), Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Internal Medicine (E.W.C.M.v.D.), VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (B.H.), Division of Endocrinology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands; Department of Pediatric Oncology (M.M.v.d.H.-E.), Sophia Children's Hospital, Erasmus Medical Center, 3000 CB Rotterdam, The Netherlands; Department of Internal Medicine (E.P.M.C.), Division of Endocrinology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pediatric Oncology (L.C.M.K., H.J.H.v.d.P., C.M.R.), Emma Children's Hospital, Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.T.N.-M., J.W.A.S.), Division of Endocrinology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; Department of Medical Oncology (H.J.H.v.d.P.), Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.P.P.) and Rotterdam Thyroid Center (R.P.P.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Institute of Pathology (K.W.S.), University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; Department of Medicine (G.R.W.), Imperial College London, London SW7 2AZ, United Kingdom; and Department of Pediatrics (H.M.v.S.), Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Cécile M Ronckers
- Departments of Endocrinology (M.S.K.H., M.N., T.P.L.), Nuclear Medicine and Molecular Imaging (A.H.B.), Epidemiology (J.G.M.B.), and Surgical Oncology (J.T.M.P.), University of Groningen, University Medical Center Groningen, and Departments of Pediatric Endocrinology (G.B.) and Pediatric Oncology (W.J.E.T.), Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Internal Medicine (E.W.C.M.v.D.), VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (B.H.), Division of Endocrinology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands; Department of Pediatric Oncology (M.M.v.d.H.-E.), Sophia Children's Hospital, Erasmus Medical Center, 3000 CB Rotterdam, The Netherlands; Department of Internal Medicine (E.P.M.C.), Division of Endocrinology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pediatric Oncology (L.C.M.K., H.J.H.v.d.P., C.M.R.), Emma Children's Hospital, Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.T.N.-M., J.W.A.S.), Division of Endocrinology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; Department of Medical Oncology (H.J.H.v.d.P.), Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.P.P.) and Rotterdam Thyroid Center (R.P.P.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Institute of Pathology (K.W.S.), University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; Department of Medicine (G.R.W.), Imperial College London, London SW7 2AZ, United Kingdom; and Department of Pediatrics (H.M.v.S.), Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Hanneke M van Santen
- Departments of Endocrinology (M.S.K.H., M.N., T.P.L.), Nuclear Medicine and Molecular Imaging (A.H.B.), Epidemiology (J.G.M.B.), and Surgical Oncology (J.T.M.P.), University of Groningen, University Medical Center Groningen, and Departments of Pediatric Endocrinology (G.B.) and Pediatric Oncology (W.J.E.T.), Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Internal Medicine (E.W.C.M.v.D.), VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (B.H.), Division of Endocrinology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands; Department of Pediatric Oncology (M.M.v.d.H.-E.), Sophia Children's Hospital, Erasmus Medical Center, 3000 CB Rotterdam, The Netherlands; Department of Internal Medicine (E.P.M.C.), Division of Endocrinology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pediatric Oncology (L.C.M.K., H.J.H.v.d.P., C.M.R.), Emma Children's Hospital, Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.T.N.-M., J.W.A.S.), Division of Endocrinology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; Department of Medical Oncology (H.J.H.v.d.P.), Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.P.P.) and Rotterdam Thyroid Center (R.P.P.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Institute of Pathology (K.W.S.), University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; Department of Medicine (G.R.W.), Imperial College London, London SW7 2AZ, United Kingdom; and Department of Pediatrics (H.M.v.S.), Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Wim J E Tissing
- Departments of Endocrinology (M.S.K.H., M.N., T.P.L.), Nuclear Medicine and Molecular Imaging (A.H.B.), Epidemiology (J.G.M.B.), and Surgical Oncology (J.T.M.P.), University of Groningen, University Medical Center Groningen, and Departments of Pediatric Endocrinology (G.B.) and Pediatric Oncology (W.J.E.T.), Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Internal Medicine (E.W.C.M.v.D.), VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (B.H.), Division of Endocrinology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands; Department of Pediatric Oncology (M.M.v.d.H.-E.), Sophia Children's Hospital, Erasmus Medical Center, 3000 CB Rotterdam, The Netherlands; Department of Internal Medicine (E.P.M.C.), Division of Endocrinology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pediatric Oncology (L.C.M.K., H.J.H.v.d.P., C.M.R.), Emma Children's Hospital, Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.T.N.-M., J.W.A.S.), Division of Endocrinology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; Department of Medical Oncology (H.J.H.v.d.P.), Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.P.P.) and Rotterdam Thyroid Center (R.P.P.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Institute of Pathology (K.W.S.), University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; Department of Medicine (G.R.W.), Imperial College London, London SW7 2AZ, United Kingdom; and Department of Pediatrics (H.M.v.S.), Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Thera P Links
- Departments of Endocrinology (M.S.K.H., M.N., T.P.L.), Nuclear Medicine and Molecular Imaging (A.H.B.), Epidemiology (J.G.M.B.), and Surgical Oncology (J.T.M.P.), University of Groningen, University Medical Center Groningen, and Departments of Pediatric Endocrinology (G.B.) and Pediatric Oncology (W.J.E.T.), Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; Department of Internal Medicine (E.W.C.M.v.D.), VU University Medical Center, 1007 MB Amsterdam, The Netherlands; Department of Internal Medicine (B.H.), Division of Endocrinology, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands; Department of Pediatric Oncology (M.M.v.d.H.-E.), Sophia Children's Hospital, Erasmus Medical Center, 3000 CB Rotterdam, The Netherlands; Department of Internal Medicine (E.P.M.C.), Division of Endocrinology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pediatric Oncology (L.C.M.K., H.J.H.v.d.P., C.M.R.), Emma Children's Hospital, Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.T.N.-M., J.W.A.S.), Division of Endocrinology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; Department of Medical Oncology (H.J.H.v.d.P.), Academic Medical Center, 1100 DD Amsterdam, The Netherlands; Department of Internal Medicine (R.P.P.) and Rotterdam Thyroid Center (R.P.P.), Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands; Institute of Pathology (K.W.S.), University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; Department of Medicine (G.R.W.), Imperial College London, London SW7 2AZ, United Kingdom; and Department of Pediatrics (H.M.v.S.), Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
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Plantinga TS, Tesselaar MH, Morreau H, Corssmit EPM, Willemsen BK, Kusters B, van Engen-van Grunsven ACH, Smit JWA, Netea-Maier RT. Autophagy activity is associated with membranous sodium iodide symporter expression and clinical response to radioiodine therapy in non-medullary thyroid cancer. Autophagy 2016; 12:1195-205. [PMID: 27105307 PMCID: PMC4990989 DOI: 10.1080/15548627.2016.1174802] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Although non-medullary thyroid cancer (NMTC) generally has a good prognosis, 30-40% of patients with distant metastases develop resistance to radioactive iodine (RAI) therapy due to tumor dedifferentiation. For these patients, treatment options are limited and prognosis is poor. In the present study, expression and activity of autophagy was assessed in large sets of normal, benign and malignant tissues and was correlated with pathology, SLC5A5/hNIS (solute carrier family 5 member 5) protein expression, and with clinical response to RAI ablation therapy in NMTC patients. Fluorescent immunostaining for the autophagy marker LC3 was performed on 100 benign and 80 malignant thyroid tissues. Semiquantitative scoring was generated for both diffuse LC3-I intensity and number of LC3-II-positive puncta and was correlated with SLC5A5 protein expression and clinical parameters. Degree of diffuse LC3-I intensity and number of LC3-II-positive puncta scoring were not discriminative for benign vs. malignant thyroid lesions. Interestingly, however, in NMTC patients significant associations were observed between diffuse LC3-I intensity and LC3-II-positive puncta scoring on the one hand and clinical response to RAI therapy on the other hand (odds ratio [OR] = 3.13, 95% confidence interval [CI] =1.91-5.12, P = 0.01; OR = 5.68, 95%CI = 3.02-10.05, P = 0.002, respectively). Mechanistically, the number of LC3-II-positive puncta correlated with membranous SLC5A5 expression (OR = 7.71, 95%CI = 4.15-11.75, P<0.001), number of RAI treatments required to reach remission (P = 0.014), cumulative RAI dose (P = 0.026) and with overall remission and recurrence rates (P = 0.031). In conclusion, autophagy activity strongly correlates with clinical response of NMTC patients to RAI therapy, potentially by its capacity to maintain tumor cell differentiation and to preserve functional iodide uptake.
