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Reincke M, Arlt W, Damdimopoulou P, Köhrle J, Bertherat J. Endocrine disrupting chemicals are a threat to hormone health: a commentary on behalf of the ESE. Nat Rev Endocrinol 2024; 20:187-188. [PMID: 38388677 DOI: 10.1038/s41574-024-00958-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/24/2024]
Affiliation(s)
- Martin Reincke
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, LMU München, München, Germany.
| | - Wiebke Arlt
- MRC Laboratory of Medical Sciences, London, UK
- Institute of Clinical Sciences, Imperial College London, London, UK
| | - Pauliina Damdimopoulou
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Huddinge, Stockholm, Sweden
- Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Josef Köhrle
- Institut für Experimentelle Endokrinologie, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jerome Bertherat
- Institut Cochin, Inserm U1016, CNRS UMR8104, Université Paris-Cité, Paris, France
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Bergougnoux A, Gaspari L, Soleirol M, Servant N, Soskin S, Rossignol S, Wagner-Mahler K, Bertherat J, Sultan C, Kalfa N, Paris F. Virilization at puberty in adolescent girls may reveal a 46,XY disorder of sexual development. Endocr Connect 2023; 12:e230267. [PMID: 37855374 PMCID: PMC10692688 DOI: 10.1530/ec-23-0267] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023]
Abstract
Although hyperandrogenism is a frequent cause of consultation in adolescent girls, more severe forms with virilization must lead to suspicion of an adrenal or ovarian tumor. However, they may also reveal a 46,XY disorder of sexual development (DSD). Here, we describe four adolescent girls referred for pubertal virilization and in whom we diagnosed a 46,XY DSD. We performed gene mutation screening by Sanger sequencing (all patients) and by next-generation sequencing (NGS) in patient #4. We identified new heterozygous NR5A1 gene variants in patients #1 and #2 and a homozygous SRD5A2 gene deletion in patient #3. Patient #4 received a diagnosis of complete androgen insensitivity in childhood; however, due the unusual pubertal virilization, we completed the gene analysis by NGS that revealed two heterozygous HSD17B3 variants. This work underlines the importance of considering the hypothesis of 46,XY DSD in adolescent girls with unexplained virilization at puberty.
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Affiliation(s)
- A Bergougnoux
- Service de Génétique Moléculaire et de Cytogénétique, Centre Hospitalier Universitaire de Montpellier, Université de Montpellier, Montpellier, France
| | - L Gaspari
- Département d'Endocrinologie et de Gynécologie Pédiatrique, Hôpital Arnaud de Villeneuve, Université de Montpellier, Montpellier, France
- INSERM Unité 1203 (DEFE), Université de Montpellier, Montpellier, France
| | - M Soleirol
- Département de Pediatrie, CHU Nîmes, France, Université de Montpellier Faculté de Médecine Montpellier-Nîmes, Montpellier, France
| | - N Servant
- Service de Génétique Moléculaire et de Cytogénétique, Centre Hospitalier Universitaire de Montpellier, Université de Montpellier, Montpellier, France
| | - S Soskin
- Département de Pédiatrie, Centre Hospitalier Universitaire Hautepierre de Strasbourg, Strasbourg, France
| | - S Rossignol
- Département de Pédiatrie, Centre Hospitalier Universitaire Hautepierre de Strasbourg, Strasbourg, France
| | - K Wagner-Mahler
- Département de Pédiatrie, CHU Nice, Hôpitaux Pédiatriques de Nice CHU-Lenval, Nice, France
| | - J Bertherat
- Department of Endocrinology, French Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Université Paris Cité, Institut Cochin, Assitance Publique-Hôpitaux de Paris, Paris, France
| | - C Sultan
- Département d'Endocrinologie et de Gynécologie Pédiatrique, Hôpital Arnaud de Villeneuve, Université de Montpellier, Montpellier, France
| | - N Kalfa
- Department of Pediatric Urological Surgery, French Reference Center for abnormalities of Genital Development (DevGen), CHU Lapeyronie, Montpellier University, Montpellier, France
| | - F Paris
- Service de Génétique Moléculaire et de Cytogénétique, Centre Hospitalier Universitaire de Montpellier, Université de Montpellier, Montpellier, France
- Département d'Endocrinologie et de Gynécologie Pédiatrique, Hôpital Arnaud de Villeneuve, Université de Montpellier, Montpellier, France
- INSERM Unité 1203 (DEFE), Université de Montpellier, Montpellier, France
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Terzolo M, Fassnacht M, Perotti P, Libé R, Kastelan D, Lacroix A, Arlt W, Haak HR, Loli P, Decoudier B, Lasolle H, Quinkler M, Haissaguerre M, Chabre O, Caron P, Stigliano A, Giordano R, Zatelli MC, Bancos I, Fragoso MCBV, Canu L, Luconi M, Puglisi S, Basile V, Reimondo G, Kroiss M, Megerle F, Hahner S, Kimpel O, Dusek T, Nölting S, Bourdeau I, Chortis V, Ettaieb MH, Cosentini D, Grisanti S, Baudin E, Berchialla P, Bovis F, Sormani MP, Bruzzi P, Beuschlein F, Bertherat J, Berruti A. Adjuvant mitotane versus surveillance in low-grade, localised adrenocortical carcinoma (ADIUVO): an international, multicentre, open-label, randomised, phase 3 trial and observational study. Lancet Diabetes Endocrinol 2023; 11:720-730. [PMID: 37619579 PMCID: PMC10522778 DOI: 10.1016/s2213-8587(23)00193-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/31/2023] [Accepted: 06/26/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Adjuvant treatment with mitotane is commonly used after resection of adrenocortical carcinoma; however, treatment remains controversial, particularly if risk of recurrence is not high. We aimed to assess the efficacy and safety of adjuvant mitotane compared with surveillance alone following complete tumour resection in patients with adrenocortical carcinoma considered to be at low to intermediate risk of recurrence. METHODS ADIUVO was a multicentre, open-label, parallel, randomised, phase 3 trial done in 23 centres across seven countries. Patients aged 18 years or older with adrenocortical carcinoma and low to intermediate risk of recurrence (R0, stage I-III, and Ki67 ≤10%) were randomly assigned to adjuvant oral mitotane two or three times daily (the dose was adjusted by the local investigator with the target of reaching and maintaining plasma mitotane concentrations of 14-20 mg/L) for 2 years or surveillance alone. All consecutive patients at 14 study centres fulfilling the eligibility criteria of the ADIUVO trial who refused randomisation and agreed on data collection via the European Network for the Study of Adrenal Tumors adrenocortical carcinoma registry were included prospectively in the ADIUVO Observational study. The primary endpoint was recurrence-free survival, defined as the time from randomisation to the first radiological evidence of recurrence or death from any cause (whichever occurred first), assessed in all randomly assigned patients by intention to treat. Overall survival, defined as time from the date of randomisation to the date of death from any cause, was a secondary endpoint analysed by intention to treat in all randomly assigned patients. Safety was assessed in all patients who adhered to the assigned regimen, which was defined by taking at least one tablet of mitotane in the mitotane group and no mitotane at all in the surveillance group. The ADIUVO trial is registered with ClinicalTrials.gov, NCT00777244, and is now complete. FINDINGS Between Oct 23, 2008, and Dec 27, 2018, 45 patients were randomly assigned to mitotane and 46 to surveillance alone. Because the study was discontinued prematurely, 5-year recurrence-free and overall survival are reported instead of recurrence-free and overall survival as defined in the protocol. 5-year recurrence-free survival was 79% (95% CI 67-94) in the mitotane group and 75% (63-90) in the surveillance group (hazard ratio 0·74 [95% CI 0·30-1·85]). Two people in the mitotane group and five people in the surveillance group died, and 5-year overall survival was not significantly different (95% [95% CI 89-100] in the mitotane group and 86% [74-100] in the surveillance group). All 42 patients who received mitotane had adverse events, and eight (19%) discontinued treatment. There were no grade 4 adverse events or treatment-related deaths. INTERPRETATION Adjuvant mitotane might not be indicated in patients with low-grade, localised adrenocortical carcinoma considering the relatively good prognosis of these patients, and no significant improvement in recurrence-free survival and treatment-associated toxicity in the mitotane group. However, the study was discontinued prematurely due to slow recruitment and cannot rule out an efficacy of treatment. FUNDING AIFA, ENSAT Cancer Health F2-2010-259735 programme, Deutsche Forschungsgemeinschaft, Cancer Research UK, and the French Ministry of Health.
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Affiliation(s)
- Massimo Terzolo
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Martin Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany; Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - Paola Perotti
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Rossella Libé
- Rare Cancer Network COMETE Cancer, Hôpital Cochin, Paris, France
| | - Darko Kastelan
- Department of Endocrinology University Hospital Zagreb, Zagreb, Croatia
| | - André Lacroix
- Service d'Endocrinologie, Département de Médecine, Centre Hospitalier de l'Universite de Montréal, Montreal, QC, Canada
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; MRC London Institute of Medical Sciences and Faculty of Medicine, Imperial College London, London, UK
| | - Harm Reinout Haak
- Department of Internal Medicine, Maxima Medisch Centrum, Eindhoven, Netherlands; CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht University, and Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Paola Loli
- Division of Endocrinology, Niguarda Cà Granda Hospital, Milan, Italy
| | - Bénédicte Decoudier
- Centre Hospitalier Universitaire de Reims, Service d'Endocrinologie-Diabètologie-Nutrition, Reims, France
| | - Helene Lasolle
- Federation d'Endocrinologie, Hospices Civils de Lyon and University de Lyon, Lyon, France
| | | | - Magalie Haissaguerre
- Department of Endocrinology and Endocrine Oncology, Haut Leveque Hospital, University Hospital of Bordeaux, France
| | - Olivier Chabre
- University Grenoble Alpes, Service d'Endocrinologie CHU Grenoble Alpes, Unité Mixte de Recherche INSERM-CEA-UGA UMR1036 38000 Grenoble Alpes, France
| | - Philippe Caron
- Department of Endocrinology and Metabolic Diseases, Cardiovascular and Metabolic Unit, CHU Larrey, Toulouse, France
| | - Antonio Stigliano
- Endocrinology, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Roberta Giordano
- Division of Endocrinology, Diabetology and Metabolism, Department of Biological and Clinical Sciences, University of Turin, Turin, Italy
| | - Maria Chiara Zatelli
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Maria Candida Barisson Villares Fragoso
- Unidade de Suprarrenal, Disciplina de Endocrinologia e Metabologia do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Instituto do Cancer do Estado de São Paulo-ICESP, São Paulo, Brazil
| | - Letizia Canu
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Michaela Luconi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Soraya Puglisi
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy.
| | - Vittoria Basile
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Giuseppe Reimondo
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Matthias Kroiss
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Felix Megerle
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Stefanie Hahner
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Otilia Kimpel
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Tina Dusek
- Department of Endocrinology University Hospital Zagreb, Zagreb, Croatia
| | - Svenja Nölting
- Department of Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany; Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Isabelle Bourdeau
- Service d'Endocrinologie, Département de Médecine, Centre Hospitalier de l'Universite de Montréal, Montreal, QC, Canada
| | - Vasileios Chortis
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | | | - Deborah Cosentini
- Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health Medical, ASST-Spedali Civili, University of Brescia, Brescia, Italy
| | - Salvatore Grisanti
- Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health Medical, ASST-Spedali Civili, University of Brescia, Brescia, Italy
| | - Eric Baudin
- Endocrine Oncology Gustave Roussy, Villejuif, France
| | - Paola Berchialla
- Statistical Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Francesca Bovis
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - Paolo Bruzzi
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Felix Beuschlein
- Department of Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany; Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Jerome Bertherat
- Université Paris Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Service d'Endocrinologie, Hopital Cochin, APHP, Paris, France
| | - Alfredo Berruti
- Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health Medical, ASST-Spedali Civili, University of Brescia, Brescia, Italy
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Pálla S, Tőke J, Bozsik A, Butz H, Papp J, Likó I, Kuroli E, Bánvölgyi A, Hamar M, Bertherat J, Medvecz M, Patócs A. Publisher Correction: Whole genome sequencing resolves 10 years diagnostic odyssey in familiar myxoma. Sci Rep 2023; 13:16339. [PMID: 37770543 PMCID: PMC10539426 DOI: 10.1038/s41598-023-43188-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Affiliation(s)
- Sára Pálla
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Judit Tőke
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
- ENDO-ERN HCP Semmelweis University, Budapest, Hungary
| | - Anikó Bozsik
- Department of Molecular Genetics, National Institute of Oncology, Ráth György U. 7-9, 1122, Budapest, Hungary
- Hereditary Cancers Research Group, Eötvös Loránd Research Network, Semmelweis University, Budapest, Hungary
- National Tumorbiology Laboratory, Budapest, Hungary
| | - Henriett Butz
- Department of Molecular Genetics, National Institute of Oncology, Ráth György U. 7-9, 1122, Budapest, Hungary
- Hereditary Cancers Research Group, Eötvös Loránd Research Network, Semmelweis University, Budapest, Hungary
- National Tumorbiology Laboratory, Budapest, Hungary
| | - János Papp
- Department of Molecular Genetics, National Institute of Oncology, Ráth György U. 7-9, 1122, Budapest, Hungary
- Hereditary Cancers Research Group, Eötvös Loránd Research Network, Semmelweis University, Budapest, Hungary
| | - István Likó
- Hereditary Cancers Research Group, Eötvös Loránd Research Network, Semmelweis University, Budapest, Hungary
| | - Enikő Kuroli
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - András Bánvölgyi
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Mátyás Hamar
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Jerome Bertherat
- Université Paris Cité, Institut Cochin, Inserm U1016, Paris, France
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Márta Medvecz
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
- ERN-Skin Semmelweis University, Budapest, Hungary
| | - Attila Patócs
- ENDO-ERN HCP Semmelweis University, Budapest, Hungary.
- Department of Molecular Genetics, National Institute of Oncology, Ráth György U. 7-9, 1122, Budapest, Hungary.
- Hereditary Cancers Research Group, Eötvös Loránd Research Network, Semmelweis University, Budapest, Hungary.
- National Tumorbiology Laboratory, Budapest, Hungary.
- National Institute of Oncology, Oncology Biobank Center, Budapest, Hungary.
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary.
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Mohammedi K, Bertherat J, Raverot G, Drui D, Reznik Y, Castinetti F, Chanson P, Fafin M, Brossaud J, Tabarin A. Evidence of Persistent Mild Hypercortisolism in Patients Medically Treated for Cushing Disease: the Haircush Study. J Clin Endocrinol Metab 2023; 108:e963-e970. [PMID: 37144820 DOI: 10.1210/clinem/dgad251] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/06/2023]
Abstract
CONTEXT Cortisol-lowering drugs may not restore a normal cortisol secretion in Cushing disease (CD). OBJECTIVE This work aimed to assess the long-term cortisol exposure in medically treated CD patients using hair-cortisol (HF) and hair-cortisone (HE) measurement. METHODS This multicenter prospective study included 3 groups of female patients: CushMed = 16 treated with a stable cortisol-lowering drug dosage and normal urinary free cortisol (UFC); CushSurg = 13 cured by pituitary surgery; CushBla = 15 receiving stable recommended doses of hydrocortisone following bilateral adrenalectomy. Patients were evaluated for 3 months with their usual treatments. Two late-night saliva and 24-hour urine samples were collected monthly in CushMed, and at study end in CushSurg and CushBla patients. A 3-cm hair sample was collected at study end from all patients. Main outcome measures included clinical score and centralized measurement of UFC, late-night salivary cortisol (LNSF), late-night salivary cortisone (LNSE), HE, HF. RESULTS Despite having almost all UFCs normalized, CushMed patients exhibited increased HE as compared to CushSurg controls (P = .003). CushMed patients also had increased clinical score (P = .001), UFC (P = .03), LNSF, LNSE (P = .0001), and variability in the latter parameters (P = .004). CushBla patients had increased HF and HE, contrasting with LNSEs similar to CushSurg patients. Six of 15 CushMed patients exhibited increased HE concentrations and had increased antihypertensive drug dosage compared to CushMed patients with normal HE (P = .05). CONCLUSION Despite normalized UFCs, a subset of medically treated CD patients displays an altered circadian rhythm of serum cortisol. A single HE measurement identifies chronic mild persistent hypercortisolism and could replace multiple saliva analyzes to monitor medical treatments in CD patients once UFC is normalized.
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Affiliation(s)
- Kamel Mohammedi
- Department of Endocrinology, French Reference Center for Adrenal Cancer, EURACAN European Expert Center on Rare Neuroendocrine Tumors, Hôpital Haut-Lévèque, CHU and University of Bordeaux, F-33604 Pessac, France
| | - Jerome Bertherat
- Department of Endocrinology, French Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Université Paris Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, F-75014, Paris, France
| | - Gerald Raverot
- Department of Endocrinology, French Reference Center for Rare Pituitary Diseases HYPO, Hospices Civils de Lyon and Inserm U1052, CNRS UMR5286, Claude Bernard Lyon 1 University, Cancer Research Center of Lyon, F-69001, Lyon, France
| | - Delphine Drui
- Department of Endocrinology and Institut du thorax, CHU de Nantes, F-44000 Nantes, France
| | - Yves Reznik
- Department of Endocrinology and Diabetology, CHU Côte de Nacre, F-14033 Caen, France
| | - Frederic Castinetti
- Department of Endocrinology, Assistance Publique-Hopitaux de Marseille, French Reference Center for Rare Pituitary Diseases, EURACAN European Expert Center on Rare Pituitary Tumors, La Conception Hospital, Aix Marseille University, F-13385, Marseille, France
| | - Philippe Chanson
- Department of Endocrinology, Reference Center for Rare Pituitary Diseases HYPO, CHU Bicêtre, F-94270 Le Kremlin-Bicêtre, France
| | - Manon Fafin
- Department of Endocrinology, French Reference Center for Adrenal Cancer, EURACAN European Expert Center on Rare Neuroendocrine Tumors, Hôpital Haut-Lévèque, CHU and University of Bordeaux, F-33604 Pessac, France
| | - Julie Brossaud
- Laboratory of Hormonology and Tumor Markers, Nutrition and Integrated Neurobiology Laboratory, UMR 1286, CHU de Bordeaux, F-33300, Bordeaux, France
| | - Antoine Tabarin
- Department of Endocrinology, French Reference Center for Adrenal Cancer, EURACAN European Expert Center on Rare Neuroendocrine Tumors, Hôpital Haut-Lévèque, CHU and University of Bordeaux, F-33604 Pessac, France
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6
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Pálla S, Tőke J, Bozsik A, Butz H, Papp J, Likó I, Kuroli E, Bánvölgyi A, Hamar M, Bertherat J, Medvecz M, Patócs A. Whole genome sequencing resolves 10 years diagnostic odyssey in familiar myxoma. Sci Rep 2023; 13:14658. [PMID: 37670105 PMCID: PMC10480295 DOI: 10.1038/s41598-023-41878-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/07/2023] [Accepted: 09/01/2023] [Indexed: 09/07/2023] Open
Abstract
Carney complex (CNC) is an ultrarare disorder causing cutaneous and cardiac myxomas, primary pigmented nodular adrenocortical disease, hypophyseal adenoma, and gonadal tumours. Genetic alterations are often missed under routine genetic testing. Pathogenic variants in PRKAR1A are identified in most cases, while large exonic or chromosomal deletions have only been reported in a few cases. Our aim was to identify the causal genetic alteration in our kindred with a clinical diagnosis of CNC and prove its pathogenic role by functional investigation. Targeted testing of PRKAR1A gene, whole exome and whole genome sequencing (WGS) were performed in the proband, one clinically affected and one unaffected relative. WGS identified a novel, large, 10,662 bp (10.6 kbp; LRG_514t1:c.-10403_-7 + 265del; hg19, chr17:g.66498293_66508954del) deletion in the promoter of PRKAR1A in heterozygous form in the affected family members. The exact breakpoints and the increased enzyme activity in deletion carriers compared to wild type carrier were proved. Segregation analysis and functional evaluation of PKA activity confirmed the pathogenic role of this alteration. A novel deletion upstream of the PRKAR1A gene was proved to be the cause of CNC. Our study underlines the need for WGS in molecular genetic testing of patients with monogenic disorders where conventional genetic analysis fails.
