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Ameti A, Chouchane K, Fontana E, Papadakis GE. [Endocrinology: what's new in 2023]. Rev Med Suisse 2024; 20:36-41. [PMID: 38231097 DOI: 10.53738/revmed.2024.20.856-7.36] [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] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
This overview provides a selection of studies published in 2023 with an impact on clinical practice. In reproductive endocrinology, important studies have addressed fertility preservation in men with Klinefelter's syndrome, the cardiovascular safety of testosterone replacement therapy, and a novel therapy, fezolinetant, for vasomotor symptoms of menopause. The updated European recommendations concerning adrenal incidentalomas will considerably modify current clinical practice. Based on a solid epidemiological work, the prevalence of pituitary adenomas has been confirmed to affect about 1 per 1000 individuals. Finally, a large British study allows to refine the benefit-risk profile of the three options available for the treatment of hyperthyroidism.
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Affiliation(s)
- Adelina Ameti
- Service d'endocrinologie, diabétologie et métabolisme, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Karim Chouchane
- Service d'endocrinologie, diabétologie et métabolisme, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Enzo Fontana
- Service de diabétologie-endocrinologie, HFR Fribourg, Hôpital cantonal, 1752 Villars-sur-Glâne
| | - Georgios E Papadakis
- Service d'endocrinologie, diabétologie et métabolisme, Centre hospitalier universitaire vaudois, 1011 Lausanne
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Papadakis GE, de Kalbermatten B, Dormoy A, Salenave S, Trabado S, Vieira-Pinto O, Richa C, Kamenicky P, Chanson P, Maione L, Pitteloud N, Young J. Impact of Cushing's syndrome on the gonadotrope axis and testicular functions in men. Hum Reprod 2023; 38:2350-2361. [PMID: 37742130 DOI: 10.1093/humrep/dead187] [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] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/17/2023] [Indexed: 09/25/2023] Open
Abstract
STUDY QUESTION Does Cushing's syndrome (CS) differently affect the gonadotrope axis and testicular functions (GA/TF) according to the hypercortisolism intensity and underlying etiology? SUMMARY ANSWER Endogenous cortisol excess caused by CS leads to varying degrees of hypogonadotropic hypogonadism (HH) with more severe GA/TF impairment and altered spermatogenesis in men with intense hypercortisolism associated with paraneoplastic/ectopic adrenocorticotrophic hormone (ACTH) secretion (EAS). WHAT IS KNOWN ALREADY CS is very rarely studied in men due to its lower prevalence in men than in women. In a few old reports focusing exclusively on a limited number of men with Cushing's disease (CD), the occurrence of hypogonadism was reported. However, a detailed assessment of the impact of CS on the GA/TF in a significant series of patients has not been performed. Yet, hypogonadism could worsen CS-associated comorbidities such as osteoporosis and myopathy. To date, the full spectrum of GA/TF impairment in men with CS of different etiologies and intensity remains unknown. STUDY DESIGN, SIZE, DURATION In this monocentric study, 89 men with CS diagnosed at a tertiary endocrine university center (Bicêtre, Paris Saclay) between January 1990 and July 2021 were evaluated and compared to 40 normal men of similar age. PARTICIPANTS/MATERIALS, SETTING, METHODS The CS patient cohort of 89 men included 51 with CD, 29 with EAS and 9 with CS of adrenal origin i.e. (ACTH-independent CS (AI-CS)). They all had frank hypercortisolism, with increased 24 h-urinary-free cortisol (24 h-UFC) in two separate samples. A case-control study was performed focusing on pituitary gonadotrope function and testicular sex steroids and peptides. An additional set of six CS men had an evaluation including semen analysis. In a subgroup of 20 men with available data after CS remission, a longitudinal analysis was conducted to assess the reversibility of GA/TF defects. MAIN RESULTS AND THE ROLE OF CHANCE Compared to controls, men with CS had significantly lower total testosterone (TT), bioavailable TT, and free TT (P < 0.0001). Hypogonadism, defined as serum TT levels <3.0 ng/ml, was present in 83% of men with EAS, in 61% of men with CD, and in 33% of men with AI-CS. Low-normal LH concentrations in the included men with hypercortisolism indicated HH. Serum sex hormone-binding globulin levels were moderately decreased in men with CD (P = 0.01 vs controls). Among the CS men, those with EAS had significantly lower TT, LH, and FSH levels than those with CD or AI-CS. When compared to controls, patients with EAS were the only group exhibiting a significant decrease in both serum FSH (P = 0.002) and the testicular peptides inhibin B (P < 0.0001) and anti-Müllerian hormone (P = 0.003). Serum INSL3 levels were significantly lower in men with CD than in the controls (P = 0.03). Of note, 24 h-UFC and ACTH were inversely and significantly associated with the majority of reproductive hormones including LH, FSH, TT, and inhibin B. Following successful curative therapy, reproductive assessment at a mean of 6.0 ± 4.3 years showed a significant increase in serum TT (P < 0.0001) and plasma LH (P = 0.02) levels, indicating a reversal of HH in 75% of the affected males. Among the six patients with available semen analysis, the two EAS cases exhibited a decrease in Sertoli cell peptides associated with a severe oligozoospermia, which completely normalized following removal of the source of hypercortisolism. LIMITATIONS, REASONS FOR CAUTION The potential bias due to the retrospective design is counteracted by the analysis of the largest male CS cohort to date as well as the use of stringent inclusion and exclusion criteria. Due to the low number of patients with semen analysis in this study, further research is needed to unravel the full spectrum of spermatogenesis defects in men with CS. WIDER IMPLICATIONS OF THE FINDINGS This work reveals the variable spectrum of reproductive impact in men with CS. We demonstrate that GA/TF impairment depends on the intensity of hypercortisolism which in turn is related to the underlying etiology. The causal link between hypercortisolism and GA/TF impairment was attested by its reversibility in most patients after CS remission. The wider implications of our findings lie in the potential generalization to a much commoner entity, iatrogenic CS due to chronic exposure to exogenous glucocorticoids. STUDY FUNDING/COMPETING INTEREST(S) Several research grants were attributed to J.Y.: (i) a grant from Programme Hospitalier de Recherche Clinique (PHRC # P081212 HYPOPROTEO); (ii) a grant from the French Association of Patients with Adrenal Diseases ('Association surrénales'); and (iii) independent Investigator Research Grants from HRA Pharma, Novartis and Recordati Pharma. A SICPA Foundation grant (Lausanne, Switzerland) allowed protected research time for G.E.P. The above sponsors were not involved in any part of the study. The authors have no competing or other conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Georgios E Papadakis
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
- Paris-Saclay University; Assistance Publique-Hôpitaux de Paris, Department of Reproductive Endocrinology, Reference Center for Rare Pituitary Diseases HYPO, Bicêtre Hospital, Le Kremlin-Bicêtre, France
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Benedicte de Kalbermatten
- Paris-Saclay University; Assistance Publique-Hôpitaux de Paris, Department of Reproductive Endocrinology, Reference Center for Rare Pituitary Diseases HYPO, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Alexandre Dormoy
