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Dormoy A, Haissaguerre M, Vitellius G, Do Cao C, Geslot A, Drui D, Lasolle H, Vieira-Pinto O, Salenave S, François M, Puerto M, Du Boullay H, Mayer A, Rod A, Laurent C, Chanson P, Reznik Y, Castinetti F, Chabre O, Baudin E, Raverot G, Tabarin A, Young J. Efficacy and safety of osilodrostat in paraneoplastic Cushing's syndrome: a real-world multicenter study in France. J Clin Endocrinol Metab 2022; 108:1475-1487. [PMID: 36470583 DOI: 10.1210/clinem/dgac691] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/16/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
CONTEXT Prospective studies have demonstrated the efficacy of osilodrostat in Cushing's disease. No study has evaluated osilodrostat in a series of patients with paraneoplastic Cushing's syndrome/ectopic ACTH syndrome (PNCS/EAS). OBJECTIVE Evaluate in France the real-world efficacy and safety of osilodrostat in PNCS/EAS. PATIENTS 33 patients with PNCS/EAS with intense/severe hypercortisolism. METHODS Retrospective multicenter real-world study. Patients received osilodrostat between May 2019 and March 2022. Median initial dose (range) 4 mg/day (1-60); maximum dose, 20 mg/day (4-100), first, under patient- then cohort- temporary authorizations and after marketing authorization. Regimens used: titration (n = 6), block and replace (n = 16), or titration followed by block and replace (n = 11). RESULTS In 11 patients receiving osilodrostat as first-line monotherapy, median 24h- urinary free cortisol (24h-UFC) decreased dramatically (from 26xULN [2.9-659] to 0.11xULN [0.08-14.9]; p < 0.001). In 9 of them, 24h-UFC normalization was achieved in 2 weeks (median). Thirteen additional patients were previously treated with classic steroidogenesis inhibitors but 10/13 were not controlled. In these patients, osilodrostat monotherapy, used in second line, induced a significantly decreased of 24h-UFC (from 2.6xULN [1.1-144] to 0.22xULN [0.12-0.66]; p < 0.01). Nine additional patients received osilodrostat in combination with another anticortisolic drug decreasing 24h-UFC from 11.8xULN (0.3-247) to 0.43xULN (0.33-2.4) (p < 0.01).In parallel, major clinical symptoms/comorbidities improved dramatically with improvement in blood pressure, hyperglycemia and hypokalemia, allowing the discontinuation or dose reduction of their treatments. Adrenal insufficiency (grade 3-4) was reported in 8/33 patients. CONCLUSIONS Osilodrostat is a rapidly efficient therapy for PNCS/EAS with severe/intense hypercortisolism. Osilodrostat was generally well tolerated; Adrenal insufficiency was the main side effect.
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Affiliation(s)
- Alexandre Dormoy
- Paris-Saclay University; Assistance Publique-Hôpitaux de Paris, Department of Endocrinology, Reference Centre for Rare Pituitary Diseases HYPO, Bicêtre Hospital, Le Kremlin-Bicêtre, F-94275, France
| | - Magalie Haissaguerre
- Bordeaux University, Department of Endocrinology, Haut-Lévêque Hospital, F-33600, Pessac, France
| | - Géraldine Vitellius
- Department of Endocrinology, Robert Debré University Hospital, F- 51100, Reims, France
| | - Christine Do Cao
- Department of Endocrinology, Centre Hospitalier Régional Universitaire de Lille, F- 59037, Lille, France
| | - Aurore Geslot
- Department of Endocrinology and metabolic diseases, Larrey University Hospital, F- 31059, Toulouse, France
| | - Delphine Drui
- Department of Endocrinology, institut du Thorax, CHU de Nantes, and Nantes Université, Hôpital Nord, F-44000 Nantes, France
| | - Hélène Lasolle
- Endocrinology Department, Reference Centre for Rare Pituitary Diseases HYPO, "Groupement Hospitalier Est" Hospices Civils de Lyon, F-69500 Bron, France
| | - Oceana Vieira-Pinto
- Paris-Saclay University; Assistance Publique-Hôpitaux de Paris, Department of Endocrinology, Reference Centre for Rare Pituitary Diseases HYPO, Bicêtre Hospital, Le Kremlin-Bicêtre, F-94275, France