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Affiliation(s)
- Sára Pálla
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Judit Tőke
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
- ENDO-ERN HCP Semmelweis University, Budapest, Hungary
| | - Anikó Bozsik
- Department of Molecular Genetics, National Institute of Oncology, Ráth György U. 7-9, 1122, Budapest, Hungary
- Hereditary Cancers Research Group, Eötvös Loránd Research Network, Semmelweis University, Budapest, Hungary
- National Tumorbiology Laboratory, Budapest, Hungary
| | - Henriett Butz
- Department of Molecular Genetics, National Institute of Oncology, Ráth György U. 7-9, 1122, Budapest, Hungary
- Hereditary Cancers Research Group, Eötvös Loránd Research Network, Semmelweis University, Budapest, Hungary
- National Tumorbiology Laboratory, Budapest, Hungary
| | - János Papp
- Department of Molecular Genetics, National Institute of Oncology, Ráth György U. 7-9, 1122, Budapest, Hungary
- Hereditary Cancers Research Group, Eötvös Loránd Research Network, Semmelweis University, Budapest, Hungary
| | - István Likó
- Hereditary Cancers Research Group, Eötvös Loránd Research Network, Semmelweis University, Budapest, Hungary
| | - Enikő Kuroli
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - András Bánvölgyi
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Mátyás Hamar
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Jerome Bertherat
- Université Paris Cité, Institut Cochin, Inserm U1016, Paris, France
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Márta Medvecz
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
- ERN-Skin Semmelweis University, Budapest, Hungary
| | - Attila Patócs
- ENDO-ERN HCP Semmelweis University, Budapest, Hungary.
- Department of Molecular Genetics, National Institute of Oncology, Ráth György U. 7-9, 1122, Budapest, Hungary.
- Hereditary Cancers Research Group, Eötvös Loránd Research Network, Semmelweis University, Budapest, Hungary.
- National Tumorbiology Laboratory, Budapest, Hungary.
- National Institute of Oncology, Oncology Biobank Center, Budapest, Hungary.
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary.
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7
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Melmed S, Kaiser UB, Lopes MB, Bertherat J, Syro LV, Raverot G, Reincke M, Johannsson G, Beckers A, Fleseriu M, Giustina A, Wass JAH, Ho KKY. Clinical Biology of the Pituitary Adenoma. Endocr Rev 2022; 43:1003-1037. [PMID: 35395078 PMCID: PMC9695123 DOI: 10.1210/endrev/bnac010] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [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: 09/17/2021] [Indexed: 02/06/2023]
Abstract
All endocrine glands are susceptible to neoplastic growth, yet the health consequences of these neoplasms differ between endocrine tissues. Pituitary neoplasms are highly prevalent and overwhelmingly benign, exhibiting a spectrum of diverse behaviors and impact on health. To understand the clinical biology of these common yet often innocuous neoplasms, we review pituitary physiology and adenoma epidemiology, pathophysiology, behavior, and clinical consequences. The anterior pituitary develops in response to a range of complex brain signals integrating with intrinsic ectodermal cell transcriptional events that together determine gland growth, cell type differentiation, and hormonal production, in turn maintaining optimal endocrine health. Pituitary adenomas occur in 10% of the population; however, the overwhelming majority remain harmless during life. Triggered by somatic or germline mutations, disease-causing adenomas manifest pathogenic mechanisms that disrupt intrapituitary signaling to promote benign cell proliferation associated with chromosomal instability. Cellular senescence acts as a mechanistic buffer protecting against malignant transformation, an extremely rare event. It is estimated that fewer than one-thousandth of all pituitary adenomas cause clinically significant disease. Adenomas variably and adversely affect morbidity and mortality depending on cell type, hormone secretory activity, and growth behavior. For most clinically apparent adenomas, multimodal therapy controlling hormone secretion and adenoma growth lead to improved quality of life and normalized mortality. The clinical biology of pituitary adenomas, and particularly their benign nature, stands in marked contrast to other tumors of the endocrine system, such as thyroid and neuroendocrine tumors.
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Affiliation(s)
| | - Ursula B Kaiser
- Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - M Beatriz Lopes
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Jerome Bertherat
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Luis V Syro
- Hospital Pablo Tobon Uribe and Clinica Medellin - Grupo Quirónsalud, Medellin, Colombia
| | - Gerald Raverot
- Hospices Civils de Lyon and Lyon 1 University, Lyon, France
| | - Martin Reincke
- University Hospital of LMU, Ludwig-Maximilians-Universität, Munich, Germany
| | - Gudmundur Johannsson
- Sahlgrenska University Hospital & Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | | | - Andrea Giustina
- San Raffaele Vita-Salute University and IRCCS Hospital, Milan, Italy
| | | | - Ken K Y Ho
- The Garvan Institute of Medical Research and St. Vincents Hospital, Sydney, Australia
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8
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Vitellius G, Donadille B, Decoudier B, Leroux A, Deguelte S, Barraud S, Bertherat J, Delemer B. Unilateral or bilateral adrenalectomy in PPNAD: six cases from a single family followed up over 40 years. Endocrine 2022; 78:201-204. [PMID: 35925470 DOI: 10.1007/s12020-022-03142-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/09/2022] [Indexed: 11/03/2022]
Abstract
The most frequent endocrine Carney complex manifestation is a bilateral primary pigmented nodular adrenocortical disease and bilateral adrenalectomy (BA) is therefore its main treatment. In this study, a 40 years follow-up of six members of the same family with heterozygous PRKAR1A germline mutation, is reported over two generations. The first cases, two sisters with severe hyperandrogenism and Cushing syndrome (CS) diagnosed in 1972 at age 14 and 25, were successfully treated with unilateral adrenalectomy (UA). Their two brothers were then diagnosed, one with a CS-related severe osteoporosis treated with BA and the other with CS treated with UA. The second generation was diagnosed with CS signs at 7 and 21 years of age and were treated with BA and UA respectively. Out of the four patients treated with UA, the only event possibly related to CS was spontaneous episode of pulmonary embolism, 30 years after surgery. Hormonal evaluation revealed either eucortisolism in one patient or partial adrenal deficiency in two and mild hypercortisolism in one patient. For the two patients with BA, one of them accidentally died. The second one, surprisingly, recovered progressively normal cortisol secretion and circadian variation. Steroid substitution was stopped 6 years after her surgery and we demonstrated by iodocholesterol scintigraphy the presence of bilateral adrenal remnants. In conclusion, our results of long term evolution of PPNAD patients show that UA in this subset of patients could be considered to treat CS.
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Affiliation(s)
- G Vitellius
- Service Endocrinologie, Diabète - Nutrition CHU Robert Debré, Reims, France.
| | - B Donadille
- Service Endocrinologie, Diabétologie, et Maladies métaboliques, Saint Antoine, Paris, France
| | - B Decoudier
- Service Endocrinologie, Diabète - Nutrition CHU Robert Debré, Reims, France
| | - A Leroux
- Polyclinique Bezannes, Reims, France
| | - S Deguelte
- Service de Chirurgie Digestive et Endocrinienne, CHU Robert Debré, Reims, France
| | - S Barraud
- Service Endocrinologie, Diabète - Nutrition CHU Robert Debré, Reims, France
- CRESTIC EA 3804, Université de Reims Champagne Ardenne, UFR Sciences Exactes et Naturelles, Moulin de la Housse, BP 1039, 51687, Reims CEDEX 2, France
| | - J Bertherat
- Service d'endocrinologie, Hôpital Cochin, Paris, France
| | - B Delemer
- Service Endocrinologie, Diabète - Nutrition CHU Robert Debré, Reims, France
- CRESTIC EA 3804, Université de Reims Champagne Ardenne, UFR Sciences Exactes et Naturelles, Moulin de la Housse, BP 1039, 51687, Reims CEDEX 2, France
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Iotova V, Bertherat J, Mastorakos G, Hiort O, Pereira AM. ENDO-ERN ON RARE ENDOCRINE CONDITIONS: Endo-ERN in its fifth year: a pinch of care, science, curiosity and new horizons. Endocr Connect 2022; 11:e220082. [PMID: 35175223 PMCID: PMC9010804 DOI: 10.1530/ec-22-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 02/16/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Violeta Iotova
- Endo-ERN Work Package ‘Education & Training’ Paediatric Chair, Department of Pediatrics, Medical University of Varna, Varna, Bulgaria
- Correspondence should be addressed to V Iotova:
| | - Jerome Bertherat
- Endo-ERN Work Package ‘Research & Science’ Adult Chair, Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
- Université de Paris, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France
| | - George Mastorakos
- Endo-ERN Work Package ‘Diagnostics & Laboratory Analysis’ Adult Chair, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Olaf Hiort
- Paediatric Chair and Deputy Coordinator of Endo-ERN, Division of Paediatric Endocrinology and Diabetes, Department of Paediatric and Adolescent Medicine, University of Lübeck, Lübeck, Germany
| | - Alberto M Pereira
- Adult Chair and Coordinator of Endo-ERN, Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
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Berruti A, Fassnacht M, Libè R, Lacroix A, Kastelan D, Haak H, Arlt W, Decoudier B, Lasolle H, Bancos I, Quinkler M, Barisson Villares Fragoso MC, Canu L, Puglisi S, Bourdeau I, Baudin E, Berchialla P, Beuschlein F, Bertherat J, Terzolo M. First randomized trial on adjuvant mitotane in adrenocortical carcinoma patients: The Adjuvo study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1 Background: The ESE-ENSAT guidelines on ACC management suggest adjuvant mitotane for patients at high risk of recurrence. This indication has limited evidence base, lacking results from randomized controlled trials. No suggestion for or against adjuvant mitotane in low-risk patients was given, since studies did not stratify patients for prognosis. The randomized controlled study ADIUVO compared the efficacy of adjuvant mitotane treatment vs. observation in prolonging recurrence-free survival (RFS) in patients at low-intermediate risk of recurrence. Methods: The main inclusion criteria were: stage I-III ACC, R0 surgery, and Ki-67 ≤10%. Patients were randomly assigned 1:1 to adjuvant mitotane or observation. The primary endpoint of the study was RFS. Patients who refused randomization were eligible for the ADIUVO OBSERVATIONAL study. In this prospective, observational study, patients were managed as in ADIUVO except for randomization. A total of 91 patients were enrolled in ADIUVO, 45 in the mitotane and 46 in the observation arm. Baseline characteristics of patients were perfectly matched between the 2 arms: median age, 51 vs. 50.5 years; female, 73% vs. 67%; stage I, 20% vs. 26%; stage II, 67% vs. 63%, stage III, 13% vs. 11%; ACC secretion 44% vs. 36%; Weiss 5 vs. 5; respectively. In ADIUVO OBSERVATIONAL, 42 patients were treated with mitotane and 53 were untreated. Baseline characteristics of patients were matched between the 2 groups and with mitotane and observation groups in ADIUVO. Thus, the ADIUVO OBSERVATIONAL cohort was analyzed in parallel to deal with the lower than expected recruitment in ADIUVO. Results: In the ADIUVO study, recurrences were 8 in the MIT and 11 in the OBS arm, while deaths were 2 and 5, respectively. RFS and overall survival (OS) did not significantly differ between the 2 arms. In the OBS arm, the HR for recurrence was 1.321 (95%CI, 0.55-3.32, p = 0.54) and HR for death 2.171 (95%CI, 0.52-12.12, p = 0.29). The survival analysis in the ADIUVO OBSERVATIONAL study confirmed that of ADIUVO. Given the outcome of both studies, the NNT is 55. Conclusions: ACC patients at low-intermediate risk of recurrence after surgery are a minority; however, they show a far better prognosis than expected (5-yr RFS is 75%) and do not benefit significantly from adjuvant mitotane. The results of the ADIUVO study do not support routine use of adjuvant mitotane in this subset of patients, who may thus avoid a potentially toxic treatment. This is an important step toward personalization of ACC care. Clinical trial information: NCT00777244.
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Affiliation(s)
| | | | - Rossella Libè
- Department of Endocrinology Cochin Hospital, Paris, France
| | - Andrè Lacroix
- Service d'Endocrinologie et Centre de Recherche du CHUM (CRCHUM), Montreal, QC, Canada
| | - Darko Kastelan
- Department of Endocrinology, University Hospital Centre, Zagreb, Croatia
| | - Harm Haak
- Maxima Medical Center, Internal Medicine, Eindhoven, Netherlands
| | - Weibke Arlt
- University of Birmingham, Birmingham, United Kingdom
| | - Bénédict Decoudier
- Service d'Endocrinologie, Hôpital Robert Debré, Centre Hospitalier Universitaire Reims, Reims, France
| | - Hélène Lasolle
- Endocrinology Department, Reference Centre for Rare Pituitary Diseases HYPO, "Groupement Hospitalier Est" Hospices Civils de Lyon, Lyon, France
| | | | | | | | - Letizia Canu
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Soraya Puglisi
- Internal Medicine Unit, Clinical and Biological Sciences Department, University of Turin, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Isabelle Bourdeau
- Division of Endocrinology, Department of Medicine and Research Center, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Eric Baudin
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | | | - Felix Beuschlein
- Endokrinologie, Diabetologie und Klinische Ernährung, Zurich, Switzerland
| | | | - Massimo Terzolo
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
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Fleseriu M, Auchus R, Bancos I, Ben-Shlomo A, Bertherat J, Biermasz NR, Boguszewski CL, Bronstein MD, Buchfelder M, Carmichael JD, Casanueva FF, Castinetti F, Chanson P, Findling J, Gadelha M, Geer EB, Giustina A, Grossman A, Gurnell M, Ho K, Ioachimescu AG, Kaiser UB, Karavitaki N, Katznelson L, Kelly DF, Lacroix A, McCormack A, Melmed S, Molitch M, Mortini P, Newell-Price J, Nieman L, Pereira AM, Petersenn S, Pivonello R, Raff H, Reincke M, Salvatori R, Scaroni C, Shimon I, Stratakis CA, Swearingen B, Tabarin A, Takahashi Y, Theodoropoulou M, Tsagarakis S, Valassi E, Varlamov EV, Vila G, Wass J, Webb SM, Zatelli MC, Biller BMK. Consensus on diagnosis and management of Cushing's disease: a guideline update. Lancet Diabetes Endocrinol 2021; 9:847-875. [PMID: 34687601 PMCID: PMC8743006 DOI: 10.1016/s2213-8587(21)00235-7] [Citation(s) in RCA: 265] [Impact Index Per Article: 88.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/22/2021] [Accepted: 08/04/2021] [Indexed: 12/19/2022]
Abstract
Cushing's disease requires accurate diagnosis, careful treatment selection, and long-term management to optimise patient outcomes. The Pituitary Society convened a consensus workshop comprising more than 50 academic researchers and clinical experts to discuss the application of recent evidence to clinical practice. In advance of the virtual meeting, data from 2015 to present about screening and diagnosis; surgery, medical, and radiation therapy; and disease-related and treatment-related complications of Cushing's disease summarised in recorded lectures were reviewed by all participants. During the meeting, concise summaries of the recorded lectures were presented, followed by small group breakout discussions. Consensus opinions from each group were collated into a draft document, which was reviewed and approved by all participants. Recommendations regarding use of laboratory tests, imaging, and treatment options are presented, along with algorithms for diagnosis of Cushing's syndrome and management of Cushing's disease. Topics considered most important to address in future research are also identified.
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Affiliation(s)
| | | | | | | | - Jerome Bertherat
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladies Rares de la Surrénale, Service d'Endocrinologie, Hôpital Cochin, Paris, France
| | - Nienke R Biermasz
- Leiden University Medical Center and European Reference Center for Rare Endocrine Conditions (Endo-ERN), Leiden, Netherlands
| | | | | | | | - John D Carmichael
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Felipe F Casanueva
- Santiago de Compostela University and Ciber OBN, Santiago de Compostela, Spain
| | - Frederic Castinetti
- Aix Marseille Université, Marseille Medical Genetics, INSERM, Marseille, France; Assistance Publique Hopitaux de Marseille, Marseille, France; Department of Endocrinology, La Conception Hospital, Marseille, France
| | - Philippe Chanson
- Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | | | - Mônica Gadelha
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eliza B Geer
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Ashley Grossman
- University of London, London, UK; University of Oxford, Oxford, UK
| | - Mark Gurnell
- University of Cambridge, Cambridge, UK; NIHR Cambridge Biomedical Research Center, Cambridge, UK; Addenbrooke's Hospital, Cambridge, UK
| | - Ken Ho
- The Garvan Institute of Medical Research, Sydney, NSW, Australia
| | | | - Ursula B Kaiser
- Brigham & Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Niki Karavitaki
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - André Lacroix
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Ann McCormack
- The Garvan Institute of Medical Research, Sydney, NSW, Australia
| | | | - Mark Molitch
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Alberto M Pereira
- Leiden University Medical Center and European Reference Center for Rare Endocrine Conditions (Endo-ERN), Leiden, Netherlands
| | - Stephan Petersenn
- ENDOC Center for Endocrine Tumors, Hamburg, Germany and University of Duisburg-Essen, Essen, Germany
| | | | - Hershel Raff
- Medical College of Wisconsin, Milwaukee, WI, USA; Advocate Aurora Research Institute, Aurora St. Luke's Medical Center, Milwaukee, WI, USA
| | - Martin Reincke
- Department of Medicine IV, University Hospital of LMU, Ludwig-Maximilians-Universität, Munich, Germany
| | | | | | - Ilan Shimon
- Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | | | | | - Antoine Tabarin
- CHU de Bordeaux, Hôpital Haut Lévêque, University of Bordeaux, Bordeaux, France
| | | | - Marily Theodoropoulou
- Department of Medicine IV, University Hospital of LMU, Ludwig-Maximilians-Universität, Munich, Germany
| | | | - Elena Valassi
- Endocrinology Unit, Hospital General de Catalunya, Barcelona, Spain; Research Center for Pituitary Diseases (CIBERER Unit 747), Hospital Sant Pau, Barcelona, Spain
| | | | - Greisa Vila
- Medical University of Vienna, Vienna, Austria
| | - John Wass
- Churchill Hospital, Oxford, United Kingdom
| | - Susan M Webb
- Research Center for Pituitary Diseases (CIBERER Unit 747), Hospital Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
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12
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Elhassan YS, Altieri B, Berhane S, Cosentini D, Calabrese A, Haissaguerre M, Kastelan D, Fragoso MCBV, Bertherat J, Al Ghuzlan A, Haak H, Boudina M, Canu L, Loli P, Sherlock M, Kimpel O, Laganà M, Sitch AJ, Kroiss M, Arlt W, Terzolo M, Berruti A, Deeks JJ, Libé R, Fassnacht M, Ronchi CL. S-GRAS score for prognostic classification of adrenocortical carcinoma: an international, multicenter ENSAT study. Eur J Endocrinol 2021; 186:25-36. [PMID: 34709200 PMCID: PMC8679848 DOI: 10.1530/eje-21-0510] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/27/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Adrenocortical carcinoma (ACC) has an aggressive but variable clinical course. Prognostic stratification based on the European Network for the Study of Adrenal Tumours stage and Ki67 index is limited. We aimed to demonstrate the prognostic role of a points-based score (S-GRAS) in a large cohort of patients with ACC. DESIGN This is a multicentre, retrospective study on ACC patients who underwent adrenalectomy. METHODS The S-GRAS score was calculated as a sum of the following points: tumour stage (1-2 = 0; 3 = 1; 4 = 2), grade (Ki67 index 0-9% = 0; 10-19% = 1; ≥20% = 2 points), resection status (R0 = 0; RX = 1; R1 = 2; R2 = 3), age (<50 years = 0; ≥50 years = 1), symptoms (no = 0; yes = 1), and categorised, generating four groups (0-1, 2-3, 4-5, and 6-9). Endpoints were progression-free survival (PFS) and disease-specific survival (DSS). The discriminative performance of S-GRAS and its components was tested by Harrell's Concordance index (C-index) and Royston-Sauerbrei's R2D statistic. RESULTS We included 942 ACC patients. The S-GRAS score showed superior prognostic performance for both PFS and DSS, with best discrimination obtained using the individual scores (0-9) (C-index = 0.73, R2D = 0.30, and C-index = 0.79, R2D = 0.45, respectively, all P < 0.01vs each component). The superiority of S-GRAS score remained when comparing patients treated or not with adjuvant mitotane (n = 481 vs 314). In particular, the risk of recurrence was significantly reduced as a result of adjuvant mitotane only in patients with S-GRAS 4-5. CONCLUSION The prognostic performance of S-GRAS is superior to tumour stage and Ki67 in operated ACC patients, independently from adjuvant mitotane. S-GRAS score provides a new important guide for personalised management of ACC (i.e. radiological surveillance and adjuvant treatment).
