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Laguillier-Morizot C, Bonnet-Serrano F, Leguy MC, Simeonovic M, Sée C, Zientek C, Soussan M, Bouys L, Bertherat J, Guibourdenche J. Diagnostic performance of an automated immunoassay for salivary cortisol. Ann Endocrinol (Paris) 2024; 85:20-26. [PMID: 37926277 DOI: 10.1016/j.ando.2023.10.007] [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] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/26/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Abstract
Automated immunoanalysis (AI) is an interesting alternative for measuring salivary cortisol, as the gold standard HPLC-MS/MS method is not yet readily available. The aim of this study was to evaluate the diagnostic performance of salivary cortisol immunoassay on the iSYS immunoanalyzer in adrenal dynamic tests. Cortisol was measured on iSYS and on HPLC-MS/MS in saliva samples collected after 1mg-dexamethasone suppression test (DST) in 115 patients suspected of Cushing syndrome, and during Synacthen® stimulation test (SST) in 108 patients suspected of adrenal insufficiency. Concentrations on AI correlated well with HPLC-MS/MS (Spearman r=0.9496; P<0.0001), but with a significant positive bias. ROC analysis of salivary cortisol identified optimal cut-off values on AI and HPLC-MS/MS of respectively 3.5 and 0.77nmol/L for DST and 32.6 and 13.8nmol/L at T60 after SST. Automated immunoassays for salivary cortisol are suitable in daily practice but require determination of specific cut-off and reference values.
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Affiliation(s)
- Christelle Laguillier-Morizot
- Department of Hormonology, bâtiment J. Dausset, 2(e) étage, CHU Cochin, 27, rue du Fg-St-Jacques, 75014 Paris, France; Faculté de santé, université Paris Cité, 2, rue Valette, 75005 Paris, France.
| | - Fidéline Bonnet-Serrano
- Department of Hormonology, bâtiment J. Dausset, 2(e) étage, CHU Cochin, 27, rue du Fg-St-Jacques, 75014 Paris, France; Faculté de santé, université Paris Cité, 2, rue Valette, 75005 Paris, France
| | - Marie-Clémence Leguy
- Department of Hormonology, bâtiment J. Dausset, 2(e) étage, CHU Cochin, 27, rue du Fg-St-Jacques, 75014 Paris, France
| | - Miliça Simeonovic
- Department of Hormonology, bâtiment J. Dausset, 2(e) étage, CHU Cochin, 27, rue du Fg-St-Jacques, 75014 Paris, France; Université Paris-Est Créteil Val-de-Marne, 61, avenue du Général-de-Gaulle, 94010 Créteil cedex, France
| | - Catherine Sée
- Department of Hormonology, bâtiment J. Dausset, 2(e) étage, CHU Cochin, 27, rue du Fg-St-Jacques, 75014 Paris, France
| | - Corinne Zientek
- Department of Hormonology, bâtiment J. Dausset, 2(e) étage, CHU Cochin, 27, rue du Fg-St-Jacques, 75014 Paris, France
| | - Mickael Soussan
- Department of Hormonology, bâtiment J. Dausset, 2(e) étage, CHU Cochin, 27, rue du Fg-St-Jacques, 75014 Paris, France; Faculté de santé, université Paris Cité, 2, rue Valette, 75005 Paris, France
| | - Lucas Bouys
- Faculté de santé, université Paris Cité, 2, rue Valette, 75005 Paris, France; Department of Endocrinology, CHU Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Reference Center for Rare Adrenal Diseases, CHU Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Jérôme Bertherat
- Faculté de santé, université Paris Cité, 2, rue Valette, 75005 Paris, France; Department of Endocrinology, CHU Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Reference Center for Rare Adrenal Diseases, CHU Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Jean Guibourdenche
- Department of Hormonology, bâtiment J. Dausset, 2(e) étage, CHU Cochin, 27, rue du Fg-St-Jacques, 75014 Paris, France; Faculté de santé, université Paris Cité, 2, rue Valette, 75005 Paris, France
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Vaduva P, Violon F, Jouinot A, Bouys L, Espiard S, Bonnet-Serrano F, North MO, Cardot-Bauters C, Raverot G, Hieronimus S, Lefebvre H, Nunes ML, Tabarin A, Groussin L, Assié G, Sibony M, Vantyghem MC, Pasmant E, Bertherat J. Carney complex predisposes to breast cancer: prospective study of 50 women. Eur J Endocrinol 2024; 190:121-129. [PMID: 38252880 DOI: 10.1093/ejendo/lvae010] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/23/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE Carney complex (CNC) is a rare genetic syndrome, mostly due to germline loss-of-function pathogenic variants in PRKAR1A. Carney complex includes pigmented skin lesions, cardiac myxomas, primary pigmented nodular adrenocortical dysplasia, and various breast benign tumors. DESIGN The present study was designed to describe the characteristics of breast lesions in CNC patients and their association with other manifestations of CNC and PRKAR1A genotype. METHODS A 3-year follow-up multicenter French prospective study of CNC patients included 50 women who were analyzed for CNC manifestations and particularly breast lesions, with breast imaging, genotyping, and hormonal settings. RESULTS Among the 38 women with breast imaging, 14 (39%) had breast lesions, half of them bilateral. Ten women (26%) presented with benign lesions and six with breast carcinomas (16%): one had ductal carcinoma in situ at 54, and five had invasive cancer before 50 years old, whom one with contralateral breast cancer during follow-up. The occurrence of breast cancer was more frequent in women with PRKAR1A pathogenic variant odds ratio = 6.34 (1.63-17.91) than in general population of same age. The mean age at breast cancer diagnosis was 44.7 years old: 17 years younger than in the general population. Breast cancer patients had good prognosis factors. All breast carcinomas occurred in individuals with familial CNC and PRKAR1A pathogenic variants. Loss of heterozygosity at the PRKAR1A locus in the 2 invasive breast carcinomas analyzed suggested a driver role of this tumor suppressor gene. CONCLUSIONS As CNC could predispose to breast carcinoma, an adequate screening strategy and follow-up should be discussed in affected women. CLINICAL TRIAL REGISTRATION ClinicalTrial.gov NCT00668291.
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Affiliation(s)
- Patricia Vaduva
- Genomics and Signaling of Endocrine Tumors Team, INSERM U1016, CNRS UMR8104, Cochin Institute, Paris Cité University, Paris 75005, France
| | - Florian Violon
- Genomics and Signaling of Endocrine Tumors Team, INSERM U1016, CNRS UMR8104, Cochin Institute, Paris Cité University, Paris 75005, France
| | - Anne Jouinot
- Genomics and Signaling of Endocrine Tumors Team, INSERM U1016, CNRS UMR8104, Cochin Institute, Paris Cité University, Paris 75005, France
- Department of Endocrinology, Reference Center for Rare Adrenal Diseases, Cochin Hospital, APHP, Paris 75014, France
| | - Lucas Bouys
- Genomics and Signaling of Endocrine Tumors Team, INSERM U1016, CNRS UMR8104, Cochin Institute, Paris Cité University, Paris 75005, France
- Department of Endocrinology, Reference Center for Rare Adrenal Diseases, Cochin Hospital, APHP, Paris 75014, France
| | - Stéphanie Espiard
- Department of Endocrinology, Diabetology, Metabolism and Nutrition, Lille University Hospital, University of Lille, Inserm 1190, Lille 59000, France
| | | | - Marie Odile North
- Department of Oncogenetics, Cochin Hospital, APHP, Paris 75014, France
| | - Catherine Cardot-Bauters
- Department of Endocrinology, Diabetology, Metabolism and Nutrition, Lille University Hospital, University of Lille, Inserm 1190, Lille 59000, France
| | - Gerald Raverot
- Department of Endocrinology, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron 69677, France
| | - Sylvie Hieronimus
- Department of Endocrinology, Diabetology, Reproductive medicine, Nice University Hospital, Nice 06200, France
| | - Hervé Lefebvre
- Department of Endocrinology, Univ Rouen Normandie, INSERM, NORDIC UMR 1239, CHU Rouen, Rouen F-76000, France
| | - Marie-Laure Nunes
- Department of Endocrinology, Diabetology and Metabolism, Bordeaux University Hospital, Pessac 33600, France
| | - Antoine Tabarin
- Department of Endocrinology, Diabetology and Metabolism, Bordeaux University Hospital, Pessac 33600, France
| | - Lionel Groussin
- Genomics and Signaling of Endocrine Tumors Team, INSERM U1016, CNRS UMR8104, Cochin Institute, Paris Cité University, Paris 75005, France
- Department of Endocrinology, Reference Center for Rare Adrenal Diseases, Cochin Hospital, APHP, Paris 75014, France
| | - Guillaume Assié
- Genomics and Signaling of Endocrine Tumors Team, INSERM U1016, CNRS UMR8104, Cochin Institute, Paris Cité University, Paris 75005, France
- Department of Endocrinology, Reference Center for Rare Adrenal Diseases, Cochin Hospital, APHP, Paris 75014, France
| | - Mathilde Sibony
- Department of Pathology, Cochin Hospital, APHP, Paris 75014, France
| | - Marie-Christine Vantyghem
- Department of Endocrinology, Diabetology, Metabolism and Nutrition, Lille University Hospital, University of Lille, Inserm 1190, Lille 59000, France
| | - Eric Pasmant
- Department of Oncogenetics, Cochin Hospital, APHP, Paris 75014, France
| | - Jérôme Bertherat
- Genomics and Signaling of Endocrine Tumors Team, INSERM U1016, CNRS UMR8104, Cochin Institute, Paris Cité University, Paris 75005, France
- Department of Endocrinology, Reference Center for Rare Adrenal Diseases, Cochin Hospital, APHP, Paris 75014, France
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Alves KC, Bonnet-Serrano F, Laguillier C, Akiki V, Dehghani L, Larger É, Leguy MC, Guibourdenche J. [Proinsulin: physiology, measurement, and interest in clinical biology]. Ann Biol Clin (Paris) 2023; 81:abc.2023.1838. [PMID: 38018823 DOI: 10.1684/abc.2023.1838] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
The proinsulin molecule results from the cleavage of pre-pro-insulin, produced in pancreatic beta cells. Its subsequent -cleavage allows the release of insulin, the key hormone of glycemia regulation and C-peptide in equimolar proportions. During fasting trial, insulinoma diagnosis relies on inadequately high insulin and C-peptide serum levels concomitant with an hypoglycemia. In this context, proinsulin assay can be interesting in the cases of discrepancy between the two parameters. In diabetes, endoplasmic reticulum stress and beta cells inflammation, lead to the secretion of misfolded proinsulin molecules. Thus, in type 2 diabetes, proinsulin/insulin ratio increases with the degree of insulin resistance. In type 1 diabetes, proinsulin/C-peptide ratio could predict the onset of diabetes in relatives. In our practice, serum pro-insulin determined using an Elisa immunoassay (Millipore®) during fasting trial can be complementary to C-peptide and insulin assays in relation to glycemia to label an hypoglycemia. In case of glucose intolerance and diabetes, proinsulin could thus be measured.
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Affiliation(s)
- Katia Carvalho Alves
- UF d'Hormonologie, CHU Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75679 Paris cedex 14, France
| | - Fidéline Bonnet-Serrano
- UF d'Hormonologie, CHU Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75679 Paris cedex 14, France
| | - Christelle Laguillier
- UF d'Hormonologie, CHU Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75679 Paris cedex 14, France
| | - Vanessa Akiki
- Service de Diabétologie, CHU Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75679 Paris cedex 14, France
| | - Léa Dehghani
- Service de Diabétologie, CHU Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75679 Paris cedex 14, France
| | - Étienne Larger
- Service de Diabétologie, CHU Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75679 Paris cedex 14, France
| | - Marie-Clémence Leguy
- UF d'Hormonologie, CHU Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75679 Paris cedex 14, France
| | - Jean Guibourdenche
- UF d'Hormonologie, CHU Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75679 Paris cedex 14, France
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Bonnet-Serrano F, Bertherat J. Non-invasive daily profiles of tissue adrenal steroids. Nat Rev Endocrinol 2023; 19:624-625. [PMID: 37696915 DOI: 10.1038/s41574-023-00901-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Affiliation(s)
- Fidéline Bonnet-Serrano
- Hormonology department, Cochin Hospital, Paris, France
- INSERM U1016, CNRS UMR8104, Cochin Institute, Paris, France
- Paris Cité University, Paris, France
| | - Jérôme Bertherat
- INSERM U1016, CNRS UMR8104, Cochin Institute, Paris, France.
- Paris Cité University, Paris, France.
- Endocrinology department, Center of Reference for Rare Adrenal Diseases, Cochin Hospital, Paris, France.