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Affiliation(s)
- Theo S Plantinga
- a Department of Internal Medicine , Radboud University Medical Center , Nijmegen , The Netherlands.,b Division of Endocrinology , Radboud University Medical Center , Nijmegen , The Netherlands.,c Department of Pathology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Marika H Tesselaar
- a Department of Internal Medicine , Radboud University Medical Center , Nijmegen , The Netherlands.,b Division of Endocrinology , Radboud University Medical Center , Nijmegen , The Netherlands.,c Department of Pathology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Hans Morreau
- d Department of Pathology , Leiden University Medical Center , Leiden , The Netherlands
| | - Eleonora P M Corssmit
- e Department of Endocrinology and Metabolic Diseases , Leiden University Medical Center , Leiden , The Netherlands
| | - Brigith K Willemsen
- c Department of Pathology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Benno Kusters
- c Department of Pathology , Radboud University Medical Center , Nijmegen , The Netherlands
| | | | - Johannes W A Smit
- a Department of Internal Medicine , Radboud University Medical Center , Nijmegen , The Netherlands.,b Division of Endocrinology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Romana T Netea-Maier
- a Department of Internal Medicine , Radboud University Medical Center , Nijmegen , The Netherlands.,b Division of Endocrinology , Radboud University Medical Center , Nijmegen , The Netherlands
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Nederstigt C, Corssmit EPM, de Koning EJP, Dekkers OM. Incidence and prevalence of thyroid dysfunction in type 1 diabetes. J Diabetes Complications 2016; 30:420-5. [PMID: 26868720 DOI: 10.1016/j.jdiacomp.2015.12.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 12/30/2015] [Accepted: 12/31/2015] [Indexed: 12/30/2022]
Abstract
AIMS To estimate prevalence and incidence of auto-immune thyroid disease and thyroid auto-antibodies in an unselected cohort of patients with DM1, including stratification by age, gender and duration of diabetes. METHODS Patients with T1D visiting our outpatient clinic between 1995 and 2011 were included. We calculated the prevalence of AITD at first screening and estimated prevalence and incidence rates during follow-up. RESULTS A total of 1304 patients were included, 48.9% being female. Mean age of diabetes onset was 18.7 years. Of all patients without known thyroid disorder first screened for AITD, 10.3 % (n=104) was diagnosed with hypo- or hyperthyroidism. The average prevalence of AITD in our population was 112/1000 patients. We found 128 new cases of AITD, 101 cases of hypothyroidism and 27 of hyperthyroidism between 1995 and 2011 with accompanying incidences of 11.2/1000 person-years (95% CI 9.5-13.4), 8.9/1000 person-years (95% CI, 7.3-10.8) and 2.4/1000 person-years (95% CI, 1.6-3.5), respectively. Age-stratified incidence of AITD was comparable at all ages in both males and females, with an approximately two times higher incidence in females. CONCLUSIONS The incidence of AITD among T1D patients is high, but stable among all ages and independent of diabetes duration.
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Affiliation(s)
- Christa Nederstigt
- Department of Internal Medicine, Section Endocrinology, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, The Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, The Netherlands; Medisch Centrum Haaglanden, Department of Internal Medicine, Lijnbaan 32, 2512 VA Den Haag, The Netherlands.
| | - Eleonora P M Corssmit
- Department of Internal Medicine, Section Endocrinology, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, The Netherlands.
| | - Eelco J P de Koning
- Department of Internal Medicine, Section Endocrinology, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, The Netherlands.
| | - Olaf M Dekkers
- Department of Internal Medicine, Section Endocrinology, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, The Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, The Netherlands; Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200 Aarhus, Denmark.
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van den Berg R, Mook-Kanamori DO, Donga E, van Dijk M, van Dijk JG, Lammers GJ, van Kralingen KW, Prehn C, Adamski J, Romijn JA, van Dijk KW, Corssmit EPM, Rensen PCN, Biermasz NR. A single night of sleep curtailment increases plasma acylcarnitines: Novel insights in the relationship between sleep and insulin resistance. Arch Biochem Biophys 2016; 589:145-51. [PMID: 26393786 DOI: 10.1016/j.abb.2015.09.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 09/01/2015] [Accepted: 09/17/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Rosa van den Berg
- Dept. of Medicine, Div. of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands.