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Affiliation(s)
- Y S Elhassan
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - B Altieri
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
| | - S Berhane
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - D Cosentini
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - A Calabrese
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - M Haissaguerre
- Service d’Endocrinologie – Diabète et Nutrition CHU de Bordeaux, Bordeaux, France
| | - D Kastelan
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - M C B V Fragoso
- Unidade de Suprarrenal da Disciplina de Endocrinologia e Metabologia da Faculdade de Medicina do Hospital das Clinicas da Universidade de São Paulo (HCFMUSP), and Instituto do Cancer do Estado de Sao Paulo (ICESP), Sao Paulo, Brazil
| | - J Bertherat
- Reference Center for Rare Adrenal Cancer (COMETE), Cochin Hospital, Paris, France
| | - A Al Ghuzlan
- Department of Pathology, Gustave Roussy Cancer Center, Paris, France
| | - H Haak
- Department of Internal Medicine, Máxima MC, Eindhoven, Netherlands
| | - M Boudina
- Department of Endocrinology, Theagenio Cancer Hospital, Thessaloniki, Greece
| | - L Canu
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - P Loli
- Clinica Polispecialistica San Carlo, Paderno Dugnano, Milano, Italy
| | - M Sherlock
- Department of Endocrinology, Beaumont Hospital, and the Royal College of Surgeons, Dublin, Republic of Ireland
| | - O Kimpel
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
| | - M Laganà
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - A J Sitch
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - M Kroiss
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
- Department for Endocrinology, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany
| | - W Arlt
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - M Terzolo
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - A Berruti
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - J J Deeks
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - R Libé
- Department of Endocrinology and Metabolic Diseases, Hôpital Cochin, Paris, France
| | - M Fassnacht
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - C L Ronchi
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
- Correspondence should be addressed to C L Ronchi;
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13
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Baussart B, Villa C, Jouinot A, Raffin-Sanson ML, Foubert L, Cazabat L, Bernier M, Bonnet F, Dohan A, Bertherat J, Assié G, Gaillard S. Pituitary surgery as alternative to dopamine agonists treatment for microprolactinomas: a cohort study. Eur J Endocrinol 2021; 185:783-791. [PMID: 34605772 DOI: 10.1530/eje-21-0293] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 04/20/2021] [Accepted: 10/04/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Microprolactinomas are currently treated with dopamine agonists. Outcome information on microprolactinoma patients treated by surgery is limited. This study reports the first large series of consecutive non-invasive microprolactinoma patients treated by pituitary surgery and evaluates the efficiency and safety of this treatment. DESIGN Follow-up of a cohort of consecutive patients treated by surgery. METHODS Between January 2008 and October 2020, 114 adult patients with pure microprolactinomas were operated on in a single tertiary expert neurosurgical department, using an endoscopic endonasal transsphenoidal approach. Eligible patients presented with a microprolactinoma with no obvious cavernous invasion on MRI. Prolactin was assayed before and after surgery. Disease-free survival was modeled using Kaplan-Meier representation. A cox regression model was used to predict remission. RESULTS Median follow-up was 18.2 months (range: 2.8-155). In this cohort, 14/114 (12%) patients were not cured by surgery, including ten early surgical failures and four late relapses occurring 37.4 months (33-41.8) after surgery. From Kaplan-Meier estimates, 1-year and 5-year disease free survival was 90.9% (95% CI: 85.6-96.4%) and 81% (95% CI: 71.2-92.1%) respectively. The preoperative prolactinemia was the only significant preoperative predictive factor for remission (P < 0.05). No severe complication was reported, with no anterior pituitary deficiency after surgery, one diabetes insipidus, and one postoperative cerebrospinal fluid leakage properly treated by muscle plasty. CONCLUSIONS In well-selected microprolactinoma patients, pituitary surgery performed by an expert neurosurgical team is a valid first-line alternative treatment to dopamine agonists.
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Affiliation(s)
| | - Chiara Villa
- INSERM U1016, Institut Cochin, 75014 Paris, France; CNRS UMR 8104, 75014 Paris, France; Université Paris Descartes-Université de Paris, 75006 Paris, France
- Department of Pathological Cytology and Anatomy, Foch Hospital, Suresnes, France
- Department of Endocrinology, Liège, Belgium
| | - Anne Jouinot
- INSERM U1016, Institut Cochin, 75014 Paris, France; CNRS UMR 8104, 75014 Paris, France; Université Paris Descartes-Université de Paris, 75006 Paris, France
- Institut Curie, INSERM U900, MINES ParisTech, PSL-Research University, CBIO-Centre for Computational Biology, Paris, France
| | - Marie-Laure Raffin-Sanson
- Department of Endocrinology, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne Billancourt, France
- UE4340, Université de Versailles Saint-Quentin-en-Yvelines Montigny-le-Bretonneux, Versailles, France
| | - Luc Foubert
- Department of Endocrinology, Foch Hospital, Suresnes, France
| | - Laure Cazabat
- Department of Endocrinology, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne Billancourt, France
- UE4340, Université de Versailles Saint-Quentin-en-Yvelines Montigny-le-Bretonneux, Versailles, France
| | - Michèle Bernier
- Department of Pathological Cytology and Anatomy, Foch Hospital, Suresnes, France
| | - Fideline Bonnet
- INSERM U1016, Institut Cochin, 75014 Paris, France; CNRS UMR 8104, 75014 Paris, France; Université Paris Descartes-Université de Paris, 75006 Paris, France
- Hormonal Biology Laboratory, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Anthony Dohan
- Department of Radiology, Hôpital Cochin, AP-HP, Paris, France
- Université de Paris, Paris, France
| | - Jerome Bertherat
- INSERM U1016, Institut Cochin, 75014 Paris, France; CNRS UMR 8104, 75014 Paris, France; Université Paris Descartes-Université de Paris, 75006 Paris, France
- Department of Endocrinology, Center for Rare Adrenal Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Guillaume Assié
- INSERM U1016, Institut Cochin, 75014 Paris, France; CNRS UMR 8104, 75014 Paris, France; Université Paris Descartes-Université de Paris, 75006 Paris, France
- Department of Endocrinology, Center for Rare Adrenal Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
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14
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Deflorenne E, Peuchmaur M, Vezzosi D, Ajzenberg C, Brunaud L, Chevalier N, Christin-Maitre S, Decoudier B, Driessens N, Drui DD, Gilly O, Goudet P, Illouz F, Jublanc C, Lefebvre H, Lopez AG, Lussey C, Morini A, Raffin-Sanson ML, Raingeard I, Renoult-Pierre P, Storey C, Tabarin A, Vantyghem MC, Vidal-Petiot E, Baudin E, Bertherat J, Amar L. Adrenal ganglioneuromas: a retrospective multicentric study of 104 cases from the COMETE network. Eur J Endocrinol 2021; 185:463-474. [PMID: 34291731 DOI: 10.1530/eje-20-1049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/06/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Adrenal ganglioneuromas are rare, differentiated, neuroblastic tumors that originate from the peripheral sympathetic nervous system. Because of their rarity, information is limited, derived from small cases series. Our objective was to characterize this tumor and provide help for its management. METHODS A retrospective multicenter analysis of adrenal ganglioneuromas from 20 French centers belonging to the COMETE network and one Belgian center. RESULTS Among the 104 cases identified, 59.6% were women (n = 62/104), median age at diagnosis was 29 years, with 24 pediatric cases. 60.6% (n = 63/104) were incidentalomas. Ganglioneuromas were non-secreting tumors in 90.8% of cases (n = 89/98), whereas the preoperative hormonal evaluation was indeterminate for 9.2% of patients (n = 9/98). CT imaging, performed on 96 patients, revealed large tumors (median diameter of 50 mm) with a non-contrast density > 10 Hounsfield units in 98.1% (n = 52/53) and calcifications in 64.6% of cases (n = 31/48). Increased uptake on 123I-MIBG scintigraphy and 18F-FDG-PET/CT was observed in 26.7% (n = 8/30) and 42.2% (n = 19/45) of the tumors, respectively. All 104 patients underwent surgery. No recurrence was observed among the 42 patients who had an imaging follow-up (mean 29.6 months, median 18 months (4-156)). CONCLUSION Adrenal ganglioneuromas are large tumors, mostly nonfunctioning, without benign imaging features. Although the duration of follow-up was limited in our series, no recurrence was identified. A review of the literature confirms the absence of postoperative recurrence. Based on all available data, in the absence of special circumstances (genetic form, uncertain histological diagnosis), long-term follow-up is not necessary after complete surgery for patients with an adrenal ganglioneuroma.
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Affiliation(s)
- Elisa Deflorenne
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Centre de Référence des Maladies Rares de la Surrénale, Unité Fonctionnelle d 'Hypertension Artérielle, Université de Paris, Paris, France
- Sorbonne Université, Médecine Paris, France, undefined
- UMR970, Paris-Cardiovascular research Center, INSERM, F-75015, Paris, France
| | - Michel Peuchmaur
- Service de Pathologie, HU Robert Debré, APHP, Paris, France
- Université de Paris, Paris, France
| | | | - Christiane Ajzenberg
- Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Service de Médecine Interne et Endocrinologie, Créteil, France
| | - Laurent Brunaud
- Département de Chirurgie Viscérale, Métabolique et Cancérologique Unité Médico-chirurgicale de chirurgie Métabolique, Endocrinienne et Thyroïdienne (UMET), Université de Lorraine, CHU de Nancy, Hôpital Brabois Adultes, Nancy, France
| | - Nicolas Chevalier
- Université Côte d'Azur, Service d'Endocrinologie, Diabétologie et Reproduction, CHU de Nice, Hôpital de l'Archet 2, Nice, France
| | - Sophie Christin-Maitre
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Service d'Endocrinologie et Maladies de la Reproduction, Paris, France
| | - Bénédicte Decoudier
- Centre Hospitalier Universitaire de Reims, Service d'Endocrinologie-Diabète-Nutrition, Reims, France
| | - Natacha Driessens
- Département d'Endocrinologie, CUB-Hôpital Erasme, Bruxelles, Belgique
| | - Delphine D Drui
- Centre Hospitalier Universitaire de Nantes, Hôpital Nord Laënnec, Service d'Endocrinologie, Diabétologie et Maladies Métaboliques, L'institut du Thorax, Nantes, France
| | - Olivier Gilly
- CHU de Nîmes, Service des Maladies Métaboliques et Endocriniennes, Nîmes, France
| | - Pierre Goudet
- CHU de Dijon, Chirurgie Endocrinienne et Métabolique, Dijon, France
| | - Frédéric Illouz
- Centre de Référence des Maladies Rares de la Thyroïde et des Récepteurs Hormonaux, Département d'Endocrinologie Diabétologie Nutrition, Angers, France
| | - Christel Jublanc
- Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Service d'Endocrinologie-Métabolisme, Institut E3M, Paris, France
| | - Hervé Lefebvre
- Université de Rouen Normandie, UNIROUEN, INSERM U1239, CHU de Rouen, Service d'Endocrinologie, Diabète et Maladies Métaboliques et CIC-CRB 1404, Rouen, France
| | - Antoine-Guy Lopez
- Université de Rouen Normandie, UNIROUEN, INSERM U1239, CHU de Rouen, Service d'Endocrinologie, Diabète et Maladies Métaboliques et CIC-CRB 1404, Rouen, France
| | - Charlotte Lussey
- Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Médecine Nucléaire, Paris, France
| | - Aurelien Morini
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Laboratoire d'Anatomo-Pathologie, Paris, France
| | - Marie-Laure Raffin-Sanson
- Assistance Publique-Hôpitaux de Paris, CHU Ambroise-Paré, Service d'Endocrinologie et Nutrition, Boulogne-Billancourt, France
| | - Isabelle Raingeard
- CHRU de Montpellier, Service d'Endocrinologie, Diabète, Maladies Métaboliques, Montpellier, France
| | - Peggy Renoult-Pierre
- Centre Hospitalier Universitaire de Tours, Département d'Endocrinologie, Tours, France
| | - Caroline Storey
- Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Paris, France
| | - Antoine Tabarin
- CHU de Bordeaux, Service d'Endocrinologie, Diabétologie et Maladies Métaboliques, Bordeaux, France
| | - Marie Christine Vantyghem
- Centre Hospitalier Régional Universitaire de Lille, Service d'Endocrinologie et Maladies Métaboliques, Lille, France
| | - Emmanuelle Vidal-Petiot
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Service de Physiologie, Paris, France
| | - Eric Baudin
- Institut Gustave Roussy, Service de Médecine Nucléaire et de Cancérologie Endocrinienne, Villejuif, France
| | - Jerome Bertherat
- Université Paris Descartes, Hôpital Cochin, Centre de Référence des Maladies Rares de la Surrénale, Service d'Endocrinologie, Paris, France
| | - Laurence Amar
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Centre de Référence des Maladies Rares de la Surrénale, Unité Fonctionnelle d 'Hypertension Artérielle, Université de Paris, Paris, France
- UMR970, Paris-Cardiovascular research Center, INSERM, F-75015, Paris, France
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15
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Elhassan Y, Altieri B, Berhane S, Cosentini D, Calabrese A, Haissaguerre M, Kastelan D, Fragoso MC, Bertherat J, Baudin E, Haak H, Boudina M, Canu L, Loli P, Sherlock M, Kimpel O, Marta L, Kroiss M, Arlt W, Terzolo M, Berruti A, Deeks J, Libe R, Fassnacht M, Ronchi CL. Modified GRAS Score for Prognostic Classification of Adrenocortical Carcinoma: An ENSAT Multicentre Study. J Endocr Soc 2021. [PMCID: PMC8265895 DOI: 10.1210/jendso/bvab048.334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Adrenocortical carcinoma (ACC) has an aggressive but heterogeneous behaviour. ENSAT stage and Ki67 proliferation index are used to predict clinical outcome but are limited in distinguishing patients with different risk of disease progress. We aimed to validate the prognostic role of a previously proposed points-based score (mGRAS) in a large ACC cohort. Methods: We included ACC patients who underwent adrenalectomy between 2010 and 2019, had complete clinical and histopathological data, and did not participate in our previous studies (Libe et al. Ann Oncol 2015; Lippert et al. JCEM 2018). The mGRAS score was calculated as follows: age (<50yr=0; ≥50yr =1), symptoms (no=0; yes=1), ENSAT stage (1–2=0; 3=1; 4=2), resection status (R0=0; RX=1; R1=2; R2=3), and Ki67 (0–9%=0; 10–19%=1; ≥20%=2 points), generating scores from 0 to 9 and four mGRAS groups (scores 0–1, 2–3, 4–5, and 6–9). Progression-free survival (PFS) and disease-specific survival (DSS) were the primary and secondary endpoints, respectively. The discriminative performance of mGRAS was investigated using the Harrell’s C-index and Royston-Sauerbrei’s R2D statistic. Results: A total of 942 ACC patients from 14 ENSAT centres were included (38% men; median age 50yrs (interquartile range 38, 61)). The four mGRAS groups showed superior prognostic discrimination compared to the individual clinical and histological parameters for both PFS and DSS (C-index 0.71, R2D=0.30 and 0.77, R2D=0.46, respectively); ENSAT staging was the second best discriminator (C-index 0.67, R2D 0.21 and 0.72, R2D=0.35, respectively). An even better prognostic discrimination was observed using the ten mGRAS scores individually (C-index 0.73, R2D=0.30, and 0.79, R2D=0.45 for PFS and DSS, respectively). The superiority of mGRAS was confirmed when separately considering patients treated or untreated with adjuvant mitotane (n=481 vs 314). In mitotane-treated patients, the four mGRAS groups showed better performance in predicting PFS than Ki67 index (C-index 0.66, R2D 0.18 vs C-index 0.62, R2D 0.12). Conclusion: The prognostic performance of mGRAS is superior to that of ENSAT staging and Ki67. This simple score may guide personalised treatment decisions in patients with ACC, e.g. regarding the need for adjuvant therapy and frequency of monitoring.
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Affiliation(s)
| | | | - Sarah Berhane
- University of Birmingham, Birmingham, United Kingdom
| | | | | | | | | | | | | | - Eric Baudin
- Endocrine Oncology Gustave Roussy, Paris, France
| | - Harm Haak
- Maxima Medisch Centrum, Eindhoven, Netherlands
| | | | | | - Paola Loli
- Clinica Polispecialistica San Carlo, Milan, Italy
| | - Mark Sherlock
- Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | - Wiebke Arlt
- University of Birmingham, Birmingham, United Kingdom
| | | | | | | | - Rossella Libe
- Department of Endocrinology and Metabolic Diseases, Paris, France
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16
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Fleseriu M, Biller BMK, Bertherat J, Young J, Arnaldi G, O’Connell P, Izquierdo M, Pedroncelli AM, Pivonello R. Long-Term Control of Urinary Free Cortisol With Osilodrostat in Patients With Cushing’s Disease: Final Results From the LINC 2 Study. J Endocr Soc 2021. [PMCID: PMC8090717 DOI: 10.1210/jendso/bvab048.1063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/24/2022] Open
Abstract
Introduction: During the 22-week core LINC 2 study, the oral 11β-hydroxylase inhibitor osilodrostat normalized mean urinary free cortisol (mUFC) in 79% (15/19) of patients with Cushing’s disease. This report describes long-term LINC 2 efficacy and safety results following an optional extension. Methods: Patients receiving clinical benefit at week 22 could enter the extension (that ran until Oct 22, 2019), continuing the same osilodrostat dose; dose adjustments were permitted based on efficacy and safety. Response rate (mUFC ≤ULN [controlled] or mUFC >ULN but ≥50% decrease from baseline [BL; partially controlled]) was assessed over time. Efficacy/safety were assessed for all patients from core BL until study end. Results: Of 19 enrolled patients (female:male 14:5; mean [SD] age 36.8 years [8.4]), 16 entered the optional extension and 8 of them remained on treatment until study end. Median (range) osilodrostat exposure was 282 weeks (2-351). Mean mUFC decreased from BL (9.9 x ULN) to ≤ULN by week 4 and remained stable throughout the study. All 19 patients achieved mUFC ≤ULN at least once during the study. At each assessment up to month 70 of the extension phase, 50-88% of ongoing patients were controlled, and up to 18% were partially controlled. Mean percentage change in clinical signs from BL (mean [SD]) to last assessment were: fasting plasma glucose, -10.8% (22.1) (from BL: 105.6 mg/dL [49.2]); HbA1c, -2.1% (9.0) (from BL: 5.7% [0.7]); systolic BP, -3.3% (12.6) (from BL: 132.6 mmHg [11.6]); diastolic BP, -2.0% (10.4) (from BL: 85.0 mmHg [6.5]); BMI, -5.9% (8.8) (from BL: 30.7 kg/m2 [7.0]). Overall, 9 patients discontinued treatment (n=2 core and n=7 extension), mostly because of AEs or no longer requiring treatment (n=3 each). The most common AEs during the entire treatment period were nausea (n=10), adrenal insufficiency, and headache (both n=9). AEs related to hypocortisolism and adrenal hormone precursor accumulation occurred in 11 (mostly adrenal insufficiency, n=9) and 12 patients (mostly hypertension, n=4), respectively; most were grade 1/2 and managed with dose adjustment/interruption and/or concomitant medication. Mean (SD) plasma ACTH increased from 1.8 x ULN (0.9) at BL to 7.1 x ULN (12.3) at week 22 and 6.9 x ULN (12.6) at last assessment. Mean (SD) 11-deoxycortisol increased from 1.2 x ULN (1.3) at BL to 13.6 x ULN (12.2) at week 22 and 3.6 x ULN (4.2) at last assessment. In females, mean (SD) testosterone increased from 0.8 x ULN (0.4) at BL to 2.4 x ULN (2.1) at week 22 and 1.0 x ULN (0.9) at last assessment. Two patients, both female, reported an AE of hirsutism. Conclusions: Rapid reductions in mUFC were sustained for up to 6 years of osilodrostat treatment and were accompanied by improvements in clinical signs of hypercortisolism. Osilodrostat was well tolerated, with no new safety signals during long-term treatment.