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Bonnet-Serrano F, Nakib S, Zientek C, Guignat L, Guibourdenche J, Bertherat J, Menet MC. Urinary Free Cortisol Determination and Interferences Studies Using Liquid Chromatography Coupled to Tandem Mass Spectrometry after On-Line Solid Phase Extraction Based on Turboflow TM Chromatography. Metabolites 2023; 13:1063. [PMID: 37887388 PMCID: PMC10608966 DOI: 10.3390/metabo13101063] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 10/28/2023] Open
Abstract
(1) A 24 h urinary free cortisol (UFF) is one of the first-line exams recommended for the diagnosis of Cushing's syndrome. In a hospital hormonology department, this activity can exceed several hundred dosages per week. The UFF is generally determined via an immunoassay with an automate using a chemiluminescence or electrochemiluminescence detection system. To increase the cortisol concentration in the analyzed sample, the automated analysis is preceded by urine extraction, which does not prevent there from being some interferences due to other steroids with close structures. (2) This paper describes the development of on-line solid phase extraction coupled to liquid chromatography and mass spectrometry for the analysis of urinary free cortisol. The on-line extraction was based on the TurboflowTM chromatography coupled to the analytical column by two valves, easily available for the laboratories. (3) The choice of the Accucore Polar Premium® analytical column made it possible to avoid analytical interferences with exogenous or endogenous molecules having the same SRM transition (363 → 121) as cortisol. (4) The method was fully validated in the range of clinically relevant concentrations from the lower limit of quantification (LLOQ) to 411.75 nmol·L-1.
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Affiliation(s)
- Fidéline Bonnet-Serrano
- Université Paris Cité, 75014 Paris, France; (F.B.-S.); (J.G.); (J.B.)
- Inserm U1016-CNRS UMR8104, 75014 Paris, France
- Hormonology Department, Cochin Hospital, 75014 Paris, France;
| | - Samir Nakib
- Specialized Biochemistry Department, Cochin Hospital, 75014 Paris, France;
| | - Corinne Zientek
- Hormonology Department, Cochin Hospital, 75014 Paris, France;
| | - Laurence Guignat
- Reference Center for Rare Adrenal Diseases, Endocrinology Department, Cochin Hospital, 75014 Paris, France;
| | - Jean Guibourdenche
- Université Paris Cité, 75014 Paris, France; (F.B.-S.); (J.G.); (J.B.)
- Hormonology Department, Cochin Hospital, 75014 Paris, France;
- Inserm U1139, 75006 Paris, France
| | - Jerôme Bertherat
- Université Paris Cité, 75014 Paris, France; (F.B.-S.); (J.G.); (J.B.)
- Inserm U1016-CNRS UMR8104, 75014 Paris, France
- Reference Center for Rare Adrenal Diseases, Endocrinology Department, Cochin Hospital, 75014 Paris, France;
| | - Marie-Claude Menet
- Institut de Chimie Physique, CNRS UMR8000, Université Paris-Saclay, 91400 Orsay, France
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Poirier J, Bonnet-Serrano F, Thomeret L, Bouys L, Bertherat J. Prolonged adrenocortical blockade following discontinuation of Osilodrostat. Eur J Endocrinol 2023; 188:K29-K32. [PMID: 37300549 DOI: 10.1093/ejendo/lvad060] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/19/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Osilodrostat is the newest approved steroidogenic inhibitor drug for the treatment of hypercortisolism. In this article, we describe 3 patients who experienced a previously undescribed adverse event: a prolonged adrenocortical blockade following treatment cessation. METHODS Patient records showing a history of successful hypercortisolism control with Osilodrostat followed by at least 4 weeks of treatment interruption were reviewed. Patient characteristics and hormonal dosage were analyzed. RESULTS Persistence of adrenocortical blockade was found in 3 patients and lasted from 6 weeks to 9 months depending on patients. This phenomenon manifested in patients regardless of lower or higher daily Osilodrostat doses (2-10 mg) and total treatment duration did not seem to predict the severity of the blockade. CONCLUSION The finding of this previously undescribed side effect highlights the importance of continuing adrenal function monitoring after Osilodrostat interruption to prevent adrenal crisis in patients at risk.
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Affiliation(s)
- Jonathan Poirier
- Assistance Publique-Hôpitaux de Paris, Service d'Endocrinologie et Maladies Métaboliques -Hôpitaux universitaires Paris-Centre, Paris F-75014, France
| | - Fidéline Bonnet-Serrano
- Assistance Publique-Hôpitaux de Paris, UF d'hormonologie-Hôpitaux universitaires Paris-Centre, Paris F-75014, France
- Institut Cochin, Inserm U1016-CNRS UMR8104-Université Paris-Cité, Paris F-75014, France
| | - Louis Thomeret
- Institut Cochin, Inserm U1016-CNRS UMR8104-Université Paris-Cité, Paris F-75014, France
| | - Lucas Bouys
- Assistance Publique-Hôpitaux de Paris, Service d'Endocrinologie et Maladies Métaboliques -Hôpitaux universitaires Paris-Centre, Paris F-75014, France
- Assistance Publique-Hôpitaux de Paris, UF d'hormonologie-Hôpitaux universitaires Paris-Centre, Paris F-75014, France
- Institut Cochin, Inserm U1016-CNRS UMR8104-Université Paris-Cité, Paris F-75014, France
| | - Jérôme Bertherat
- Assistance Publique-Hôpitaux de Paris, Service d'Endocrinologie et Maladies Métaboliques -Hôpitaux universitaires Paris-Centre, Paris F-75014, France
- Assistance Publique-Hôpitaux de Paris, UF d'hormonologie-Hôpitaux universitaires Paris-Centre, Paris F-75014, France
- Institut Cochin, Inserm U1016-CNRS UMR8104-Université Paris-Cité, Paris F-75014, France
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Balakirouchenane D, Vasseur A, Bonnet-Serrano F, Choi M, Khoudour N, Puszkiel A, Groussin L, Vidal M, Declèves X, Bertherat J, Blanchet B. LC-MS/MS method for simultaneous quantification of osilodrostat and metyrapone in human plasma from patients treated for Cushing's Syndrome. J Pharm Biomed Anal 2023; 228:115316. [PMID: 36868030 DOI: 10.1016/j.jpba.2023.115316] [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: 01/04/2023] [Revised: 02/13/2023] [Accepted: 02/23/2023] [Indexed: 03/05/2023]
Abstract
Steroidogenesis inhibitors such as metyrapone (MTP) and osilodrostat (ODT) have a key role in the medical treatment of endogenous Cushing's Syndrome (ECS). Both drugs are characterized by a high inter-individual variability of response and require a dose-titration period to achieve optimal control of cortisol excess. However, PK/PD data remain scarce for both molecules and a pharmacokinetically guided approach could help reaching eucortisolism more rapidly. We aimed to develop and validate a liquid chromatography tandem mass spectrometry (LC-MS/MS) method for the simultaneous quantification of ODT and MTP in human plasma. After addition of isotopically labeled internal standard (IS), plasma pretreatment consisted in protein precipitation with acetonitrile including 1% formic acid (v/v). Chromatographic separation was performed on Kinetex® HILIC (4.6 × 50 mm; 2.6 µm) analytical column with an isocratic elution during the 2.0-min run time. The method was linear from 0.5 to 250 ng/mL for ODT and from 2.5 to 1250 ng/mL for MTP. Intra- and inter-assay precisions were < 7.2%, with an accuracy ranging from 95.9% to 114.9%. The IS-normalized matrix effect ranged from 106.0% to 123.0% (ODT) and from 107.0% to 123.0% (MTP) and the range of the IS-normalized extraction recovery was 84.0-101.0% for ODT and 87.0-101.0% for MTP. The LC-MS/MS method was successfully applied in patients' plasma samples (n = 36), trough concentration of ODT and MTP ranged from 2.7 ng/mL to 8.2 ng/mL and from 10.8 ng/mL to 27.8 ng/mL, respectively. Incurred sample reanalysis exhibits less than 14% difference between the first and the second analysis for both drugs. This accurate and precise method, meeting all validation criteria, can therefore be used for plasma drug monitoring of ODT and MTP within the dose-titration period.
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Affiliation(s)
- David Balakirouchenane
- Department of Pharmacokinetics and Pharmacochemistry, Cochin Hospital, AP-HP, CARPEM, 75014 Paris, France; Université Paris Cité, UMR8038 CNRS, U1268 INSERM, Faculty of Pharmacy, CARPEM, 75006 Paris, France.
| | - Axelle Vasseur
- Department of Pharmacokinetics and Pharmacochemistry, Cochin Hospital, AP-HP, CARPEM, 75014 Paris, France
| | - Fidéline Bonnet-Serrano
- Hormonal Biology Laboratory, Cochin Hospital, AP-HP, 75014 Paris, France; Université Paris Cité, Institut Cochin, INSERM U1016, CNRS UMR8104, 75006 Paris, France
| | - Minna Choi
- Department of Pharmacokinetics and Pharmacochemistry, Cochin Hospital, AP-HP, CARPEM, 75014 Paris, France
| | - Nihel Khoudour
- Department of Pharmacokinetics and Pharmacochemistry, Cochin Hospital, AP-HP, CARPEM, 75014 Paris, France
| | - Alicja Puszkiel
- Department of Pharmacokinetics and Pharmacochemistry, Cochin Hospital, AP-HP, CARPEM, 75014 Paris, France; Université Paris Cité, INSERM UMR-S1144, Faculty of Pharmacy, 75006 Paris, France
| | - Lionel Groussin
- Université Paris Cité, Institut Cochin, INSERM U1016, CNRS UMR8104, 75006 Paris, France; Department of Endocrinology, Cochin Hospital, AP-HP, 75014 Paris, France
| | - Michel Vidal
- Department of Pharmacokinetics and Pharmacochemistry, Cochin Hospital, AP-HP, CARPEM, 75014 Paris, France; Université Paris Cité, UMR8038 CNRS, U1268 INSERM, Faculty of Pharmacy, CARPEM, 75006 Paris, France
| | - Xavier Declèves
- Department of Pharmacokinetics and Pharmacochemistry, Cochin Hospital, AP-HP, CARPEM, 75014 Paris, France; Université Paris Cité, INSERM UMR-S1144, Faculty of Pharmacy, 75006 Paris, France
| | - Jérôme Bertherat
- Université Paris Cité, Institut Cochin, INSERM U1016, CNRS UMR8104, 75006 Paris, France; Department of Endocrinology, Cochin Hospital, AP-HP, 75014 Paris, France
| | - Benoit Blanchet
- Department of Pharmacokinetics and Pharmacochemistry, Cochin Hospital, AP-HP, CARPEM, 75014 Paris, France; Université Paris Cité, UMR8038 CNRS, U1268 INSERM, Faculty of Pharmacy, CARPEM, 75006 Paris, France
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Bonnet-Serrano F, Devin-Genteuil C, Thomeret L, Laguillier-Morizot C, Leguy MC, Vaczlavik A, Bouys L, Zientek C, Bricaire L, Bessiène L, Guignat L, Libé R, Mosnier-Pudar H, Assié G, Groussin L, Guibourdenche J, Bertherat J. C-peptide level concomitant with hypoglycemia gives better performances than insulin for the diagnosis of endogenous hyperinsulinism: a single-center study of 159 fasting trials. Eur J Endocrinol 2023; 188:7032309. [PMID: 36756737 DOI: 10.1093/ejendo/lvad012] [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] [Received: 10/24/2022] [Revised: 01/13/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Diagnosis of endogenous hyperinsulinism relies on the occurrence of a hypoglycemia, concomitant with inadequate high insulin and C-peptide levels. However, diagnostic cutoffs are not consensual among the different learned societies. The objective of this work was to propose optimized cutoffs for these three parameters for the diagnosis of endogenous hyperinsulinism. METHODS All the patients having performed a fasting trial in Cochin Hospital Endocrinology Department between February 2012 and August 2022 were included. The results of glycemia, insulin and C-peptide levels during fasting trial were collected and analyzed. RESULTS One hundred and fifty-nine patients were included: 26 with endogenous hyperinsulinism and 133 without endogenous hyperinsulinism. ROC analysis of glycemia nadir during fasting trial identified the value of 2.3 mmol/L as the optimal cutoff, ensuring a sensitivity of 100% associated with a specificity of 81%. ROC analysis of insulin and C-peptide levels concomitant with hypoglycemia <2.3 mmol/L showed very good diagnostic performances of both parameters with respective cutoffs of 3.1 mUI/L (=21.5 pmol/L; sensitivity = 96%; specificity = 92%) and 0.30 nmol/L (sensitivity = 96%; specificity = 100%). Insulin to glycemia ratio as well as C-peptide to glycemia ratio (in pmol/mmol) at the time of glycemia nadir did not show better diagnostic performances than C-peptide alone. CONCLUSION A C-peptide level 0.3 nmol/L concomitant with a hypoglycemia <2.3 mmol/L appears as the best criterion to make the diagnosis of endogenous hyperinsulinism. Insulin level can be underestimated on hemolyzed blood samples, frequently observed in fasting trial, and thus shows lower diagnostic performances.