| | - Dennis O Mook-Kanamori
- Dept. of Medicine, Div. of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands; Dept. of Epidemiology, Leiden University Medical Center, Leiden, The Netherlands; Epidemiology Section, Dept. of BESC, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Esther Donga
- Dept. of Medicine, Div. of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke van Dijk
- Dept. of Medicine, Div. of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - J Gert van Dijk
- Dept. of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gert-Jan Lammers
- Dept. of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Cornelia Prehn
- Institute of Experimental Genetics, Genome Analysis Center, Helmholtz Zentrum München, Neuherberg, Germany
| | - Jerzy Adamski
- Institute of Experimental Genetics, Genome Analysis Center, Helmholtz Zentrum München, Neuherberg, Germany; German Center for Diabetes Research, Neuherberg, Germany; Lehrstul für Experimentelle Genetik, Technische Universität München, Freising-Weihenstephan, Germany
| | - Johannes A Romijn
- Dept. of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Ko Willems van Dijk
- Dept. of Medicine, Div. of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands; Dept. Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Eleonora P M Corssmit
- Dept. of Medicine, Div. of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Patrick C N Rensen
- Dept. of Medicine, Div. of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Nienke R Biermasz
- Dept. of Medicine, Div. of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
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Joustra SD, Roelfsema F, Endert E, Ballieux BEPB, van Trotsenburg ASP, Fliers E, Corssmit EPM, Bernard DJ, Oostdijk W, Wit JM, Pereira AM, Biermasz NR. Pituitary Hormone Secretion Profiles in IGSF1 Deficiency Syndrome. Neuroendocrinology 2016; 103:408-16. [PMID: 26336917 DOI: 10.1159/000439433] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 08/15/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Loss-of-function mutations in immunoglobulin superfamily member 1 (IGSF1) cause an X-linked syndrome of central hypothyroidism, macroorchidism, delayed pubertal testosterone rise, variable prolactin deficiency and variable partial GH deficiency in childhood. The clinical features and gene expression pattern suggest a pivotal role for IGSF1 in the pituitary, but detailed knowledge on pituitary hormone secretion in this syndrome is lacking. We therefore aimed to study the 24-hour pituitary hormone secretion in male patients with IGSF1 deficiency. METHODS We collected blood samples every 10 min for 24 h in eight adult male IGSF1-deficient patients and measured circulating TSH, prolactin and gonadotropins. Deconvolution, modified cosinor and approximate entropy analyses were applied to quantify secretion rates, diurnal rhythmicity and regularity of hormone release. Results were compared to healthy controls matched for age and body mass index. RESULTS Compared to healthy controls, IGSF1-deficient patients showed decreased pulsatile secretion of TSH with decreased disorderliness and reduced diurnal variation. Basal and pulsatile secretion of FSH was increased by over 200%, while LH secretion did not differ from healthy controls. We observed a bimodal distribution of prolactin secretion, i.e. severe deficiency in three and increased basal and total secretion in the other five patients. CONCLUSION The altered TSH secretion pattern is consistent with the previously hypothesized defect in thyrotropin-releasing hormone signaling in IGSF1 deficiency. However, the phenotype is more extensive and includes increased FSH secretion without altered LH secretion as well as either undetectable or increased prolactin secretion.
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Affiliation(s)
- Sjoerd D Joustra
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
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Niemeijer ND, Papathomas TG, Korpershoek E, de Krijger RR, Oudijk L, Morreau H, Bayley JP, Hes FJ, Jansen JC, Dinjens WNM, Corssmit EPM. Succinate Dehydrogenase (SDH)-Deficient Pancreatic Neuroendocrine Tumor Expands the SDH-Related Tumor Spectrum. J Clin Endocrinol Metab 2015; 100:E1386-93. [PMID: 26259135 DOI: 10.1210/jc.2015-2689] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Mutations in genes encoding the subunits of succinate dehydrogenase (SDH) can lead to pheochromocytoma/paraganglioma formation. However, SDH mutations have also been linked to nonparaganglionic tumors. OBJECTIVE The objective was to investigate which nonparaganglionic tumors belong to the SDH-associated tumor spectrum. DESIGN This was a retrospective cohort study. SETTING The setting was a tertiary referral center. PATIENTS Patients included all consecutive SDHA/SDHB/SDHC and SDHD mutation carriers followed at the Department of Endocrinology of the Leiden University Medical Center who were affected by non-pheochromocytoma/paraganglioma solid tumors. MAIN OUTCOME MEASURES Main outcome measures were SDHA/SDHB immunohistochemistry, mutation analysis, and loss of heterozygosity analysis of the involved SDH-encoding genes. RESULTS Twenty-five of 35 tumors (from 26 patients) showed positive staining on SDHB and SDHA immunohistochemistry. Eight tumors showed negative staining for SDHB and positive staining for SDHA: a pancreatic neuroendocrine tumor, a macroprolactinoma, two gastric gastrointestinal stromal tumors, an abdominal ganglioneuroma, and three renal cell carcinomas. With the exception of the abdominal ganglioneuroma, loss of heterozygosity was detected in all tumors. A prolactinoma in a patient with a germline SDHA mutation was the only tumor immunonegative for both SDHA and SDHB. Sanger sequencing of this tumor revealed a somatic mutation (p.D38V) as a likely second hit leading to biallelic inactivation of SDHA. One tumor (breast cancer) showed heterogeneous SDHB staining, positive SDHA staining, and retention of heterozygosity. CONCLUSIONS This study strengthens the etiological association of SDH genes with pituitary neoplasia, renal tumorigenesis, and gastric gastrointestinal stromal tumors. Furthermore, our results indicate that pancreatic neuroendocrine tumor also falls within the SDH-related tumor spectrum.