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Affiliation(s)
| | | | | | - Jacques Young
- Paris-Sud University, Paris Saclay University and Bicêtre Hospital, Le Kremlin-Bicêtre, France
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17
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Maria AG, Tatsi C, Berthon A, Drougat L, Settas N, Hannah-Shmouni F, Bertherat J, Faucz FR, Stratakis CA. ARMC5 variants in PRKAR1A-mutated patients modify cortisol levels and Cushing's syndrome. Endocr Relat Cancer 2020; 27:509-517. [PMID: 32638579 PMCID: PMC9262153 DOI: 10.1530/erc-20-0273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 07/02/2020] [Indexed: 11/08/2022]
Abstract
Mutations in the protein kinase A (PKA) regulatory subunit type 1A (PRKAR1A) and armadillo repeat-containing 5 (ARMC5) genes cause Cushing's syndrome (CS) due to primary pigmented nodular adrenocortical disease (PPNAD) and primary bilateral macronodular adrenocortical hyperplasia (PBMAH), respectively. Between the two genes, ARMC5 is highly polymorphic with several variants in the population, whereas PRKAR1A has very little, if any, non-pathogenic variation in its coding sequence. We tested the hypothesis that ARMC5 variants may affect the clinical presentation of PPNAD and CS among patients with PRKAR1A mutations. In this study, 91 patients with PPNAD due to PRKAR1A mutations were tested for abnormal cortisol secretion or CS and for ARMC5 sequence variants. Abnormal cortisol secretion was present in 71 of 74 patients with ARMC5 variants, whereas 11 of 17 patients negative for ARMC5 variants did not have hypercortisolemia. The presence of ARMC5 variants was a statistically strong predictor of CS among patients with PRKAR1A mutations (P < 0.001). Among patients with CS due to PPNAD, ARMC5 variants were associated with lower cortisol levels at baseline (P = 0.04) and after high dose dexamethasone administration (P = 0.02). The ARMC5 p.I170V variant increased ARMC5 protein accumulation in vitro and decreased viability of NCI-H295 cells (but not HEK 293T cells). PPNAD tissues with ARMC5 variants showed stronger ARMC5 protein expression than those that carried a normal ARMC5 sequence. Taken together, our results suggest that ARMC5 variants among patients with PPNAD due to PRKAR1A defects may play the role of a genetic modifier for the presence and severity of hypercortisolemia.
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Affiliation(s)
- Andrea Gutierrez Maria
- Section on Endocrinology & Genetics (SEGEN), National Institutes of Health (NIH), Bethesda, MD20892, USA
| | - Christina Tatsi
- Section on Endocrinology & Genetics (SEGEN), National Institutes of Health (NIH), Bethesda, MD20892, USA
- Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD20892, USA
| | - Annabel Berthon
- Section on Endocrinology & Genetics (SEGEN), National Institutes of Health (NIH), Bethesda, MD20892, USA
| | - Ludivine Drougat
- Section on Endocrinology & Genetics (SEGEN), National Institutes of Health (NIH), Bethesda, MD20892, USA
| | - Nikolaos Settas
- Section on Endocrinology & Genetics (SEGEN), National Institutes of Health (NIH), Bethesda, MD20892, USA
| | - Fady Hannah-Shmouni
- Section on Endocrinology & Genetics (SEGEN), National Institutes of Health (NIH), Bethesda, MD20892, USA
| | - Jerome Bertherat
- Department of Endocrinology, Hopital Cochin, Paris,75014, France
| | - Fabio R. Faucz
- Section on Endocrinology & Genetics (SEGEN), National Institutes of Health (NIH), Bethesda, MD20892, USA
| | - Constantine A. Stratakis
- Section on Endocrinology & Genetics (SEGEN), National Institutes of Health (NIH), Bethesda, MD20892, USA
- Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD20892, USA
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18
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Chortis V, Bancos I, Nijman T, Gilligan LC, Taylor AE, Ronchi CL, O’Reilly MW, Schreiner J, Asia M, Riester A, Perotti P, Libé R, Quinkler M, Canu L, Paiva I, Bugalho MJ, Kastelan D, Dennedy MC, Sherlock M, Ambroziak U, Vassiliadi D, Bertherat J, Beuschlein F, Fassnacht M, Deeks JJ, Biehl M, Arlt W. Urine Steroid Metabolomics as a Novel Tool for Detection of Recurrent Adrenocortical Carcinoma. J Clin Endocrinol Metab 2020; 105:dgz141. [PMID: 31665449 PMCID: PMC7112967 DOI: 10.1210/clinem/dgz141] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/25/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT Urine steroid metabolomics, combining mass spectrometry-based steroid profiling and machine learning, has been described as a novel diagnostic tool for detection of adrenocortical carcinoma (ACC). OBJECTIVE, DESIGN, SETTING This proof-of-concept study evaluated the performance of urine steroid metabolomics as a tool for postoperative recurrence detection after microscopically complete (R0) resection of ACC. PATIENTS AND METHODS 135 patients from 14 clinical centers provided postoperative urine samples, which were analyzed by gas chromatography-mass spectrometry. We assessed the utility of these urine steroid profiles in detecting ACC recurrence, either when interpreted by expert clinicians or when analyzed by random forest, a machine learning-based classifier. Radiological recurrence detection served as the reference standard. RESULTS Imaging detected recurrent disease in 42 of 135 patients; 32 had provided pre- and post-recurrence urine samples. 39 patients remained disease-free for ≥3 years. The urine "steroid fingerprint" at recurrence resembled that observed before R0 resection in the majority of cases. Review of longitudinally collected urine steroid profiles by 3 blinded experts detected recurrence by the time of radiological diagnosis in 50% to 72% of cases, improving to 69% to 92%, if a preoperative urine steroid result was available. Recurrence detection by steroid profiling preceded detection by imaging by more than 2 months in 22% to 39% of patients. Specificities varied considerably, ranging from 61% to 97%. The computational classifier detected ACC recurrence with superior accuracy (sensitivity = specificity = 81%). CONCLUSION Urine steroid metabolomics is a promising tool for postoperative recurrence detection in ACC; availability of a preoperative urine considerably improves the ability to detect ACC recurrence.
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Affiliation(s)
- Vasileios Chortis
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Irina Bancos
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN
| | - Thomas Nijman
- Bernoulli Institute for Mathematics, Computer Science and Artificial Intelligence, University of Groningen, Groningen, The Netherlands
| | - Lorna C Gilligan
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Angela E Taylor
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Cristina L Ronchi
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
| | - Michael W O’Reilly
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jochen Schreiner
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
| | - Miriam Asia
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Anna Riester
- Medizinische Klinik and Poliklinik IV, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Paola Perotti
- Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Turin, Italy
| | - Rosella Libé
- INCa-COMETE, Cochin Hospital, Institut Cochin, Institut National de la Santé et de la Recherche Medicale Unite ´ 1016, René Descartes University, Paris
| | - Marcus Quinkler
- Endocrinology in Charlottenburg, University of Berlin, Berlin, Germany
| | - Letizia Canu
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Isabel Paiva
- Department of Endocrinology, University Hospital of Coimbra, Coimbra, Portugal
| | - Maria J Bugalho
- Serviço de Endocrinologia Diabetes e Metabolismo, Hospital de Santa Maria, Lisbon, Portugal
| | - Darko Kastelan
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - M Conall Dennedy
- School of Medicine, National University of Ireland Galway (NUIG), Galway, Republic of Ireland
| | - Mark Sherlock
- Department of Endocrinology, Beaumont Hospital, Dublin and the Royal College of Surgeons, Republic of Ireland
| | - Urszula Ambroziak
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Dimitra Vassiliadi
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece
| | - Jerome Bertherat
- INCa-COMETE, Cochin Hospital, Institut Cochin, Institut National de la Santé et de la Recherche Medicale Unite ´ 1016, René Descartes University, Paris
| | - Felix Beuschlein
- Medizinische Klinik and Poliklinik IV, Ludwig-Maximilians-Universität München, Munich, Germany
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitäts-Spital Zürich, Zürich, Switzerland
| | - Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
- Central Laboratory, University Hospital of Würzburg, Würzburg, Germany
| | - Jonathan J Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham NHS Trust and University of Birmingham, Birmingham, UK
| | - Michael Biehl
- Bernoulli Institute for Mathematics, Computer Science and Artificial Intelligence, University of Groningen, Groningen, The Netherlands
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham NHS Trust and University of Birmingham, Birmingham, UK
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19
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Osswald A, Quinkler M, Di Dalmazi G, Deutschbein T, Rubinstein G, Ritzel K, Zopp S, Bertherat J, Beuschlein F, Reincke M. Long-Term Outcome of Primary Bilateral Macronodular Adrenocortical Hyperplasia After Unilateral Adrenalectomy. J Clin Endocrinol Metab 2019; 104:2985-2993. [PMID: 30844071 DOI: 10.1210/jc.2018-02204] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 03/01/2019] [Indexed: 02/03/2023]
Abstract
CONTEXT Unilateral adrenalectomy has been proposed in selected patients with primary bilateral macronodular adrenocortical hyperplasia (PBMAH), but its long-term outcome is unclear. OBJECTIVE The aim of this study was to analyze long-term clinical and biochemical outcomes of unilateral adrenalectomy vs bilateral adrenalectomy in patients with PBMAH in comparison with the outcome of cortisol-producing adenoma (CPA) treated with unilateral adrenalectomy. DESIGN Retrospective observational study in three German and one Italian academic tertiary care center. PATIENTS AND METHODS Twenty-five patients with PBMAH after unilateral adrenalectomy (unilat-ADX-PBMAH), nine patients with PBMAH and bilateral adrenalectomy (bilat-ADX-PBMAH), and 39 patients with CPA and unilateral adrenalectomy (unilat-ADX-CPA) were included. RESULTS Baseline clinical and biochemical parameters were comparable in patients with unilat-ADX-PBMAH, bilat-ADX-PBMAH, and unilat-ADX-CPA. Directly after surgery, 84% of the patients with unilat-ADX-PBMAH experienced initial remission of Cushing syndrome (CS). In contrast, at last follow-up (median, 50 months), 32% of the patients with unilat-ADX-PBMAH were biochemically controlled compared with nearly all patients in the other two groups (P = 0.000). Adrenalectomy of the contralateral side had to be performed in 12% of the initial patients with unilat-ADX-PBMAH. Three of 20 patients with unilat-ADX-PBMAH (15%) died during follow-up, presumably of CS-related causes; no deaths occurred in the other two groups (P = 0.008). Deaths occurred exclusively in patients who were not biochemically controlled after unilateral ADX. CONCLUSIONS Our data suggest that unilateral adrenalectomy of patients with PBMAH leads to clinical remission and a lower incidence of adrenal crisis but in less sufficient biochemical control of hypercortisolism, potentially leading to higher mortality.
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Affiliation(s)
- Andrea Osswald
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, München, Germany
| | | | - Guido Di Dalmazi
- Endocrinology Unit and Center for Applied Biomedical Research, Department of Medical and Surgical Sciences, Alma Mater University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Timo Deutschbein
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - German Rubinstein
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, München, Germany
| | - Katrin Ritzel
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, München, Germany
| | - Stephanie Zopp
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, München, Germany
| | - Jerome Bertherat
- Université Paris Descartes, hôpital Cochin, centre de référence des maladies rares de la surrénale, service d'endocrinologie, Paris, France
| | - Felix Beuschlein
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, München, Germany
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, UniversitätsSpital Zürich, Zürich, Switzerland
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, München, Germany
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20
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Hescot S, Curras-Freixes M, Deutschbein T, van Berkel A, Vezzosi D, Amar L, de la Fouchardière C, Valdes N, Riccardi F, Do Cao C, Bertherat J, Goichot B, Beuschlein F, Drui D, Canu L, Niccoli P, Laboureau S, Tabarin A, Leboulleux S, Calsina B, Libé R, Faggiano A, Schlumberger M, Borson-Chazot F, Mannelli M, Gimenez-Roqueplo AP, Caron P, Timmers HJLM, Fassnacht M, Robledo M, Borget I, Baudin E. Prognosis of Malignant Pheochromocytoma and Paraganglioma (MAPP-Prono Study): A European Network for the Study of Adrenal Tumors Retrospective Study. J Clin Endocrinol Metab 2019; 104:2367-2374. [PMID: 30715419 DOI: 10.1210/jc.2018-01968] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/29/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Malignant pheochromocytoma and paraganglioma (MPP) are characterized by prognostic heterogeneity. Our objective was to look for prognostic parameters of overall survival (OS) in MPP patients. PATIENTS AND METHODS Retrospective multicenter study of MPP characterized by a neck-thoraco-abdomino-pelvic CT or MRI at the time of malignancy diagnosis in European centers between 1998 and 2010. RESULTS One hundred sixty-nine patients from 18 European centers were included. Main characteristics of patients with MPP were: primary pheochromocytoma in 53% of patients; tumor- or hormone-related symptoms in 57% or 58% of cases; positive plasma or urine hormones in 81% of patients; identification of a mutation in SDHB in 42% of cases. Metastatic sites included bone (64%), lymph node (40%), lung (29%), and liver (26%); mean time between initial and malignancy diagnosis was 43 months (range, 0 to 614). Median follow-up was 68 months and median survival 6.7 years. Using univariate analysis, better survival was associated with head and neck paraganglioma, age <40 years, metanephrines less than fivefold the upper limits of the normal range, and low proliferative index. In multivariate analysis, hypersecretion [hazard ratio 3.02 (1.65 to 5.55); P = 0.0004] was identified as an independent significant prognostic factor of worst OS. CONCLUSIONS Our results do not confirm SDHB mutations as a major prognostic parameter in MPP and suggest additional key molecular events involved in MPP tumor progression. Aside from SDHB mutation, the biology of aggressive MPP remains to be understood.
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Affiliation(s)
- Segolene Hescot
- Department of Nuclear Medicine and Endocrine Tumors, Gustave Roussy, Villejuif, France
| | - Maria Curras-Freixes
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Timo Deutschbein
- Department of Internal Medicine and Central Laboratory, University Hospital of Würzburg, Würzburg, Germany
| | - Anouk van Berkel
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Laurence Amar
- Department of Genetics, Hôpital Européen Georges Pompidou, Paris, France
- INSERM UMR970, Paris-Cardiovascular Research Center, Paris Descartes University, Paris, France
| | | | - Nuria Valdes
- Department of Endocrinology and Nutrition, University Hospital Central de Asturias, Oviedo, Spain
- Unit of Endocrinology, Nutrition, Diabetes and Obesity, Institute of Sanitary Research of Asturias, Oviedo, Spain
| | | | - Christine Do Cao
- Department of Endocrinology, Hôpital Huriez, CHR-U, Lille, France
| | | | - Bernard Goichot
- Department of Internal Medicine, Endocrinology and Nutrition, University Hospital of Strasbourg, Strasbourg, France
| | - Felix Beuschlein
- Medical Clinics and Polyclinics IV, University Hospital of Munich, Munich, Germany
- Unit of Endocrinology, Nutrition, Diabetes, University Hospital of Zurich, Zurich, Switzerland
| | - Delphine Drui
- Department of Endocrinology, L'Institut du Thorax, CHU Nantes, Nantes, France
| | - Letizia Canu
- Department of Experimental and Clinical Biomedical Sciences, "Mario Serio," University of Florence, Florence, Italy
| | - Patricia Niccoli
- Department of Oncology, Institut Paoli Calmettes, Marseille, France
| | | | | | - Sophie Leboulleux
- Department of Nuclear Medicine and Endocrine Tumors, Gustave Roussy, Villejuif, France
| | - Bruna Calsina
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Rossella Libé
- Department of Endocrinology, Hôpital Cochin, Paris, France
| | - Antongiulio Faggiano
- Division of Endocrinology, Department of Clinical Medicine and Surgery, Università Federico II, Naples, Italy
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Tumors, Gustave Roussy, Villejuif, France
| | | | - Massimo Mannelli
- Department of Experimental and Clinical Biomedical Sciences, "Mario Serio," University of Florence, Florence, Italy
| | - Anne-Paule Gimenez-Roqueplo
- Department of Genetics, Hôpital Européen Georges Pompidou, Paris, France
- INSERM UMR970, Paris-Cardiovascular Research Center, Paris Descartes University, Paris, France
| | - Philippe Caron
- Department of Endocrinology, CHU Toulouse, Toulouse, France
| | - Henri J L M Timmers
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Martin Fassnacht
- Department of Internal Medicine and Central Laboratory, University Hospital of Würzburg, Würzburg, Germany
| | - Mercedes Robledo
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Isabelle Borget
- Department of Biostatistic and Epidemiology, Gustave Roussy, Villejuif, France
- University Paris-Saclay, University Paris-Sud, UVSQ, CESP ONCOSTAT, INSERM, Villejuif, France
| | - Eric Baudin
- Department of Nuclear Medicine and Endocrine Tumors, Gustave Roussy, Villejuif, France
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21
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Allard L, Albarel Loy F, Bertherat J, Caron P, Cortet-Rudelli C, Courtillot C, Delemer B, Jublanc C, Maiter D, Nunes ML, Raverot G, Salenave S, Sarfati J, Chanson P. SUN-444 Efficacy and Safety of Dopamine Agonists in Psychiatric Patients Treated with Antipsychotics and Presenting a Macroprolactinoma. J Endocr Soc 2019. [PMCID: PMC6552775 DOI: 10.1210/js.2019-sun-444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Dopamine agonists (DAs), which are used as first line therapy in patients with macroprolactinomas, and antipsychotics have opposite effects on D2 dopamine receptors. In patients with severe psychiatric conditions treated with antipsychotics, the rare occurrence of a macroprolactinoma, particularly when it compresses the optic chiasm represents a therapeutic challenge. Indeed, on one hand, antipsychotics by their antagonistic effect on D2 receptors, could decrease or even abolish the effects of DAs on prolactinomas; on the other hand, DAs could make antipsychotics ineffective and lead to psychiatric exacerbation. Our retrospective study aimed at evaluating the efficacy and psychiatric safety of DAs prescribed for the treatment of large prolactin (PRL)-secreting macroadenomas in patients whose underlying psychiatric disorder necessitated treatment with antipsychotics. Endocrinological and psychiatric data on 18 patients were obtained from clinical charts collected in several Endocrinology centers in France and Belgium. Results are expressed as median value (interquartile range). Each of the 18 patient received DAs. Nine had also pituitary surgery (most often because of insufficient tumoral response) and two had radiotherapy. The median decrease of prolactin (PRL) levels, under DA, was -94.7 (30.6) % for the 8 patients treated with DAs only [from an initial median level of 1247 (13012) ng/ml to a minimal level of 42 (244) ng/ml, p=0.008], -85,5 (16,5) % for the 7 patients treated before surgery [3850 (8831) ng/ml to 141 (1510) ng/ml, p=0.03] and -18 (62,75)% for the 6 patients treated after surgery [1664 (1473) ng/ml to 1215 (3094) ng/ml, p=0.56]. The median decrease of prolactinoma largest diameter was -28 (23.5) % for patients only treated with DAs [from an initial median diameter of 27 (22.5) mm to 24 (11.75) mm after treatment; p=0.02] and it almost did not change in the patients who had surgery. Nevertheless, DA treatment allowed optic chiasm decompression in 82% of the patients. Five patients (28%) were admitted for psychiatric relapse while they were receiving DAs (but three of them had stopped their antipsychotic treatment at that time). Moreover, 89% of these patients had a history of one or more psychiatric admissions compared to 11% among those who did not have any relapse (p=0.0034). Even if DAs efficacy on PRL levels and tumoral volume in macroprolactinoma patients under antipsychotic drugs is less impressive than that observed usually, it may considered as satisfactory for half of our patients, particularly in case of optic chiasm compression. Psychiatric symptoms exacerbation was unusual in these patients, occurring mostly in those with the most severe psychiatric conditions. DAs may therefore be used as antitumoral treatment of macroprolactinoma in patients receiving antipsychotics.