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Affiliation(s)
- Fidéline Bonnet-Serrano
- Hormonology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
- Faculté de Médecine, Université Paris Cité, Paris 75005, France
- Inserm U1016-CNRS UMR8104, Institut Cochin, Paris 75014, France
| | | | - Louis Thomeret
- Faculté de Médecine, Université Paris Cité, Paris 75005, France
- Inserm U1016-CNRS UMR8104, Institut Cochin, Paris 75014, France
| | - Christelle Laguillier-Morizot
- Hormonology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
- Faculté de Médecine, Université Paris Cité, Paris 75005, France
- INSERM, Physiopathologie et pharmacotoxicologie placentaire humaine : Microbiote pré & post natal, F-75006 Paris, France
| | | | - Anna Vaczlavik
- Endocrinology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
| | - Lucas Bouys
- Faculté de Médecine, Université Paris Cité, Paris 75005, France
- Inserm U1016-CNRS UMR8104, Institut Cochin, Paris 75014, France
- Endocrinology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
| | - Corinne Zientek
- Hormonology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
| | - Léopoldine Bricaire
- Endocrinology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
| | - Laura Bessiène
- Endocrinology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
| | - Laurence Guignat
- Endocrinology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
| | - Rossela Libé
- Endocrinology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
| | - Helen Mosnier-Pudar
- Endocrinology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
| | - Guillaume Assié
- Faculté de Médecine, Université Paris Cité, Paris 75005, France
- Inserm U1016-CNRS UMR8104, Institut Cochin, Paris 75014, France
- Endocrinology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
| | - Lionel Groussin
- Faculté de Médecine, Université Paris Cité, Paris 75005, France
- Inserm U1016-CNRS UMR8104, Institut Cochin, Paris 75014, France
- Endocrinology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
| | - Jean Guibourdenche
- Hormonology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
- Faculté de Médecine, Université Paris Cité, Paris 75005, France
| | - Jérôme Bertherat
- Faculté de Médecine, Université Paris Cité, Paris 75005, France
- Inserm U1016-CNRS UMR8104, Institut Cochin, Paris 75014, France
- Endocrinology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
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9
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Bessiène L, Moutel S, Lataud M, Jouinot A, Bonnet-Serrano F, Guibourdenche J, Villa C, Baussart B, Gaillard S, Barat M, Dohan A, Bertagna X, Dousset B, Bertherat J, Assié G. Corticotroph tumor progression speed after adrenalectomy. Eur J Endocrinol 2022; 187:797-807. [PMID: 36206174 DOI: 10.1530/eje-22-0536] [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: 06/17/2022] [Accepted: 10/06/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES After bilateral adrenalectomy in Cushing's disease, corticotroph tumor progression occurs in one-third to half of patients. However, progression speed is variable, ranging from slow to rapid. The aim was to explore corticotroph progression speed, its consequences and its risk factors. DESIGN A retrospective single-center observational study. METHODS In total,103 patients with Cushing's disease who underwent bilateral adrenalectomy between 1990 and 2020 were included. Clinical, biological, histological and MRI features were collected. Median duration of follow-up after bilateral adrenalectomy was 9.31 years. RESULTS In total,44 patients progressed (43%). Corticotroph tumor progression speed ranged from 1 to 40.7 mm per year. Progression speed was not different before and after bilateral adrenalectomy (P = 0.29). In univariate analyses, predictive factors for rapid corticotroph tumor progression included the severity of Cushing's disease before adrenalectomy as the cause of adrenalectomy, high ACTH in the year following adrenalectomy and high Ki67 immunopositivity in the tumor. During follow-up, early morning ACTH absolute variation was associated with corticotroph tumor progression speed (P-value = 0.001). ACTH measurement after dynamic testing did not improve this association. CONCLUSION After adrenalectomy, corticotroph progression speed is highly variable and manageable with MRI and ACTH surveillance. Progression speed does not seem related to bilateral adrenalectomy but rather to intrinsic properties of highly proliferative and secreting tumors.
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Affiliation(s)
- Laura Bessiène
- Department of Endocrinology, Hôpital Cochin, Reference and Competence Center Rare Adrenal Diseases and for Rare Pituitary Diseases, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sandrine Moutel
- Department of Endocrinology, Hôpital Cochin, Reference and Competence Center Rare Adrenal Diseases and for Rare Pituitary Diseases, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marine Lataud
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne Jouinot
- Department of Endocrinology, Hôpital Cochin, Reference and Competence Center Rare Adrenal Diseases and for Rare Pituitary Diseases, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France
| | - Fidéline Bonnet-Serrano
- Department of Hormonology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France
| | - Jean Guibourdenche
- Department of Hormonology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Chiara Villa
- Department of Pathological Cytology and Anatomy, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France
| | - Bertrand Baussart
- Department of Neurosurgery, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France
| | - Stephan Gaillard
- Department of Neurosurgery, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France
| | - Maxime Barat
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France
| | - Anthony Dohan
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France
| | - Xavier Bertagna
- Department of Endocrinology, Hôpital Cochin, Reference and Competence Center Rare Adrenal Diseases and for Rare Pituitary Diseases, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France
| | - Bertrand Dousset
- Department of Visceral and Endocrine Surgery, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France
| | - Jérôme Bertherat
- Department of Endocrinology, Hôpital Cochin, Reference and Competence Center Rare Adrenal Diseases and for Rare Pituitary Diseases, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France
| | - Guillaume Assié
- Department of Endocrinology, Hôpital Cochin, Reference and Competence Center Rare Adrenal Diseases and for Rare Pituitary Diseases, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France
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10
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Armignacco R, Reel PS, Reel S, Jouinot A, Septier A, Gaspar C, Perlemoine K, Larsen CK, Bouys L, Braun L, Riester A, Kroiss M, Bonnet-Serrano F, Amar L, Blanchard A, Gimenez-Roqueplo AP, Prejbisz A, Januszewicz A, Dobrowolski P, Davies E, MacKenzie SM, Rossi GP, Lenzini L, Ceccato F, Scaroni C, Mulatero P, Williams TA, Pecori A, Monticone S, Beuschlein F, Reincke M, Zennaro MC, Bertherat J, Jefferson E, Assié G. Whole blood methylome-derived features to discriminate endocrine hypertension. Clin Epigenetics 2022; 14:142. [PMCID: PMC9635165 DOI: 10.1186/s13148-022-01347-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/18/2022] [Indexed: 11/06/2022] Open
Abstract
Background Arterial hypertension represents a worldwide health burden and a major risk factor for cardiovascular morbidity and mortality. Hypertension can be primary (primary hypertension, PHT), or secondary to endocrine disorders (endocrine hypertension, EHT), such as Cushing's syndrome (CS), primary aldosteronism (PA), and pheochromocytoma/paraganglioma (PPGL). Diagnosis of EHT is currently based on hormone assays. Efficient detection remains challenging, but is crucial to properly orientate patients for diagnostic confirmation and specific treatment. More accurate biomarkers would help in the diagnostic pathway. We hypothesized that each type of endocrine hypertension could be associated with a specific blood DNA methylation signature, which could be used for disease discrimination. To identify such markers, we aimed at exploring the methylome profiles in a cohort of 255 patients with hypertension, either PHT (n = 42) or EHT (n = 213), and at identifying specific discriminating signatures using machine learning approaches. Results Unsupervised classification of samples showed discrimination of PHT from EHT. CS patients clustered separately from all other patients, whereas PA and PPGL showed an overall overlap. Global methylation was decreased in the CS group compared to PHT. Supervised comparison with PHT identified differentially methylated CpG sites for each type of endocrine hypertension, showing a diffuse genomic location. Among the most differentially methylated genes, FKBP5 was identified in the CS group. Using four different machine learning methods—Lasso (Least Absolute Shrinkage and Selection Operator), Logistic Regression, Random Forest, and Support Vector Machine—predictive models for each type of endocrine hypertension were built on training cohorts (80% of samples for each hypertension type) and estimated on validation cohorts (20% of samples for each hypertension type). Balanced accuracies ranged from 0.55 to 0.74 for predicting EHT, 0.85 to 0.95 for predicting CS, 0.66 to 0.88 for predicting PA, and 0.70 to 0.83 for predicting PPGL. Conclusions The blood DNA methylome can discriminate endocrine hypertension, with methylation signatures for each type of endocrine disorder. Supplementary Information The online version contains supplementary material available at 10.1186/s13148-022-01347-y.
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Affiliation(s)
- Roberta Armignacco
- grid.462098.10000 0004 0643 431XUniversité Paris Cité, CNRS, INSERM, Institut Cochin, F-75014 Paris, France
| | - Parminder S. Reel
- grid.8241.f0000 0004 0397 2876Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, DD2 4BF UK
| | - Smarti Reel
- grid.8241.f0000 0004 0397 2876Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, DD2 4BF UK
| | - Anne Jouinot
- grid.462098.10000 0004 0643 431XUniversité Paris Cité, CNRS, INSERM, Institut Cochin, F-75014 Paris, France ,grid.440907.e0000 0004 1784 3645Institut Curie, INSERM U900, MINES ParisTech, PSL-Research University, CBIO-Centre for Computational Biology, Paris, France
| | - Amandine Septier
- grid.462098.10000 0004 0643 431XUniversité Paris Cité, CNRS, INSERM, Institut Cochin, F-75014 Paris, France
| | - Cassandra Gaspar
- Sorbonne Université, INSERM, UMS Production et Analyse de données en Sciences de la vie et en Santé, PASS, Plateforme Post-génomique de la Pitié-Salpêtrière, P3S, 75013 Paris, France
| | - Karine Perlemoine
- grid.462098.10000 0004 0643 431XUniversité Paris Cité, CNRS, INSERM, Institut Cochin, F-75014 Paris, France
| | - Casper K. Larsen
- grid.462416.30000 0004 0495 1460Université Paris Cité, Inserm, PARCC, F-75015 Paris, France
| | - Lucas Bouys
- grid.462098.10000 0004 0643 431XUniversité Paris Cité, CNRS, INSERM, Institut Cochin, F-75014 Paris, France
| | - Leah Braun
- grid.411095.80000 0004 0477 2585Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anna Riester
- grid.411095.80000 0004 0477 2585Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Matthias Kroiss
- grid.411095.80000 0004 0477 2585Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Fidéline Bonnet-Serrano
- grid.462098.10000 0004 0643 431XUniversité Paris Cité, CNRS, INSERM, Institut Cochin, F-75014 Paris, France ,grid.411784.f0000 0001 0274 3893Service d’Hormonologie, AP-HP, Hôpital Cochin, F-75014 Paris, France
| | - Laurence Amar
- grid.462416.30000 0004 0495 1460Université Paris Cité, Inserm, PARCC, F-75015 Paris, France ,grid.414093.b0000 0001 2183 5849Unité Hypertension Artérielle, AP-HP, Hôpital Européen Georges Pompidou, 75015 Paris, France
| | - Anne Blanchard
- grid.414093.b0000 0001 2183 5849Centre d’Investigations Cliniques 9201, AP-HP, Hôpital Européen Georges Pompidou, F-75015 Paris, France
| | - Anne-Paule Gimenez-Roqueplo
- grid.462416.30000 0004 0495 1460Université Paris Cité, Inserm, PARCC, F-75015 Paris, France ,grid.414093.b0000 0001 2183 5849Département de Médecine Génomique des Tumeurs et des Cancers, Hôpital Européen Georges Pompidou, F-75015 Paris, France
| | - Aleksander Prejbisz
- grid.418887.aDepartment of Hypertension, Institute of Cardiology, Warsaw, Poland
| | - Andrzej Januszewicz
- grid.418887.aDepartment of Hypertension, Institute of Cardiology, Warsaw, Poland
| | - Piotr Dobrowolski
- grid.418887.aDepartment of Hypertension, Institute of Cardiology, Warsaw, Poland
| | - Eleanor Davies
- grid.8756.c0000 0001 2193 314XBHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, G12 8TA UK
| | - Scott M. MacKenzie
- grid.8756.c0000 0001 2193 314XBHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, G12 8TA UK
| | - Gian Paolo Rossi
- Department of Medicine-DIMED, Emergency and Hypertension Unit, University of Padova, University Hospital, Padua, Italy