- Paris-Saclay University; Assistance Publique-Hôpitaux de Paris, Department of Reproductive Endocrinology, Reference Center for Rare Pituitary Diseases HYPO, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Sylvie Salenave
- Paris-Saclay University; Assistance Publique-Hôpitaux de Paris, Department of Reproductive Endocrinology, Reference Center for Rare Pituitary Diseases HYPO, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Severine Trabado
- Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Hôpitaux Universitaires Paris Saclay, Assistance Publique-Hôpitaux de Paris, CHU Bicêtre, L Kremlin Bicêtre, France
| | - Oceana Vieira-Pinto
- Paris-Saclay University; Assistance Publique-Hôpitaux de Paris, Department of Reproductive Endocrinology, Reference Center for Rare Pituitary Diseases HYPO, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Carine Richa
- Paris-Saclay University; Assistance Publique-Hôpitaux de Paris, Department of Reproductive Endocrinology, Reference Center for Rare Pituitary Diseases HYPO, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Peter Kamenicky
- Paris-Saclay University; Assistance Publique-Hôpitaux de Paris, Department of Reproductive Endocrinology, Reference Center for Rare Pituitary Diseases HYPO, Bicêtre Hospital, Le Kremlin-Bicêtre, France
- INSERM UMR_S 1185, Paris-Saclay Medical School, Le Kremlin-Bicêtre, France
- University Paris Saclay, Orsay, France
| | - Philippe Chanson
- Paris-Saclay University; Assistance Publique-Hôpitaux de Paris, Department of Reproductive Endocrinology, Reference Center for Rare Pituitary Diseases HYPO, Bicêtre Hospital, Le Kremlin-Bicêtre, France
- INSERM UMR_S 1185, Paris-Saclay Medical School, Le Kremlin-Bicêtre, France
- University Paris Saclay, Orsay, France
| | - Luigi Maione
- Paris-Saclay University; Assistance Publique-Hôpitaux de Paris, Department of Reproductive Endocrinology, Reference Center for Rare Pituitary Diseases HYPO, Bicêtre Hospital, Le Kremlin-Bicêtre, France
- INSERM UMR_S 1185, Paris-Saclay Medical School, Le Kremlin-Bicêtre, France
- University Paris Saclay, Orsay, France
| | - Nelly Pitteloud
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Jacques Young
- Paris-Saclay University; Assistance Publique-Hôpitaux de Paris, Department of Reproductive Endocrinology, Reference Center for Rare Pituitary Diseases HYPO, Bicêtre Hospital, Le Kremlin-Bicêtre, France
- INSERM UMR_S 1185, Paris-Saclay Medical School, Le Kremlin-Bicêtre, France
- University Paris Saclay, Orsay, France
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Cossu G, Belouaer A, Kloeckner J, Caliman C, Agri F, Daniel RT, Gaudet JG, Papadakis GE, Messerer M. The Enhanced Recovery After Surgery protocol for the perioperative management of pituitary neuroendocrine tumors/pituitary adenomas. Neurosurg Focus 2023; 55:E9. [PMID: 38039521 DOI: 10.3171/2023.9.focus23529] [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: 07/30/2023] [Accepted: 09/28/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative care pathway that has radically modified the management of patients in multiple surgical specialties. Until now, no ERAS Society guidelines have been formulated for the management of cranial pathologies. During the process of ERAS certification for their neurosurgical department, the authors formulated an ERAS protocol for the perioperative care of patients with pituitary neuroendocrine tumors (PitNET), along with a compliance checklist to monitor the adherence to it and its feasibility. The authors describe the protocol and checklist and report the results, including a cost-minimization analysis, with the application of the ERAS philosophy. METHODS The steps that led to the development of this ERAS protocol, including items concerning the preoperative, intraoperative, and postoperative period, are detailed. The authors report their preliminary results through the comparison of the care practice of a historical cohort with a consecutive surgical cohort of patients with PitNET who underwent operation after the implementation of this ERAS protocol. A compliance checklist with key performance indicators was useful to monitor the adherence to the protocol and the changes in the perioperative management. RESULTS Following the introduction of this ERAS protocol, the authors significantly shortened the duration of the antibiotic therapy (p < 0.00001) and increased the use of mechanical (p < 0.00001) and pharmacological measures to prevent deep venous thrombosis (p = 0.002). The median length of hospital stay was significantly shorter for the ERAS group (p = 0.00014), and there was no increase in readmission rate or postoperative complications. The documentation and data tracking strongly improved in the ERAS cohort and the authors were more attentive in pain evaluation (p = 0.001), postoperative hormonal supplementation (p = 0.001) and early feeding and mobilization (p = 0.0008 and p < 0.00001, respectively). More patients were discharged on day 3 after surgery in the ERAS group (p < 0.00001). The compliance to the whole process increased from 64.2% to 89.5% (p = 0.016), and the compliance per patient was also found to have significantly increased (p < 0.00001). CONCLUSIONS The introduction of a standardized ERAS protocol for the perioperative management of patients with PitNET allowed the authors to improve the multidisciplinary management of these patients. With the application of simple cost-effective interventions and with the avoidance of unnecessary measures, gains were made in terms of early mobilization and feeding, thereby resulting in a shorter in-hospital stay.
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Affiliation(s)
| | | | - Julie Kloeckner
- 2Faculty of Medicine and Biology, University of Lausanne; and
| | | | - Fabio Agri
- 3Department of Administration and Finance, University Hospital of Lausanne, Switzerland
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Belouaer A, Cossu G, Papadakis GE, Gaudet JG, Perez MH, Chanez V, Boegli Y, Mury C, Peters D, Addor V, Levivier M, Daniel RT, Demartines N, Messerer M. Implementation of the Enhanced Recovery After Surgery (ERAS®) program in neurosurgery. Acta Neurochir (Wien) 2023; 165:3137-3145. [PMID: 37688648 PMCID: PMC10624709 DOI: 10.1007/s00701-023-05789-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/22/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Over the past decade, Enhanced Recovery After Surgery (ERAS®) guidelines have been proven to simplify postoperative care and improve recovery in several surgical disciplines. The authors set out to create and launch an ERAS® program for cranial neurosurgery that meets official ERAS® Society standards. The authors summarize the successive steps taken to achieve this goal in two specific neurosurgical conditions and describe the challenges they faced. METHODS Pituitary neuroendocrine tumors (Pit-NET) resected by a transsphenoidal approach and craniosynostosis (Cs) repair were selected as appropriate targets for the implementation of ERAS® program in the Department of Neurosurgery. A multidisciplinary team with experience in managing these pathologies was created. A specialized ERAS® nurse coordinator was hired. An ERAS® certification process was performed involving 4 seminars separated by 3 active phases under the supervision of an ERAS® coach. RESULTS The ERAS® Pit-NET team included 8 active members. The ERAS® Cs team included 12 active members. Through the ERAS® certification process, areas for improvement were identified, local protocols were written, and the ERAS® program was implemented. Patient-centered strategies were developed to increase compliance with the ERAS® protocols. A prospective database was designed for ongoing program evaluation. Certification was achieved in 18 months. Direct costs and time requirements are reported. CONCLUSION Successful ERAS® certification requires a committed multidisciplinary team, an ERAS® coach, and a dedicated nurse coordinator.