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Affiliation(s)
| | | | | | - Philippe Caron
- Dept of Endocrinology, CHU Larrey, Toulouse Cedex 9, , France
| | | | | | | | | | - Dominique Maiter
- Dept of Endo & Nutrition, Cliniques Universitaires Saint-Luc UCL, Brussels, , Belgium
| | | | | | | | - Julie Sarfati
- Endocrinology and Reproductive Diseases, Hosp Saint-Antoine, Paris, , France
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22
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Hannah-Shmouni F, Berthon A, Faucz F, Medina Briceno J, Gutierrez Maria A, Demidowich A, Peitzsch M, Masjkur J, Bonnet-Serrano F, Vaczlavik A, Bertherat J, Reincke M, Eisenhofer G, Stratakis C. OR02-6 Mass Spectrometry-Based Steroid Profiling Inprimary Bilateral Macronodular Adrenocortical Hyperplasia. J Endocr Soc 2019. [PMCID: PMC6554999 DOI: 10.1210/js.2019-or02-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Biochemical characterization of primary bilateral macronodular adrenocortical hyperplasia (PBMAH) by distinct plasma steroid profiles and its putative correlation to disease has not been previously studied. Methods: LC-MS/MS-based steroid profiling of 16 plasma steroids was applied to 36 subjects (22 females, 14 males) with PBMAH, 19 subjects (16 females, 3 males) with other forms of adrenal CS (ACS), and an age and sex-matched control group. Germline ARMC5 sequencing was performed in all PBMAH cases. Results: The steroids showing the most dramatic differences between subject groups included 11-deoxycortisol, corticosterone, 11-deoxycorticosterone, 18-hydroxycortisol, progesterone and DHEA/DHEA-S. Steroids that showed isolated differences included cortisol and 18-oxocortisol with higher (P<0·05) concentrations in ACS than in controls, and aldosterone with higher concentrations in PBMAH when compared to controls. Larger differences in PBMAH than with ACS were most clear for corticosterone, but there were also trends in this direction for 18-hydroxycortisol and aldosterone. Logistic regression analysis indicated four steroids - DHEA, 11-deoxycortisol, 18-oxocortisol, and corticosterone - with the most power for distinguishing the groups. Discriminant analyses with step-wise variable selection indicated correct classification of 95·2% of all subjects of the four groups using a panel of nine steroids; correct classification of subjects with and without germline variants in ARMC5 was achieved in 91·7% of subjects with PBMAH. Conclusion: Subjects with PBMAH show distinctive plasma steroid profiles that may offer a supplementary single-test alternative for screening purposes.
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Affiliation(s)
- Fady Hannah-Shmouni
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Instit, Bethesda, MD, United States
| | | | - Fabio Faucz
- NICHD-SEGEN, NIH/NICHD, Bethesda, MD, United States
| | - Juan Medina Briceno
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Instit, Bethesda, MD, United States
| | - Andrea Gutierrez Maria
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Instit, Bethesda, MD, United States
| | | | - Mirko Peitzsch
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Dresden, , Germany
| | - Jimmy Masjkur
- The University Clinic of Heidelberg, Heidelberg, , Germany
| | | | - Anna Vaczlavik
- Department of Endocrinology & Hormonal Biology, Cochin Hospital, Paris, , France
| | | | - Martin Reincke
- Klinikum der Univ Muenchen, Medizinische Klinik und Poliklinik IV, Munich, , Germany
| | - Graeme Eisenhofer
- Div of Neu, Faculty of Medicine, Techniche Universitt Dresden, Dresden, , Germany
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23
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Castinetti F, Albarel F, Archambeaud F, Bertherat J, Bouillet B, Buffier P, Briet C, Cariou B, Caron P, Chabre O, Chanson P, Cortet C, Do Cao C, Drui D, Haissaguerre M, Hescot S, Illouz F, Kuhn E, Lahlou N, Merlen E, Raverot V, Smati S, Verges B, Borson-Chazot F. French Endocrine Society Guidance on endocrine side effects of immunotherapy. Endocr Relat Cancer 2019; 26:G1-G18. [PMID: 30400055 PMCID: PMC6347286 DOI: 10.1530/erc-18-0320] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [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: 09/10/2018] [Accepted: 10/08/2018] [Indexed: 12/14/2022]
Abstract
The management of cancer patients has changed due to the considerably more frequent use of immune checkpoint inhibitors (ICPIs). However, the use of ICPI has a risk of side effects, particularly endocrine toxicity. Since the indications for ICPI are constantly expanding due to their efficacy, it is important that endocrinologists and oncologists know how to look for this type of toxicity and how to treat it when it arises. In view of this, the French Endocrine Society initiated the formulation of a consensus document on ICPI-related endocrine toxicity. In this paper, we will introduce data on the general pathophysiology of endocrine toxicity, and we will then outline expert opinion focusing primarily on methods for screening, management and monitoring for endocrine side effects in patients treated by ICPI. We will then look in turn at endocrinopathies that are induced by ICPI including dysthyroidism, hypophysitis, primary adrenal insufficiency and fulminant diabetes. In each chapter, expert opinion will be given on the diagnosis, management and monitoring for each complication. These expert opinions will also discuss the methodology for categorizing these side effects in oncology using 'common terminology criteria for adverse events' (CTCAE) and the difficulties in applying this to endocrine side effects in the case of these anti-cancer therapies. This is shown in particular by certain recommendations that are used for other side effects (high-dose corticosteroids, contraindicated in ICPI for example) and that cannot be considered as appropriate in the management of endocrine toxicity, as it usually does not require ICPI withdrawal or high-dose glucocorticoid intake.
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Affiliation(s)
- F Castinetti
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), and Department of Endocrinology, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital de la Conception, Centre de Référence des Maladies Rares de l’Hypophyse HYPO, Marseille, France
- Correspondence should be addressed to F Castinetti:
| | - F Albarel
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), and Department of Endocrinology, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital de la Conception, Centre de Référence des Maladies Rares de l’Hypophyse HYPO, Marseille, France
| | - F Archambeaud
- Service de Médecine Interne B – Endocrinologie, Limoges Cedex, France
| | - J Bertherat
- Hôpital Cochin, Service d’Endocrinologie et Maladies Métaboliques, Paris Cedex 14, France
| | - B Bouillet
- CHU Dijon, Hôpital François Mitterrand, Service d’Endocrinologie, Diabétologie, Maladies Métaboliques, Dijon Cedex, France
- Unité INSERM LNC-UMR 1231, Université de Bourgogne, Dijon, France
| | - P Buffier
- CHU Dijon, Hôpital François Mitterrand, Service d’Endocrinologie, Diabétologie, Maladies Métaboliques, Dijon Cedex, France
| | - C Briet
- Institut MITOVASC, INSERM U1083, Angers University, Department of Endocrinology, Diabetology and Nutrition, University Medical Center, Angers, France
| | - B Cariou
- Department of Endocrinology, L’Institut du Thorax, CHU Nantes, Nantes, France
| | - Ph Caron
- CHU de Toulouse – Hôpital Larrey – Service d’Endocrinologie – Maladies métaboliques – Nutrition, TSA 30030, Toulouse Cedex 9, France
| | - O Chabre
- CHU de Grenoble – Hôpital Albert Michallon, Service d’Endocrinologie-Diabétologie-Nutrition, Grenoble Cedex 9, France
| | - Ph Chanson
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital de Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, et UMR S-1185 Faculté de Médecine Paris-Sud, University of Paris-Saclay, Le Kremlin-Bicêtre, France
| | - C Cortet
- CHRU de Lille – Hopital Huriez, Service d’Endocrinologie, Lille Cedex, France
| | - C Do Cao
- CHRU de Lille – Hopital Huriez, Service d’Endocrinologie, Lille Cedex, France
| | - D Drui
- Department of Endocrinology, L’Institut du Thorax, CHU Nantes, Nantes, France
| | - M Haissaguerre
- CHU de Bordeaux – Hôpital du Haut Lévêque, Service d’Endocrinologie-Diabétologie et Maladies Métaboliques, Pessac Cedex, France
| | - S Hescot
- Institut Curie, Oncologie Endocrinienne, Saint Cloud, France
| | - F Illouz
- Department of Endocrinology, Diabetes and Nutrition, Reference Centre of Rare Thyroid Disease, Hospital of Angers, Angers Cedex 09, France
| | - E Kuhn
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital de Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, et UMR S-1185 Faculté de Médecine Paris-Sud, University of Paris-Saclay, Le Kremlin-Bicêtre, France
| | - N Lahlou
- Département d’Hormonologie Spécialisée, BPR-AS, Pannes, France
| | - E Merlen
- CHRU de Lille – Hopital Huriez, Service d’Endocrinologie, Lille Cedex, France
| | - V Raverot
- Hospices Civils de Lyon, Laboratoire d’Hormonologie, Service de Biochimie et Biologie Moléculaire, Groupement Hospitalier Est, Lyon, France
| | - S Smati
- Department of Endocrinology, L’Institut du Thorax, CHU Nantes, Nantes, France
| | - B Verges
- CHU Dijon, Hôpital François Mitterrand, Service d’Endocrinologie, Diabétologie, Maladies Métaboliques, Dijon Cedex, France
- Unité INSERM LNC-UMR 1231, Université de Bourgogne, Dijon, France
| | - F Borson-Chazot
- Hospices Civils de Lyon, Fédération d’Endocrinologie, Université Claude Bernard Lyon 1, Lyon, France
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Jouinot A, Royer B, Moeung S, Chatelut E, Bellesoeur A, Assié G, Thomas-Schoemann A, Bertherat J, Goldwasser F, Blanchet B. Pharmacokinetic drug-drug interaction between mitotane and etoposide in the treatment of adrenocortical carcinoma. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy280.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
Primary adrenal insufficiency during immunotherapy is rare and does not warrant systematic screening during treatment. It should be suspected in case of typical clinical and biological presentation, but also in case of subclinical presentation with impaired general health status and/or hyponatremia. Diagnosis is based on low cortisol levels, measured at any time in case of emergency or else at 8 am, associated to elevated ACTH to rule out pituitary origin. Secondarily, anti-21-hydroxylase antibody assay may be performed, with screening for mineralocorticoid deficiency. Imaging is recommended, although not urgent, to screen for "adrenalitis" or adrenal atrophy and rule out differential diagnosis of adrenal metastasis. Primary adrenal insufficiency during immunotherapy is a medical emergency requiring hydrocortisone replacement adapted to the clinical and biological context. Management by an endocrinologist is essential, in order to adapt hydrocortisone and fludrocortisone replacement therapy and to educate both patient and oncologist in hydrocortisone dose adaptation. Current data suggest that treatment needs to be life-long, even after termination of immunotherapy. The present article does not deal with secondary adrenal insufficiency, which is included in the section on "Pituitary toxicity".
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Affiliation(s)
- M Haissaguerre
- Service d'endocrinologie-diabétologie et maladies métaboliques, hôpital Haut-Lévêque, CHU de Bordeaux, 33604 Pessac cedex, France.
| | - S Hescot
- Oncologie endocrinienne, institut Curie, 92210 Saint Cloud, France
| | - J Bertherat
- Service d'endocrinologie et maladies métaboliques, hôpital Cochin, 75674 Paris cedex 14, France
| | - O Chabre
- Service d'endocrinologie-diabétologie-nutrition, hôpital Albert-Michallon, CHU de Grenoble, 38043 Grenoble cedex 9, France
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Berthon A, Faucz FR, Espiard S, Drougat L, Bertherat J, Stratakis CA. Age-dependent effects of Armc5 haploinsufficiency on adrenocortical function. Hum Mol Genet 2018; 26:3495-3507. [PMID: 28911199 DOI: 10.1093/hmg/ddx235] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 06/09/2017] [Indexed: 01/01/2023] Open
Abstract
Inactivating mutations in the Armadillo repeat-containing 5 (ARMC5) gene have recently been discovered in primary macronodular adrenal hyperplasia (PMAH), a cause of Cushing syndrome. Biallelic ARMC5 inactivation in PMAH suggested that ARMC5 may have tumor suppressor functions in the adrenal cortex. We generated and characterized a new mouse model of Armc5 deficiency. Almost all Armc5 knockout mice died during early embryonic development, around 6.5 and 8.5 days. Knockout embryos did not undergo gastrulation, as demonstrated by the absence of mesoderm development at E7.5. Armc5 heterozygote mice (Armc5+/-) developed normally but at the age of 1 year, their corticosterone levels decreased; this was associated with a decrease of protein kinase A (PKA) catalytic subunit α (Cα) expression both at the RNA and protein levels that were also seen in human patients with PMAH and ARMC5 defects. However, this was transient, as corticosterone levels normalized later, followed by the development of hypercorticosteronemia in one-third of the mice at 18 months of age, which was associated with increases in PKA and Cα expression. Adrenocortical tissue analysis from Armc5+/- mice at 18 months showed an abnormal activation of the Wnt/β-catenin signaling pathway in a subset of zona fasciculata cells. These data confirm that Armc5 plays an important role in early mouse embryonic development. Our new mouse line can be used to study tissue-specific effects of Armc5. Finally, Armc5 haploinsufficiency leads to Cushing syndrome in mice, but only later in life, and this involves PKA, its catalytic subunit Cα, and the Wnt/β-catenin pathway.
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Affiliation(s)
- A Berthon
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | - F R Faucz
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | - S Espiard
- Institut Cochin, INSERM U 1016, CNRS UMR8104, Université Paris Descartes, 75014 Paris, France
| | - L Drougat
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | - J Bertherat
- Institut Cochin, INSERM U 1016, CNRS UMR8104, Université Paris Descartes, 75014 Paris, France.,Department of Endocrinology, Referral Center for Rare Adrenal Diseases, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, 75014 Paris, France
| | - C A Stratakis
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
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28
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Peverelli E, Catalano R, Giardino E, Treppiedi D, Morelli V, Ronchi CL, Vaczlavik A, Fusco N, Ferrero S, Bertherat J, Beuschlein F, Chiodini I, Arosio M, Spada A, Mantovani G. Cofilin is a cAMP effector in mediating actin cytoskeleton reorganization and steroidogenesis in mouse and human adrenocortical tumor cells. Cancer Lett 2017; 406:54-63. [PMID: 28826686 DOI: 10.1016/j.canlet.2017.07.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/20/2017] [Accepted: 07/27/2017] [Indexed: 11/17/2022]
Abstract
cAMP pathway plays a major role in the pathogenesis of cortisol-producing adrenocortical adenomas (CPA). cAMP-induced steroidogenesis is preceded by actin cytoskeleton reorganization, a process regulated by cofilin activity. In this study we investigated cofilin role in mediating cAMP effects on cell morphology and steroidogenesis in adrenocortical tumor cells. We demonstrated that forskolin induced cell rounding and strongly reduced phosphorylated (P)-cofilin/total cofilin ratio in Y1 (-52 ± 16%, p < 0.001) and human CPA cells (-53 ± 18%, p < 0.05). Cofilin silencing significantly reduced both forskolin-induced morphological changes and progesterone production (1.3-fold vs 1.8-fold in controls, p < 0.05), whereas transfection of wild-type or S3A (active), but not S3D (inactive) cofilin, potentiated forskolin effects on cell rounding and increased 3-fold progesterone synthesis with respect to control (p < 0.05). Furthermore, cofilin dephosphorylation by a ROCK inhibitor potentiated forskolin-induced cell rounding and steroidogenesis (2-fold increase vs forskolin alone). Finally, we found a reduced P-cofilin/total cofilin ratio and increased cofilin expression in CPA vs endocrine inactive adenomas by western blot and immunohistochemistry. Overall, these results identified cofilin as a mediator of cAMP effects on both morphological changes and steroidogenesis in mouse and human adrenocortical tumor cells.
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Affiliation(s)
- E Peverelli
- Endocrine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - R Catalano
- Endocrine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - E Giardino
- Endocrine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - D Treppiedi
- Endocrine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - V Morelli
- Endocrine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - C L Ronchi
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - A Vaczlavik
- Institut Cochin, Inserm U1016, CNRS UMR8104, Descartes University, Paris, France; Department of Endocrinology, Reference Center for Rare Adrenal Diseases, Hôpital Cochin, Paris, France
| | - N Fusco
- Division of Pathology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan Medical School, Milan, Italy
| | - S Ferrero
- Division of Pathology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan Medical School, Milan, Italy
| | - J Bertherat
- Institut Cochin, Inserm U1016, CNRS UMR8104, Descartes University, Paris, France; Department of Endocrinology, Reference Center for Rare Adrenal Diseases, Hôpital Cochin, Paris, France
| | - F Beuschlein
- Medizinische Klinik und Poliklinik IV, Endocrine Research Unit, Klinikum der Universität München, LMU, Munich, Germany
| | - I Chiodini
- Endocrine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - M Arosio
- Endocrine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - A Spada
- Endocrine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - G Mantovani
- Endocrine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Belmihoub I, Silvera S, Sibony M, Dousset B, Legmann P, Bertagna X, Bertherat J, Assié G. From benign adrenal incidentaloma to adrenocortical carcinoma: an exceptional random event. Eur J Endocrinol 2017; 176:K15-K19. [PMID: 28348073 DOI: 10.1530/eje-17-0037] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 03/09/2017] [Accepted: 03/27/2017] [Indexed: 01/09/2023]
Abstract
New European guidelines for the management of adrenal incidentalomas were recently released. One of the most novel recommendations is to stop following patients when they present a typical, small and non-secreting adenoma. We report here the case of a 71-year-old man with such an adenoma, who developed an adrenocortical carcinoma (ACC) fourteen years later, with subsequent metastases and death. Clinically, he had a normal blood pressure and no sign of hormonal hypersecretion. The hormonal work-up showed no hormone excess: urinary free cortisol level was normal, the diurnal cortisol rhythm was respected and urinary catecholamine metabolites levels were normal. Computed tomography (CT) scan showed a homogeneous lesion, with a low density. The lesion remained unchanged during the five years of follow-up. Eight years after the last CT, a large right heterogeneous adrenal mass was incidentally discovered during an ultrasound examination. On CT scan, it was a 6 cm heterogeneous tumor. On hormonal work-up, there was no secretion. The patient was operated of an adrenalectomy, and the histology described an ACC with a Weiss score at 8, with no benign contingent. To our knowledge, this is the first case of an ACC occurring in a patient with prior adrenal imaging showing a typical benign adenoma.
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Affiliation(s)
- I Belmihoub
- Department of EndocrinologyCenter for Rare Adrenal Diseases, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - S Silvera
- Department of RadiologySaint Joseph Hospital, Paris, France
| | | | - B Dousset
- Departments of Digestive and Endocrine Surgery
| | - P Legmann
- Departments of Radiology AHôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - X Bertagna
- Department of EndocrinologyCenter for Rare Adrenal Diseases, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - J Bertherat
- Department of EndocrinologyCenter for Rare Adrenal Diseases, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
- Institut CochinInstitut National de la Santé et de la Recherche Médicale U1016, Centre National de la Recherche Scientifique UMR8104, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - G Assié
- Department of EndocrinologyCenter for Rare Adrenal Diseases, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
- Institut CochinInstitut National de la Santé et de la Recherche Médicale U1016, Centre National de la Recherche Scientifique UMR8104, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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30
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Ferriere A, Cortet C, Chanson P, Delemer B, Caron P, Chabre O, Reznik Y, Bertherat J, Rohmer V, Briet C, Raingeard I, Castinetti F, Beckers A, Vroonen L, Maiter D, Cephise-Velayoudom FL, Nunes ML, Haissaguerre M, Tabarin A. Cabergoline for Cushing's disease: a large retrospective multicenter study. Eur J Endocrinol 2017; 176:305-314. [PMID: 28007845 DOI: 10.1530/eje-16-0662] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [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] [Received: 08/04/2016] [Revised: 11/19/2016] [Accepted: 12/22/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The efficacy of cabergoline in Cushing's disease (CD) is controversial. The aim of this study was to assess the efficacy and tolerability of cabergoline in a large contemporary cohort of patients with CD. DESIGN We conducted a retrospective multicenter study from thirteen French and Belgian university hospitals. METHODS Sixty-two patients with CD received cabergoline monotherapy or add-on therapy. Symptom score, biological markers of hypercortisolism and adverse effects were recorded. RESULTS Twenty-one (40%) of 53 patients who received cabergoline monotherapy had normal urinary free cortisol (UFC) values within 12 months (complete responders), and five of these patients developed corticotropic insufficiency. The fall in UFC was associated with significant reductions in midnight cortisol and plasma ACTH, and with clinical improvement. Compared to other patients, complete responders had similar median baseline UFC (2.0 vs 2.5xULN) and plasma prolactin concentrations but received lower doses of cabergoline (1.5 vs 3.5 mg/week, P < 0.05). During long-term treatment (>12 months), cabergoline was withdrawn in 28% of complete responders because of treatment escape or intolerance. Overall, sustained control of hypercortisolism was obtained in 23% of patients for 32.5 months (19-105). Nine patients on steroidogenesis inhibitors received cabergoline add-on therapy for 19 months (1-240). Hypercortisolism was controlled in 56% of these patients during the first year of treatment with cabergoline at 1.0 mg/week (0.5-3.5). CONCLUSIONS About 20-25% of CD patients are good responders to cabergoline therapy allowing long-term control of hypercortisolism at relatively low dosages and with acceptable tolerability. No single parameter, including the baseline UFC and prolactin levels, predicted the response to cabergoline.