| | - Sylvie Salenave
- Paris-Saclay University; Assistance Publique-Hôpitaux de Paris, Department of Endocrinology, Reference Centre for Rare Pituitary Diseases HYPO, Bicêtre Hospital, Le Kremlin-Bicêtre, F-94275, France
| | - Maud François
- Department of Endocrinology, Robert Debré University Hospital, F- 51100, Reims, France
| | - Marie Puerto
- Bordeaux University, Department of Endocrinology, Haut-Lévêque Hospital, F-33600, Pessac, France
| | - Hélène Du Boullay
- Department of Endocrinology, Savoie CHMS Hospital, F-73000 Chambéry, France
| | - Anne Mayer
- Department of Endocrinology, Savoie CHMS Hospital, F-73000 Chambéry, France
| | - Anne Rod
- Department of Endocrinology, CH de Niort, F-79000, Niort, France
| | - Claire Laurent
- Department of Endocrinology, CH de Niort, F-79000, Niort, France
| | - Philippe Chanson
- Paris-Saclay University; Assistance Publique-Hôpitaux de Paris, Department of Endocrinology, Reference Centre for Rare Pituitary Diseases HYPO, Bicêtre Hospital, Le Kremlin-Bicêtre, F-94275, France
- Paris-Saclay Neuroendocrine tumors working group, F-94800 Villejuif, France
- INSERM UMR_S 1185, Paris-Saclay Medical School, Le Kremlin-Bicêtre, F-94275, France
| | - Yves Reznik
- Department of Endocrinology and Diabetology, CHU Côte de Nacre, F-14033 Caen cedex, France
| | - Frédéric Castinetti
- Department of Endocrinology, Assistance Publique-Hopitaux de Marseille, French Reference Center for Rare Pituitary Diseases, Endo-European Reference Network and EURACAN European Expert Center on Rare Pituitary Tumors, La Conception Hospital, Aix Marseille University, F-13385, Marseille, France
| | - Olivier Chabre
- Univ. Grenoble Alpes, UMR 1292 INSERM-CEA-UGA, Endocrinologie CHU Grenoble Alpes, F-38000 GrenobleFrance
| | - Eric Baudin
- Gustave Roussy Cancer Institute; Paris-Saclay University, Endocrine Oncology and Nuclear Medicine Department, F-94800 Villejuif, France
- Paris-Saclay Neuroendocrine tumors working group, F-94800 Villejuif, France
- INSERM UMR_S 1185, Paris-Saclay Medical School, Le Kremlin-Bicêtre, F-94275, France
| | - Gérald Raverot
- Endocrinology Department, Reference Centre for Rare Pituitary Diseases HYPO, "Groupement Hospitalier Est" Hospices Civils de Lyon, F-69500 Bron, France
| | - Antoine Tabarin
- Bordeaux University, Department of Endocrinology, Haut-Lévêque Hospital, F-33600, Pessac, France
| | - Jacques Young
- Paris-Saclay University; Assistance Publique-Hôpitaux de Paris, Department of Endocrinology, Reference Centre for Rare Pituitary Diseases HYPO, Bicêtre Hospital, Le Kremlin-Bicêtre, F-94275, France
- Paris-Saclay Neuroendocrine tumors working group, F-94800 Villejuif, France
- INSERM UMR_S 1185, Paris-Saclay Medical School, Le Kremlin-Bicêtre, F-94275, France
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Gourmelon R, Donadio-Andréi S, Chikh K, Rabilloud M, Kuczewski E, Gauchez AS, Charrié A, Brard PY, Andréani R, Bourre JC, Waterlot C, Guédel D, Mayer A, Disse E, Thivolet C, Boullay HD, Falandry C, Gilbert T, François-Joubert A, Vignoles A, Ronin C, Bonnefoy M. Subclinical Hypothyroidism: is it Really Subclinical with Aging? Aging Dis 2019; 10:520-529. [PMID: 31164997 PMCID: PMC6538219 DOI: 10.14336/ad.2018.0817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 06/06/2018] [Accepted: 08/17/2018] [Indexed: 01/16/2023] Open
Abstract
No recent study has focused on clinical features of subclinical hypothyroidism (SCH), especially in older patients. TSH measurement has remarkably evolved these last 20 years and thus reconsideration is needed. In our prospective multicenter study (2012-2014) including 807 subjects aged <60 years (<60y) and 531 subjects ≥60 years (≥60y), we have monitored 11 hypothyroidism-related clinical signs (hCS) together with TSH, FT4, FT3 and anti-thyroperoxidase antibodies values. hCS expression has been compared in patients with SCH vs euthyroidism in each age group. The number of hCS above 60y of age were found to be more elevated