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Affiliation(s)
- Amani Belouaer
- Department of Clinical Neuroscience, Service of Neurosurgery, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Giulia Cossu
- Department of Clinical Neuroscience, Service of Neurosurgery, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Georgios E Papadakis
- Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - John G Gaudet
- Department of Anesthesiology, Neurospinal Unit, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Maria-Helena Perez
- Pediatric Intensive and Intermediate Care Units, Department of Pediatrics, Women-Mother-Child Department, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Vivianne Chanez
- Pediatric Intensive and Intermediate Care Units, Department of Pediatrics, Women-Mother-Child Department, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Yann Boegli
- Department of Anesthesiology, Pediatric Unit, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Caroline Mury
- Department of Anesthesiology, Pediatric Unit, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - David Peters
- Department of Clinical Neuroscience, Service of Neurosurgery, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Valérie Addor
- Department of Visceral Surgery, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Marc Levivier
- Department of Clinical Neuroscience, Service of Neurosurgery, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Roy Thomas Daniel
- Department of Clinical Neuroscience, Service of Neurosurgery, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Mahmoud Messerer
- Department of Clinical Neuroscience, Service of Neurosurgery, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
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Fargeat M, Blondet F, Papadakis GE. [Brittle bones]. Rev Med Suisse 2023; 19:1852-1853. [PMID: 37819183 DOI: 10.53738/revmed.2023.19.845.1852] [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] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
The use of corticosteroids is common in our clinical practice. Cortico-induced osteoporosis should be taken into consideration when using a dosage higher than 7.5 mg/d of prednisone or equivalent for a minimum of 3 months. We describe the case of a 69-year-old female patient who received long-term corticosteroid treatment for low back pain and developed secondary vertebral compression fractures. This case illustrates the importance of assessing fracture risk when prescribing corticosteroids, in order to offer preventive measures and introduce (in subjects with high risk) prophylactic treatments aiming to reduce the risk of irreversible consequences.
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Affiliation(s)
- Mathilde Fargeat
- Service de médecine interne générale, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Fanny Blondet
- Département de médecine, Ensemble hospitalier de la Côte, 1110 Morges
| | - Georgios E Papadakis
- Service d'endocrinologie, diabétologie et métabolisme, Centre hospitalier universitaire vaudois, 1011 Lausanne
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Cotellessa L, Marelli F, Duminuco P, Adamo M, Papadakis GE, Bartoloni L, Sato N, Lang-Muritano M, Troendle A, Dhillo WS, Morelli A, Guarnieri G, Pitteloud N, Persani L, Bonomi M, Giacobini P, Vezzoli V. Defective jagged-1 signaling affects GnRH development and contributes to congenital hypogonadotropic hypogonadism. JCI Insight 2023; 8:161998. [PMID: 36729644 PMCID: PMC10077483 DOI: 10.1172/jci.insight.161998] [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: 05/18/2022] [Accepted: 02/01/2023] [Indexed: 02/03/2023] Open
Abstract
In vertebrate species, fertility is controlled by gonadotropin-releasing hormone (GnRH) neurons. GnRH cells arise outside the central nervous system, in the developing olfactory pit, and migrate along olfactory/vomeronasal/terminal nerve axons into the forebrain during embryonic development. Congenital hypogonadotropic hypogonadism (CHH) and Kallmann syndrome are rare genetic disorders characterized by infertility, and they are associated with defects in GnRH neuron migration and/or altered GnRH secretion and signaling. Here, we documented the expression of the jagged-1/Notch signaling pathway in GnRH neurons and along the GnRH neuron migratory route both in zebrafish embryos and in human fetuses. Genetic knockdown of the zebrafish ortholog of JAG1 (jag1b) resulted in altered GnRH migration and olfactory axonal projections to the olfactory bulbs. Next-generation sequencing was performed in 467 CHH unrelated probands, leading to the identification of heterozygous rare variants in JAG1. Functional in vitro validation of JAG1 mutants revealed that 7 out of the 9 studied variants exhibited reduced protein levels and altered subcellular localization. Together our data provide compelling evidence that Jag1/Notch signaling plays a prominent role in the development of GnRH neurons, and we propose that JAG1 insufficiency may contribute to the pathogenesis of CHH in humans.
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Affiliation(s)
- Ludovica Cotellessa
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy.,University Lille, INSERM, CHU Lille, Laboratory of Development and Plasticity of the Neuroendocrine Brain, Lille Neuroscience & Cognition UMR-S 1172, FHU 1000 days for health, Lille, France
| | - Federica Marelli
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Paolo Duminuco
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Michela Adamo
- Department of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Georgios E Papadakis
- Department of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Lucia Bartoloni
- Department of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Naoko Sato
- Department of Pediatrics, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Mariarosaria Lang-Muritano
- Department of Pediatric Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland
| | - Amineh Troendle
- Department of Endocrinology, Diabetology, and Metabolism, Lindenhofspital, Bern, Switzerland
| | - Waljit S Dhillo
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, United Kingdom
| | - Annamaria Morelli
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Giulia Guarnieri
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Nelly Pitteloud
- Department of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Luca Persani
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy.,Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Marco Bonomi
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy.,Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Paolo Giacobini
- University Lille, INSERM, CHU Lille, Laboratory of Development and Plasticity of the Neuroendocrine Brain, Lille Neuroscience & Cognition UMR-S 1172, FHU 1000 days for health, Lille, France
| | - Valeria Vezzoli
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Dwyer AA, Héritier V, Llahana S, Edelman L, Papadakis GE, Vaucher L, Pitteloud N, Hauschild M. Navigating Disrupted Puberty: Development and Evaluation of a Mobile-Health Transition Passport for Klinefelter Syndrome. Front Endocrinol (Lausanne) 2022; 13:909830. [PMID: 35813640 PMCID: PMC9264386 DOI: 10.3389/fendo.2022.909830] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
Klinefelter syndrome (KS) is the most common aneuploidy in men and has long-term sequelae on health and wellbeing. KS is a chronic, lifelong condition and adolescents/young adults (AYAs) with KS face challenges in transitioning from pediatric to adult-oriented services. Discontinuity of care contributes to poor outcomes for health and wellbeing and transition programs for KS are lacking. We aimed to develop and test a mobile health tool (KS Transition Passport) to educate patients about KS, encourage self-management and support successful transition to adult-oriented care. First, we conducted a retrospective chart review and patient survey to examine KS transition at a university hospital. Second, we conducted a systematic scoping review of the literature on AYAs with KS. Last, we developed a mobile health transition passport and evaluated it with patient support groups. Participants evaluated the tool using the System Usability Scale and Patient Education Materials Assessment Tool (PEMAT). Chart review identified 21 AYAs diagnosed between 3.9-16.8 years-old (median 10.2 years). The survey revealed only 4/10 (40%) were on testosterone therapy and fewer (3/10, 30%) had regular medical care. The scoping review identified 21 relevant articles highlighting key aspects of care for AYAs with KS. An interprofessional team developed the mobile-health KS transition passport using an iterative process. Support group members (n=35) rated passport usability as 'ok' to 'good' (70 ± 20, median 73.5/100). Of PEMAT dimensions, 5/6 were deemed 'high quality' (86-90/100) and participants knew what to do with the information (actionability = 83/100). In conclusion, many patients with KS appear to have gaps in transition to adult-oriented care. Iterative development of a KS transition passport produced a mobile health tool that was usable, understandable and had high ratings for actionability.