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Affiliation(s)
- A Ferriere
- CHU BordeauxHôpital Haut-Lévêque, Service d'Endocrinologie, Diabétologie et Nutrition, Pessac, France or INSERM U862, Neurocentre Magendie, Université Bordeaux, Bordeaux Cedex, France
| | - C Cortet
- CHRU LilleService d'Endocrinologie, Diabétologie et Métabolisme, Lille Cedex, France
| | - P Chanson
- Assistance Publique-Hôpitaux de ParisHôpitaux universitaires Paris-Sud, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, France
| | - B Delemer
- CHU ReimsHôpital Robert Debré, Service d'Endocrinologie, Diabétologie et Nutrition, Reims, France
| | - P Caron
- CHU ToulouseHôpital Larrey, Service d'Endocrinologie, Maladies Métaboliques et Nutrition, Toulouse cedex 9, France
| | - O Chabre
- CHU Grenoble AlpesService d'Endocrinologie-Diabétologie, Boulevard de la Chantourne, La Tronche, France
| | - Y Reznik
- CHU CaenService d'Endocrinologie-Diabétologie, CAEN cedex 9, France
| | - J Bertherat
- Assistance Publique-Hôpitaux de ParisHôpitaux universitaires Paris-Centre, Hôpital Cochin, Service d'Endocrinologie et Maladies Métaboliques, Paris, France
| | - V Rohmer
- CHU AngersDépartement d'Endocrinologie-Diabétologie-Nutrition, Angers Cedex 9, France
| | - C Briet
- CHU AngersDépartement d'Endocrinologie-Diabétologie-Nutrition, Angers Cedex 9, France
| | - I Raingeard
- CHU MontpellierService d'Endocrinologie, Diabète, Maladies métaboliques, Montpellier, France
| | - F Castinetti
- Assistance Publique-Hôpitaux de MarseilleHôpital de la Conception, Service d'Endocrinologie, Diabètes et Maladies Métaboliques, Marseille, France
| | - A Beckers
- CHU LiègeService d'Endocrinologie, Domaine Universitaire du Sart Tilman, Liège, Belgique
| | - L Vroonen
- CHU LiègeService d'Endocrinologie, Domaine Universitaire du Sart Tilman, Liège, Belgique
| | - D Maiter
- Clinique Universitaire Saint LucService d'Endocrinologie et de Nutrition, Bruxelles, Belgique
| | | | - M L Nunes
- CHU BordeauxHôpital Haut-Lévêque, Service d'Endocrinologie, Diabétologie et Nutrition, Pessac, France or INSERM U862, Neurocentre Magendie, Université Bordeaux, Bordeaux Cedex, France
| | - M Haissaguerre
- CHU BordeauxHôpital Haut-Lévêque, Service d'Endocrinologie, Diabétologie et Nutrition, Pessac, France or INSERM U862, Neurocentre Magendie, Université Bordeaux, Bordeaux Cedex, France
| | - A Tabarin
- CHU BordeauxHôpital Haut-Lévêque, Service d'Endocrinologie, Diabétologie et Nutrition, Pessac, France or INSERM U862, Neurocentre Magendie, Université Bordeaux, Bordeaux Cedex, France
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Abstract
Mutations in ARMC5 gene have been recently identified as the main cause of Primary Macronodular Adrenocortical Hyperplasia (PMAH). PMAH patients have an ARMC5 germline mutation and, in addition, somatic tissue-specific mutations. This is consistent with the two-hit hypothesis of tumorigenesis and suggests that ARMC5 may be a tumor suppressor gene. As its function is still unclear, we analyzed the expression of the four ARMC5 isoforms in 46 normal human tissues. This showed that at least one ARMC5 isoform is ubiquitously expressed throughout the body; however, only 7 tissues expressed all isoforms, including the adrenal gland and the brain. Interestingly, the highest expression for ARMC5 in the brain is in the pituitary gland. The isoform ARMC5-003 was present in most endocrine tissues including the pituitary, adrenal glands and the pancreas. In this report, we present new data about the ARMC5 expression pattern in human tissues; its wide expression in brain, pituitary gland and other tissues suggest that mutations may be responsible for additional pathologies, beyond what is already known in PMAH and meningiomas.
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Affiliation(s)
- Annabel Berthon
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | - Fabio Faucz
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jerome Bertherat
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1016, Centre National de la Recherche Scientifique (CNRS) UMR 8104, Institut Cochin, 75014 Paris, France; Department of Endocrinology, Referral Center for Rare Adrenal Diseases, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, 75014 Paris, France
| | - Constantine A Stratakis
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA.
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Plöckinger U, Chrusciel M, Doroszko M, Saeger W, Blankenstein O, Weizsäcker K, Kroiss M, Hauptmann K, Radke C, Pöllinger A, Tiling N, Steinmüller T, Huhtaniemi I, Quinkler M, Bertherat J, Lacroix A, Rahman N. Functional Implications of LH/hCG Receptors in Pregnancy-Induced Cushing Syndrome. J Endocr Soc 2017; 1:57-71. [PMID: 29264446 PMCID: PMC5677213 DOI: 10.1210/js.2016-1021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 10/14/2016] [Accepted: 12/20/2016] [Indexed: 12/15/2022] Open
Abstract
Context: Elevated human choriogonadotropin (hCG) may stimulate aberrantly expressed luteinizing hormone (LH)/hCG receptor (LHCGR) in adrenal glands, resulting in pregnancy-induced bilateral macronodular adrenal hyperplasia and transient Cushing syndrome (CS). Objective: To determine the role of LHCGR in transient, pregnancy-induced CS. Design, Setting, Patient, and Intervention: We investigated the functional implications of LHCGRs in a patient presenting, at a tertiary referral center, with repeated pregnancy-induced CS with bilateral adrenal hyperplasia, resolving after parturition. Main Outcome Measures and Results: Acute testing for aberrant hormone receptors was negative except for arginine vasopressin (AVP)–increased cortisol secretion. Long-term hCG stimulation induced hypercortisolism, which was unsuppressed by dexamethasone. Postadrenalectomy histopathology demonstrated steroidogenically active adrenocortical hyperplasia and ectopic cortical cell clusters in the medulla. Quantitative polymerase chain reaction showed upregulated expression of LHCGR, transcription factors GATA4, ZFPM2, and proopiomelanocortin (POMC), AVP receptors (AVPRs) AVPR1A and AVPR2, and downregulated melanocortin 2 receptor (MC2R) vs control adrenals. LHCGR was localized in subcapsular, zona glomerulosa, and hyperplastic cells. Single adrenocorticotropic hormone–positive medullary cells were demonstrated in the zona reticularis. The role of adrenal adrenocorticotropic hormone was considered negligible due to downregulated MC2R. Coexpression of CYP11B1/CYP11B2 and AVPR1A/AVPR2 was observed in ectopic cortical cells in the medulla. hCG stimulation of the patient’s adrenal cell cultures significantly increased cyclic adenosine monophosphate, corticosterone, 11-deoxycortisol, cortisol, and androstenedione production. CTNNB1, PRKAR1A, ARMC5, and PRKACA gene mutational analyses were negative. Conclusion: Nongenetic, transient, somatic mutation-independent, pregnancy-induced CS was due to hCG-stimulated transformation of LHCGR-positive undifferentiated subcapsular cells (presumably adrenocortical progenitors) into LHCGR-positive hyperplastic cortical cells. These cells respond to hCG stimulation with cortisol secretion. Without the ligand, they persist with aberrant LHCGR expression and the ability to respond to the same stimulus.
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Affiliation(s)
- Ursula Plöckinger
- Interdisciplinary Center of Metabolism: Endocrinology, Diabetes and Metabolism, Charité University Medicine Berlin, 13353 Berlin, Germany
| | - Marcin Chrusciel
- Department of Physiology, Institute of Biomedicine, 20520 Turku, Finland
| | - Milena Doroszko
- Department of Physiology, Institute of Biomedicine, 20520 Turku, Finland
| | - Wolfgang Saeger
- Institute of Pathology, University of Hamburg, 2000 Hamburg, Germany
| | | | | | - Matthias Kroiss
- Endocrine and Diabetes Unit, Department of Internal Medicine I, University of Würzburg, 97080 Würzburg, Germany
| | - Kathrin Hauptmann
- Institute of Pathology, Charité University Medicine Berlin, 10117 Berlin, Germany
| | | | - Alexander Pöllinger
- Department of Radiology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
| | - Nikolaus Tiling
- Interdisciplinary Center of Metabolism: Endocrinology, Diabetes and Metabolism, Charité University Medicine Berlin, 13353 Berlin, Germany
| | | | - Ilpo Huhtaniemi
- Department of Physiology, Institute of Biomedicine, 20520 Turku, Finland.,Faculty of Medicine, Department of Surgery and Cancer, Imperial College London, London W12 0NN, United Kingdom
| | | | | | - André Lacroix
- Division of Endocrinology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec H2W 1T8 Canada; and
| | - Nafis Rahman
- Department of Physiology, Institute of Biomedicine, 20520 Turku, Finland.,Medical University of Białytsok, 15001 Białytsok, Poland
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Ronchi CL, Di Dalmazi G, Faillot S, Sbiera S, Assié G, Weigand I, Calebiro D, Schwarzmayr T, Appenzeller S, Rubin B, Waldmann J, Scaroni C, Bartsch DK, Mantero F, Mannelli M, Kastelan D, Chiodini I, Bertherat J, Reincke M, Strom TM, Fassnacht M, Beuschlein F. Genetic Landscape of Sporadic Unilateral Adrenocortical Adenomas Without PRKACA p.Leu206Arg Mutation. J Clin Endocrinol Metab 2016; 101:3526-38. [PMID: 27389594 DOI: 10.1210/jc.2016-1586] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Adrenocortical adenomas (ACAs) are among the most frequent human neoplasias. Genetic alterations affecting the cAMP/protein kinase A signaling pathway are common in cortisol-producing ACAs, whereas activating mutations in the gene encoding β-catenin (CTNNB1) have been reported in a subset of both benign and malignant adrenocortical tumors. However, the molecular pathogenesis of most ACAs is still largely unclear. OBJECTIVE The aim of the study was to define the genetic landscape of sporadic unilateral ACAs. DESIGN AND SETTING Next-generation whole-exome sequencing was performed on fresh-frozen tumor samples and corresponding normal tissue samples. PATIENTS Ninety-nine patients with ACAs (74 cortisol-producing and 25 endocrine inactive) negative for p.Leu206Arg PRKACA mutation. MAIN OUTCOME MEASURES Identification of known and/or new genetic alterations potentially involved in adrenocortical tumorigenesis and autonomous hormone secretion, genotype-phenotype correlation. RESULTS A total of 706 somatic protein-altering mutations were detected in 88 of 99 tumors (median, six per tumor). We identified several mutations in genes of the cAMP/protein kinase A pathway, including three novel mutations in PRKACA, associated with female sex and Cushing's syndrome. We also found genetic alterations in different genes involved in the Wnt/β-catenin pathway, associated with larger tumors and endocrine inactivity, and notably, in many genes of the Ca(2+)-signaling pathway. Finally, by comparison of our genetic data with those available in the literature, we describe a comprehensive genetic landscape of unilateral ACAs. CONCLUSIONS This study provides the largest sequencing effort on ACAs to date. We thereby identified somatic alterations affecting known and novel pathways potentially involved in adrenal tumorigenesis.
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Affiliation(s)
- Cristina L Ronchi
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Guido Di Dalmazi
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Simon Faillot
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Silviu Sbiera
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Guillaume Assié
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Isabel Weigand
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Davide Calebiro
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Thomas Schwarzmayr
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Silke Appenzeller
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Beatrice Rubin
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Jens Waldmann
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Carla Scaroni
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Detlef K Bartsch
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Franco Mantero
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Massimo Mannelli
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Darko Kastelan
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Iacopo Chiodini
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Jerome Bertherat
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Martin Reincke
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Tim M Strom
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Martin Fassnacht
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Felix Beuschlein
- Department of Internal Medicine I (C.L.R., I.W., M.F.), Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany; Medizinische Klinik und Poliklinik IV (G.D.D., M.R., F.B.), Klinikum der Universitaet Muenchen, 80337 Munich, Germany; Comprehensive Cancer Center Mainfranken (S.S., S.A., M.F.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institut Cochin, Inserm U1016 (S.F., G.A., J.B.), CNRS UMR8104, Descartes University, 75006 Paris, France; Department of Endocrinology (S.F., G.A., J.B.), Reference Center for Rare Adrenal Diseases, Hôpital Cochin, 75014 Paris, France; Institute of Pharmacology and Toxicology and Bio-Imaging Center/Rudolf Virchow Center (D.C.), University of Wuerzburg, 97080 Wuerzburg, Germany; Institute of Human Genetics (T.S., T.M.S.), Helmholtz Zentrum Munich, 85764 Neuherberg, Germany; Core Unit System Medicine University of Wuerzburg (S.A.), 97080 Wuerzburg, Germany; Endocrinology Unit (B.R., C.S., F.M.), University Hospital of Padua, 35122 Padua, Italy; Department of Visceral, Thoracic, and Vascular Surgery (J.W., D.K.B.), University Hospital Giessen and Marburg, 35043 Marburg, Germany; Endocrinology Unit (M.M.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy; Department of Endocrinology (D.K.), University Hospital Centre Zagreb, 10000 Zagreb, Croatia; Unit of Endocrinology and Metabolic Diseases (I.C.), Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; Institute of Human Genetics (T.M.S.), Technische Universität Munich, 80333 Munich, Germany; and Central Laboratory (M.F.), Research Unit, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
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Liu-Chittenden Y, Patel D, Gaskins K, Giordano TJ, Assie G, Bertherat J, Kebebew E. Serum RARRES2 Is a Prognostic Marker in Patients With Adrenocortical Carcinoma. J Clin Endocrinol Metab 2016; 101:3345-52. [PMID: 27336360 PMCID: PMC5010575 DOI: 10.1210/jc.2016-1781] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 02/01/2023]
Abstract
CONTEXT Retinoic acid receptor responder protein 2 (RARRES2) is a small secreted protein involved in multiple cancers, including adrenocortical carcinoma (ACC). However, discordant tumor and serum RARRES2 levels have been reported in various cancers. The etiology of this discordance is unknown and has not been studied in pair-matched tumor and serum samples. OBJECTIVE To determine tissue and serum RARRES2 levels in patients with adrenocortical neoplasm and to elucidate the prognostic implications of RARRES2 levels. DESIGN, SETTINGS, AND PATIENTS Tissue and serum RARRES2 levels were analyzed. A pair-matched analysis was performed to examine tissue and serum RARRES2 from 51 patients with benign adrenocortical tumors and 18 patients with ACC. Overall survival was analyzed based on RARRES2 expression. A mouse xenograft model was used to determine the source of serum RARRES2. RESULTS Patients with ACC had decreased tumor RARRES2 gene expression (P < .0001) and increased serum RARRES2 levels (P < .005) as compared with patients with benign adrenocortical tumors. Higher serum RARRES2 levels were associated with improved overall survival (P = .0227). A mouse xenograft model demonstrated that higher tissue RARRES2 expression was associated with higher RARRES2 secretion in the serum and that there was an intrinsic mechanism in maintaining serum RARRES2 homeostasis. CONCLUSIONS Serum and tissue RARRES2 expression levels are paradoxical in patients with ACC. The elevated RARRES2 in patient serum is unlikely to be secreted from tumor cells. Serum RARRES2 may be used as a novel prognostic marker for ACC.
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MESH Headings
- Adrenal Cortex Neoplasms/blood
- Adrenal Cortex Neoplasms/genetics
- Adrenal Cortex Neoplasms/pathology
- Adrenocortical Carcinoma/blood
- Adrenocortical Carcinoma/genetics
- Adrenocortical Carcinoma/secondary
- Adult
- Aged
- Animals
- Biomarkers, Tumor/blood
- Biomarkers, Tumor/genetics
- Blotting, Western
- Case-Control Studies
- Chemokines/blood
- Chemokines/genetics
- Female
- Follow-Up Studies
- Humans
- Intercellular Signaling Peptides and Proteins/blood
- Intercellular Signaling Peptides and Proteins/genetics
- Lymphatic Metastasis
- Male
- Mice
- Mice, Inbred NOD
- Mice, SCID
- Middle Aged
- Neoplasm Recurrence, Local/blood
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/pathology
- Neoplasm Staging
- Prognosis
- RNA, Messenger/genetics
- Real-Time Polymerase Chain Reaction
- Reverse Transcriptase Polymerase Chain Reaction
- Survival Rate
- Tumor Cells, Cultured
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Affiliation(s)
- Yi Liu-Chittenden
- Endocrine Oncology Branch (Y.L.-C., D.P., K.G., E.K.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892; Department of Pathology (T.J.G.), University of Michigan, Ann Arbor, Michigan 48109; Institut Cochin (G.A., J.B.), Inserm Unité 1016, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8104, Descartes University, 75014, Paris, France; and Department of Endocrinology (G.A., J.B.), Reference Center for Rare Adrenal Diseases, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, 75014, Paris, France
| | - Dhaval Patel
- Endocrine Oncology Branch (Y.L.-C., D.P., K.G., E.K.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892; Department of Pathology (T.J.G.), University of Michigan, Ann Arbor, Michigan 48109; Institut Cochin (G.A., J.B.), Inserm Unité 1016, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8104, Descartes University, 75014, Paris, France; and Department of Endocrinology (G.A., J.B.), Reference Center for Rare Adrenal Diseases, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, 75014, Paris, France
| | - Kelli Gaskins
- Endocrine Oncology Branch (Y.L.-C., D.P., K.G., E.K.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892; Department of Pathology (T.J.G.), University of Michigan, Ann Arbor, Michigan 48109; Institut Cochin (G.A., J.B.), Inserm Unité 1016, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8104, Descartes University, 75014, Paris, France; and Department of Endocrinology (G.A., J.B.), Reference Center for Rare Adrenal Diseases, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, 75014, Paris, France
| | - Thomas J Giordano
- Endocrine Oncology Branch (Y.L.-C., D.P., K.G., E.K.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892; Department of Pathology (T.J.G.), University of Michigan, Ann Arbor, Michigan 48109; Institut Cochin (G.A., J.B.), Inserm Unité 1016, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8104, Descartes University, 75014, Paris, France; and Department of Endocrinology (G.A., J.B.), Reference Center for Rare Adrenal Diseases, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, 75014, Paris, France
| | - Guillaume Assie
- Endocrine Oncology Branch (Y.L.-C., D.P., K.G., E.K.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892; Department of Pathology (T.J.G.), University of Michigan, Ann Arbor, Michigan 48109; Institut Cochin (G.A., J.B.), Inserm Unité 1016, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8104, Descartes University, 75014, Paris, France; and Department of Endocrinology (G.A., J.B.), Reference Center for Rare Adrenal Diseases, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, 75014, Paris, France
| | - Jerome Bertherat
- Endocrine Oncology Branch (Y.L.-C., D.P., K.G., E.K.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892; Department of Pathology (T.J.G.), University of Michigan, Ann Arbor, Michigan 48109; Institut Cochin (G.A., J.B.), Inserm Unité 1016, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8104, Descartes University, 75014, Paris, France; and Department of Endocrinology (G.A., J.B.), Reference Center for Rare Adrenal Diseases, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, 75014, Paris, France
| | - Electron Kebebew
- Endocrine Oncology Branch (Y.L.-C., D.P., K.G., E.K.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892; Department of Pathology (T.J.G.), University of Michigan, Ann Arbor, Michigan 48109; Institut Cochin (G.A., J.B.), Inserm Unité 1016, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8104, Descartes University, 75014, Paris, France; and Department of Endocrinology (G.A., J.B.), Reference Center for Rare Adrenal Diseases, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, 75014, Paris, France
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Libé R, Borget I, Ronchi CL, Zaggia B, Kroiss M, Kerkhofs T, Bertherat J, Volante M, Quinkler M, Chabre O, Bala M, Tabarin A, Beuschlein F, Vezzosi D, Deutschbein T, Borson-Chazot F, Hermsen I, Stell A, Fottner C, Leboulleux S, Hahner S, Mannelli M, Berruti A, Haak H, Terzolo M, Fassnacht M, Baudin E. Prognostic factors in stage III-IV adrenocortical carcinomas (ACC): an European Network for the Study of Adrenal Tumor (ENSAT) study. Ann Oncol 2016; 26:2119-25. [PMID: 26392430 DOI: 10.1093/annonc/mdv329] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The clinical course of advanced adrenocortical carcinoma (ACC) is heterogeneous. Our study aimed primarily to refine and make headway in the prognostic stratification of advanced ACC. PATIENTS AND METHODS Patients with advanced ENSAT ACC (stage III or stage IV) at diagnosis registered between 2000 and 2009 in the ENSAT database were enrolled. The primary end point was overall survival (OS). Parameters of potential prognostic relevance were selected. Univariate and multivariate analyses were carried out: model 1 'before surgery'; model 2 'post-surgery'. RESULTS Four hundred and forty-four patients with advanced ENSAT ACC (stage III: 210; stage IV: 234) were analyzed. After a median follow-up of 55.2 months, the median OS was 24 months. A modified ENSAT (mENSAT) classification was validated: stage III (invasion of surrounding tissues/organs or the vena renalis/cava) and stage IVa, IVb, IVc (2, 3 or >3 metastatic organs, including N, respectively). Two- or 5-year OS was 73%, 46%, 26% and 15% or 50%, 15%, 14% and 2% for stages III, IVa, IVb and IVc, respectively. In the multivariate analysis, mENSAT stages (stages IVa, IVb, or IVc, respectively) were significantly correlated with OS (P < 0.0001), as well as additional parameters: age ≥ 50 years (P < 0.0001), tumor- or hormone-related symptoms (P = 0.01 and 0.03, respectively) in model 1 but also the R status (P = 0.001) and Grade (Weiss >6 and/or Ki67 ≥ 20%, P = 0.06) in model 2. CONCLUSION The mENSAT classification and GRAS parameters (Grade, R status, Age and Symptoms) were found to best stratify the prognosis of patients with advanced ACC.