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Affiliation(s)
- Nicolasine D Niemeijer
- Department of Endocrinology and Metabolic Diseases (N.D.N., E.P.M.C.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pathology (T.G.P., E.K., L.O., W.N.M.D., R.R.d.K.) Erasmus Medical Center, 3015 CE Rotterdam, The Netherlands; Department of Pathology (R.R.d.K.), Reinier de Graaf Hospital, 2625 AD Delft, The Netherlands; and Departments of Pathology (H.M.), Human Genetics (J.P.B.), Clinical Genetics (F.J.H.), and Otorhinolaryngology (J.C.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Thomas G Papathomas
- Department of Endocrinology and Metabolic Diseases (N.D.N., E.P.M.C.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pathology (T.G.P., E.K., L.O., W.N.M.D., R.R.d.K.) Erasmus Medical Center, 3015 CE Rotterdam, The Netherlands; Department of Pathology (R.R.d.K.), Reinier de Graaf Hospital, 2625 AD Delft, The Netherlands; and Departments of Pathology (H.M.), Human Genetics (J.P.B.), Clinical Genetics (F.J.H.), and Otorhinolaryngology (J.C.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Esther Korpershoek
- Department of Endocrinology and Metabolic Diseases (N.D.N., E.P.M.C.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pathology (T.G.P., E.K., L.O., W.N.M.D., R.R.d.K.) Erasmus Medical Center, 3015 CE Rotterdam, The Netherlands; Department of Pathology (R.R.d.K.), Reinier de Graaf Hospital, 2625 AD Delft, The Netherlands; and Departments of Pathology (H.M.), Human Genetics (J.P.B.), Clinical Genetics (F.J.H.), and Otorhinolaryngology (J.C.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Ronald R de Krijger
- Department of Endocrinology and Metabolic Diseases (N.D.N., E.P.M.C.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pathology (T.G.P., E.K., L.O., W.N.M.D., R.R.d.K.) Erasmus Medical Center, 3015 CE Rotterdam, The Netherlands; Department of Pathology (R.R.d.K.), Reinier de Graaf Hospital, 2625 AD Delft, The Netherlands; and Departments of Pathology (H.M.), Human Genetics (J.P.B.), Clinical Genetics (F.J.H.), and Otorhinolaryngology (J.C.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Lindsey Oudijk
- Department of Endocrinology and Metabolic Diseases (N.D.N., E.P.M.C.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pathology (T.G.P., E.K., L.O., W.N.M.D., R.R.d.K.) Erasmus Medical Center, 3015 CE Rotterdam, The Netherlands; Department of Pathology (R.R.d.K.), Reinier de Graaf Hospital, 2625 AD Delft, The Netherlands; and Departments of Pathology (H.M.), Human Genetics (J.P.B.), Clinical Genetics (F.J.H.), and Otorhinolaryngology (J.C.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Hans Morreau
- Department of Endocrinology and Metabolic Diseases (N.D.N., E.P.M.C.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pathology (T.G.P., E.K., L.O., W.N.M.D., R.R.d.K.) Erasmus Medical Center, 3015 CE Rotterdam, The Netherlands; Department of Pathology (R.R.d.K.), Reinier de Graaf Hospital, 2625 AD Delft, The Netherlands; and Departments of Pathology (H.M.), Human Genetics (J.P.B.), Clinical Genetics (F.J.H.), and Otorhinolaryngology (J.C.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Jean-Pierre Bayley
- Department of Endocrinology and Metabolic Diseases (N.D.N., E.P.M.C.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pathology (T.G.P., E.K., L.O., W.N.M.D., R.R.d.K.) Erasmus Medical Center, 3015 CE Rotterdam, The Netherlands; Department of Pathology (R.R.d.K.), Reinier de Graaf Hospital, 2625 AD Delft, The Netherlands; and Departments of Pathology (H.M.), Human Genetics (J.P.B.), Clinical Genetics (F.J.H.), and Otorhinolaryngology (J.C.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Frederik J Hes
- Department of Endocrinology and Metabolic Diseases (N.D.N., E.P.M.C.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pathology (T.G.P., E.K., L.O., W.N.M.D., R.R.d.K.) Erasmus Medical Center, 3015 CE Rotterdam, The Netherlands; Department of Pathology (R.R.d.K.), Reinier de Graaf Hospital, 2625 AD Delft, The Netherlands; and Departments of Pathology (H.M.), Human Genetics (J.P.B.), Clinical Genetics (F.J.H.), and Otorhinolaryngology (J.C.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Jeroen C Jansen
- Department of Endocrinology and Metabolic Diseases (N.D.N., E.P.M.C.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pathology (T.G.P., E.K., L.O., W.N.M.D., R.R.d.K.) Erasmus Medical Center, 3015 CE Rotterdam, The Netherlands; Department of Pathology (R.R.d.K.), Reinier de Graaf Hospital, 2625 AD Delft, The Netherlands; and Departments of Pathology (H.M.), Human Genetics (J.P.B.), Clinical Genetics (F.J.H.), and Otorhinolaryngology (J.C.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Winand N M Dinjens
- Department of Endocrinology and Metabolic Diseases (N.D.N., E.P.M.C.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pathology (T.G.P., E.K., L.O., W.N.M.D., R.R.d.K.) Erasmus Medical Center, 3015 CE Rotterdam, The Netherlands; Department of Pathology (R.R.d.K.), Reinier de Graaf Hospital, 2625 AD Delft, The Netherlands; and Departments of Pathology (H.M.), Human Genetics (J.P.B.), Clinical Genetics (F.J.H.), and Otorhinolaryngology (J.C.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Eleonora P M Corssmit
- Department of Endocrinology and Metabolic Diseases (N.D.N., E.P.M.C.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Department of Pathology (T.G.P., E.K., L.O., W.N.M.D., R.R.d.K.) Erasmus Medical Center, 3015 CE Rotterdam, The Netherlands; Department of Pathology (R.R.d.K.), Reinier de Graaf Hospital, 2625 AD Delft, The Netherlands; and Departments of Pathology (H.M.), Human Genetics (J.P.B.), Clinical Genetics (F.J.H.), and Otorhinolaryngology (J.C.J.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands
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Donga E, Dekkers OM, Corssmit EPM, Romijn JA. Insulin resistance in patients with type 1 diabetes assessed by glucose clamp studies: systematic review and meta-analysis. Eur J Endocrinol 2015; 173:101-9. [PMID: 25899581 DOI: 10.1530/eje-14-0911] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 04/20/2015] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The aim of this study was to perform a systematic review and meta-analysis on insulin resistance in adult patients with type 1 diabetes mellitus compared to healthy controls, assessed by hyperinsulinemic euglycemic clamp studies. DESIGN AND METHODS We conducted a systematic search of publications using PubMed, EMBASE, Web of Science and COCHRANE Library. Hyperinsulinemic euglycemic clamp studies comparing adult patients with type 1 diabetes mellitus to healthy controls were eligible. Primary outcome measures were pooled mean differences of insulin sensitivity of endogenous glucose production (EGP), of glucose uptake and of lipolysis. We estimated mean (standardized) differences and 95% CIs using random effects meta-analysis. RESULTS We included 38 publications in this meta-analysis. The weighed mean differences in EGP during hyperinsulinemia between patients and controls was 0.88 (95% CI: 0.47, 1.29) in the basal state and 0.52 (95% CI: 0.09, 0.95) in insulin stimulated conditions, indicating decreased hepatic insulin sensitivity in patients. Insulin sensitivity of glucose uptake was either reported as M value (M), glucose infusion rate (GIR), glucose disposal rate (GDR) or metabolic clearance rate (MCR). Weighed mean differences were similar for M -3.98 (95% CI: -4.68, -3.29) and GIR -4.61 (95% CI: -5.86, -3.53). Weighed mean difference for GDR was -2.43 (95% CI: -3.03, -1.83) and -3.29 (95% CI: -5.37, -1.22) for MCR, indicating decreased peripheral insulin sensitivity in patients. Insulin mediated inhibition of lipolysis was decreased in patients, reflected by increased non-esterified fatty acid levels. CONCLUSIONS Insulin resistance is a prominent feature of patients with type 1 diabetes mellitus and involves hepatic, peripheral and adipose tissues.