| | - Livia Lenzini
- Department of Medicine-DIMED, Emergency and Hypertension Unit, University of Padova, University Hospital, Padua, Italy
| | - Filippo Ceccato
- grid.411474.30000 0004 1760 2630UOC Endocrinologia, Dipartimento di Medicina DIMED, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - Carla Scaroni
- grid.411474.30000 0004 1760 2630UOC Endocrinologia, Dipartimento di Medicina DIMED, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - Paolo Mulatero
- grid.7605.40000 0001 2336 6580Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Turin, Italy
| | - Tracy A. Williams
- grid.7605.40000 0001 2336 6580Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Turin, Italy
| | - Alessio Pecori
- grid.7605.40000 0001 2336 6580Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Turin, Italy
| | - Silvia Monticone
- grid.7605.40000 0001 2336 6580Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Turin, Italy
| | - Felix Beuschlein
- grid.411095.80000 0004 0477 2585Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany ,grid.412004.30000 0004 0478 9977Klinikfür Endokrinologie, Diabetologie Und Klinische Ernährung, UniversitätsSpital Zürich (USZ) and Universität Zürich (UZH), Raemistrasse 100, 8091 Zurich, Switzerland
| | - Martin Reincke
- grid.411095.80000 0004 0477 2585Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Maria-Christina Zennaro
- grid.462416.30000 0004 0495 1460Université Paris Cité, Inserm, PARCC, F-75015 Paris, France ,grid.414093.b0000 0001 2183 5849Service de Génétique, AP-HP, Hôpital Européen Georges Pompidou, F-75015 Paris, France
| | - Jérôme Bertherat
- grid.462098.10000 0004 0643 431XUniversité Paris Cité, CNRS, INSERM, Institut Cochin, F-75014 Paris, France ,grid.411784.f0000 0001 0274 3893Service d’Endocrinologie, Center for Rare Adrenal Diseases, AP-HP, Hôpital Cochin, F-75014 Paris, France
| | - Emily Jefferson
- grid.8241.f0000 0004 0397 2876Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, DD2 4BF UK ,grid.8756.c0000 0001 2193 314XInstitute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ UK
| | - Guillaume Assié
- grid.462098.10000 0004 0643 431XUniversité Paris Cité, CNRS, INSERM, Institut Cochin, F-75014 Paris, France ,grid.411784.f0000 0001 0274 3893Service d’Endocrinologie, Center for Rare Adrenal Diseases, AP-HP, Hôpital Cochin, F-75014 Paris, France
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11
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Assié G, Bertherat J, Bonnet-Serrano F, Borson-Chazot F, Bricaire L, Cavalcante IP, Chevalier N, Christin-Maitre S, Espiard S, Fassnacht M, Groussin L, Guignat L, Haissaguerre M, Jouinot A, Jublanc C, Kamenicky P, Kroiss M, Lefebvre H, Libé R, Maione L, North MO, Pasmant E, Perlemoine K, Raffin-Sanson ML, Ragazzon B, Raverot G, Reincke M, Tabarin A, Touraine P, Vaczlavik A, Vaduva P, Vantyghem MC, Vatier C, Bouys L. OR12-3 Identification of Predictive Criteria for the Primary Bilateral Macronodular Adrenal Hyperplasia Gene ARMC5: A European Series of 352 Unselected Patients. J Endocr Soc 2022; 6. [PMCID: PMC9627251 DOI: 10.1210/jendso/bvac150.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective Primary Bilateral Macronodular Adrenal Hyperplasia (PBMAH) is a heterogeneous disease characterized by adrenal macronodules and variable levels of cortisol excess, with not clearly established clinical diagnostic criteria. PBMAH can be caused by germline inactivating variants of the tumor suppressor gene ARMC5. We aimed to better characterize ARMC5-mutated and wild-type patients and to identify predictive criteria for ARMC5 variants. Methods We included 352 consecutive index patients from 12 European centers, sequenced for germline ARMC5alteration because of PBMAH suspicion, regardless their clinical presentation. Clinical, biological and imaging data were collected retrospectively. Sensitivity, specificity, negative and positive predictive values for the prediction of ARMC5variant were calculated for various parameters. Results 53 patients (15.1%) carried 40 different ARMC5 germline pathogenic variants and showed a more distinct phenotype than non-mutated patients for cortisol excess (24-hour urinary free cortisol 2.32 vs. 1.11-fold ULN, respectively, p<0.001; plasma cortisol after 1 mg dexamethasone suppression test 337.5 vs. 142.4 nmol/L, respectively, p<0.001) and adrenal morphology (maximal adrenal diameter 104 vs. 83 mm, respectively, p<0.001; 9.8 vs. 3.2 adrenal nodules, respectively, p<0.001), with more frequent metabolic complications such as diabetes (51.0 vs. 35.4%, respectively, p=0.038) and hypertension (88.0 vs. 70.6%, respectively, p=0.014). Thus, ARMC5-mutated patients were more often surgically or medically treated in order to control cortisol excess (67.9 vs. 36.8%, respectively, p<0.001). Among operated patients, a bilateral adrenalectomy was more often performed in those carrying an ARMC5 pathogenic variant than in wild-type patients (56.7 vs. 32.3%, respectively, p=0.019). Even if all patients were more often primarily investigated in front of adrenal incidentaloma than clinical evidence for Cushing's syndrome (73 vs. 27%, respectively), ARMC5 patients were more often referred for Cushing's syndrome than wild-type patients (44 vs. 24%, respectively, p=0.004). To improve the ARMC5 mutation rate, the association of a clear bilateral adrenal involvement with evidence for autonomous cortisol secretion (defined at least by a plasma cortisol after 1 mg dexamethasone suppression test above 50 nmol/L) holds the better yield with a 27% specificity and a 20% positive predictive value, and a 100% sensitivity and negative predictive value, meaning that a useless genotyping could have been avoided for more than 20% of negative patients, without missing any mutated patient. Conclusion We report the largest series of index case patients investigated for ARMC5 with clinical characterization and confirm that ARMC5 pathogenic variants are associated with a more severe phenotype. In order to minimize negative ARMC5 screening, genotyping could be limited to clear bilateral adrenal involvement on imaging and autonomous cortisol secretion, with an optimum yield for routine clinical practice. These findings will also help better define PBMAH diagnostic criteria. Presentation: Sunday, June 12, 2022 11:30 a.m. - 11:45 a.m.
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12
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Armignacco R, Assié G, Barat M, Bertherat J, Berthon A, Bonnet-Serrano F, Cavalcante IP, Dousset B, Giannone G, Groussin L, Guignat L, Jouinot A, Libé R, North MO, Pasmant E, Perlemoine K, Ragazzon B, Ribes C, Sibony M, Vaczlavik A, Vaduva P, Violon F, Bouys L. OR04-3 Genetic Alterations of ARMC5 and KDM1A Are Associated With Different Expression Profiles of Illegitimate Receptors in Primary Bilateral Macronodular Adrenal Hyperplasia. J Endocr Soc 2022. [DOI: 10.1210/jendso/bvac150.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abstract
Introduction
Primary Bilateral Macronodular Adrenal Hyperplasia (PBMAH) is a heterogeneous disease characterized by bilateral adrenal macronodules responsible for adrenal Cushing. To date, two genetic causes of PBMAH are known: germline inactivating variants of the tumor suppressor genes ARMC5 identified in 2013 (Assié, N Eng J Med 2013), responsible for 20 to 25% of index cases, and KDM1A, identified recently (Vaczlavik, GIM 2021; Chasseloup, Lancet D&E 2021), responsible for the rare presentation associated with food-dependent Cushing's syndrome (FDCS) due to aberrant expression of the GIP receptor (GIPR) in adrenocortical cells. Multiple other illegitimate receptors are known to be responsible for abnormal cortisol response to various physiological stimuli in PBMAH. A recent multiomic analysis, identified three distinct molecular PBMAH groups: G1 with ARMC5-mutated tumors, G2 with KDM1A-mutated tumors from FDCS patients, and G3 with no identified genetic cause at present. We aimed to identify specific expression profiles of illegitimate receptors in the three groups.
Methods
Based on the transcriptome data obtained by RNA sequencing (Illumina) of the tumors from 31 patients (G1/ARMC5, 16 patients; G2/KDM1A, 6 patients; G3, 9 patients), expression of the following genes, encoding potential illegitimate receptors, were compared: ADRA1A, ADRA1B, ADRA1D, ADRA2A, ADRA2B, ADRA2C, ADRB1, ADRB2, ADRB3, AVPR1A, AVPR1B, AVPR2, GCGR, GIPR, HTR4, HTR7, LHCGR. Calculations were performed using R statistical software. The Bioconductor limma package was used to analyze mRNA differential expression.
Results
G1/ARMC5 tumors showed a relative overexpression of the vasopressin receptors AVPR1A and AVPR1B compared to the two other groups (fold-change [FC] =7.39, p<0.001 and 3.98, p<0.001, respectively) but a lower expression of AVPR2 (FC=0.43, p=0.015). G2/KDM1A tumors showed a dramatic overexpression of GIPR compared to the two other groups (FC=105.02, p<0.001) but also of the adrenergic receptors ADRA1D and ADRA2A (FC=2.93, p=0.027 and 9.99, p<0.001, respectively) and of the LH/hCG receptor (LHCGR) (FC=12.20, p<0.001). G3 tumors showed a slight overexpression of the adrenergic receptor ADRA1B (FC=3.49, p=0.001) and in few tumors ADRA1D, AVPR2 and LHCGR were highly expressed suggesting molecular heterogeneity in G3.
Conclusion
This study reveals specific expression profiles of illegitimate receptors related to the three molecular groups. ARMC5 tumors are associated with the overexpression of two vasopressin receptors, while, besides GIPR, KDM1A inactivation seems to drive the overexpression of the LH/hCG receptor, as previously suggested in patients with FDCS (Bertherat, JCE&M 2005), potentially responsible for Cushing's syndrome associated with pregnancy and menopause. These molecular patterns need to be corroborated by clinical data with a systematic testing of the aberrant cortisol responses. Additionally, further studies would be needed to investigate the clinical relevance and significance of moderate fold-changes in gene expression (e.g. <4).
Presentation: Saturday, June 11, 2022 12:00 p.m. - 12:15 p.m.
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13
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Bonnet-Serrano F, Barat M, Vaczlavik A, Jouinot A, Bouys L, Laguillier-Morizot C, Zientek C, Simonneau C, Larger E, Guignat L, Groussin L, Assié G, Guibourdenche J, Nicolis I, Menet MC, Bertherat J. Decreased steroidogenic enzyme activity in benign adrenocortical tumors is more pronounced in bilateral lesions as determined by steroid profiling in LC-MS/MS during ACTH stimulation test. Endocr Connect 2022; 11:EC-22-0063. [PMID: 35731238 PMCID: PMC9346343 DOI: 10.1530/ec-22-0063] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/22/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Large response of steroid precursors, including 17-hydroxyprogesterone, to adrenocorticotropic hormone (ACTH) has been described in adrenocortical tumors, suggesting the existence of intra-tumoral enzymatic deficiencies. This study aimed to compare steroidogenesis enzymes activity in unilateral and bilateral benign tumors using serum steroid profiling in liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) in the basal state and after ACTH 1-24 stimulation. DESIGN AND METHODS A serum profile of seven consecutive adrenal steroids was determined in LC-MS/MS in the basal state (T0) and after ACTH 1-24 stimulation (T60) in 35 patients with bilateral adrenocortical tumors (BL), 38 patients with unilateral tumors (UL) and 37 control subjects (CT). Response amplitude of each individual steroid was evaluated by T60/T0 ratio, whereas enzymatic activity was assessed by the downstream/upstream steroid ratio. Adrenal volume was quantified by a semi-automatic segmentation method. RESULTS For the seven steroids assayed, the amplitude of response to ACTH was higher in BL than in UL and in CT. The difference between BL and UL persisted even after matching patients on adrenal volume. On glucocorticoids pathway, enzymatic activity of CYP11B1 was significantly decreased in BL (78.3 (43.1-199.4)) in comparison to both UL (122.7 (13.8-228.4), P = 0.0002) and CT (186.8 (42.1-1236.3), P < 0.0001). On mineralocorticoids and androgens pathways, the enzymatic activity of CYP11B2 and CYP17A1-17,20 lyase was also lower in BL than UL and CT. CONCLUSIONS Decreased activity of distal steroidogenesis enzymes CYP11B1, CYP11B2 and CYP17A1-17,20 lyase, responsible for an explosive response to ACTH of upstream precursors in bilateral tumors, limits the synthesis of bioactive steroids, in particular cortisol, despite the increase in adrenal mass. SIGNIFICANCE STATEMENT Activity of distal steroidogenesis enzymes (CYP11B1, CYP11B2 and CYP17A1 on glucocorticoids, mineralocorticoids and androgens pathways, respectively) is decreased in adrenocortical benign tumors. This decrease is more pronounced in bilateral lesions and seems to depend more on the nature of the lesion than on the increase in adrenal volume. It is responsible for the explosive response to ACTH of steroid precursors located upstream of these enzymes. It probably allows bioactive steroids, particularly cortisol, to stay in the normal range for a long time despite the increase in adrenal mass.