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Affiliation(s)
- R Libé
- French Adrenal Cancer Network, Institut National du Cancer, Paris
| | - I Borget
- Department of Biostatistics and Epidemiology, Gustave Roussy and University Paris-Sud, Villejuif, France
| | - C L Ronchi
- Central Laboratory, Research Unit, University Hospital Wurzburg, Wurzburg, Germany
| | - B Zaggia
- Internal Medicine, San Luigi Hospital, University of Turin, Italy
| | - M Kroiss
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - T Kerkhofs
- Internal Medicine, Maxima Medisch Centrum, Eindhoven, The Netherlands
| | - J Bertherat
- Endocrinology Unit, Cochin Hospital, Paris, France
| | - M Volante
- Department of Oncology, University of Turin, San Luigi Hospital, Turin, Italy
| | - M Quinkler
- Clinical Endocrinology, Charit Campus Mitte, Charitί University Medicine Berlin, Germany
| | - O Chabre
- Endocrinology Unit, University Hospital of Grenoble, France
| | - M Bala
- Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - A Tabarin
- Department of Endocrinology, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - F Beuschlein
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | - D Vezzosi
- Department of Endocrinology and Metabolic Diseases, CHU Larrey, Toulouse
| | - T Deutschbein
- Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - F Borson-Chazot
- Nuclear Medicine Unit, University of Lyon 1, Hospices Civils de Lyon Bron, France
| | - I Hermsen
- Internal Medicine, Maxima Medisch Centrum, Eindhoven, The Netherlands
| | - A Stell
- Melbourne eResearch Group Level 3, Doug McDonell Building, University of Melbourne, Melbourne, Australia
| | - C Fottner
- Department of Medicine 1, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - S Leboulleux
- Department of Nuclear Medicine and Endocrine Tumors, Institut Gustave Roussy, Villejuif, France
| | - S Hahner
- Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - M Mannelli
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', Florence
| | - A Berruti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili Hospital, Brescia, Italy
| | - H Haak
- Internal Medicine, Maxima Medisch Centrum, Eindhoven, The Netherlands
| | - M Terzolo
- Internal Medicine, San Luigi Hospital, University of Turin, Italy
| | - M Fassnacht
- Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - E Baudin
- Department of Nuclear Medicine and Endocrine Tumors, Institut Gustave Roussy, Villejuif, France
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Diaz E, Vanhaecke C, Laurent-Roussel S, Bricaire L, Groussin L, Bertherat J, Bernier M, Jrad G, Grange P, Dupin N. Une hypophysite infectieuse bactérienne bien atypique. Ann Dermatol Venereol 2015. [DOI: 10.1016/j.annder.2015.10.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Thevenon J, Bourredjem A, Faivre L, Cardot-Bauters C, Calender A, Le Bras M, Giraud S, Niccoli P, Odou MF, Borson-Chazot F, Barlier A, Lombard-Bohas C, Clauser E, Tabarin A, Pasmant E, Chabre O, Castermans E, Ruszniewski P, Bertherat J, Delemer B, Christin-Maitre S, Beckers A, Guilhem I, Rohmer V, Goichot B, Caron P, Baudin E, Chanson P, Groussin L, Du Boullay H, Weryha G, Lecomte P, Schillo F, Bihan H, Archambeaud F, Kerlan V, Bourcigaux N, Kuhn JM, Vergès B, Rodier M, Renard M, Sadoul JL, Binquet C, Goudet P. Unraveling the intrafamilial correlations and heritability of tumor types in MEN1: a Groupe d'étude des Tumeurs Endocrines study. Eur J Endocrinol 2015; 173:819-26. [PMID: 26392472 DOI: 10.1530/eje-15-0691] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 09/21/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND MEN1, which is secondary to the mutation of the MEN1 gene, is a rare autosomal-dominant disease that predisposes mutation carriers to endocrine tumors. Most studies demonstrated the absence of direct genotype-phenotype correlations. The existence of a higher risk of death in the Groupe d'étude des Tumeurs Endocrines-cohort associated with a mutation in the JunD interacting domain suggests heterogeneity across families in disease expressivity. This study aims to assess the existence of modifying genetic factors by estimating the intrafamilial correlations and heritability of the six main tumor types in MEN1. METHODS The study included 797 patients from 265 kindred and studied seven phenotypic criteria: parathyroid and pancreatic neuroendocrine tumors (NETs) and pituitary, adrenal, bronchial, and thymic (thNET) tumors and the presence of metastasis. Intrafamilial correlations and heritability estimates were calculated from family tree data using specific validated statistical analysis software. RESULTS Intrafamilial correlations were significant and decreased along parental degrees distance for pituitary, adrenal and thNETs. The heritability of these three tumor types was consistently strong and significant with 64% (s.e.m.=0.13; P<0.001) for pituitary tumor, 65% (s.e.m.=0.21; P<0.001) for adrenal tumors, and 97% (s.e.m.=0.41; P=0.006) for thNETs. CONCLUSION The present study shows the existence of modifying genetic factors for thymus, adrenal, and pituitary MEN1 tumor types. The identification of at-risk subgroups of individuals within cohorts is the first step toward personalization of care. Next generation sequencing on this subset of tumors will help identify the molecular basis of MEN1 variable genetic expressivity.
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Affiliation(s)
- J Thevenon
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - A Bourredjem
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - L Faivre
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - C Cardot-Bauters
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - A Calender
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - M Le Bras
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - S Giraud
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - P Niccoli
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - M F Odou
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - F Borson-Chazot
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - A Barlier
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - C Lombard-Bohas
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - E Clauser
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - A Tabarin
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - E Pasmant
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - O Chabre
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - E Castermans
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - P Ruszniewski
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - J Bertherat
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - B Delemer
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - S Christin-Maitre
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - A Beckers
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - I Guilhem
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - V Rohmer
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - B Goichot
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - P Caron
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - E Baudin
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - P Chanson
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - L Groussin
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - H Du Boullay
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - G Weryha
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - P Lecomte
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - F Schillo
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - H Bihan
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - F Archambeaud
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - V Kerlan
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - N Bourcigaux
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - J M Kuhn
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - B Vergès
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - M Rodier
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - M Renard
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - J L Sadoul
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - C Binquet
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
| | - P Goudet
- CHU de DijonCentre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs, University of Burgundy, EA4271 GAD, Dijon, FranceINSERMCIC1432, Dijon, FranceCentre Hospitalier Universitaire de DijonCentre d'Investigation Clinique, éssais cliniques/épidémiologie clinique, Dijon FranceCentre Hospitalier Régional et Universitaire de LilleService de Médecine interne et Endocrinologie, Clinique Marc Linquette, Lille, FranceHospices Civils de LyonHôpital E. Herriot, Génétique moléculaire et clinique, Lyon, FranceCentre Hospitalier Universitaire de NantesClinique d'Endocrinologie, Nantes, FranceAPHMservice d'Oncologie Médicale, Institut Paoli-Calmettes, Université Aix-Marseille, Marseille, FranceCHRU de LilleService d'Hormonologie, Métabolisme-Nutrition, Oncologie, Pôle de Biologie Pathologie Génétique, Université de Lille2, Lille, FranceHospices Civils de Lyon et Université LYON1Groupement hospitalier Est, Fédération d'Endocrinologie, Lyon, FranceAP-HMHôpital la Conception, Laboratoire de Biologie Moléculaire, Marseille, FranceAix-Marseille UniversityCRN2M UMR 7286-CNRS, Marseille, FranceHospices Civils de LyonHôpital E. Herriot, Service d'Oncologie, Lyon, FranceUniversité Paris-DescartesFaculté de Médecine Paris-Descartes-Paris-V, UMR-S970, Paris, FranceAPHPHôpital Cochin, Laboratoire d'Oncogénétique, Paris, FranceCentre Hospitalier Universitaire et Université de Bordeaux 2Service d'Endocrinologie,Hôpital du Haut Levêque, Pessac,FranceAPHPHôpital Cochin, Service de Biochimie et de Génétique Moléculaire,Paris, FranceCentre Hospitalier Universitaire de GrenobleService d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital Michalon, Grenoble,FranceCentre Hospitalier Universitaire de LiègeDomaine Universitaire du Sart-Tilman, University of Liège, Laboratoire de génétique moléculaire, Liège, BelgiumAPHPHôpital Beaujon et Université Paris 7 Denis Diderot, Service de Gastroentérologie-pancréa
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Rhayem Y, Le Stunff C, Abdel Khalek W, Auzan C, Bertherat J, Linglart A, Couvineau A, Silve C, Clauser E. Functional Characterization of PRKAR1A Mutations Reveals a Unique Molecular Mechanism Causing Acrodysostosis but Multiple Mechanisms Causing Carney Complex. J Biol Chem 2015; 290:27816-28. [PMID: 26405036 PMCID: PMC4646027 DOI: 10.1074/jbc.m115.656553] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 05/01/2015] [Indexed: 02/05/2023] Open
Abstract
The main target of cAMP is PKA, the main regulatory subunit of which (PRKAR1A) presents mutations in two genetic disorders: acrodysostosis and Carney complex. In addition to the initial recurrent mutation (R368X) of the PRKAR1A gene, several missense and nonsense mutations have been observed recently in acrodysostosis with hormonal resistance. These mutations are located in one of the two cAMP-binding domains of the protein, and their functional characterization is presented here. Expression of each of the PRKAR1A mutants results in a reduction of forskolin-induced PKA activation (measured by a reporter assay) and an impaired ability of cAMP to dissociate PRKAR1A from the catalytic PKA subunits by BRET assay. Modeling studies and sensitivity to cAMP analogs specific for domain A (8-piperidinoadenosine 3',5'-cyclic monophosphate) or domain B (8-(6-aminohexyl)aminoadenosine-3',5'-cyclic monophosphate) indicate that the mutations impair cAMP binding locally in the domain containing the mutation. Interestingly, two of these mutations affect amino acids for which alternative amino acid substitutions have been reported to cause the Carney complex phenotype. To decipher the molecular mechanism through which homologous substitutions can produce such strikingly different clinical phenotypes, we studied these mutations using the same approaches. Interestingly, the Carney mutants also demonstrated resistance to cAMP, but they expressed additional functional defects, including accelerated PRKAR1A protein degradation. These data demonstrate that a cAMP binding defect is the common molecular mechanism for resistance of PKA activation in acrodysosotosis and that several distinct mechanisms lead to constitutive PKA activation in Carney complex.
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Affiliation(s)
- Yara Rhayem
- From the INSERM U970, Université Paris Descartes, Paris Centre de Recherche Cardiovasculaire, 56 Rue Leblanc, 75015 Paris, France, the Service de Biochimie et Génétique Moléculaire and
| | - Catherine Le Stunff
- INSERM U1169, Université Paris Sud, Hôpital Bicêtre, 94270 Le Kremlin Bicêtre, France
| | - Waed Abdel Khalek
- From the INSERM U970, Université Paris Descartes, Paris Centre de Recherche Cardiovasculaire, 56 Rue Leblanc, 75015 Paris, France
| | - Colette Auzan
- From the INSERM U970, Université Paris Descartes, Paris Centre de Recherche Cardiovasculaire, 56 Rue Leblanc, 75015 Paris, France
| | - Jerome Bertherat
- Service d'Endocrinologie, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, 75014 Paris, France, the Institut Cochin, INSERM U1060, Université Paris Descartes, 75014 Paris, France
| | - Agnès Linglart
- the Service d'Endocrinologie Pédiatrique, Hôpital Bicêtre, Assistance Publique, Hôpitaux de Paris, 94270 Le Kremlin Bicêtre, France, and
| | - Alain Couvineau
- UMR 1149 INSERM, Université Paris Diderot, ERL CNRS 8252, Faculté de Médecine Site Bichat, 75018 Paris, France
| | - Caroline Silve
- the Service de Biochimie et Génétique Moléculaire and INSERM U1169, Université Paris Sud, Hôpital Bicêtre, 94270 Le Kremlin Bicêtre, France
| | - Eric Clauser
- From the INSERM U970, Université Paris Descartes, Paris Centre de Recherche Cardiovasculaire, 56 Rue Leblanc, 75015 Paris, France, the Service de Biochimie et Génétique Moléculaire and
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Haller F, Moskalev EA, Faucz FR, Barthelmesz S, Wiemann S, Bieg M, Assie G, Bertherat J, Schaefer IM, Otto C, Rattenberry E, Maher ER, Strobel P, Werner M, Carney JA, Hartmann A, Stratakis CA, Agaimyg A. Aberrant DNA hypermethylation of SDHC: a novel mechanism of tumor development in Carney triad. ACTA ACUST UNITED AC 2015. [DOI: 10.1530/endoabs.38.ja3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Rostomyan L, Daly AF, Petrossians P, Nachev E, Lila AR, Lecoq AL, Lecumberri B, Trivellin G, Salvatori R, Moraitis AG, Holdaway I, Kranenburg-van Klaveren DJ, Chiara Zatelli M, Palacios N, Nozieres C, Zacharin M, Ebeling T, Ojaniemi M, Rozhinskaya L, Verrua E, Jaffrain-Rea ML, Filipponi S, Gusakova D, Pronin V, Bertherat J, Belaya Z, Ilovayskaya I, Sahnoun-Fathallah M, Sievers C, Stalla GK, Castermans E, Caberg JH, Sorkina E, Auriemma RS, Mittal S, Kareva M, Lysy PA, Emy P, De Menis E, Choong CS, Mantovani G, Bours V, De Herder W, Brue T, Barlier A, Neggers SJCMM, Zacharieva S, Chanson P, Shah NS, Stratakis CA, Naves LA, Beckers A. Clinical and genetic characterization of pituitary gigantism: an international collaborative study in 208 patients. Endocr Relat Cancer 2015; 22:745-57. [PMID: 26187128 PMCID: PMC6533620 DOI: 10.1530/erc-15-0320] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2015] [Indexed: 12/19/2022]
Abstract
Despite being a classical growth disorder, pituitary gigantism has not been studied previously in a standardized way. We performed a retrospective, multicenter, international study to characterize a large series of pituitary gigantism patients. We included 208 patients (163 males; 78.4%) with growth hormone excess and a current/previous abnormal growth velocity for age or final height >2 s.d. above country normal means. The median onset of rapid growth was 13 years and occurred significantly earlier in females than in males; pituitary adenomas were diagnosed earlier in females than males (15.8 vs 21.5 years respectively). Adenomas were ≥10 mm (i.e., macroadenomas) in 84%, of which extrasellar extension occurred in 77% and invasion in 54%. GH/IGF1 control was achieved in 39% during long-term follow-up. Final height was greater in younger onset patients, with larger tumors and higher GH levels. Later disease control was associated with a greater difference from mid-parental height (r=0.23, P=0.02). AIP mutations occurred in 29%; microduplication at Xq26.3 - X-linked acrogigantism (X-LAG) - occurred in two familial isolated pituitary adenoma kindreds and in ten sporadic patients. Tumor size was not different in X-LAG, AIP mutated and genetically negative patient groups. AIP-mutated and X-LAG patients were significantly younger at onset and diagnosis, but disease control was worse in genetically negative cases. Pituitary gigantism patients are characterized by male predominance and large tumors that are difficult to control. Treatment delay increases final height and symptom burden. AIP mutations and X-LAG explain many cases, but no genetic etiology is seen in >50% of cases.