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Affiliation(s)
- Esther Donga
- Department of Endocrinology and Metabolic Diseases C7Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment of Clinical EpidemiologyLeiden University Medical Center, Leiden, The NetherlandsDepartment of Internal MedicineAmsterdam Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Olaf M Dekkers
- Department of Endocrinology and Metabolic Diseases C7Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment of Clinical EpidemiologyLeiden University Medical Center, Leiden, The NetherlandsDepartment of Internal MedicineAmsterdam Medical Center, University of Amsterdam, Amsterdam, The Netherlands Department of Endocrinology and Metabolic Diseases C7Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment of Clinical EpidemiologyLeiden University Medical Center, Leiden, The NetherlandsDepartment of Internal MedicineAmsterdam Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Eleonora P M Corssmit
- Department of Endocrinology and Metabolic Diseases C7Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment of Clinical EpidemiologyLeiden University Medical Center, Leiden, The NetherlandsDepartment of Internal MedicineAmsterdam Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes A Romijn
- Department of Endocrinology and Metabolic Diseases C7Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment of Clinical EpidemiologyLeiden University Medical Center, Leiden, The NetherlandsDepartment of Internal MedicineAmsterdam Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Rijken JA, Niemeijer ND, Corssmit EPM, Jonker MA, Leemans CR, Menko FH, Hensen EF. Low penetrance of paraganglioma and pheochromocytoma in an extended kindred with a germline SDHB exon 3 deletion. Clin Genet 2015; 89:128-32. [PMID: 25827221 DOI: 10.1111/cge.12591] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 03/06/2015] [Accepted: 03/25/2015] [Indexed: 11/29/2022]
Abstract
In the Netherlands, the majority of hereditary paragangliomas (PGL) is caused by SDHD, SDHB and SDHAF2 mutations. Founder mutations in SDHD are particularly prevalent, but several SDHB founder mutations have also been described. Here, we describe an extended PGL family with a Dutch founder mutation in SDHB, c.201-4429_287-933del. The proband presented with apparently sporadic head and neck paraganglioma at advanced age. Subsequently, evaluation of the family identified several unaffected mutation carriers, asymptomatic and symptomatic PGL patients, and patients presenting with early-onset malignant pheochromocytoma. The calculated penetrance of the SDHB mutation in this kindred is lower than the risk suggested for SDHB mutations in the literature. This may represent a characteristic of this particular SDHB mutation, but may also be a reflection of the inclusion of relatively large numbers of asymptomatic mutation carriers in this family and adequate statistical correction for ascertainment bias. The low penetrance of SDHB mutations may obscure the hereditary nature of SDHB-linked disease and is important in the counseling of SDHB-linked patients. Risk estimates should preferably be based on the specific mutation involved.
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Affiliation(s)
- J A Rijken
- Department of Otolaryngology - Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - N D Niemeijer
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - E P M Corssmit
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - M A Jonker
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - C R Leemans
- Department of Otolaryngology - Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - F H Menko
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands.,Department of Clinical Genetics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E F Hensen
- Department of Otolaryngology - Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
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Niemeijer ND, Corssmit EPM, Reijntjes RHAM, Lammers GJ, van Dijk JG, Thijs RD. Sleep-mediated heart rate variability after bilateral carotid body tumor resection. Sleep 2015; 38:633-9. [PMID: 25325476 DOI: 10.5665/sleep.4586] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 09/14/2014] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES The carotid bodies are thought to play an important role in sleep-dependent autonomic changes. Patients who underwent resection of bilateral carotid body tumors have chronically attenuated baroreflex sensitivity. These subjects provide a unique opportunity to investigate the role of the baroreflex during sleep. DESIGN One-night ambulatory polysomnography (PSG) recording. SETTING Participants' homes. PARTICIPANTS Nine patients with bilateral carotid body tumor resection (bCBR) (four women, mean age 50.4 ± 7.2 years) and nine controls matched for age, gender, and body mass index. INTERVENTIONS N/A. MEASUREMENTS Sleep parameters were obtained from PSG. Heart rate (HR) and its variability were calculated using 30-s epochs. RESULTS In bCBR patients, HR was slightly but not significantly increased during wake and all sleep stages. The effect of sleep on HR was similar for patients and controls. Low frequency (LF) power of the heart rate variability spectrum was significantly lower in bCBR patients in active wakefulness, sleep stage 1 and REM sleep. No differences were found between patients and controls for high frequency (HF) power and the LF/HF ratio. CONCLUSIONS Bilateral carotid body tumor resection (bCBR) is associated with decreased low frequency power during sleep, suggesting impaired baroreflex function. Despite this, sleep-related heart rate changes were similar between bCBR patients and controls. These findings suggest that the effects of sleep on heart rate are predominantly generated through central, non-baroreflex mediated pathways.
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Affiliation(s)
- Nicolasine D Niemeijer
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Eleonora P M Corssmit
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Gert Jan Lammers
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Sleep Wake Center SEIN, Heemstede, The Netherlands
| | - J Gert van Dijk
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Roland D Thijs
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,SEIN, Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands
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Gill AJ, Hes O, Papathomas T, Šedivcová M, Tan PH, Agaimy A, Andresen PA, Kedziora A, Clarkson A, Toon CW, Sioson L, Watson N, Chou A, Paik J, Clifton-Bligh RJ, Robinson BG, Benn DE, Hills K, Maclean F, Niemeijer ND, Vlatkovic L, Hartmann A, Corssmit EPM, van Leenders GJLH, Przybycin C, McKenney JK, Magi-Galluzzi C, Yilmaz A, Yu D, Nicoll KD, Yong JL, Sibony M, Yakirevich E, Fleming S, Chow CW, Miettinen M, Michal M, Trpkov K. Succinate dehydrogenase (SDH)-deficient renal carcinoma: a morphologically distinct entity: a clinicopathologic series of 36 tumors from 27 patients. Am J Surg Pathol 2015; 38:1588-602. [PMID: 25025441 PMCID: PMC4229399 DOI: 10.1097/pas.0000000000000292] [Citation(s) in RCA: 213] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Succinate dehydrogenase (SDH)-deficient renal carcinoma has been accepted as a provisional entity in the 2013 International Society of Urological Pathology Vancouver Classification. To further define its morphologic and clinical features, we studied a multi-institutional cohort of 36 SDH-deficient renal carcinomas from 27 patients, including 21 previously unreported cases. We estimate that 0.05% to 0.2% of all renal carcinomas are SDH deficient. Mean patient age at presentation was 37 years (range, 14 to 76 y), with a slight male predominance (M:F=1.7:1). Bilateral tumors were observed in 26% of patients. Thirty-four (94%) tumors demonstrated the previously reported morphology at least focally, which included: solid or focally cystic growth, uniform cytology with eosinophilic flocculent cytoplasm, intracytoplasmic vacuolations and inclusions, and round to oval low-grade nuclei. All 17 patients who underwent genetic testing for mutation in the SDH subunits demonstrated germline mutations (16 in SDHB and 1 in SDHC). Nine of 27 (33%) patients developed metastatic disease, 2 of them after prolonged follow-up (5.5 and 30 y). Seven of 10 patients (70%) with high-grade nuclei metastasized as did all 4 patients with coagulative necrosis. Two of 17 (12%) patients with low-grade nuclei metastasized, and both had unbiopsied contralateral tumors, which may have been the origin of the metastatic disease. In conclusion, SDH-deficient renal carcinoma is a rare and unique type of renal carcinoma, exhibiting stereotypical morphologic features in the great majority of cases and showing a strong relationship with SDH germline mutation. Although this tumor may undergo dedifferentiation and metastasize, sometimes after a prolonged delay, metastatic disease is rare in the absence of high-grade nuclear atypia or coagulative necrosis.