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Affiliation(s)
- Fidéline Bonnet-Serrano
- Université Paris Cité, Paris, France
- Inserm U1016-CNRS UMR8104, Paris, France
- Hormonology Department, Cochin Hospital, Paris, France
- Correspondence should be addressed to F Bonnet-Serrano:
| | - Maxime Barat
- Université Paris Cité, Paris, France
- Inserm U1016-CNRS UMR8104, Paris, France
- Radiology Department, Cochin Hospital, Paris, France
| | - Anna Vaczlavik
- Université Paris Cité, Paris, France
- Inserm U1016-CNRS UMR8104, Paris, France
- Reference Center for Rare Adrenal Diseases, Endocrinology Department, Cochin Hospital, Paris, France
| | | | - Lucas Bouys
- Université Paris Cité, Paris, France
- Inserm U1016-CNRS UMR8104, Paris, France
- Reference Center for Rare Adrenal Diseases, Endocrinology Department, Cochin Hospital, Paris, France
| | - Christelle Laguillier-Morizot
- Université Paris Cité, Paris, France
- Hormonology Department, Cochin Hospital, Paris, France
- INSERM, Physiopathologie et Pharmacotoxicologie Placentaire Humaine : Microbiote Pré & Post natal, Paris, France
| | | | | | - Etienne Larger
- Université Paris Cité, Paris, France
- Inserm U1016-CNRS UMR8104, Paris, France
- Diabetology Department, Cochin Hospital, Paris, France
| | - Laurence Guignat
- Reference Center for Rare Adrenal Diseases, Endocrinology Department, Cochin Hospital, Paris, France
| | - Lionel Groussin
- Université Paris Cité, Paris, France
- Inserm U1016-CNRS UMR8104, Paris, France
- Reference Center for Rare Adrenal Diseases, Endocrinology Department, Cochin Hospital, Paris, France
| | - Guillaume Assié
- Université Paris Cité, Paris, France
- Inserm U1016-CNRS UMR8104, Paris, France
- Reference Center for Rare Adrenal Diseases, Endocrinology Department, Cochin Hospital, Paris, France
| | - Jean Guibourdenche
- Université Paris Cité, Paris, France
- Hormonology Department, Cochin Hospital, Paris, France
- INSERM, Physiopathologie et Pharmacotoxicologie Placentaire Humaine : Microbiote Pré & Post natal, Paris, France
| | - Ioannis Nicolis
- Université Paris Cité, Paris, France
- UR 7537 BioSTM, Paris, France
| | - Marie-Claude Menet
- Institut de Chimie Physique, Université Paris-Saclay-CNRS, UMR8000, Orsay, France
| | - Jérôme Bertherat
- Université Paris Cité, Paris, France
- Inserm U1016-CNRS UMR8104, Paris, France
- Reference Center for Rare Adrenal Diseases, Endocrinology Department, Cochin Hospital, Paris, France
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14
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Bonnet-Serrano F, Poirier J, Vaczlavik A, Laguillier-Morizot C, Blanchet B, Baron S, Guignat L, Bessiene L, Bricaire L, Groussin L, Assié G, Guibourdenche J, Bertherat J. Differences in the spectrum of steroidogenic enzyme inhibition between Osilodrostat and Metyrapone in ACTH-dependent Cushing syndrome patients. Eur J Endocrinol 2022; 187:315-322. [PMID: 35699971 DOI: 10.1530/eje-22-0208] [Citation(s) in RCA: 10] [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: 03/11/2022] [Accepted: 06/14/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Osilodrostat is a new 11β-hydroxylase inhibitor with a mode of action analogous to Metyrapone. The objective of this study was to compare steroidogenic profiles in patients treated with either Osilodrostat or Metyrapone for adrenocorticotrophic hormone (ACTH)-dependent Cushing's syndrome (CS). METHODS Patients followed up at Cochin hospital Endocrinology department between March 2019 and December 2021 for an ACTH-dependent CS, controlled by either Osilodrostat or Metyrapone, were included. A serum profile of five steroids (cortisol, 11-deoxycortisol, 17-hydroxyprogesterone, androstenedione and testosterone) was determined using UPLC- tandem mass spectrometry (UPLC-MS/MS). RESULTS Nineteen patients treated with Osilodrostat, eight patients treated with Metyrapone and six patients treated with consecutive Metyrapone then Osilodrostat were included. Hypocortisolism (basal cortisol <100 nmol/L) was found in 48% of patients treated with Osilodrostat and 7% of patients treated with Metyrapone. 11-deoxycortisol and androstenedione levels were higher in patients treated with Metyrapone (80.9 (2.2-688.4) and 14.9 (2.5-54.3) nmol/L, respectively) than in patients treated with Osilodrostat (10.3 (0.5-71.9) and 4.0 (0.3-13.3) nmol/L) (P = 0.0009 and P = 0.0005). Testosterone level in women was also higher in Metyrapone group (3.3 (0.93-4.82) nmol/L vs 1.31(0.13-5.09) nmol/L, P = 0.0146). CYP11B1 activity (11-deoxycortisol/cortisol) was not significantly different between the two groups. CYP21A2 activity (17OHprogesterone/11-deoxycortisol) and CYP17A1 activity (17OHprogesterone/androstenedione) were significantly decreased in Osilodrostat group (P < 0.0001). CONCLUSION In patients with ACTH-dependent CS, the use of CYP11B1 inhibitors in routine care suggests that Osilodrostat has a less specific effect on the inhibition of steroidogenic enzymes than Metyrapone. This might explain a smaller increase in 11-deoxycortisol and androgen levels in patients treated with Osilodrostat.
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Affiliation(s)
- Fidéline Bonnet-Serrano
- Assistance Publique - Hôpitaux de Paris, UF d'Hormonologie - Hôpitaux Universitaires Paris-Centre, Paris, France
- Institut Cochin, Inserm U1016-CNRS UMR8104-Université de Paris, Paris, France
| | - Jonathan Poirier
- Assistance Publique - Hôpitaux de Paris, Service d'Endocrinologie et Maladies Métaboliques - Hôpitaux Universitaires Paris-Centre, Paris, France
| | - Anna Vaczlavik
- Institut Cochin, Inserm U1016-CNRS UMR8104-Université de Paris, Paris, France
- Assistance Publique - Hôpitaux de Paris, Service d'Endocrinologie et Maladies Métaboliques - Hôpitaux Universitaires Paris-Centre, Paris, France
| | - Christelle Laguillier-Morizot
- Assistance Publique - Hôpitaux de Paris, UF d'Hormonologie - Hôpitaux Universitaires Paris-Centre, Paris, France
- Faculté de Pharmacie Paris Centre, Université de Paris, Paris, France
| | - Benoît Blanchet
- Assistance Publique - Hôpitaux de Paris, Department of Pharmacokinetics and Pharmacochemistry, Cochin Hospital, Paris, France
- UMR8038 CNRS, U1268 INSERM, Faculty of Pharmacy, PRES Sorbonne Paris Cité, University of Paris, Paris, France
| | - Stéphanie Baron
- Hopital Europeen Georges Pompidou, Physiology, Paris, France
| | - Laurence Guignat
- Assistance Publique - Hôpitaux de Paris, Service d'Endocrinologie et Maladies Métaboliques - Hôpitaux Universitaires Paris-Centre, Paris, France
| | - Laura Bessiene
- Assistance Publique - Hôpitaux de Paris, Service d'Endocrinologie et Maladies Métaboliques - Hôpitaux Universitaires Paris-Centre, Paris, France
| | - Léopoldine Bricaire
- Assistance Publique - Hôpitaux de Paris, Service d'Endocrinologie et Maladies Métaboliques - Hôpitaux Universitaires Paris-Centre, Paris, France
| | - Lionel Groussin
- Institut Cochin, Inserm U1016-CNRS UMR8104-Université de Paris, Paris, France
- Assistance Publique - Hôpitaux de Paris, Service d'Endocrinologie et Maladies Métaboliques - Hôpitaux Universitaires Paris-Centre, Paris, France
| | - Guillaume Assié
- Institut Cochin, Inserm U1016-CNRS UMR8104-Université de Paris, Paris, France
- Assistance Publique - Hôpitaux de Paris, Service d'Endocrinologie et Maladies Métaboliques - Hôpitaux Universitaires Paris-Centre, Paris, France
| | - Jean Guibourdenche
- Assistance Publique - Hôpitaux de Paris, UF d'Hormonologie - Hôpitaux Universitaires Paris-Centre, Paris, France
- Faculté de Pharmacie Paris Centre, Université de Paris, Paris, France
| | - Jérôme Bertherat
- Institut Cochin, Inserm U1016-CNRS UMR8104-Université de Paris, Paris, France
- Assistance Publique - Hôpitaux de Paris, Service d'Endocrinologie et Maladies Métaboliques - Hôpitaux Universitaires Paris-Centre, Paris, France
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15
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Bouys L, Vaczlavik A, Jouinot A, Vaduva P, Espiard S, Assié G, Libé R, Perlemoine K, Ragazzon B, Guignat L, Groussin L, Bricaire L, Cavalcante IP, Bonnet-Serrano F, Lefebvre H, Raffin-Sanson ML, Chevalier N, Touraine P, Jublanc C, Vatier C, Raverot G, Haissaguerre M, Maione L, Kroiss M, Fassnacht M, Christin-Maitre S, Pasmant E, Borson-Chazot F, Tabarin A, Vantyghem MC, Reincke M, Kamenicky P, North MO, Bertherat J. Identification of predictive criteria for pathogenic variants of primary bilateral macronodular adrenal hyperplasia (PBMAH) gene ARMC5 in 352 unselected patients. Eur J Endocrinol 2022; 187:123-134. [PMID: 35521700 DOI: 10.1530/eje-21-1032] [Citation(s) in RCA: 1] [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: 10/06/2021] [Accepted: 04/14/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Primary bilateral macronodular adrenal hyperplasia (PBMAH) is a heterogeneous disease characterized by adrenal macronodules and variable levels of cortisol excess, with not clearly established clinical diagnostic criteria. It can be caused by ARMC5 germline pathogenic variants. In this study, we aimed to identify predictive criteria for ARMC5 variants. METHODS We included 352 consecutive index patients from 12 European centers, sequenced for germline ARMC5 alteration. Clinical, biological and imaging data were collected retrospectively. RESULTS 52 patients (14.8%) carried ARMC5 germline pathogenic variants and showed a more distinct phenotype than non-mutated patients for cortisol excess (24-h urinary free cortisol 2.32 vs 1.11-fold ULN, respectively, P < 0.001) and adrenal morphology (maximal adrenal diameter 104 vs 83 mm, respectively, P < 0.001) and were more often surgically or medically treated (67.9 vs 36.8%, respectively, P < 0.001). ARMC5-mutated patients showed a constant, bilateral adrenal involvement and at least a possible autonomous cortisol secretion (defined by a plasma cortisol after 1 mg dexamethasone suppression above 50 nmol/L), while these criteria were not systematic in WT patients (78.3%). The association of these two criteria holds a 100% sensitivity and a 100% negative predictive value for ARMC5 pathogenic variant. CONCLUSION We report the largest series of index patients investigated for ARMC5 and confirm that ARMC5 pathogenic variants are associated with a more severe phenotype in most cases. To minimize negative ARMC5 screening, genotyping should be limited to clear bilateral adrenal involvement and autonomous cortisol secretion, with an optimum sensitivity for routine clinical practice. These findings will also help to better define PBMAH diagnostic criteria.
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Affiliation(s)
- Lucas Bouys
- Université Paris-Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France
| | - Anna Vaczlavik
- Université Paris-Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Anne Jouinot
- Université Paris-Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
- Institut Curie, INSERM U900, MINES ParisTech, PSL-Research University, CBIO-Centre for Computational Biology, Paris, France
| | - Patricia Vaduva
- Université Paris-Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France
- Department of Endocrinology, Diabetology and Nutrition, CHU Rennes, Rennes, France
| | - Stéphanie Espiard
- Department of Endocrinology, Diabetology, Metabolism and Nutrition, CHU Lille, Inserm U1190, Lille, France
| | - Guillaume Assié
- Université Paris-Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Rossella Libé
- Université Paris-Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Karine Perlemoine
- Université Paris-Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France
| | - Bruno Ragazzon
- Université Paris-Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France
| | - Laurence Guignat
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Lionel Groussin
- Université Paris-Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Léopoldine Bricaire
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Fidéline Bonnet-Serrano
- Université Paris-Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France
- Unit of Hormonology, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Hervé Lefebvre
- Department of Endocrinology, Diabetes and Metabolic Diseases, CHU Rouen, Rouen, France
| | - Marie-Laure Raffin-Sanson
- Department of Endocrinology, Diabetology and Nutrition, Hôpital Ambroise Paré, Assistance Publique Hôpitaux de Paris, Boulogne-Billancourt, France
| | - Nicolas Chevalier
- Department of Endocrinology, Diabetology and Reproduction, CHU Nice, Nice, France
| | - Philippe Touraine
- Department of Endocrinology and Reproduction, Hôpital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Christel Jublanc
- Department of Endocrinology and Metabolism, Hôpital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Camille Vatier
- Department of Endocrinology, Diabetology and Reproduction, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Gérald Raverot
- Department of Endocrinology, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Magalie Haissaguerre
- Department of Endocrinology, Diabetology and Nutrition, Hôpital Haut-Lévêque, CHU Bordeaux, Bordeaux, France
| | - Luigi Maione
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Department of Endocrinology and Reproduction, Reference Center for Rare Pituitary Diseases, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Matthias Kroiss
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital of Würzburg, University of Würzburg, Würzburg, Germany
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital of Würzburg, University of Würzburg, Würzburg, Germany
| | - Sophie Christin-Maitre
- Department of Endocrinology, Diabetology and Reproduction, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Eric Pasmant
- Université Paris-Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France
- Unit of Oncogenetics, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Françoise Borson-Chazot
- Department of Endocrinology, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Antoine Tabarin
- Department of Endocrinology, Diabetology and Nutrition, Hôpital Haut-Lévêque, CHU Bordeaux, Bordeaux, France
| | - Marie-Christine Vantyghem
- Department of Endocrinology, Diabetology, Metabolism and Nutrition, CHU Lille, Inserm U1190, Lille, France
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Peter Kamenicky
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Department of Endocrinology and Reproduction, Reference Center for Rare Pituitary Diseases, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Marie-Odile North
- Unit of Oncogenetics, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jérôme Bertherat
- Université Paris-Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
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16
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Groussin L, Theodon H, Bessiene L, Bricaire L, Bonnet-Serrano F, Cochand-Priollet B, Leroy K, Garinet S, Pasmant E, Zerbit J, Seban R, Goldwasser F, Clerc J, Cottereau AS, Huillard O. Redifferentiating Effect of Larotrectinib in NTRK-Rearranged Advanced Radioactive-Iodine Refractory Thyroid Cancer. Thyroid 2022; 32:594-598. [PMID: 35171708 DOI: 10.1089/thy.2021.0524] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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
Metastatic thyroid cancers may dedifferentiate and become radioactive-iodine (RAI) resistant. A redifferentiating effect can be observed with inhibitors of the mitogen-activated protein kinase pathway in thyroid cancers with point mutation in oncogenes. This effect allows RAI reuptake that may lead to a therapeutic effect different from the antitumoral effect of the inhibitor. The potential redifferentiating effect of inhibitors targeting oncogenic fusion-genes was suggested by one adult and one pediatric patient using larotrectinib in NTRK-rearranged tumors. We report on three consecutive adult patients with metastatic RAI-resistant NTRK-rearranged thyroid cancer who received larotrectinib for disease progression and for whom the redifferentiating effect was examined. Larotrectinib-induced RAI reuptake in all or part of the metastatic disease for two patients and no reuptake was noted for the other patient. We demonstrate that redifferentiation of NTRK-rearranged RAI-resistant thyroid cancer with larotrectinib may exist but does not occur in all patients.