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Affiliation(s)
- Andrew A. Dwyer
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, United States
- Endocrinology, Diabetes & Metabolism Service of the Department of Medicine, Lausanne University Hospital Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Vanessa Héritier
- Pediatric Endocrinology, Diabetes and Obesity Unit, Department of Women-Mother-Child, Lausanne University Hospital Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Sofia Llahana
- School of Health and Psychological Sciences, City University of London, London, United Kingdom
| | - Lauren Edelman
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, United States
| | - Georgios E. Papadakis
- Endocrinology, Diabetes & Metabolism Service of the Department of Medicine, Lausanne University Hospital Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Laurent Vaucher
- Reproductive Medicine Unit, Department of Obstetrics and Gynecology, Lausanne University Hospital Centre Hospitalier Universitaire Vaudois Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Nelly Pitteloud
- Endocrinology, Diabetes & Metabolism Service of the Department of Medicine, Lausanne University Hospital Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Michael Hauschild
- Pediatric Endocrinology, Diabetes and Obesity Unit, Department of Women-Mother-Child, Lausanne University Hospital Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- *Correspondence: Michael Hauschild,
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Ostertag A, Papadakis GE, Collet C, Trabado S, Maione L, Pitteloud N, Bouligand J, De Vernejoul MC, Cohen-Solal M, Young J. Compromised Volumetric Bone Density and Microarchitecture in Men With Congenital Hypogonadotropic Hypogonadism. J Clin Endocrinol Metab 2021; 106:e3312-e3326. [PMID: 33725720 DOI: 10.1210/clinem/dgab169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Men with congenital hypogonadotropic hypogonadism (CHH) and Kallmann syndrome (KS) have both low circulating testosterone and estradiol levels. Whether bone structure is affected remains unknown. OBJECTIVE To characterize bone geometry, volumetric density and microarchitecture in CHH/KS. METHODS This cross-sectional study, conducted at a single French tertiary academic medical center, included 51 genotyped CHH/KS patients and 40 healthy volunteers. Among CHH/KS men, 98% had received testosterone and/or combined gonadotropins. High-resolution peripheral quantitative computed tomography (HR-pQCT), dual-energy x-ray absorptiometry (DXA), and measurement of serum bone markers were used to determine volumetric bone mineral density (vBMD) and cortical and trabecular microarchitecture. RESULTS CHH and controls did not differ for age, body mass index, and levels of vitamin D and PTH. Despite long-term hormonal treatment (10.8 ± 6.8 years), DXA showed lower areal bone mineral density (aBMD) in CHH/KS at lumbar spine, total hip, femoral neck, and distal radius. Consistent with persistently higher serum bone markers, HR-pQCT revealed lower cortical and trabecular vBMD as well as cortical thickness at the tibia and the radius. CHH/KS men had altered trabecular microarchitecture with a predominant decrease of trabecular thickness. Moreover, CHH/KS men exhibited lower cortical bone area, whereas total and trabecular areas were higher only at the tibia. Earlier treatment onset (before age 19 years) conferred a significant advantage for trabecular bone volume/tissue volume and trabecular vBMD at the tibia. CONCLUSION Both vBMD and bone microarchitecture remain impaired in CHH/KS men despite long-term hormonal treatment. Treatment initiation during adolescence is associated with enhanced trabecular outcomes, highlighting the importance of early diagnosis.
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Affiliation(s)
- Agnès Ostertag
- Department of Rheumatology, Université de Paris and INSERM UMR-U1132 (Biology of bone and cartilage research unit), Hôpital Lariboisière, F-75010 Paris, France
| | - Georgios E Papadakis
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, CH-1011, Lausanne, Switzerland
- Department of Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, F-94275, Le Kremlin-Bicêtre, France
| | - Corinne Collet
- Service de Biochimie et de Génétique Moléculaire, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, France and INSERM UMR-U1132, UFR Sciences pharmaceutiques et biologiques - Faculté de pharmacie, Université de Paris, France
| | - Severine Trabado
- Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Hôpitaux Universitaires Paris Saclay, Assistance Publique-Hôpitaux de Paris, CHU Bicêtre, F-94275,France
- INSERM UMR-U1185, Fac Med Paris Saclay, Université Paris Saclay, Le Kremlin-Bicêtre, F-94276, France
- University Paris Saclay, F-91405 Orsay cedex, France
| | - Luigi Maione
- Department of Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, F-94275, Le Kremlin-Bicêtre, France
- INSERM UMR-U1185, Fac Med Paris Saclay, Université Paris Saclay, Le Kremlin-Bicêtre, F-94276, France
- University Paris Saclay, F-91405 Orsay cedex, France
| | - Nelly Pitteloud
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, CH-1011, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, CH-1011, Lausanne, Switzerland
| | - Jerome Bouligand
- Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Hôpitaux Universitaires Paris Saclay, Assistance Publique-Hôpitaux de Paris, CHU Bicêtre, F-94275,France
- INSERM UMR-U1185, Fac Med Paris Saclay, Université Paris Saclay, Le Kremlin-Bicêtre, F-94276, France
- University Paris Saclay, F-91405 Orsay cedex, France
| | - Marie Christine De Vernejoul
- Department of Rheumatology, Université de Paris and INSERM UMR-U1132 (Biology of bone and cartilage research unit), Hôpital Lariboisière, F-75010 Paris, France
| | - Martine Cohen-Solal
- Department of Rheumatology, Université de Paris and INSERM UMR-U1132 (Biology of bone and cartilage research unit), Hôpital Lariboisière, F-75010 Paris, France
| | - Jacques Young
- Department of Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, F-94275, Le Kremlin-Bicêtre, France
- INSERM UMR-U1185, Fac Med Paris Saclay, Université Paris Saclay, Le Kremlin-Bicêtre, F-94276, France
- University Paris Saclay, F-91405 Orsay cedex, France
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9
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Papadakis GE, Dumont A, Bouligand J, Chasseloup F, Raggi A, Catteau-Jonard S, Boute-Benejean O, Pitteloud N, Young J, Dewailly D. Non-classic cytochrome P450 oxidoreductase deficiency strongly linked with menstrual cycle disorders and female infertility as primary manifestations. Hum Reprod 2021; 35:939-949. [PMID: 32242900 DOI: 10.1093/humrep/deaa020] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/14/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Can cytochrome P450 oxidoreductase deficiency (PORD) be revealed in adult women with menstrual disorders and/or infertility? SUMMARY ANSWER PORD was biologically and genetically confirmed in five adult women with chronically elevated serum progesterone (P) who were referred for oligo-/amenorrhea and/or infertility. WHAT IS KNOWN ALREADY PORD is an autosomal recessive disease typically diagnosed in neonates and children with ambiguous genitalia and/or skeletal abnormalities. It is responsible for the decreased activity of several P450 enzymes, including CYP21A2, CYP17A1 and CYP19A1, that are involved in adrenal and/or gonadal steroidogenesis. Little is known about the optimal way to investigate and treat patients with adult-onset PORD. STUDY DESIGN, SIZE, DURATION In this series, we report five adult females who were evaluated in three tertiary endocrine reproductive departments between March 2015 and September 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS Five women aged 19-38 years were referred for unexplained oligo-/amenorrhea and/or infertility. Genetic testing excluded 21-hydroxylase deficiency (21OH-D), initially suspected due to the increased 17-hydroxyprogesterone (17-OHP) levels. Extensive phenotyping, steroid profiling by mass spectrometry, pelvic imaging and next-generation sequencing of 84 genes involved in gonadal and adrenal disorders were performed in all patients. IVF followed by frozen embryo transfer (ET) under glucocorticoid suppression therapy was performed for two patients. MAIN RESULTS AND THE ROLE OF CHANCE All patients had oligomenorrhea or amenorrhea. None had hyperandrogenism. Low-normal serum estradiol (E2) and testosterone levels contrasted with chronically increased serum P and 17-OHP levels, which further increased after adrenocorticotrophic hormone (ACTH) administration. Despite excessive P, 17OH-P and 21-deoxycortisol rise after ACTH stimulation suggesting non-classic 21OH-D, CYP21A2 sequencing did not support this hypothesis. Basal serum cortisol levels were low to normal, with inadequate response to ACTH in some women, suggesting partial adrenal insufficiency. All patients harbored rare biallelic POR mutations classified as pathogenic or likely pathogenic according to the American College of Medical Genetics and Genomics standards. Pelvic imaging revealed bilateral ovarian macrocysts in all women. IVF was performed for two women after retrieval of a normal oocyte number despite very low E2 levels during ovarian stimulation. Frozen ET under glucocorticoid suppression therapy led to successful pregnancies. LIMITATIONS, REASONS FOR CAUTION The number of patients described here is limited and these data need to be confirmed on a larger number of women with non-classic PORD. WIDER IMPLICATIONS OF THE FINDINGS The diagnosis of PORD must be considered in infertile women with chronically elevated P and 17OH-P levels and ovarian macrocysts. Differentiation of this entity from non-classic 21OH-D is important, as the multiple enzyme deficiency requires a specific management. Successful fertility induction is possible by IVF, providing that P levels be sufficiently suppressed by glucocorticoid therapy prior to implantation. STUDY FUNDING/COMPETING INTEREST(S) No specific funding was used for this study. There are no potential conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Georgios E Papadakis