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Affiliation(s)
- Anthony J Gill
- *Department of Anatomical Pathology †Cancer Diagnosis and Pathology Research Group §§Cancer Genetics, Kolling Institute of Medical Research, Royal North Shore Hospital ‡University of Sydney, Sydney ††Histopath Pathology ¶¶Douglass Hanly Moir Pathology, North Ryde ‡‡Department of Anatomical Pathology, St Vincents Hospital, Darlinghurst §§§Department of Anatomical Pathology, South Western Area Pathology Service, Liverpool, NSW ∥∥Pathology Queensland, Gold Coast University Hospital, Qld ****Department of Anatomical Pathology, Royal Children's Hospital, Parkville, Vic., Australia §Department of Pathology, Medical Faculty and Charles University, Pilsen, Czech Republic ∥Department of Pathology, Josephine Nefkens Institute, Erasmus Medical Centre, Rotterdam ##Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands ¶Department of Pathology, Singapore General Hospital, Singapore, Singapore #Institute of Pathology, Friedrich-Alexander-University, Erlangen, Germany **Department of Pathology, Oslo University Hospital ***Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway †††Robert J Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH ¶¶¶Department of Pathology, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI ††††Laboratory of Surgical Pathology, National Cancer Institute, Bethesda, MD ‡‡‡Department of Pathology and Laboratory Medicine, Calgary Laboratory Services and University of Calgary, Calgary, AB, Canada ∥∥∥Department of Pathology, Hopital Cochin Université Paris Descartes, Paris, France ###Department of Molecular Pathology, University of Dundee, Ninewells Hospital, Dundee, UK
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van der Meijden WP, Fronczek R, Reijntjes RHAM, Corssmit EPM, Biermasz NR, Lammers GJ, van Dijk JG, Thijs RD. Time- and state-dependent analysis of autonomic control in narcolepsy: higher heart rate with normal heart rate variability independent of sleep fragmentation. J Sleep Res 2014; 24:206-14. [DOI: 10.1111/jsr.12253] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 09/21/2014] [Indexed: 01/30/2023]
Affiliation(s)
- Wisse P. van der Meijden
- Department of Neurology; Leiden University Medical Center; Leiden The Netherlands
- Department of Sleep and Cognition; Netherlands Institute for Neuroscience; Royal Netherlands Academy of Arts and Sciences; Amsterdam The Netherlands
| | - Rolf Fronczek
- Department of Neurology; Leiden University Medical Center; Leiden The Netherlands
| | | | - Eleonora P. M. Corssmit
- Department of Endocrinology and Metabolic Diseases; Leiden University Medical Center; Leiden The Netherlands
| | - Nienke R. Biermasz
- Department of Endocrinology and Metabolic Diseases; Leiden University Medical Center; Leiden The Netherlands
| | - Gert Jan. Lammers
- Department of Neurology; Leiden University Medical Center; Leiden The Netherlands
- Sleep Wake Center SEIN; Heemstede The Netherlands
| | - J. Gert van Dijk
- Department of Neurology; Leiden University Medical Center; Leiden The Netherlands
| | - Roland D. Thijs
- Department of Neurology; Leiden University Medical Center; Leiden The Netherlands
- SEIN - Stichting Epilepsie Instellingen Nederland; Heemstede The Netherlands
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Niemeijer ND, Alblas G, van Hulsteijn LT, Dekkers OM, Corssmit EPM. Chemotherapy with cyclophosphamide, vincristine and dacarbazine for malignant paraganglioma and pheochromocytoma: systematic review and meta-analysis. Clin Endocrinol (Oxf) 2014; 81:642-51. [PMID: 25041164 DOI: 10.1111/cen.12542] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 05/24/2014] [Accepted: 07/01/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Chemotherapy with cyclophosphamide, vincristine and dacarbazine (CVD) can be used for palliative treatment of malignant pheochromocytoma and paraganglioma. However, the precise effect of this chemotherapeutic regimen on tumour volume is unclear. The main objective of this study was to perform a systematic review and meta-analysis assessing the effect of chemotherapy with CVD on tumour volume in patients with malignant paraganglioma/pheochromocytoma. METHODS A literature search was performed in October 2013 to identify potentially relevant studies. Main outcomes were the pooled percentages of complete response, partial response and stable disease after chemotherapy with CVD. A meta-analysis was performed with an exact likelihood approach using a logistic regression. Pooled percentages with 95% confidence intervals (CI) were reported. RESULTS Four studies concerning a total of 50 patients with malignant paraganglioma/pheochromocytoma reported on treatment with a combination of CVD chemotherapy. A meta-analysis of the effect of chemotherapy on tumour volume showed pooled percentages of complete response, partial response and stable disease of, respectively, 4% (95% CI: 1%-15%), 37%(95% CI: 25%-51%) and 14% (95% CI: 7%-27%). Only two studies concerning a total of 35 patients assessed the response on catecholamine excess; pooled percentages for complete, partial and stable hormonal response were 14% (95% CI: 6%-30%), 40% (95% CI: 25%-57%) and 20% (95% CI: 10%-36%), respectively. Duration of response was also reported in only two studies with a median duration of response of 20 months and 40 months. CONCLUSIONS Data on the effects of a combination of CVD chemotherapy on malignant paraganglioma/pheochromocytoma suggest that a partial response concerning tumour volume can be achieved in about 37% of patients and a partial response on catecholamine excess in about 40% of patients. However, in the included studies, the protocol when to initiate treatment was not well described. Therefore, it cannot be excluded that the reported effect of chemotherapy on tumour volume reflects the natural course of the disease, at least partially.