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Affiliation(s)
- Lionel Groussin
- Department of Endocrinology, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - Hélène Theodon
- Department of Endocrinology, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - Laura Bessiene
- Department of Endocrinology, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - Leopoldine Bricaire
- Department of Endocrinology, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - Fidéline Bonnet-Serrano
- Department of Hormonology, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - Béatrix Cochand-Priollet
- Department of Pathology, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - Karen Leroy
- Department of Biochemistry, Unit of Pharmacogenetics and Molecular Oncology, Georges Pompidou European Hospital, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - Simon Garinet
- Department of Biochemistry, Unit of Pharmacogenetics and Molecular Oncology, Georges Pompidou European Hospital, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - Eric Pasmant
- Department of Genetics, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - Jérémie Zerbit
- Department of Pharmacy, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - Romain Seban
- Department of Medical Oncology, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - François Goldwasser
- Department of Medical Oncology, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - Jérôme Clerc
- Department of Nuclear Medicine, Hopital Cochin, Unit of Pharmacogenetics and Molecular Oncology, Georges Pompidou European Hospital; Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - Anne Segolene Cottereau
- Department of Nuclear Medicine, Hopital Cochin, Unit of Pharmacogenetics and Molecular Oncology, Georges Pompidou European Hospital; Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - Olivier Huillard
- Department of Medical Oncology, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
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17
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Armignacco R, Jouinot A, Bouys L, Septier A, Lartigue T, Neou M, Gaspar C, Perlemoine K, Braun L, Riester A, Bonnet-Serrano F, Blanchard A, Amar L, Scaroni C, Ceccato F, Rossi GP, Williams TA, Larsen CK, Allassonnière S, Zennaro MC, Beuschlein F, Reincke M, Bertherat J, Assié G. Identification of glucocorticoid-related molecular signature by whole blood methylome analysis. Eur J Endocrinol 2022; 186:297-308. [PMID: 34914631 PMCID: PMC8789024 DOI: 10.1530/eje-21-0907] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/16/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cushing's syndrome represents a state of excessive glucocorticoids related to glucocorticoid treatments or to endogenous hypercortisolism. Cushing's syndrome is associated with high morbidity, with significant inter-individual variability. Likewise, adrenal insufficiency is a life-threatening condition of cortisol deprivation. Currently, hormone assays contribute to identify Cushing's syndrome or adrenal insufficiency. However, no biomarker directly quantifies the biological glucocorticoid action. The aim of this study was to identify such markers. DESIGN We evaluated whole blood DNA methylome in 94 samples obtained from patients with different glucocorticoid states (Cushing's syndrome, eucortisolism, adrenal insufficiency). We used an independent cohort of 91 samples for validation. METHODS Leukocyte DNA was obtained from whole blood samples. Methylome was determined using the Illumina methylation chip array (~850 000 CpG sites). Both unsupervised (principal component analysis) and supervised (Limma) methods were used to explore methylome profiles. A Lasso-penalized regression was used to select optimal discriminating features. RESULTS Whole blood methylation profile was able to discriminate samples by their glucocorticoid status: glucocorticoid excess was associated with DNA hypomethylation, recovering within months after Cushing's syndrome correction. In Cushing's syndrome, an enrichment in hypomethylated CpG sites was observed in the region of FKBP5 gene locus. A methylation predictor of glucocorticoid excess was built on a training cohort and validated on two independent cohorts. Potential CpG sites associated with the risk for specific complications, such as glucocorticoid-related hypertension or osteoporosis, were identified, needing now to be confirmed on independent cohorts. CONCLUSIONS Whole blood DNA methylome is dynamically impacted by glucocorticoids. This biomarker could contribute to better assessment of glucocorticoid action beyond hormone assays.
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Affiliation(s)
- Roberta Armignacco
- Université de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France
- Correspondence should be addressed to R Armignacco or G Assié; or
| | - Anne Jouinot
- Université de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France
| | - Lucas Bouys
- Université de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France
| | - Amandine Septier
- Université de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France
| | - Thomas Lartigue
- ARAMIS Project-Team, Inria Paris, France
- CMAP, UMR 7641, CNRS, École polytechnique, I.P. Paris, France
| | - Mario Neou
- Université de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France
| | - Cassandra Gaspar
- Sorbonne Université, Inserm, UMS Pass, Plateforme Post-génomique de la Pitié-Salpêtrière, P3S, Paris, France
| | - Karine Perlemoine
- Université de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France
| | - Leah Braun
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anna Riester
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Fidéline Bonnet-Serrano
- Université de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Service d’Hormonologie, Paris, France
| | - Anne Blanchard
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Centre d’Investigations Cliniques 9201, Paris, France
| | - Laurence Amar
- Université de Paris, PARCC, INSERM, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Unité Hypertension Artérielle, Paris, France
| | - Carla Scaroni
- UOC Endocrinologia, Dipartimento di Medicina DIMED, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - Filippo Ceccato
- UOC Endocrinologia, Dipartimento di Medicina DIMED, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - Gian Paolo Rossi
- Clinica dell’Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Tracy Ann Williams
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | | | - Maria-Christina Zennaro
- Université de Paris, PARCC, INSERM, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique, Paris, France
| | - Felix Beuschlein
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, UniversitätsSpital Zürich, Zürich, Switzerland
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Jérôme Bertherat
- Université de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Service d’Endocrinologie, Center for Rare Adrenal Diseases, Paris, France
| | - Guillaume Assié
- Université de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Service d’Endocrinologie, Center for Rare Adrenal Diseases, Paris, France
- Correspondence should be addressed to R Armignacco or G Assié; or
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Bonnet-Serrano F, Jaoude MA, Laguillier C, Gobeaux C, Bouzerara A, Mosnier-Pudar H, Guibourdenche J. Pattern of C-peptide response to oral glucose tolerance test: interest and cut-off values. Annales d'Endocrinologie 2022; 83:95-102. [DOI: 10.1016/j.ando.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 12/06/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022]
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19
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Salviat F, Gauthier-Villars M, Carton M, Cassoux N, Lumbroso-Le Rouic L, Dehainault C, Levy C, Golmard L, Aerts I, Doz F, Bonnet-Serrano F, Hayek S, Savignoni A, Stoppa-Lyonnet D, Houdayer C. Association Between Genotype and Phenotype in Consecutive Unrelated Individuals With Retinoblastoma. JAMA Ophthalmol 2021; 138:843-850. [PMID: 32556071 DOI: 10.1001/jamaophthalmol.2020.2100] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Retinoblastoma (RB) is the most common pediatric intraocular neoplasm. RB is a complex model in which atypical pathogenic variants, modifier genes, imprinting, and mosaicism are known to be associated with the phenotype. In-depth understanding of RB therefore requires large genotype-phenotype studies. Objective To assess the association between genotype and phenotype in patients with RB. Design, Setting, and Participants This single-center, retrospective cohort study, conducted from January 1, 2000, to September 30, 2017, enrolled 1404 consecutive ascertained patients with RB who consulted an oncogeneticist. All patients had their genotype and phenotype recorded. Statistical analysis was performed from July 1, 2018, to December 31, 2018. Main Outcomes and Measures RB1 germline and somatic pathogenic variant types, family history, and disease presentation characteristics (ie, age at diagnosis, sex, laterality, and International Intraocular Retinoblastoma Classification group). Results Among 1404 patients with RB (734 [52.3%] female; mean [SD] age, 20.2 [21.2] months), 866 cases (61.7%) were unilateral and 538 cases (38.3%) were bilateral. Loss of function variants were found throughout the coding sequence, with 259 of 272 (95.2%) somatic pathogenic variants and 537 of 606 (88.6%) germline pathogenic variants (difference, 6.6%; 95% CI, 4.0%-9.2%; P < .001) after excluding tumor-specific pathogenic variants (ie, promoter methylation and loss of heterozygosity); a novel low-penetrance region was identified in exon 24. Compared with germline pathogenic variants estimated to retain RB protein expression, germline pathogenic variants estimated to abrogate RB protein expression were associated with an earlier mean (SD) age at diagnosis (12.3 [11.3] months among 457 patients vs 16.3 [13.2] months among 55 patients; difference, 4 months; 95% CI, 1.9-6.1 months; P = .01), more frequent bilateral involvement (84.2% among 452 patients vs 65.2% among 45 patients; difference, 18.9%; 95% CI, 14.5%-23.3%; P < .001), and more advanced International Intraocular Retinoblastoma Classification group (85.3% among 339 patients vs 73.9% among 34 patients; difference: 11.4%; 95% CI, 6.5%-16.3%; P = .047). Among the 765 nongermline carriers of an RB1 pathogenic variant, most were female (419 females [54.8%] vs 346 males [45.2%]; P = .008), and males were more likely to have bilateral RB (23 males [71.4%] vs 12 females [34.3%]; P = .01). Conclusions and Relevance These results suggest that RB risk is associated with the germline pathogenic variant and with maintenance of RB protein and that there is a sex-linked mechanism for nongermline carriers.
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Affiliation(s)
- Flore Salviat
- Department of Biostatistics, Institut Curie, PSL Research University, Saint-Cloud, France
| | - Marion Gauthier-Villars
- Department of Genetics, Institut Curie, PSL Research University, Department of Genetics, Paris, France
| | - Matthieu Carton
- Department of Biostatistics, Institut Curie, PSL Research University, Saint-Cloud, France
| | - Nathalie Cassoux
- Faculty of Medicine Paris-Descartes, Paris University, Paris, France.,Service of Ophthalmology, Department of Surgical Oncology, Institut Curie, Paris, France
| | | | - Catherine Dehainault
- Department of Genetics, Institut Curie, PSL Research University, Department of Genetics, Paris, France
| | - Christine Levy
- Service of Ophthalmology, Department of Surgical Oncology, Institut Curie, Paris, France
| | - Lisa Golmard
- Department of Genetics, Institut Curie, PSL Research University, Department of Genetics, Paris, France
| | - Isabelle Aerts
- Oncology Center, Soins, Innovation, Recherche en Oncologie de l'Enfant, l'Adolescent et du Jeune Adulte, Institut Curie, Paris, France
| | - François Doz
- Faculty of Medicine Paris-Descartes, Paris University, Paris, France.,Oncology Center, Soins, Innovation, Recherche en Oncologie de l'Enfant, l'Adolescent et du Jeune Adulte, Institut Curie, Paris, France
| | - Fidéline Bonnet-Serrano
- Department of Genetics, Institut Curie, PSL Research University, Department of Genetics, Paris, France
| | - Stéphanie Hayek
- Department of Genetics, Institut Curie, PSL Research University, Department of Genetics, Paris, France
| | - Alexia Savignoni
- Department of Biostatistics, Institut Curie, PSL Research University, Saint-Cloud, France
| | - Dominique Stoppa-Lyonnet
- Department of Genetics, Institut Curie, PSL Research University, Department of Genetics, Paris, France.,Faculty of Medicine Paris-Descartes, Paris University, Paris, France.,Research Center Institut National de la Santé et de la Recherche Médicale, Unit U830, Institut Curie, Paris, France
| | - Claude Houdayer
- Department of Genetics, Institut Curie, PSL Research University, Department of Genetics, Paris, France.,Department of Genetics, Rouen University Hospital, Rouen, France.,University of Rouen Normandy, UNIROUEN, Mont-Saint-Aignan, France.,Institut National de la Santé et de la Recherche Médicale U1245, Normandy Center for Genomic and Personalized Medicine, Rouen, France
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20
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Fraichard C, Bonnet-Serrano F, Laguillier-Morizot C, Hebert-Schuster M, Lai-Kuen R, Sibiude J, Fournier T, Cohen M, Guibourdenche J. Protease Inhibitor Anti-HIV, Lopinavir, Impairs Placental Endocrine Function. Int J Mol Sci 2021; 22:E683. [PMID: 33445576 PMCID: PMC7827556 DOI: 10.3390/ijms22020683] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 12/12/2022] Open
Abstract
Protease Inhibitors (PI e.g., ritonavir (RTV) and lopinavir (LPV)) used to treat pregnant mothers infected by HIV induce prematurity and endocrine dysfunctions. The maintenance of pregnancy relies on placental hormone production (human Chorionic Gonadotrophin (hCG) and progesterone (P4)). Those functions are ensured by the villous trophoblast and are mainly regulated by the Unfolded Protein Response (UPR) pathway and mitochondria. We investigated, in vitro, if PI impair hCG and P4 production and the potential intracellular mechanisms involved. Term villous cytotrophoblast (VCT) were cultured with or without RTV or LPV from 6 to 48 h. VCT differentiation into syncytiotrophoblast (ST) was followed measuring hCG and P4 secretion. We evaluated the expression of P4 synthesis partners (Metastatic Lymph Node 64 (MLN64), cholesterol side-chain cleavage (P450SCC), Hydroxy-delta-5-Steroid Dehydrogenase and 3 Beta-and steroid delta-isomerase 1 (HSD3B1)), of mitochondrial pro-fusion factors (Mitofusin 2 (Mfn2), Optic Atrophy 1 (OPA1)) and of UPR factors (Glucose-Regulated Protein 78 (GRP78), Activating Transcription Factor 4 (ATF4), Activating Transcription Factor 6 (ATF6), spliced X-box Binding Protein 1 (sXBP1)). RTV had no significant effect on hCG and P4 secretion, whereas lopinavir significantly decreased both secretions. LPV also decreased P450SCC and HSD3B1 expression, whereas it increased Mfn2, GRP78 and sXBP1 expression in ST. RTV has no effect on the endocrine placenta. LPV impairs both villous trophoblast differentiation and P4 production. It is likely to act via mitochondrial fusion and UPR pathway activation. These trophoblastic alterations may end in decreased P4 levels in maternal circulation, inducing prematurity.