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, CH-1011 Lausanne, Switzerland.,Department of Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, F-94275 Le Kremlin-Bicêtre, France
| | - Agathe Dumont
- Department of Reproductive Medicine, Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, F-59000 Lille, France
| | - Jerome Bouligand
- Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Kremlin-Bicêtre F-94275 France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche-U1185, Fac Med Paris Saclay, Université Paris-Saclay, F-94276 Le Kremlin-Bicêtre, France
| | - Fanny Chasseloup
- Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Kremlin-Bicêtre F-94275 France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche-U1185, Fac Med Paris Saclay, Université Paris-Saclay, F-94276 Le Kremlin-Bicêtre, France
| | | | - Sophie Catteau-Jonard
- Department of Reproductive Medicine, Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, F-59000 Lille, France.,University of Lille, Laboratory of Development and Plasticity of the Neuroendocrine Brain, INSERM U1172, Lille, France
| | - Odile Boute-Benejean
- Department of Clinical Genetics, Université de Lille, CHU Lille, F-59000 Lille, France
| | - Nelly Pitteloud
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, CH-1011 Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Jacques Young
- Department of Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, F-94275 Le Kremlin-Bicêtre, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche-U1185, Fac Med Paris Saclay, Université Paris-Saclay, F-94276 Le Kremlin-Bicêtre, France.,Université Paris-Saclay, F-91405 Orsay Cedex, France
| | - Didier Dewailly
- Department of Reproductive Medicine, Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, F-59000 Lille, France.,University of Lille, Laboratory of Development and Plasticity of the Neuroendocrine Brain, INSERM U1172, Lille, France
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10
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Papadakis GE, Dumont A, Bouligand J, Chasseloup F, Raggi A, Catteau-Jonard S, Boute-Benejean O, Pitteloud N, Young J, Dewailly DR. SAT-010 Non-Classic POR Deficiency as a Cause of Menstrual Disorders & Infertility. J Endocr Soc 2020. [PMCID: PMC7209003 DOI: 10.1210/jendso/bvaa046.898] [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: 11/19/2022] Open
Abstract
Abstract
P450 oxidoreductase deficiency (PORD) is an autosomal recessive disease caused by bi-allelic mutations of the POR gene. It is responsible for decreased activity of several P450 enzymes including CYP21A2, CYP17A1 and CYP19A1 that are involved in adrenal and/or gonadal steroidogenesis. PORD is typically diagnosed in neonates and children with ambiguous genitalia and/or skeletal abnormalities. Adult-onset PORD has been very seldom reported and little is known about the optimal way to investigate and treat such patients. In this series, we report five women aged 19-38 years, who were referred for unexplained oligo-/amenorrhea and/or infertility. Genetic testing excluded 21-hydroxylase deficiency (21OH-D), initially suspected due to increased 17-hydroxyprogesterone (17-OHP) levels. Extensive phenotyping, steroid profile by mass spectrometry, pelvic imaging and next-generation sequencing of 84 genes involved in gonadal and adrenal disorders were performed in all patients. In Vitro Fertilization (IVF) followed by frozen embryo transfer under glucocorticoid suppression therapy was performed in two patients. All patients had oligomenorrhea or amenorrhea. None had hyperandrogenism. Low-normal serum estradiol (E2) and testosterone levels contrasted with chronically increased serum progesterone (P) and 17-OHP levels, which further increased after ACTH administration. Despite excessive P, 17OH-P and 21-deoxycortisol rises after ACTH stimulation suggesting non-classic 21-hydroxylase deficiency, CYP21A2 sequencing did not support this hypothesis. Basal serum cortisol levels were low to normal, with inadequate response to ACTH in some women, suggesting partial adrenal insufficiency. Pelvic imaging revealed bilateral ovarian macrocysts in all women. All patients were found to harbor rare bi-allelic POR mutations classified as pathogenic according to American College of Medical Genetics standards. IVF was performed in two women after retrieval of a normal oocyte number despite very low E2 levels during controlled ovarian hyperstimulation. Frozen embryo transfer under glucorticoid suppression therapy led to successful pregnancies. These observations suggest that diagnosis of PORD must be considered in infertile women with chronically elevated P and 17OH-P levels and ovarian macrocysts. Differentiation of this entity from non-classic 21-hydroxylase deficiency is important, as the multiple enzyme deficiency requires a specific management. Successful fertility induction is possible by IVF, providing that P levels be sufficiently suppressed by glucocorticoid therapy prior to implantation.
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Affiliation(s)
- Georgios E Papadakis
- Service of Endocrinology, Diabetes and Metabolism, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Agathe Dumont
- Department of Reproductive Medicine, Univ. Lille, CHU Lille, Lille, France
| | - Jerome Bouligand
- Service of Molecular Genetics, Pharmacogenetics and Hormonology, Assistance Publique-Hôpitaux de Paris, Bicetre Hospital, Le Kremlin-Bicêtre, France
| | - Fanny Chasseloup
- Service of Molecular Genetics, Pharmacogenetics and Hormonology, Assistance Publique-Hôpitaux de Paris, Bicetre Hospital, Le Kremlin-Bicêtre, France
| | - Anna Raggi
- Fertisuisse, Olten and Basel, Switzerland
| | | | | | - Nelly Pitteloud
- Service of Endocrinology, Diabetes and Metabolism, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Jacques Young
- Department of Reproductive Medicine, Assistance Publique-Hôpitaux de Paris, Bicetre Hospital, Le Kremlin Bicetre, France
| | - Didier R Dewailly
- Department of Reproductive Medicine, Univ. Lille, CHU Lille, Lille, France
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11
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Malone SA, Papadakis GE, Messina A, Mimouni NEH, Trova S, Imbernon M, Allet C, Cimino I, Acierno J, Cassatella D, Xu C, Quinton R, Szinnai G, Pigny P, Alonso-Cotchico L, Masgrau L, Maréchal JD, Prevot V, Pitteloud N, Giacobini P. Defective AMH signaling disrupts GnRH neuron development and function and contributes to hypogonadotropic hypogonadism. eLife 2019; 8:47198. [PMID: 31291191 PMCID: PMC6620045 DOI: 10.7554/elife.47198] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/28/2019] [Indexed: 12/27/2022] Open
Abstract
Congenital hypogonadotropic hypogonadism (CHH) is a condition characterized by absent puberty and infertility due to gonadotropin releasing hormone (GnRH) deficiency, which is often associated with anosmia (Kallmann syndrome, KS). We identified loss-of-function heterozygous mutations in anti-Müllerian hormone (AMH) and its receptor, AMHR2, in 3% of CHH probands using whole-exome sequencing. We showed that during embryonic development, AMH is expressed in migratory GnRH neurons in both mouse and human fetuses and unconvered a novel function of AMH as a pro-motility factor for GnRH neurons. Pathohistological analysis of Amhr2-deficient mice showed abnormal development of the peripheral olfactory system and defective embryonic migration of the neuroendocrine GnRH cells to the basal forebrain, which results in reduced fertility in adults. Our findings highlight a novel role for AMH in the development and function of GnRH neurons and indicate that AMH signaling insufficiency contributes to the pathogenesis of CHH in humans.