in the euthyroid population (1.9 vs 1.6, p<0.01) than in the SCH population (2.3 vs 2.6, p=0.41) while increase in hCS is limited to SCH subjects in the <60y group (p<0.01). The percentage of subjects with at least 3 signs increased with SCH in the <60y group (42.6% vs 25.0%, p<0.01) but not ≥60y (34.4% vs 33.9%, p=0.96). In older individuals, only three hCS could be related to both SCH and a decreased T3/T4-ratio (0.26 vs 0.27, p<0.01), suggesting either a reduced activity of TSH, or an adaptive response with aging. While hCS are clearly associated with SCH in patients <60y, they are not so informative in older subjects. TSH measurements carried out on the basis of hCS need to be interpreted with caution in aged patients. A reassessment of the TSH reference range in older patients is clearly needed and should be associated to more appropriate monitoring of thyroid dysfunction
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Affiliation(s)
- Robin Gourmelon
- 1Service de Gériatrie, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | | | - Karim Chikh
- 1Service de Gériatrie, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France.,3Hospices Civils de Lyon, 69002 Lyon, France.,4Laboratoire de Biochimie et Biologie Moléculaire, Centre de Biologie Sud, Centre Hospitalier Lyon Sud 69 495 Pierre Bénite Cedex, France.,5Société Française de Médecine Nucléaire, Groupe de Biologie Spécialisée, 75237 Paris Cedex 05, France
| | - Muriel Rabilloud
- 6Service de Biostatistiques, Hospices Civils de Lyon, Lyon, France
| | | | - Anne-Sophie Gauchez
- 5Société Française de Médecine Nucléaire, Groupe de Biologie Spécialisée, 75237 Paris Cedex 05, France.,7UMR-S INSERM 1039, 38000 Grenoble, France.,8Service de Médecine Nucléaire, Centre Hospitalier Métropole Savoie, 73000 Chambéry, France.,10Service d'Endocrinologie, Centre Hospitalier Métropole Savoie, 73000 Chambéry, France
| | - Anne Charrié
- 1Service de Gériatrie, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France.,3Hospices Civils de Lyon, 69002 Lyon, France.,4Laboratoire de Biochimie et Biologie Moléculaire, Centre de Biologie Sud, Centre Hospitalier Lyon Sud 69 495 Pierre Bénite Cedex, France.,5Société Française de Médecine Nucléaire, Groupe de Biologie Spécialisée, 75237 Paris Cedex 05, France
| | - Pierre-Yves Brard
- 10Service d'Endocrinologie, Centre Hospitalier Métropole Savoie, 73000 Chambéry, France
| | - Raphaëlle Andréani
- 10Service d'Endocrinologie, Centre Hospitalier Métropole Savoie, 73000 Chambéry, France
| | - Jean-Cyril Bourre
- 10Service d'Endocrinologie, Centre Hospitalier Métropole Savoie, 73000 Chambéry, France
| | - Christine Waterlot
- 8Service de Médecine Nucléaire, Centre Hospitalier Métropole Savoie, 73000 Chambéry, France
| | - Domitille Guédel
- 8Service de Médecine Nucléaire, Centre Hospitalier Métropole Savoie, 73000 Chambéry, France
| | - Anne Mayer
- 8Service de Médecine Nucléaire, Centre Hospitalier Métropole Savoie, 73000 Chambéry, France
| | - Emmanuel Disse
- 1Service de Gériatrie, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Charles Thivolet
- 1Service de Gériatrie, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Hélène Du Boullay
- 8Service de Médecine Nucléaire, Centre Hospitalier Métropole Savoie, 73000 Chambéry, France
| | - Claire Falandry
- 1Service de Gériatrie, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Thomas Gilbert
- 1Service de Gériatrie, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Anne François-Joubert
- 8Service de Médecine Nucléaire, Centre Hospitalier Métropole Savoie, 73000 Chambéry, France
| | - Antoine Vignoles
- 1Service de Gériatrie, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Catherine Ronin
- 2Siamed'Xpress, Hôtel Technologique Morandat, 13120 Gardanne, France
| | - Marc Bonnefoy
- 1Service de Gériatrie, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