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Affiliation(s)
- Camille Fraichard
- INSERM UMR-S 1139, Faculté de Pharmacie, Université de Paris, 75006 Paris, France; (C.F.); (C.L.-M.); (T.F.)
| | | | - Christelle Laguillier-Morizot
- INSERM UMR-S 1139, Faculté de Pharmacie, Université de Paris, 75006 Paris, France; (C.F.); (C.L.-M.); (T.F.)
- Service d’Hormonologie, CHU Cochin, HUPC, AP-HP, 75014 Paris, France;
| | - Marylise Hebert-Schuster
- Service de Gynécologie-Obstétrique, Faculté de Médecine, Université de Genève, 1206 Genève, Suisse; (M.H.-S.); (M.C.)
| | - René Lai-Kuen
- INSERM UMS 025—CNRS UMS 3612, Faculté de Pharmacie, Université de Paris, 75006 Paris, France;
| | - Jeanne Sibiude
- Service de Gynécologie-Obstétrique, CHU Louis Mourier, HUPN, AP-HP, 92700 Colombes, France;
| | - Thierry Fournier
- INSERM UMR-S 1139, Faculté de Pharmacie, Université de Paris, 75006 Paris, France; (C.F.); (C.L.-M.); (T.F.)
| | - Marie Cohen
- Service de Gynécologie-Obstétrique, Faculté de Médecine, Université de Genève, 1206 Genève, Suisse; (M.H.-S.); (M.C.)
| | - Jean Guibourdenche
- INSERM UMR-S 1139, Faculté de Pharmacie, Université de Paris, 75006 Paris, France; (C.F.); (C.L.-M.); (T.F.)
- Service d’Hormonologie, CHU Cochin, HUPC, AP-HP, 75014 Paris, France;
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21
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Faillot S, Foulonneau T, Néou M, Espiard S, Garinet S, Vaczlavik A, Jouinot A, Rondof W, Septier A, Drougat L, Hécale-Perlemoine K, Ragazzon B, Rizk-Rabin M, Sibony M, Bonnet-Serrano F, Guibourdenche J, Libé R, Groussin L, Dousset B, de Reyniès A, Bertherat J, Assié G. Genomic classification of benign adrenocortical lesions. Endocr Relat Cancer 2021; 28:79-95. [PMID: 33151900 DOI: 10.1530/erc-20-0128] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 10/24/2020] [Accepted: 11/04/2020] [Indexed: 11/08/2022]
Abstract
Benign adrenal tumors cover a spectrum of lesions with distinct morphology and steroid secretion. Current classification is empirical. Beyond a few driver mutations, pathophysiology is not well understood. Here, a pangenomic characterization of benign adrenocortical tumors is proposed, aiming at unbiased classification and new pathophysiological insights. Benign adrenocortical tumors (n = 146) were analyzed by transcriptome, methylome, miRNome, chromosomal alterations and mutational status, using expression arrays, methylation arrays, miRNA sequencing, SNP arrays, and exome or targeted next-generation sequencing respectively. Pathological and hormonal data were collected for all tumors. Pangenomic analysis identifies four distinct molecular categories: (1) tumors responsible for overt Cushing, gathering distinct tumor types, sharing a common cAMP/PKA pathway activation by distinct mechanisms; (2) adenomas with mild autonomous cortisol excess and non-functioning adenomas, associated with beta-catenin mutations; (3) primary macronodular hyperplasia with ARMC5 mutations, showing an ovarian expression signature; (4) aldosterone-producing adrenocortical adenomas, apart from other benign tumors. Epigenetic alterations and steroidogenesis seem associated, including CpG island hypomethylation in tumors with no or mild cortisol secretion, miRNA patterns defining specific molecular groups, and direct regulation of steroidogenic enzyme expression by methylation. Chromosomal alterations and somatic mutations are subclonal, found in less than 2/3 of cells. New pathophysiological insights, including distinct molecular signatures supporting the difference between mild autonomous cortisol excess and overt Cushing, ARMC5 implication into the adreno-gonadal differentiation faith, and the subclonal nature of driver alterations in benign tumors, will orient future research. This first genomic classification provides a large amount of data as a starting point.
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Affiliation(s)
- Simon Faillot
- Université de Paris, Institut Cochin, INSERM, CNRS, Paris, France
| | | | - Mario Néou
- Université de Paris, Institut Cochin, INSERM, CNRS, Paris, France
| | | | - Simon Garinet
- Université de Paris, Institut Cochin, INSERM, CNRS, Paris, France
| | - Anna Vaczlavik
- Université de Paris, Institut Cochin, INSERM, CNRS, Paris, France
| | - Anne Jouinot
- Université de Paris, Institut Cochin, INSERM, CNRS, Paris, France
| | - Windy Rondof
- Université de Paris, Institut Cochin, INSERM, CNRS, Paris, France
| | - Amandine Septier
- Université de Paris, Institut Cochin, INSERM, CNRS, Paris, France
| | - Ludivine Drougat
- Université de Paris, Institut Cochin, INSERM, CNRS, Paris, France
| | | | - Bruno Ragazzon
- Université de Paris, Institut Cochin, INSERM, CNRS, Paris, France
| | | | - Mathilde Sibony
- Université de Paris, Institut Cochin, INSERM, CNRS, Paris, France
- Department of Pathology, AP-HP, Hôpital Pitié-Salpétrière, Pierre et Marie Curie Université, Paris, France
| | - Fidéline Bonnet-Serrano
- Université de Paris, Institut Cochin, INSERM, CNRS, Paris, France
- Department of Endocrinology, Center for Rare Adrenal Diseases, AP-HP, Hôpital Cochin, Paris, France
- Department of Hormonology, AP-HP, Hôpital Cochin, Paris, France
| | - Jean Guibourdenche
- Université de Paris, Institut Cochin, INSERM, CNRS, Paris, France
- Department of Hormonology, AP-HP, Hôpital Cochin, Paris, France
| | - Rosella Libé
- Université de Paris, Institut Cochin, INSERM, CNRS, Paris, France
- Department of Endocrinology, Center for Rare Adrenal Diseases, AP-HP, Hôpital Cochin, Paris, France
| | - Lionel Groussin
- Université de Paris, Institut Cochin, INSERM, CNRS, Paris, France
- Department of Endocrinology, Center for Rare Adrenal Diseases, AP-HP, Hôpital Cochin, Paris, France
| | - Bertrand Dousset
- Department of Endocrine Surgery, AP-HP, Hôpital Cochin, Paris, France
| | - Aurélien de Reyniès
- Programme Cartes d'Identité des Tumeurs (CIT), Ligue Nationale Contre Le Cancer, Paris, France
| | - Jérôme Bertherat
- Université de Paris, Institut Cochin, INSERM, CNRS, Paris, France
- Department of Endocrinology, Center for Rare Adrenal Diseases, AP-HP, Hôpital Cochin, Paris, France
| | - Guillaume Assié
- Université de Paris, Institut Cochin, INSERM, CNRS, Paris, France
- Department of Endocrinology, Center for Rare Adrenal Diseases, AP-HP, Hôpital Cochin, Paris, France
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22
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Hannah-Shmouni F, Berthon A, Faucz FR, Briceno JM, Maria AG, Demidowich A, Peitzsch M, Masjkur J, Bonnet-Serrano F, Vaczlavik A, Bertherat J, Reincke M, Eisenhofer G, Stratakis CA. Mass spectrometry-based steroid profiling in primary bilateral macronodular adrenocortical hyperplasia. Endocr Relat Cancer 2020; 27:403-413. [PMID: 32348959 PMCID: PMC7354003 DOI: 10.1530/erc-20-0102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/22/2020] [Accepted: 04/29/2020] [Indexed: 01/19/2023]
Abstract
Biochemical characterization of primary bilateral macronodular adrenocortical hyperplasia (PBMAH) by distinct plasma steroid profiles and its putative correlation to disease has not been previously studied. LC-MS/MS-based steroid profiling of 16 plasma steroids was applied to 36 subjects (22 females, 14 males) with PBMAH, 19 subjects (16 females, 3 males) with other forms of adrenal Cushing's syndrome (ACS), and an age and sex-matched control group. Germline ARMC5 sequencing was performed in all PBMAH cases. Compared to controls, PBMAH showed increased plasma 11-deoxycortisol, corticosterone, 11-deoxycorticosterone, 18-hydroxycortisol, and aldosterone, but lower progesterone, DHEA, and DHEA-S with distinct differences in subjects with and without pathogenic variants in ARMC5. Steroids that showed isolated differences included cortisol and 18-oxocortisol with higher (P < 0.05) concentrations in ACS than in controls and aldosterone with higher concentrations in PBMAH when compared to controls. Larger differences in PBMAH than with ACS were most clear for corticosterone, but there were also trends in this direction for 18-hydroxycortisol and aldosterone. Logistic regression analysis indicated four steroids - DHEA, 11-deoxycortisol, 18-oxocortisol, and corticosterone - with the most power for distinguishing the groups. Discriminant analyses with step-wise variable selection indicated correct classification of 95.2% of all subjects of the four groups using a panel of nine steroids; correct classification of subjects with and without germline variants in ARMC5 was achieved in 91.7% of subjects with PBMAH. Subjects with PBMAH show distinctive plasma steroid profiles that may offer a supplementary single-test alternative for screening purposes.
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Affiliation(s)
- Fady Hannah-Shmouni
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Annabel Berthon
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Fabio R. Faucz
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Juan Medina Briceno
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Andrea Gutierrez Maria
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Andrew Demidowich
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Mirko Peitzsch
- Institute of Clinical Chemistry and Laboratory Medicine & University Hospital Carl Gustav Carus, TechnischeUniversität Dresden, Germany
| | - Jimmy Masjkur
- Department of Medicine III, University Hospital Carl Gustav Carus, TechnischeUniversität Dresden, Germany
| | - Fidéline Bonnet-Serrano
- Department of Endocrinology & Hormonal Biology, Cochin Hospital, INSERM U1506, CNRS 8104, Institut Cochin, Paris Descartes University, Paris, France
| | - Anna Vaczlavik
- Department of Endocrinology & Hormonal Biology, Cochin Hospital, INSERM U1506, CNRS 8104, Institut Cochin, Paris Descartes University, Paris, France
| | - Jérôme Bertherat
- Department of Endocrinology & Hormonal Biology, Cochin Hospital, INSERM U1506, CNRS 8104, Institut Cochin, Paris Descartes University, Paris, France
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Graeme Eisenhofer
- Institute of Clinical Chemistry and Laboratory Medicine & University Hospital Carl Gustav Carus, TechnischeUniversität Dresden, Germany
- Department of Medicine III, University Hospital Carl Gustav Carus, TechnischeUniversität Dresden, Germany
| | - Constantine A. Stratakis
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
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23
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Bonnet-Serrano F, Jaoude MA, Gobeaux C, Bouzerara A, Mosnier-Pudar H, Laguillier-Morizot C, Guibourdenche J. MON-623 Pattern of C-Peptide Response to Oral Glucose Tolerance Test: Interest and Cut-Off Values. J Endocr Soc 2020. [PMCID: PMC7208023 DOI: 10.1210/jendso/bvaa046.1019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: Oral glucose tolerance test (OGTT) allows classification of subjects in 3 groups, depending on glycaemia 120 minutes after 75g glucose ingestion: normal (glycaemia < 1.4 g/L), glucose intolerant (1.4-2 g/L) and diabetic (>2g/L). Five insulin profiles following OGTT associated with different incidence rates of diabetes over 10 years of follow-up have also previously been described (Kraft J et al, Laboratory Medicine, 1975; Hayashi T et al, Diabetes Care.2013). Insulin measurement is very sensible to hemolysis and can advantageously be replaced by C-peptide determination. However, little is known about C-peptide reference values and response to OGTT.Material and Methods: 128 patients were included to evaluate glyceamia (COBASe801® ROCHE Diagnostics, France), insulin and C-peptide (LiaisonXL®, Diasorin, France) responses to OGTT.Results: According to Hayashi classification, 23 (18%) patients of the whole cohort harbored a physiological insulin response corresponding to profile I (peak of insulin during OGTT at 30 min and higher insulin level at 60 vs. 120 min). Others presented 5 pathological profiles: 14 (11%) patients were classified in profile II (peak of insulin at 30 min and lower or equal insulin level at 60 vs. 120 min), 56 (44%) in profile III (peak of insulin at 60 min), 26 (20%) in profile IV (peak of insulin at 120 min and lower insulin level at 30 vs. 60 min), and finally 9 (7%) in profile V (peak of insulin at 120 min and higher or equal insulin level at 30 vs. 60 min). Only 4 different mean C-peptide profiles emerged from the subgroups previously defined by insulin profile, mean C-peptide profile being substantially similar to mean insulin profile. The only major difference relied on a similar C-peptide profile corresponding to a growing curve from T0 to T120 in both patients with insulin profile IV and V. Mean and 95% confidence interval of C-peptide value at the different times of OGTT were also calculated in the subgroup of patients with both normal glycemic and insulin (pattern I) responses to propose reference values: respectively T0: 0.53 (0.26-0.77); T30: 2.2 (1.24-3.29); T60: 2.26 (1.36-3.68); T120: 1.88 (0.84-2.62) nmol/L. Conclusion: C-peptide response to OGTT profile seems to give globally the same information as insulin profile and should therefore also be predictive of the risk type 2 diabetes in case of hemolyzed samples. The slight differences observed between insulin and C-peptide profiles can be explained by their different metabolic pathways, insulin being quickly degraded in the liver and C-peptide undergoing a longer renal elimination. This work also allows us to propose for the first-time reference values for C-peptide at the different times of OGTT using Liaison XL®.