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Affiliation(s)
- Samuel Andrew Malone
- Jean-Pierre Aubert Research Center (JPArc), Laboratory of Development and Plasticity of the Neuroendocrine Brain, Inserm, UMR-S 1172, Lille, France.,University of Lille, FHU 1, 000 Days for Health, Lille, France
| | - Georgios E Papadakis
- Faculty of Biology and Medicine, Service of Endocrinology, Diabetology and Metabolism, University Hospital, Lausanne, Switzerland
| | - Andrea Messina
- Faculty of Biology and Medicine, Service of Endocrinology, Diabetology and Metabolism, University Hospital, Lausanne, Switzerland
| | - Nour El Houda Mimouni
- Jean-Pierre Aubert Research Center (JPArc), Laboratory of Development and Plasticity of the Neuroendocrine Brain, Inserm, UMR-S 1172, Lille, France.,University of Lille, FHU 1, 000 Days for Health, Lille, France
| | - Sara Trova
- Jean-Pierre Aubert Research Center (JPArc), Laboratory of Development and Plasticity of the Neuroendocrine Brain, Inserm, UMR-S 1172, Lille, France.,University of Lille, FHU 1, 000 Days for Health, Lille, France
| | - Monica Imbernon
- Jean-Pierre Aubert Research Center (JPArc), Laboratory of Development and Plasticity of the Neuroendocrine Brain, Inserm, UMR-S 1172, Lille, France.,University of Lille, FHU 1, 000 Days for Health, Lille, France
| | - Cecile Allet
- Jean-Pierre Aubert Research Center (JPArc), Laboratory of Development and Plasticity of the Neuroendocrine Brain, Inserm, UMR-S 1172, Lille, France.,University of Lille, FHU 1, 000 Days for Health, Lille, France
| | - Irene Cimino
- Jean-Pierre Aubert Research Center (JPArc), Laboratory of Development and Plasticity of the Neuroendocrine Brain, Inserm, UMR-S 1172, Lille, France
| | - James Acierno
- Faculty of Biology and Medicine, Service of Endocrinology, Diabetology and Metabolism, University Hospital, Lausanne, Switzerland
| | - Daniele Cassatella
- Faculty of Biology and Medicine, Service of Endocrinology, Diabetology and Metabolism, University Hospital, Lausanne, Switzerland
| | - Cheng Xu
- Faculty of Biology and Medicine, Service of Endocrinology, Diabetology and Metabolism, University Hospital, Lausanne, Switzerland
| | - Richard Quinton
- Institute of Genetic Medicine, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne, United Kingdom
| | - Gabor Szinnai
- Pediatric Endocrinology and Diabetology, University of Basel Children's Hospital, Basel, Switzerland
| | - Pascal Pigny
- CHU Lille, Laboratoire de Biochimie et Hormonologie, Centre de Biologie Pathologie, Lille, France
| | - Lur Alonso-Cotchico
- Departament de Química, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Laura Masgrau
- Departament de Química, Universitat Autònoma de Barcelona, Bellaterra, Spain.,Institut de Biotecnologia i de Biomedicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | | | - Vincent Prevot
- Jean-Pierre Aubert Research Center (JPArc), Laboratory of Development and Plasticity of the Neuroendocrine Brain, Inserm, UMR-S 1172, Lille, France.,University of Lille, FHU 1, 000 Days for Health, Lille, France
| | - Nelly Pitteloud
- Faculty of Biology and Medicine, Service of Endocrinology, Diabetology and Metabolism, University Hospital, Lausanne, Switzerland
| | - Paolo Giacobini
- Jean-Pierre Aubert Research Center (JPArc), Laboratory of Development and Plasticity of the Neuroendocrine Brain, Inserm, UMR-S 1172, Lille, France.,University of Lille, FHU 1, 000 Days for Health, Lille, France
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12
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Young J, Xu C, Papadakis GE, Acierno JS, Maione L, Hietamäki J, Raivio T, Pitteloud N. Clinical Management of Congenital Hypogonadotropic Hypogonadism. Endocr Rev 2019; 40:669-710. [PMID: 30698671 DOI: 10.1210/er.2018-00116] [Citation(s) in RCA: 182] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 10/05/2018] [Indexed: 12/12/2022]
Abstract
The initiation and maintenance of reproductive capacity in humans is dependent on pulsatile secretion of the hypothalamic hormone GnRH. Congenital hypogonadotropic hypogonadism (CHH) is a rare disorder that results from the failure of the normal episodic GnRH secretion, leading to delayed puberty and infertility. CHH can be associated with an absent sense of smell, also termed Kallmann syndrome, or with other anomalies. CHH is characterized by rich genetic heterogeneity, with mutations in >30 genes identified to date acting either alone or in combination. CHH can be challenging to diagnose, particularly in early adolescence where the clinical picture mirrors that of constitutional delay of growth and puberty. Timely diagnosis and treatment will induce puberty, leading to improved sexual, bone, metabolic, and psychological health. In most cases, patients require lifelong treatment, yet a notable portion of male patients (∼10% to 20%) exhibit a spontaneous recovery of their reproductive function. Finally, fertility can be induced with pulsatile GnRH treatment or gonadotropin regimens in most patients. In summary, this review is a comprehensive synthesis of the current literature available regarding the diagnosis, patient management, and genetic foundations of CHH relative to normal reproductive development.
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Affiliation(s)
- Jacques Young
- University of Paris-Sud, Paris-Sud Medical School, Le Kremlin-Bicêtre, France.,Department of Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Bicêtre Hôpital, Le Kremlin-Bicêtre, France.,INSERM Unité 1185, Le Kremlin-Bicêtre, France
| | - Cheng Xu
- Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Georgios E Papadakis
- Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - James S Acierno
- Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Luigi Maione
- University of Paris-Sud, Paris-Sud Medical School, Le Kremlin-Bicêtre, France.,Department of Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Bicêtre Hôpital, Le Kremlin-Bicêtre, France.,INSERM Unité 1185, Le Kremlin-Bicêtre, France
| | - Johanna Hietamäki
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Translational Stem Cell Biology and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Taneli Raivio
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Translational Stem Cell Biology and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Nelly Pitteloud
- Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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13
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Papadakis GE, Lamy O. Response to Letter to the Editor: "Menopausal Hormone Therapy Is Associated With Reduced and Total Visceral Adiposity: The OsteoLaus Cohort". J Clin Endocrinol Metab 2018; 103:4035-4036. [PMID: 30137398 DOI: 10.1210/jc.2018-01681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/15/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Georgios E Papadakis
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Lamy
- Center of Bone Diseases, Centre Hospitalier Universitaire Vaudois, Lausanne University Hospital, Lausanne, Switzerland
- Service of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne University Hospital, Lausanne, Switzerland
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14
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Papadakis GE, Hans D, Gonzalez Rodriguez E, Vollenweider P, Waeber G, Marques-Vidal P, Lamy O. Menopausal Hormone Therapy Is Associated With Reduced Total and Visceral Adiposity: The OsteoLaus Cohort. J Clin Endocrinol Metab 2018; 103:1948-1957. [PMID: 29596606 DOI: 10.1210/jc.2017-02449] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [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: 11/11/2017] [Accepted: 02/16/2018] [Indexed: 01/25/2023]
Abstract
CONTEXT After menopause, fat mass (FM) and visceral adipose tissue (VAT) increase and nonbone lean body mass (LBM) decreases. Whether menopausal hormone therapy (MHT) reverses these changes remains controversial. OBJECTIVE To assess the effect of MHT on FM, VAT, and LBM before and after its withdrawal and evaluate potential confounders. DESIGN Cross-sectional study. SETTING General community. PATIENTS OR OTHER PARTICIPANTS Women of the OsteoLaus cohort (50 to 80 years old) who underwent dual-energy X-ray absorptiometry (DXA) with body composition assessment. After we excluded women with estrogen-modifying medications, the 1053 participants were categorized into current users (CUs), past users (PUs), and never users (NUs) of MHT. INTERVENTION None. MAIN OUTCOME MEASURES VAT measured by DXA was the primary outcome. We assessed subtotal and android FM, LBM, muscle strength (hand grip), and confounding factors (caloric intake, physical activity, biomarkers). RESULTS The groups significantly differed in age, NU < CU < PU. Age-adjusted VAT was lower in CUs than NUs (P = 0.03). CUs exhibited lower age-adjusted body mass index (BMI) (-0.9 kg/m2) and a trend for lower FM (-1.3 kg). The 10-year gain of VAT (P < 0.01) and subtotal and android FM (P < 0.05) was prevented in CUs. No difference in LBM or hand grip was detected. No residual effect was detected for PUs, including for early MHT discontinuers. The confounding factors did not significantly differ between groups except for higher caloric intake in PUs compared with NUs. CONCLUSIONS MHT is associated with significantly decreased VAT, BMI, and android FM. No benefit is detected for LBM. The benefits are not preserved in PUs, suggesting caution when MHT is discontinued.