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Thevenon J, Bourredjem A, Faivre L, Cardot-Bauters C, Calender A, Murat A, Giraud S, Niccoli P, Odou MF, Borson-Chazot F, Barlier A, Lombard-Bohas C, Clauser E, Tabarin A, Parfait B, Chabre O, Castermans E, Beckers A, Ruszniewski P, Le Bras M, Delemer B, Bouchard P, Guilhem I, Rohmer V, Goichot B, Caron P, Baudin E, Chanson P, Groussin L, Du Boullay H, Weryha G, Lecomte P, Penfornis A, Bihan H, Archambeaud F, Kerlan V, Duron F, Kuhn JM, Vergès B, Rodier M, Renard M, Sadoul JL, Binquet C, Goudet P. Higher risk of death among MEN1 patients with mutations in the JunD interacting domain: a Groupe d’étude des Tumeurs Endocrines (GTE) cohort study. Hum Mol Genet 2013; 22:1940-8. [DOI: 10.1093/hmg/ddt039] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Sarfati J, Guiochon-Mantel A, Rondard P, Arnulf I, Garcia-Piñero A, Wolczynski S, Brailly-Tabard S, Bidet M, Ramos-Arroyo M, Mathieu M, Lienhardt-Roussie A, Morgan G, Turki Z, Bremont C, Lespinasse J, Du Boullay H, Chabbert-Buffet N, Jacquemont S, Reach G, De Talence N, Tonella P, Conrad B, Despert F, Delobel B, Brue T, Bouvattier C, Cabrol S, Pugeat M, Murat A, Bouchard P, Hardelin JP, Dodé C, Young J. A comparative phenotypic study of kallmann syndrome patients carrying monoallelic and biallelic mutations in the prokineticin 2 or prokineticin receptor 2 genes. J Clin Endocrinol Metab 2010; 95:659-69. [PMID: 20022991 DOI: 10.1210/jc.2009-0843] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
CONTEXT Both biallelic and monoallelic mutations in PROK2 or PROKR2 have been found in Kallmann syndrome (KS). OBJECTIVE The objective of the study was to compare the phenotypes of KS patients harboring monoallelic and biallelic mutations in these genes. DESIGN AND PATIENTS We studied clinical and endocrine features that reflect the functioning of the pituitary-gonadal axis, and the nonreproductive phenotype, in 55 adult KS patients (42 men and 13 women), of whom 41 had monoallelic mutations and 14 biallelic mutations in PROK2 or PROKR2. RESULTS Biallelic mutations were associated with more frequent cryptorchidism (70% vs. 34%, P < 0.05) and microphallus (90% vs. 28%, P < 0.001) and lower mean testicular volume (1.2 +/- 0.4 vs. 4.5 +/- 6.0 ml; P < 0.01) in male patients. Likewise, the testosterone level as well as the basal FSH level and peak LH level under GnRH-stimulation were lower in males with biallelic mutations (0.2 +/- 0.1 vs. 0.7 +/- 0.8 ng/ml; P = 0.05, 0.3 +/- 0.1 vs. 1.8 +/- 3.0 IU/liter; P < 0.05, and 0.8 +/- 0.8 vs. 5.2 +/- 5.5 IU/liter; P < 0.05, respectively). Nonreproductive, nonolfactory anomalies were rare in both sexes and were never found in patients with biallelic mutations. The mean body mass index of the patients (23.9 +/- 4.2 kg/m(2) in males and 26.3 +/- 6.6 kg/m(2) in females) did not differ significantly from that of gender-, age-, and treatment-matched KS individuals who did not carry a mutation in PROK2 or PROKR2. Finally, circadian cortisol levels evaluated in five patients, including one with biallelic PROKR2 mutations, were normal in all cases. CONCLUSION Male patients carrying biallelic mutations in PROK2 or PROKR2 have a less variable and on average a more severe reproductive phenotype than patients carrying monoallelic mutations in these genes. Nonreproductive, nonolfactory clinical anomalies associated with KS seem to be restricted to patients with monoallelic mutations.
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Affiliation(s)
- Julie Sarfati
- Service d'Endocrinologie, Hôpital Bicêtre, 78 Rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
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Leroy C, Fouveaut C, Leclercq S, Jacquemont S, Boullay HD, Lespinasse J, Delpech M, Dupont JM, Hardelin JP, Dodé C. Biallelic mutations in the prokineticin-2 gene in two sporadic cases of Kallmann syndrome. Eur J Hum Genet 2008; 16:865-8. [DOI: 10.1038/ejhg.2008.15] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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