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Le Mestre J, Duparc C, Reznik Y, Bonnet-Serrano F, Touraine P, Chabre O, Young J, Suzuki M, Sibony M, Gobet F, Stratakis CA, Raverot G, Bertherat J, Lefebvre H, Louiset E. Illicit Upregulation of Serotonin Signaling Pathway in Adrenals of Patients With High Plasma or Intra-Adrenal ACTH Levels. J Clin Endocrinol Metab 2019; 104:4967-4980. [PMID: 31074783 PMCID: PMC6937520 DOI: 10.1210/jc.2019-00425] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/06/2019] [Indexed: 12/21/2022]
Abstract
CONTEXT In the human adrenal, serotonin (5-HT), released by mast cells stimulates corticosteroid secretion through activation of type 4 serotonin receptors (5-HT4R). In primary pigmented nodular adrenocortical disease cells, activation of the cAMP/protein kinase A (PKA) pathway by PRKAR1A mutations triggers upregulation of the 5-HT synthesizing enzyme tryptophan hydroxylase (TPH) and the 5-HT4, 5-HT6, and 5-HT7 receptors. Because ACTH stimulates cortisol secretion through activation of PKA, adrenocortical tissues exposed to sustained stimulation by ACTH may harbor increased expression of TPH and 5-HT4/6/7 receptors. OBJECTIVE To investigate the effects of long-term ACTH stimulation on the serotonergic pathway in adrenals of patients with high plasma or intra-adrenal ACTH levels. METHODS Adrenal tissues were obtained from patients with Cushing disease, ectopic secretion of ACTH [paraneoplastic Cushing syndrome; (paraCS)], 21-hydroxylase deficiency (21-OHD), primary bilateral macronodular adrenal hyperplasia with intra-adrenal ACTH presence, or cortisol-producing adenomas. TPH and 5-HT4/6/7 receptor expression was investigated using RT-PCR and immunochemistry in comparison with normal adrenals. Primary cultured adrenocortical cells originating from a patient with paraCS were incubated with 5-HT and 5-HTR agonists/antagonists. RESULTS TPH and/or 5-HT4/6/7 receptors were overexpressed in the different types of tissues. In paraCS cultured cells, the cortisol response to 5-HT was exaggerated compared with normal adrenal cells and the stimulatory action of 5-HT was reduced by 5-HT4R antagonist. CONCLUSION Our results indicate that prolonged activation of the cAMP/PKA pathway by ACTH induces an aberrant serotonergic stimulatory loop in the adrenal cortex that likely participates in the pathogenesis of corticosteroid hypersecretion.
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Affiliation(s)
- Julie Le Mestre
- Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Normandie University, UNIROUEN, INSERM, U1239, Rouen, France
| | - Céline Duparc
- Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Normandie University, UNIROUEN, INSERM, U1239, Rouen, France
| | - Yves Reznik
- Department of Endocrinology-Diabetology, Caen University Hospital, Caen, France
| | - Fidéline Bonnet-Serrano
- Hormonal Biology Laboratory, Assistance Publique des Hôpitaux de Paris (AP-HP), Cochin Hospital, Paris, France
- Institut Cochin, INSERMU1016, CNRSUMR8104, Université Paris Descartes, Paris, France
| | - Philippe Touraine
- Department of Endocrinology and Reproductive Medicine, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Olivier Chabre
- Department of Endocrinology, Diabetes and Nutrition, INSERM, U1036, Grenoble-Alpes University Hospital, Grenoble, France
| | - Jacques Young
- Department of Endocrinology and Reproductive Medicine, AP-HP, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Mari Suzuki
- Section on Endocrinology and Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland
| | - Mathilde Sibony
- Institut Cochin, INSERMU1016, CNRSUMR8104, Université Paris Descartes, Paris, France
- Department of Pathology, AP-HP, Cochin Hospital, Paris, France
| | - Françoise Gobet
- Department of Pathology, Rouen University Hospital, Rouen, France
| | - Constantine A Stratakis
- Section on Endocrinology and Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland
| | - Gérald Raverot
- Department of Endocrinology, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
| | - Jérôme Bertherat
- Institut Cochin, INSERMU1016, CNRSUMR8104, Université Paris Descartes, Paris, France
- Department of Endocrinology, AP-HP, Cochin Hospital, Paris, France
| | - Hervé Lefebvre
- Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Normandie University, UNIROUEN, INSERM, U1239, Rouen, France
- Department of Endocrinology, Diabetes and Metabolic Diseases, Rouen University Hospital, Rouen, France
- Correspondence and Reprint Requests: Hervé Lefebvre, MD, PhD, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, University of Rouen, INSERM U1239, 76821 Mont-Saint-Aignan Cedex, France. E-mail:
| | - Estelle Louiset
- Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Normandie University, UNIROUEN, INSERM, U1239, Rouen, France
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Hannah-Shmouni F, Berthon A, Faucz F, Medina Briceno J, Gutierrez Maria A, Demidowich A, Peitzsch M, Masjkur J, Bonnet-Serrano F, Vaczlavik A, Bertherat J, Reincke M, Eisenhofer G, Stratakis C. OR02-6 Mass Spectrometry-Based Steroid Profiling Inprimary Bilateral Macronodular Adrenocortical Hyperplasia. J Endocr Soc 2019. [PMCID: PMC6554999 DOI: 10.1210/js.2019-or02-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/19/2022] Open
Abstract
Background: Biochemical characterization of primary bilateral macronodular adrenocortical hyperplasia (PBMAH) by distinct plasma steroid profiles and its putative correlation to disease has not been previously studied. Methods: LC-MS/MS-based steroid profiling of 16 plasma steroids was applied to 36 subjects (22 females, 14 males) with PBMAH, 19 subjects (16 females, 3 males) with other forms of adrenal CS (ACS), and an age and sex-matched control group. Germline ARMC5 sequencing was performed in all PBMAH cases. Results: The steroids showing the most dramatic differences between subject groups included 11-deoxycortisol, corticosterone, 11-deoxycorticosterone, 18-hydroxycortisol, progesterone and DHEA/DHEA-S. Steroids that showed isolated differences included cortisol and 18-oxocortisol with higher (P<0·05) concentrations in ACS than in controls, and aldosterone with higher concentrations in PBMAH when compared to controls. Larger differences in PBMAH than with ACS were most clear for corticosterone, but there were also trends in this direction for 18-hydroxycortisol and aldosterone. Logistic regression analysis indicated four steroids - DHEA, 11-deoxycortisol, 18-oxocortisol, and corticosterone - with the most power for distinguishing the groups. Discriminant analyses with step-wise variable selection indicated correct classification of 95·2% of all subjects of the four groups using a panel of nine steroids; correct classification of subjects with and without germline variants in ARMC5 was achieved in 91·7% of subjects with PBMAH. Conclusion: Subjects with PBMAH show distinctive plasma steroid profiles that may offer a supplementary single-test alternative for screening purposes.
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Affiliation(s)
- Fady Hannah-Shmouni
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Instit, Bethesda, MD, United States
| | | | - Fabio Faucz
- NICHD-SEGEN, NIH/NICHD, Bethesda, MD, United States
| | - Juan Medina Briceno
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Instit, Bethesda, MD, United States
| | - Andrea Gutierrez Maria
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Instit, Bethesda, MD, United States
| | | | - Mirko Peitzsch
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Dresden, , Germany
| | - Jimmy Masjkur
- The University Clinic of Heidelberg, Heidelberg, , Germany
| | | | - Anna Vaczlavik
- Department of Endocrinology & Hormonal Biology, Cochin Hospital, Paris, , France
| | | | - Martin Reincke
- Klinikum der Univ Muenchen, Medizinische Klinik und Poliklinik IV, Munich, , Germany
| | - Graeme Eisenhofer
- Div of Neu, Faculty of Medicine, Techniche Universitt Dresden, Dresden, , Germany
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Abstract
This review describes the molecular alterations observed in the various types of tumors of the adrenal cortex, excluding Conn adenomas, especially the alterations identified by genomic approaches these last five years. Two main forms of bilateral adrenocortical tumors can be distinguished according to size and aspect of the nodules: primary pigmented nodular adrenal disease (PPNAD), which can be sporadic or part of Carney complex and primary bilateral macro nodular adrenal hyperplasia (PBMAH). The bilateral nature of the tumors suggests the existence of an underlying genetic predisposition. PPNAD and Carney complex are mainly due to germline-inactivating mutations of PRKAR1A, coding for a regulatory subunit of PKA, whereas PBMAH genetic seems more complex. However, genome-wide approaches allowed the identification of a new tumor suppressor gene, ARMC5, whose germline alteration could be responsible for at least 25% of PBMAH cases. Unilateral adrenocortical tumors are more frequent, mostly adenomas. The Wnt/beta-catenin pathway can be activated in both benign and malignant tumors by CTNNB1 mutations and by ZNRF3 inactivation in adrenal cancer (ACC). Some other signaling pathways are more specific of the tumor dignity. Thus, somatic mutations of cAMP/PKA pathway genes, mainly PRKACA, coding for the catalytic alpha-subunit of PKA, are found in cortisol-secreting adenomas, whereas IGF-II overexpression and alterations of p53 signaling pathway are observed in ACC. Genome-wide approaches including transcriptome, SNP, methylome and miRome analysis have identified new genetic and epigenetic alterations and the further clustering of ACC in subgroups associated with different prognosis, allowing the development of new prognosis markers.
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Affiliation(s)
- Fidéline Bonnet-Serrano
- Institut CochinINSERM U1016, CNRS UMR8104, Paris Descartes University, Paris, France
- Hormonal Biology LaboratoryAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Jérôme Bertherat
- Institut CochinINSERM U1016, CNRS UMR8104, Paris Descartes University, Paris, France
- Department of EndocrinologyAssistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France
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Bonnet-Serrano F, Diedisheim M, Mallone R, Larger E. Decreased α-cell mass and early structural alterations of the exocrine pancreas in patients with type 1 diabetes: An analysis based on the nPOD repository. PLoS One 2018; 13:e0191528. [PMID: 29352311 PMCID: PMC5774815 DOI: 10.1371/journal.pone.0191528] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 01/05/2018] [Indexed: 01/21/2023] Open
Abstract
Background and aims Abnormal glucagon secretion and functional alterations of the exocrine pancreas have been described in patients with type 1 diabetes (T1D), but their respective anatomical substrata have seldom been investigated. Our aim was to develop an automated morphometric analysis process to characterize the anatomy of α-cell and exocrine pancreas in patients with T1D, using the publicly available slides of the Network for Pancreatic Organ Donors (nPOD). Materials and methods The ratio of β- and α-cell area to total tissue area were quantified in 75 patients with T1D (thereafter patients) and 66 control subjects (thereafter controls), on 2 insulin-stained and 4 glucagon-stained slides from both the head and the tail of the pancreas. The β- and α-cell masses were calculated in the 66 patients and the 50 controls for which the pancreas weight was available. Non-exocrine-non-endocrine tissue area (i.e. non-acinar, non-insular tissue) to total tissue area ratio was evaluated on both insulin- and glucagon-stained slides. Results were expressed as mean ±SD. Results An automated quantification method was set up using the R software and was validated by quantification of β-cell mass, a well characterized parameter. β-cell mass was 29.6±112 mg in patients and 628 ±717 mg in controls (p<0.0001). α-cell mass was 181±176 mg in patients and 349 ±241mg in controls (p<0.0001). Non-exocrine-non-endocrine area to total tissue area ratio was 39±9% in patients and 29± 10% in controls (p<0.0001) and increased with age in both groups, with no correlation with diabetes duration in patients. Conclusion The absolute α-cell mass was lower in patients compared to controls, in proportion to the decrease in pancreas weight observed in patients. Non-exocrine-non-endocrine area to total tissue area ratio increased with age in both groups but was higher in patients at all ages.
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Affiliation(s)
- Fidéline Bonnet-Serrano
- Assistance Publique Hôpitaux de Paris, Hôpital Cochin, UF d’Hormonologie, DHU « AUTHORS », Paris, France
- Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Service de diabétologie, DHU « AUTHORS », Paris, France
| | - Marc Diedisheim
- Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Service de diabétologie, DHU « AUTHORS », Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- INSERM, U1016 and CNRS UMR8104, Cochin Institute, Paris, France
| | - Roberto Mallone
- Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Service de diabétologie, DHU « AUTHORS », Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- INSERM, U1016 and CNRS UMR8104, Cochin Institute, Paris, France
| | - Etienne Larger
- Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Service de diabétologie, DHU « AUTHORS », Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- INSERM, U1016 and CNRS UMR8104, Cochin Institute, Paris, France
- * E-mail:
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