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Affiliation(s)
- Georgios E Papadakis
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Didier Hans
- Center of Bone Diseases, Centre Hospitalier Universitaire Vaudois, Lausanne University Hospital, Lausanne, Switzerland
| | - Elena Gonzalez Rodriguez
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
- Center of Bone Diseases, Centre Hospitalier Universitaire Vaudois, Lausanne University Hospital, Lausanne, Switzerland
| | - Peter Vollenweider
- Service of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne University Hospital, Lausanne, Switzerland
| | - Gerard Waeber
- Service of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne University Hospital, Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Service of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Lamy
- Center of Bone Diseases, Centre Hospitalier Universitaire Vaudois, Lausanne University Hospital, Lausanne, Switzerland
- Service of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne University Hospital, Lausanne, Switzerland
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15
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Bongiovanni M, Papadakis GE, Rouiller N, Marino L, Lamine F, Bisig B, Ziadi S, Sykiotis GP. The Bethesda System for Reporting Thyroid Cytopathology Explained for Practitioners: Frequently Asked Questions. Thyroid 2018; 28:556-565. [PMID: 29591914 DOI: 10.1089/thy.2017.0685] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Indexed: 12/30/2022]
Abstract
BACKGROUND The recent update of The Bethesda System for Reporting Thyroid Cytology (TBSRTC) is a very important development in the evaluation of thyroid nodules. Clinical experience and scientific literature both show that practitioners performing thyroid fine-needle aspiration are accustomed to basing the clinical management of patients on reports using TBSRTC. Specifically, clinicians are familiar with the percent risk of malignancy corresponding to each TBSRTC diagnostic category (DC), as well as with the respective recommendation for clinical management. However, most clinicians are much less familiar with the specific considerations that lie between a given DC, on the one end, and the respective risk of malignancy and associated management recommendation, on the other end. SUMMARY A deeper understanding of the system can enlighten the clinician's thinking about the specific nodule under examination and can guide the decision-making process in a more meaningful way. Such an understanding can only be developed via close two-way communication between cytopathologists and clinicians. Through this type of interaction in the authors' tertiary medical center, recurring issues of particular importance for clinical practice were identified, which are reported here in the form of 16 frequently asked questions posed by the clinician to the cytopathologist. CONCLUSIONS For each frequently asked question, an answer is provided based on the literature, the authors' experience, the new version of TBSRTC, and the new World Health Organization classification of tumors of endocrine organs.
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Affiliation(s)
- Massimo Bongiovanni
- 1 Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital , Lausanne, Switzerland
| | - Georgios E Papadakis
- 2 Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital , Lausanne, Switzerland
| | - Nathalie Rouiller
- 2 Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital , Lausanne, Switzerland
| | - Laura Marino
- 2 Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital , Lausanne, Switzerland
| | - Faiza Lamine
- 2 Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital , Lausanne, Switzerland
| | - Bettina Bisig
- 1 Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital , Lausanne, Switzerland
| | - Sonia Ziadi
- 1 Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital , Lausanne, Switzerland
| | - Gerasimos P Sykiotis
- 2 Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital , Lausanne, Switzerland
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16
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Cassatella D, Howard SR, Acierno JS, Xu C, Papadakis GE, Santoni FA, Dwyer AA, Santini S, Sykiotis GP, Chambion C, Meylan J, Marino L, Favre L, Li J, Liu X, Zhang J, Bouloux PM, Geyter CD, Paepe AD, Dhillo WS, Ferrara JM, Hauschild M, Lang-Muritano M, Lemke JR, Flück C, Nemeth A, Phan-Hug F, Pignatelli D, Popovic V, Pekic S, Quinton R, Szinnai G, l'Allemand D, Konrad D, Sharif S, Iyidir ÖT, Stevenson BJ, Yang H, Dunkel L, Pitteloud N. Congenital hypogonadotropic hypogonadism and constitutional delay of growth and puberty have distinct genetic architectures. Eur J Endocrinol 2018; 178:377-388. [PMID: 29419413 PMCID: PMC5863472 DOI: 10.1530/eje-17-0568] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 02/01/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Congenital hypogonadotropic hypogonadism (CHH) and constitutional delay of growth and puberty (CDGP) represent rare and common forms of GnRH deficiency, respectively. Both CDGP and CHH present with delayed puberty, and the distinction between these two entities during early adolescence is challenging. More than 30 genes have been implicated in CHH, while the genetic basis of CDGP is poorly understood. DESIGN We characterized and compared the genetic architectures of CHH and CDGP, to test the hypothesis of a shared genetic basis between these disorders. METHODS Exome sequencing data were used to identify rare variants in known genes in CHH (n = 116), CDGP (n = 72) and control cohorts (n = 36 874 ExAC and n = 405 CoLaus). RESULTS Mutations in at least one CHH gene were found in 51% of CHH probands, which is significantly higher than in CDGP (7%, P = 7.6 × 10-11) or controls (18%, P = 5.5 × 10-12). Similarly, oligogenicity (defined as mutations in more than one gene) was common in CHH patients (15%) relative to CDGP (1.4%, P = 0.002) and controls (2%, P = 6.4 × 10-7). CONCLUSIONS Our data suggest that CDGP and CHH have distinct genetic profiles, and this finding may facilitate the differential diagnosis in patients presenting with delayed puberty.