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Affiliation(s)
- N D Niemeijer
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, the Netherlands
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Bayley JP, Oldenburg RA, Nuk J, Hoekstra AS, van der Meer CA, Korpershoek E, McGillivray B, Corssmit EPM, Dinjens WNM, de Krijger RR, Devilee P, Jansen JC, Hes FJ. Paraganglioma and pheochromocytoma upon maternal transmission of SDHD mutations. BMC Med Genet 2014; 15:111. [PMID: 25300370 PMCID: PMC4259087 DOI: 10.1186/s12881-014-0111-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 09/24/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND The SDHD gene encodes a subunit of the mitochondrial tricarboxylic acid cycle enzyme and tumor suppressor, succinate dehydrogenase. Mutations in this gene show a remarkable pattern of parent-of-origin related tumorigenesis, with almost all SDHD-related cases of head and neck paragangliomas and pheochromocytomas attributable to paternally-transmitted mutations. METHODS Here we explore the underlying molecular basis of three cases of paraganglioma or pheochromocytoma that came to our attention due to apparent maternal transmission of an SDHD mutation. We used DNA analysis of family members to establish the mode of inheritance of each mutation. Genetic and immunohistochemical studies of available tumors were then carried out to confirm SDHD-related tumorigenesis. RESULTS We found convincing genetic and immunohistochemical evidence for the maternally-related occurrence of a case of pheochromocytoma, and suggestive evidence in a case of jugular paraganglioma. The third case appears to be a phenocopy, a sporadic paraganglioma in an SDHD mutation carrier with no immunohistochemical or DNA evidence to support a causal link between the mutation and the tumor. Microsatellite analysis in the tumor of patient 1 provided evidence for somatic recombination and loss of the paternal region of chromosome 11 including SDHD and the maternal chromosome including the centromere and the p arm. CONCLUSIONS Transmission of SDHD mutations via the maternal line can, in rare cases, result in tumorigenesis. Despite this finding, the overwhelming majority of carriers of maternally-transmitted mutations will remain tumor-free throughout life.
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Affiliation(s)
- Jean-Pierre Bayley
- Department of Human Genetics, Leiden University Medical Center, PZ S-04, Leiden, 2300, RC, the Netherlands.
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van Hulsteijn LT, Niemeijer ND, Hes FJ, Bayley JP, Tops CM, Jansen JC, Corssmit EPM. Phenotype of SDHB mutation carriers in the Netherlands. Fam Cancer 2014; 13:651-7. [DOI: 10.1007/s10689-014-9738-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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van Hulsteijn LT, Niemeijer ND, Dekkers OM, Corssmit EPM. (131)I-MIBG therapy for malignant paraganglioma and phaeochromocytoma: systematic review and meta-analysis. Clin Endocrinol (Oxf) 2014; 80:487-501. [PMID: 24118038 DOI: 10.1111/cen.12341] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 08/14/2013] [Accepted: 02/23/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND (131)I-MIBG therapy can be used for palliative treatment of malignant paraganglioma and phaeochromocytoma. The main objective of this study was to perform a systematic review and meta-analysis assessing the effect of (131)I-MIBG therapy on tumour volume in patients with malignant paraganglioma/phaeochromocytoma. METHODS A literature search was performed in December 2012 to identify potentially relevant studies. Main outcomes were the pooled proportions of complete response, partial response and stable disease after radionuclide therapy. A meta-analysis was performed with an exact likelihood approach using a logistic regression with a random effect at the study level. Pooled proportions with 95% confidence intervals (CI) were reported. RESULTS Seventeen studies concerning a total of 243 patients with malignant paraganglioma/phaeochromocytoma were treated with (131)I-MIBG therapy. The mean follow-up ranged from 24 to 62 months. A meta-analysis of the effect of (131)I-MIBG therapy on tumour volume showed pooled proportions of complete response, partial response and stable disease of, respectively, 0·03 (95% CI: 0·06-0·15), 0·27 (95% CI: 0·19-0·37) and 0·52 (95% CI: 0·41-0·62) and for hormonal response 0·11 (95% CI: 0·05-0·22), 0·40 (95% CI: 0·28-0·53) and 0·21 (95% CI: 0·10-0·40), respectively. Separate analyses resulted in better results in hormonal response for patients with paraganglioma than for patients with phaeochromocytoma. CONCLUSIONS Data on the effects of (131)I-MIBG therapy on malignant paraganglioma/phaeochromocytoma suggest that stable disease concerning tumour volume and a partial hormonal response can be achieved in over 50% and 40% of patients, respectively, treated with (131)I-MIBG therapy. It cannot be ruled out that stable disease reflects not only the effect of MIBG therapy, but also (partly) the natural course of the disease.
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Affiliation(s)
- L T van Hulsteijn
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, The Netherlands
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van Dijk M, Donga E, van Schie MKM, Lammers GJ, van Zwet EW, Corssmit EPM, Romijn JA, van Dijk JG. Impaired sustained attention in adult patients with type 1 diabetes is related to diabetes per se. Diabetes Metab Res Rev 2014; 30:132-9. [PMID: 24026944 DOI: 10.1002/dmrr.2467] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 08/16/2013] [Accepted: 09/06/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patients with type 1 diabetes have altered sleep characteristics and are thought to have deficits in sustained attention. We compared the sustained attention to response task (SART) of patients with type 1 diabetes to that of healthy controls, and related results with sleep characteristics and disease-related factors. METHODS SART was applied in 122 patients and 109 controls. Glucoregulation was assessed by HbA1c values and a questionnaire assessing glycaemic history. Clinical parameters were obtained from medical charts. Polyneuropathy was assessed by neurological examination and quantitative sensory testing. Sleep characteristics were assessed with sleep questionnaires. Anxiety and depression scores were assessed by the Hospital Anxiety and Depression Scale. RESULTS The SART reaction time (RT) was significantly longer than in controls (327 ± 5 vs. 285 ± 3 ms, p < 0.001), although there were no significant differences in error scores. Repeated measurement analyses showed that diabetes per se was associated with prolonged RT (p < 0.001) and more commission errors (p = 0.010). None of the sleep-related and diabetes-related factors were significantly associated with these SART parameters. CONCLUSIONS Patients with type 1 diabetes had impaired sustained attention, which was associated with diabetes per se but not with disturbed sleep characteristics.