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Affiliation(s)
- Daniele Cassatella
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and MedicineUniversity of Lausanne, Lausanne, Switzerland
| | - Sasha R Howard
- Centre for EndocrinologyWilliam Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - James S Acierno
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and MedicineUniversity of Lausanne, Lausanne, Switzerland
| | - Cheng Xu
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and MedicineUniversity of Lausanne, Lausanne, Switzerland
| | - Georgios E Papadakis
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Federico A Santoni
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Andrew A Dwyer
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and MedicineUniversity of Lausanne, Lausanne, Switzerland
| | - Sara Santini
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Gerasimos P Sykiotis
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Caroline Chambion
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Jenny Meylan
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Laura Marino
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Lucie Favre
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Jiankang Li
- BGI-ShenzhenShenzhen, China
- Shenzhen Key Laboratory of NeurogenomicsBGI-Shenzhen, Shenzhen, China
| | | | - Jianguo Zhang
- BGI-ShenzhenShenzhen, China
- Shenzhen Key Laboratory of NeurogenomicsBGI-Shenzhen, Shenzhen, China
| | - Pierre-Marc Bouloux
- Centre for Neuroendocrinology (Royal Free Campus)University College London, London, UK
| | - Christian De Geyter
- University Hospital BaselClinic of Gynecological Endocrinology and Reproductive Medicine, Basel, Switzerland
| | - Anne De Paepe
- Center for Medical GeneticsGhent University Hospital, Ghent, Belgium
| | - Waljit S Dhillo
- Section of Investigative MedicineImperial College London, Hammersmith Hospital, London, UK
| | | | - Michael Hauschild
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Mariarosaria Lang-Muritano
- Division of Pediatric Endocrinology and Diabetology and Children's Research CentreUniversity Children's Hospital, Zurich, Switzerland
| | - Johannes R Lemke
- Institute of Human GeneticsUniversity of Leipzig Hospitals and Clinics, Leipzig, Germany
| | - Christa Flück
- Pediatric Endocrinology and DiabetologyDepartment of Clinical Research, University Children's Hospital Bern, Bern, Switzerland
| | | | - Franziska Phan-Hug
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Duarte Pignatelli
- Serviço de EndocrinologiaDiabetes e Metabolismo, Hospital de São João e Faculdade de Medicina do Porto, Porto, Portugal
| | - Vera Popovic
- School of MedicineUniversity of Belgrade, Belgrade, Serbia
| | - Sandra Pekic
- School of MedicineUniversity of Belgrade, Belgrade, Serbia
- Clinic for EndocrinologyDiabetes and Diseases of Metabolism, University Clinical Center, Belgrade, Serbia
| | - Richard Quinton
- Department of EndocrinologyInstitute for Human Genetics, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne, UK
| | - Gabor Szinnai
- University of Basel Chidren's HospitalBasel, Switzerland
| | - Dagmar l'Allemand
- Department of EndocrinologyChildren's Hospital of Eastern Switzerland, St Gallen, Switzerland
| | - Daniel Konrad
- Division of Pediatric Endocrinology and Diabetology and Children's Research CentreUniversity Children's Hospital, Zurich, Switzerland
| | - Saba Sharif
- Clinical Genetics UnitBirmingham Women's Hospital, Birmingham, UK
| | - Özlem Turhan Iyidir
- Department of Endocrinology and MetabolismGazi University Faculty of Medicine, Ankara, Turkey
| | | | - Huanming Yang
- BGI-ShenzhenShenzhen, China
- James D. Watson Institute of Genome SciencesHangzhou, China
| | - Leo Dunkel
- Centre for EndocrinologyWilliam Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Nelly Pitteloud
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and MedicineUniversity of Lausanne, Lausanne, Switzerland
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17
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Papadakis GE, Tabotta F, Levotanec I, Gonzalez M, Prior JO, La Rosa S, Sykiotis GP. Uptake of 99mTc-MIBI by Sclerosing Pneumocytoma Raising a False Suspicion of Metastasis From Medullary Thyroid Carcinoma. J Endocr Soc 2018; 2:386-390. [PMID: 29644341 PMCID: PMC5890471 DOI: 10.1210/js.2018-00014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/19/2018] [Indexed: 11/22/2022] Open
Abstract
Technetium-99m methoxy isobutyl isonitrile (99mTc-MIBI; sestamibi) single-photon emission computed tomography (SPECT)/computed tomography (CT) performed for preoperative localization of parathyroid adenomas or for other indications can reveal incidentalomas. Interpretation of such findings can be challenging, particularly when thyroid or other endocrine tumors are also present. Preoperative staging of a 59-year-old female patient with medullary thyroid carcinoma (MTC) showing moderate hypermetabolism on 18F-fluorodeoxyglucose positron emission tomography/CT also detected a slightly hypermetabolic pulmonary nodule (standardized uptake value normalized by body weight max = 2.0 g/mL). A sestamibi SPECT/CT performed because of concomitant primary hyperparathyroidism showed increased uptake by both the MTC and the pulmonary nodule, raising suspicion of MTC metastasis. Lung wedge resection biopsy revealed a sclerosing pneumocytoma (SPC), a rare benign pulmonary tumor not previously known to retain sestamibi. In contrast to classical knowledge that sestamibi uptake by tumors is associated with its retention by mitochondria, immunohistochemical analyses showed that the mitochondrial content of the patient’s SPC was low. This case illustrates the behavior of SPC in sestamibi scintigraphy and indicates that SPC is a potential cancer mimicker in this setting.
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Affiliation(s)
- Georgios E Papadakis
- Service of Endocrinology, Diabetology and Metabolism, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Flavian Tabotta
- Service of Nuclear Medicine and Molecular Imaging, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Igor Levotanec
- Service of Clinical Pathology, Institute of Pathology, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - John O Prior
- Service of Nuclear Medicine and Molecular Imaging, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Stefano La Rosa
- Service of Clinical Pathology, Institute of Pathology, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Gerasimos P Sykiotis
- Service of Endocrinology, Diabetology and Metabolism, CHUV, Lausanne University Hospital, Lausanne, Switzerland
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18
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Papadakis GE, Lamine F, Chtioui H, Moschouri E, Christinet MF, Marino L, Favre L, Sciarra A, Sempoux C, Schneider A, Duss FR, Sartori C, Moradpour D, Sykiotis GP. Rapid Remission of Graves' Hyperthyroidism Without Thionamides Under Immunosuppressive Treatment for Concomitant Autoimmune Hepatitis. Thyroid 2018; 28:276-278. [PMID: 29336235 DOI: 10.1089/thy.2017.0613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Georgios E Papadakis
- 1 Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital , Lausanne, Switzerland
| | - Faiza Lamine
- 1 Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital , Lausanne, Switzerland
| | - Haithem Chtioui
- 2 Division of Clinical Pharmacology, Lausanne University Hospital , Lausanne, Switzerland
| | - Eleni Moschouri
- 3 Service of Gastroenterology and Hepatology, Lausanne University Hospital , Lausanne, Switzerland
| | | | - Laura Marino
- 1 Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital , Lausanne, Switzerland
| | - Lucie Favre
- 1 Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital , Lausanne, Switzerland
| | - Amedeo Sciarra
- 4 Institute of Pathology, Lausanne University Hospital , Lausanne, Switzerland
| | - Christine Sempoux
- 4 Institute of Pathology, Lausanne University Hospital , Lausanne, Switzerland
| | - Alexandra Schneider
- 5 Service of Internal Medicine, Lausanne University Hospital , Lausanne, Switzerland
| | - Francois-Regis Duss
- 5 Service of Internal Medicine, Lausanne University Hospital , Lausanne, Switzerland
| | - Claudio Sartori
- 5 Service of Internal Medicine, Lausanne University Hospital , Lausanne, Switzerland
| | - Darius Moradpour
- 3 Service of Gastroenterology and Hepatology, Lausanne University Hospital , Lausanne, Switzerland
| | - Gerasimos P Sykiotis
- 1 Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital , Lausanne, Switzerland
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