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Affiliation(s)
- Marieke van Dijk
- Departments of Endocrinology and Metabolic Diseases (MvD, ED, EPMC, JAR), Leiden University Medical Center, Leiden, The Netherlands
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Papathomas TG, Gaal J, Corssmit EPM, Oudijk L, Korpershoek E, Heimdal K, Bayley JP, Morreau H, van Dooren M, Papaspyrou K, Schreiner T, Hansen T, Andresen PA, Restuccia DF, van Kessel I, van Leenders GJLH, Kros JM, Looijenga LHJ, Hofland LJ, Mann W, van Nederveen FH, Mete O, Asa SL, de Krijger RR, Dinjens WNM. Non-pheochromocytoma (PCC)/paraganglioma (PGL) tumors in patients with succinate dehydrogenase-related PCC-PGL syndromes: a clinicopathological and molecular analysis. Eur J Endocrinol 2014; 170:1-12. [PMID: 24096523 DOI: 10.1530/eje-13-0623] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Although the succinate dehydrogenase (SDH)-related tumor spectrum has been recently expanded, there are only rare reports of non-pheochromocytoma/paraganglioma tumors in SDHx-mutated patients. Therefore, questions still remain unresolved concerning the aforementioned tumors with regard to their pathogenesis, clinicopathological phenotype, and even causal relatedness to SDHx mutations. Absence of SDHB expression in tumors derived from tissues susceptible to SDH deficiency is not fully elucidated. DESIGN AND METHODS Three unrelated SDHD patients, two with pituitary adenoma (PA) and one with papillary thyroid carcinoma (PTC), and three SDHB patients affected by renal cell carcinomas (RCCs) were identified from four European centers. SDHA/SDHB immunohistochemistry (IHC), SDHx mutation analysis, and loss of heterozygosity analysis of the involved SDHx gene were performed on all tumors. A cohort of 348 tumors of unknown SDHx mutational status, including renal tumors, PTCs, PAs, neuroblastic tumors, seminomas, and adenomatoid tumors, was investigated by SDHB IHC. RESULTS Of the six index patients, all RCCs and one PA displayed SDHB immunonegativity in contrast to the other PA and PTC. All immunonegative tumors demonstrated loss of the WT allele, indicating bi-allelic inactivation of the germline mutated gene. Of 348 tumors, one clear cell RCC exhibited partial loss of SDHB expression. CONCLUSIONS These findings strengthen the etiological association of SDHx genes with pituitary neoplasia and provide evidence against a link between PTC and SDHx mutations. Somatic deletions seem to constitute the second hit in SDHB-related renal neoplasia, while SDHx alterations do not appear to be primary drivers in sporadic tumorigenesis from tissues affected by SDH deficiency.
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Affiliation(s)
- Thomas G Papathomas
- Department of Pathology, Josephine Nefkens Institute, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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van Hulsteijn LT, den Dulk AC, Hes FJ, Bayley JP, Jansen JC, Corssmit EPM. No difference in phenotype of the main Dutch SDHD founder mutations. Clin Endocrinol (Oxf) 2013; 79:824-31. [PMID: 23586964 DOI: 10.1111/cen.12223] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 03/24/2013] [Accepted: 04/11/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE SDHD mutations predispose carriers to hereditary paraganglioma syndrome. The objective of this study was to assess the genotype-phenotype correlation of a large Dutch cohort of SDHD mutation carriers and evaluate potential differences in clinical phenotypes due to specific SDHD gene mutations. DESIGN Retrospective, descriptive single-centre study. PATIENTS All consecutive SDHD mutation carriers followed at the Department of Endocrinology of the Leiden University Medical Center were included. MEASUREMENTS Subjects were investigated according to structured protocols used for standard care, including repetitive biochemical and radiological screening for paragangliomas. RESULTS Two hundred and one SDHD mutation carriers with a mean age at presentation of 42·6 ± 14·4 years and a mean follow-up of 5·8 ± 5·4 years were evaluated. Eighty-one percent carried the SDHD c.274G>T (p.Asp92Tyr) mutation and 13% the SDHD c.416T>C (p.Leu139Pro) mutation. No differences in clinical phenotype between these two specific SDHD mutations were found. Ninety-one percent developed one or multiple paragangliomas in the head and neck region (HNPGLs), of which the carotid body tumour was the most prevalent (85%). Eighteen carriers developed pheochromocytomas, fifteen sympathetic paragangliomas and nine carriers (4%) suffered from malignant paraganglioma. By end of follow-up, sixteen SDHD mutation carriers (8%) displayed no biochemical or radiological evidence of manifest disease. CONCLUSIONS The two main Dutch SDHD founder mutations do not differ in clinical expression. SDHD mutations are associated with the development of multiple HNPGLs and predominantly benign disease.
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Affiliation(s)
- L T van Hulsteijn
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, The Netherlands
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van Duinen N, Corssmit EPM, de Jong WHA, Brookman D, Kema IP, Romijn JA. Plasma levels of free metanephrines and 3-methoxytyramine indicate a higher number of biochemically active HNPGL than 24-h urinary excretion rates of catecholamines and metabolites. Eur J Endocrinol 2013; 169:377-82. [PMID: 23832865 DOI: 10.1530/eje-13-0529] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
CONTEXT A substantial number of patients with head and neck paragangliomas (HNPGLs) have biochemically active tumors, evidenced by increased urinary excretion of catecholamines and metabolites, including 3-methoxytyramine (3MT). It is unclear whether plasma levels of these parameters are more sensitive to detect biochemical activity in HNPGL patients than urinary excretion rates. OBJECTIVE To compare plasma free levels vs urinary excretion rates of deconjugated 3MT and combined metanephrines (MNs) in patients with HNPGL. PATIENTS AND METHODS We included 124 consecutive patients with HNPGL for screening of catecholamine excess by measurement of 24-h urinary excretion rates of deconjugated (nor)metanephrine, (nor)epinephrine, dopamine, vanillylmandelic acid, 3MT, and plasma free levels of (nor)metanephrine and 3MT. RESULTS Plasma free 3MT levels were increased in 35 of the 124 patients (28%), whereas 24-h urinary excretion of deconjugated 3MT was increased in 30 patients (24%) (P=0.13). Plasma free MN levels were increased in seven patients (6%) and urinary deconjugated MN levels in six patients (5%) (P=1.00). Plasma free normetanephrine (NMN) levels were increased in seven patients (6%), and five patients had increased urinary excretion of deconjugated NMN (4%) (P=0.69). Plasma free combined MN levels (NMN, MN, and 3MT) were increased in 41 patients (33%), whereas 24-h urinary excretion rates of deconjugated combined MNs were increased in 33 patients (27%, P<0.05). CONCLUSIONS The combined levels of free MNs and free 3MT in plasma indicate a higher number of biochemically active HNPGLs than the 24-h urinary excretion rates of these markers.
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Affiliation(s)
- N van Duinen
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
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