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Affiliation(s)
- Liliya Rostomyan
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Adrian F Daly
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Patrick Petrossians
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Emil Nachev
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Anurag R Lila
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Anne-Lise Lecoq
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Beatriz Lecumberri
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Giampaolo Trivellin
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Roberto Salvatori
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Andreas G Moraitis
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Ian Holdaway
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Dianne J Kranenburg-van Klaveren
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Maria Chiara Zatelli
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Nuria Palacios
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Cecile Nozieres
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Margaret Zacharin
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Tapani Ebeling
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Marja Ojaniemi
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Liudmila Rozhinskaya
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Elisa Verrua
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Marie-Lise Jaffrain-Rea
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Silvia Filipponi
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Daria Gusakova
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Vyacheslav Pronin
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Jerome Bertherat
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Zhanna Belaya
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Irena Ilovayskaya
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Mona Sahnoun-Fathallah
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Caroline Sievers
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Gunter K Stalla
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Emilie Castermans
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Jean-Hubert Caberg
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Ekaterina Sorkina
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Renata Simona Auriemma
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Sachin Mittal
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Maria Kareva
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Philippe A Lysy
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Philippe Emy
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Ernesto De Menis
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Catherine S Choong
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Giovanna Mantovani
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Vincent Bours
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Wouter De Herder
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Thierry Brue
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Anne Barlier
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Sebastian J C M M Neggers
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Sabina Zacharieva
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Philippe Chanson
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Nalini Samir Shah
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Constantine A Stratakis
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Luciana A Naves
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
| | - Albert Beckers
- Departments of Endocrinology and Human GeneticsCentre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumClinical Center of Endocrinology and GerontologyMedical University, Sofia, BulgariaDepartment of EndocrinologyKing Edward Memorial Hospital, Mumbai, IndiaAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Le Kremlin-Bicêtre F-94275, FranceUMR S1185Univ Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceINSERM U1185Faculté de Médecine Paris-Sud, F-94276 Le Kremlin-Bicêtre, FranceServicio de Endocrinología y NutriciónHospital Universitario La Paz, Madrid, SpainSection on Endocrinology and GeneticsProgram on Developmental Endocrinology & Genetics & Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health (NIH), Bethesda, Maryland 20892, USADivision of EndocrinologyDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of EndocrinologyGreenlane Clinical Centre, Auckland, New ZealandSection of EndocrinologyDepartment of Internal Medicine, Erasmus Medical Centre, Rotterdam, The NetherlandsSection of Endocrinology and Internal MedicineDepartment of Medical Sciences, University of Ferrara, Via Savonarola 9, 44121 Ferrara, ItalyServicio de EndocrinologíaHospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainService d'endocrinologie-diabétologieCentre Hospitalier Lucien Hussel, Montée du Docteur Chapuis BP127, 38 209 Vienne cedex, FranceMurdoch Children's Research InstituteRoyal Children's Hospital, University of Melbourne, Parkville, Victoria, AustraliaDepartments of Internal Medicine and PediatricsOulu University Hospital, University of Oulu, Oulu, FinlandDepartments of Neuroen
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Lefebvre H, Duparc C, Prévost G, Zennaro MC, Bertherat J, Louiset E. Paracrine control of steroidogenesis by serotonin in adrenocortical neoplasms. Mol Cell Endocrinol 2015; 408:198-204. [PMID: 25433205 DOI: 10.1016/j.mce.2014.11.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 10/07/2014] [Revised: 11/18/2014] [Accepted: 11/19/2014] [Indexed: 12/19/2022]
Abstract
Serotonin (5-hydroxytryptamine; 5-HT) is able to activate the hypothalamo-pituitary-adrenal axis via multiple actions at different levels. In the human adrenal gland, 5-HT, released by subcapsular mast cells, stimulates corticosteroid production through a paracrine mode of communication which involves 5-HT receptor type 4 (5-HT4) primarily located in zona glomerulosa. As a result, 5-HT is much more efficient to stimulate aldosterone secretion than cortisol release in vitro and administration of 5-HT4 receptor agonists to healthy individuals is followed by an increase in plasma aldosterone levels without any change in plasma cortisol concentrations. Interestingly, adrenocortical hyperplasias and tumors responsible for corticosteroid hypersecretion exhibit various cellular and molecular defects which tend to reinforce the intraadrenal serotonergic tone. These pathophysiological mechanisms, which are summarized in the present review, include an increase in adrenal 5-HT production and overexpression of 5-HT receptors in adrenal neoplastic tissues. Altogether, these data support the concept of adrenal serotonergic paracrinopathy and suggest that 5-HT and its receptors may constitute valuable targets for pharmacological treatments of primary adrenal diseases.
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Affiliation(s)
- H Lefebvre
- INSERM, U982, Laboratory of Differentiation & Neuronal and Neuroendocrine Communication, IRIB, University of Rouen, Mont-Saint-Aignan, France; Department of Endocrinology, University Hospital of Rouen, Rouen, France.
| | - C Duparc
- INSERM, U982, Laboratory of Differentiation & Neuronal and Neuroendocrine Communication, IRIB, University of Rouen, Mont-Saint-Aignan, France
| | - G Prévost
- INSERM, U982, Laboratory of Differentiation & Neuronal and Neuroendocrine Communication, IRIB, University of Rouen, Mont-Saint-Aignan, France; Department of Endocrinology, University Hospital of Rouen, Rouen, France
| | - M C Zennaro
- INSERM, UMRS 970, Paris Cardiovascular Research Center, Paris, France
| | - J Bertherat
- Department of Endocrinology, University Hospital Cochin and Cochin Institute, Assistance Publique-Hôpitaux de Paris, Université Paris V, Paris, France
| | - E Louiset
- INSERM, U982, Laboratory of Differentiation & Neuronal and Neuroendocrine Communication, IRIB, University of Rouen, Mont-Saint-Aignan, France
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Rivas LGP, Theodoropoulou M, Ferrau F, Nusser C, Kawaguchi K, Stratakis C, Faucz FR, Wildemberg LE, Assie G, Beschorner R, Stalla G, Buchfelder M, Popovic V, Honneger J, Bertherat J, Gadelha MR, Beuschlein F, Komada M, Korbonits M, Reincke M. The ubiquitin-specific protease 8 gene is frequently mutated in adenomas causing Cushing's disease. ACTA ACUST UNITED AC 2015. [DOI: 10.1530/endoabs.37.oc12.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Perez-Rivas L, Theodoropoulou M, Ferraù F, Nusser C, Kawaguchi K, Stratakis CA, Rueda Faucz F, Wildemberg LE, Assiè G, Beschorner R, Dimopoulou C, Buchfelder M, Popovic V, Berr C, Toth MI, Ardisasmita AI, Honegger J, Bertherat J, Gadelha M, Beuschlein F, Stalla G, Komada M, Korbonits M, Reincke M. The ubiquitin-specific peptidase 8 (USP8) gene is frequently mutated in adenomas causing Cushing's disease. Exp Clin Endocrinol Diabetes 2015. [DOI: 10.1055/s-0035-1547607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Trivellin G, Daly AF, Faucz FR, Yuan B, Rostomyan L, Larco DO, Schernthaner-Reiter MH, Szarek E, Leal LF, Caberg JH, Castermans E, Villa C, Dimopoulos A, Chittiboina P, Xekouki P, Shah N, Metzger D, Lysy PA, Ferrante E, Strebkova N, Mazerkina N, Zatelli MC, Lodish M, Horvath A, de Alexandre RB, Manning AD, Levy I, Keil MF, Sierra MDLL, Palmeira L, Coppieters W, Georges M, Naves LA, Jamar M, Bours V, Wu TJ, Choong CS, Bertherat J, Chanson P, Kamenický P, Farrell WE, Barlier A, Quezado M, Bjelobaba I, Stojilkovic SS, Wess J, Costanzi S, Liu P, Lupski JR, Beckers A, Stratakis CA. Gigantism and acromegaly due to Xq26 microduplications and GPR101 mutation. N Engl J Med 2014; 371:2363-74. [PMID: 25470569 PMCID: PMC4291174 DOI: 10.1056/nejmoa1408028] [Citation(s) in RCA: 193] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Increased secretion of growth hormone leads to gigantism in children and acromegaly in adults; the genetic causes of gigantism and acromegaly are poorly understood. METHODS We performed clinical and genetic studies of samples obtained from 43 patients with gigantism and then sequenced an implicated gene in samples from 248 patients with acromegaly. RESULTS We observed microduplication on chromosome Xq26.3 in samples from 13 patients with gigantism; of these samples, 4 were obtained from members of two unrelated kindreds, and 9 were from patients with sporadic cases. All the patients had disease onset during early childhood. Of the patients with gigantism who did not carry an Xq26.3 microduplication, none presented before the age of 5 years. Genomic characterization of the Xq26.3 region suggests that the microduplications are generated during chromosome replication and that they contain four protein-coding genes. Only one of these genes, GPR101, which encodes a G-protein-coupled receptor, was overexpressed in patients' pituitary lesions. We identified a recurrent GPR101 mutation (p.E308D) in 11 of 248 patients with acromegaly, with the mutation found mostly in tumors. When the mutation was transfected into rat GH3 cells, it led to increased release of growth hormone and proliferation of growth hormone-producing cells. CONCLUSIONS We describe a pediatric disorder (which we have termed X-linked acrogigantism [X-LAG]) that is caused by an Xq26.3 genomic duplication and is characterized by early-onset gigantism resulting from an excess of growth hormone. Duplication of GPR101 probably causes X-LAG. We also found a recurrent mutation in GPR101 in some adults with acromegaly. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and others.).
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Affiliation(s)
- C A Stratakis
- Section on Endocrinology & Genetics, Program on Developmental Endocrinology & Genetics, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, USA
| | - J Bertherat
- Endocrinology Department, Hôpital Cochin, AP-HP & Institut Cochin, INSERM U1016, CNRS 8104, Université Paris Descartes, Paris, France
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Louiset E, Duparc C, Groussin L, Gobet F, Desailloud R, Barrande G, Reznik Y, Bertherat J, Prévost G, Lefebvre H. Abnormal Sensitivity to Glucagon and Related Peptides in Primary Adrenal Cushing's Syndrome. Horm Metab Res 2014; 46:876-82. [PMID: 25054435 DOI: 10.1055/s-0034-1384522] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Illegitimate G-protein coupled receptors are known to control cortisol secretion in adrenal adenomas and bilateral macronodular adrenal hyperplasias (BMAHs) causing Cushing's syndrome. In the present study, we have evaluated the role of glucagon in the regulation of cortisol secretion in 13 patients with BMAH or adrenocortical adenoma causing subclinical or overt Cushing's syndrome. Injection of glucagon provoked an increase in plasma cortisol in 2 patients. After surgery, immunohistochemical studies showed the presence of glucagon receptor-like immunoreactivity in clusters of spongiocytic cells in adrenal tissues from patients who were sensitive in vivo to glucagon. We also observed an in vitro cortisol response to vasoactive intestinal peptide from an adenoma, which was insensitive to glucagon and pituitary adenylate cyclase-activating peptide. Altogether, our data show that ectopic glucagon receptors are expressed in some adrenal cortisol-producing benign lesions. Our results also indicate that circulating glucagon may influence cortisol release under fasting conditions.
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Affiliation(s)
- E Louiset
- INSERM, U982, Laboratory of Differentiation & Neuronal and Neuroendocrine Communication, IRIB, University of Rouen, Mont-Saint-Aignan, France
| | - C Duparc
- INSERM, U982, Laboratory of Differentiation & Neuronal and Neuroendocrine Communication, IRIB, University of Rouen, Mont-Saint-Aignan, France
| | - L Groussin
- Department of Endocrinology, University Hospital Cochin and Cochin Institute, Assistance Publique des Hôpitaux de Paris, Université Paris V, Paris, France
| | - F Gobet
- Department of Pathology, University Hospital of Rouen, Rouen, France
| | - R Desailloud
- Department of Endocrinology, University Hospital of Amiens, Amiens, France
| | - G Barrande
- Department of Endocrinology, Regional Hospital of Orléans, Orléans, France
| | - Y Reznik
- Department of Endocrinology, University Hospital of Caen, Caen, France
| | - J Bertherat
- Department of Endocrinology, University Hospital Cochin and Cochin Institute, Assistance Publique des Hôpitaux de Paris, Université Paris V, Paris, France
| | - G Prévost
- INSERM, U982, Laboratory of Differentiation & Neuronal and Neuroendocrine Communication, IRIB, University of Rouen, Mont-Saint-Aignan, France
| | - H Lefebvre
- INSERM, U982, Laboratory of Differentiation & Neuronal and Neuroendocrine Communication, IRIB, University of Rouen, Mont-Saint-Aignan, France
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Basso F, Rocchetti F, Rodriguez S, Nesterova M, Cormier F, Stratakis C, Ragazzon B, Bertherat J, Rizk-Rabin M. Comparison of the effects of PRKAR1A and PRKAR2B depletion on signaling pathways, cell growth, and cell cycle control of adrenocortical cells. Horm Metab Res 2014; 46:883-8. [PMID: 25268545 PMCID: PMC4727442 DOI: 10.1055/s-0034-1389951] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The cyclic AMP/protein kinase A signaling cascade is one of the main pathways involved in the pathogenesis of adrenocortical tumors. The PKA R1A and R2B proteins are the most abundant regulatory subunits in endocrine tissues. Inactivating mutations of PRKAR1A are associated with Carney complex and a subset of sporadic tumors and the abundance of R2B protein is low in a subset of secreting adrenocortical adenomas. We previously showed that PRKAR1A and PRKAR2B inactivation have anti-apoptotic effects on the adrenocortical carcinoma cell line H295R. The aim of this study was to compare the effects of PRKAR1A and PRKAR2B depletion on cell proliferation, apoptosis, cell signaling pathways, and cell cycle regulation. We found that PRKAR2B depletion is compensated by an upregulation of R1A protein, whereas PRKAR1A depletion has no effect on the production of R2B. The depletion of either PRKAR1A or PRKAR2B promotes the expression of Bcl-xL and resistance to apoptosis; and is associated with a high percentage of cells in S and G2 phase, activates PKA and MEK/ERK pathways, and impairs the expression of IkB leading to activate the NF-κB pathway. However, we observed differences in the regulation of cyclins. The depletion of PRKAR1A leads to the accumulation of cyclin D1 and p27kip, whereas the depletion of PRKAR2B promotes the accumulation of cyclin A, B, cdk1, cdc2, and p21Cip. In conclusion, although the depletion of PRKAR1A and PRKAR2B in adrenocortical cells has similar effects on cell proliferation and apoptosis; loss of these PKA subunits differentially affects cyclin expression.
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Affiliation(s)
- F. Basso
- INSERM U1016, CNRS (UMR 8104), Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France, Paris, France
| | - F. Rocchetti
- INSERM U1016, CNRS (UMR 8104), Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France, Paris, France
| | - S. Rodriguez
- INSERM U1016, CNRS (UMR 8104), Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France, Paris, France
| | - M. Nesterova
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda
| | - F. Cormier
- INSERM U1016, CNRS (UMR 8104), Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France, Paris, France
| | - C. Stratakis
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda
| | - B. Ragazzon
- INSERM U1016, CNRS (UMR 8104), Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France, Paris, France
| | - J. Bertherat
- INSERM U1016, CNRS (UMR 8104), Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France, Paris, France
- Hôpital Cochin, Department of Endocrinology, Center for Rare Adrenal Diseases, Paris, France
| | - M. Rizk-Rabin
- INSERM U1016, CNRS (UMR 8104), Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France, Paris, France
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Abstract
Stimulation of the cAMP pathway by adrenocorticotropin (ACTH) is essential for adrenal cortex maintenance, glucocorticoid and adrenal androgens synthesis, and secretion. Various molecular and cellular alterations of the cAMP pathway have been observed in endocrine tumors. Protein kinase A (PKA) is a central key component of the cAMP pathway. Molecular alterations of PKA subunits have been observed in adrenocortical tumors. PKA molecular defects can be germline in hereditary disorders or somatic in sporadic tumors. Heterozygous germline inactivating mutations of the PKA regulatory subunit RIα gene (PRKAR1A) can be observed in patients with ACTH-independent Cushing's syndrome (CS) due to primary pigmented nodular adrenocortical disease (PPNAD). PRKAR1A is considered as a tumor suppressor gene. Interestingly, these mutations can also be observed as somatic alterations in sporadic cortisol-secreting adrenocortical adenomas. Germline gene duplication of the catalytic subunits Cα (PRKACA) has been observed in patients with PPNAD. Furthermore, exome sequencing revealed recently activating somatic mutations of PRKACA in about 40% of cortisol-secreting adrenocortical adenomas. In vitro and in vivo functional studies help in the progress to understand the mechanisms of adrenocortical tumors development due to PKA regulatory subunits alterations. All these alterations are observed in benign oversecreting tumors and are mimicking in some way cAMP pathway constitutive activation. On the long term, unraveling these alterations will open new strategies of pharmacological treatment targeting the cAMP pathway in adrenal tumors and cortisol-secretion disorders.
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Affiliation(s)
- S Espiard
- INSERM U1016, Institut Cochin, Paris, France
| | - B Ragazzon
- INSERM U1016, Institut Cochin, Paris, France
| | - J Bertherat
- INSERM U1016, Institut Cochin, Paris, France
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Faucz FR, Beuschlei F, Fassnacht M, Assie G, Calebiro D, Stratakis C, Osswald A, Ronchi CL, Wieland T, Sbiera S, Schaak K, Schmittfull A, Schwarzmayr T, Barreau O, Vezzosi D, Rizk-Rabbin M, Zabel U, Szarek E, Salpea P, Forlino A, Vetro A, Zuffardi O, Kisker C, Diener S, Meitinger T, Lohse MJ, Reincke M, Bertherat J, Strom TM, Allolio B. Abstract LB-182: Constitutive activation of PRKACA in adrenal Cushing's syndrome. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-lb-182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Corticotropin-independent Cushing's syndrome may be caused by tumors or hyperplasia of the adrenal cortex. Until now genetic alterations explain only a small fraction of cases. The observation that a subset of adrenal adenomas is characterized by abnormal PKA activity despite the absence of mutations in candidate genes suggested as yet unknown alterations in the cAMP/PKA signaling cascade in these tumors. The aim of this study was the analysis of the genetic basis of Cushing's syndrome in order to reveal the gene/s responsible for the disease. Exome sequencing was performed in ten cortisol-producing adenomas and recurrent mutations in candidate genes were evaluated in additional 171 patients with adrenocortical tumors. Genome-wide copy number analysis was performed in 35 patients with cortisol secreting bilateral hyperplasias. The effects of these genetic defects were studied both clinically and in vitro. Exome sequencing in 8/10 adenomas revealed somatic mutations in the PRKACA gene, which encodes the main catalytic subunit of cyclic AMP-dependent protein kinase (PKA) (c.617A>C in seven and c.595_596insCAC in one). Overall, PRKACA somatic mutations were identified in a total of 22/59 (37%) adenomas from patients with overt Cushing's syndrome while these mutations were not detectable in patients with subclinical hypercortisolism (n=40) or in other adrenal tumors (n=82). Among 35 patients with cortisol producing hyperplasias, 5 (with two patients as first degree relatives) carried germline copy number gain of the chromosome 19 region including the PRKACA gene. In vitro studies demonstrated impaired inhibition of the mutant PRKACA by the PKA regulatory subunit, while cells from patients with germline chromosomal gains showed increased protein levels; in both cases, PKA activity was increased. The present study shows that more than one third of cortisol-producing adenomas associated with overt Cushing syndrome harbor unique somatic mutations of the main cAMP-dependent kinase catalytic subunit, PRKACA resulting in constitutive PKA activation. While in these patients the mutation is present only in tumor cells, germline duplication of the PRKACA gene was identified in a group of patients with bilateral adrenal hyperplasias. This is the first report of genetic alterations of the catalytic subunit of PKA linked to human disease: Germline PRKACA duplications with bilateral adrenal hyperplasias and somatic PRKACA mutations with unilateral cortisol producing adrenal adenomas.
Citation Format: Fabio R. Faucz, Felix Beuschlei, Martin Fassnacht, Guilaume Assie, Davide Calebiro, Constantine Stratakis, Andrea Osswald, Cristina L. Ronchi, Thomas Wieland, Silviu Sbiera, Katrin Schaak, Anett Schmittfull, Thomas Schwarzmayr, Olivia Barreau, Delphine Vezzosi, Marthe Rizk-Rabbin, Ulrike Zabel, Eva Szarek, Paraskevi Salpea, Antonella Forlino, Annalisa Vetro, Orsetta Zuffardi, Caroline Kisker, Susanne Diener, Thomas Meitinger, Martin J. Lohse, Martin Reincke, Jerome Bertherat, Tim M. Strom, Bruno Allolio. Constitutive activation of PRKACA in adrenal Cushing's syndrome. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr LB-182. doi:10.1158/1538-7445.AM2014-LB-182
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Affiliation(s)
| | - Felix Beuschlei
- 2Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, München, Germany
| | - Martin Fassnacht
- 2Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, München, Germany
| | - Guilaume Assie
- 3INSERM U1016, CNRS UMR 8104, Institut Cochin, Faculté de Médecine Paris Descartes, Université Paris Descartes, Paris, France
| | - Davide Calebiro
- 4Rudolf Virchow Center for Experimental Biomedicine, University of Würzburg, Würzburg, Germany
| | | | - Andrea Osswald
- 2Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, München, Germany
| | - Cristina L. Ronchi
- 5Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - Thomas Wieland
- 6Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Silviu Sbiera
- 2Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, München, Germany
| | - Katrin Schaak
- 2Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, München, Germany
| | - Anett Schmittfull
- 5Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - Thomas Schwarzmayr
- 6Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Olivia Barreau
- 3INSERM U1016, CNRS UMR 8104, Institut Cochin, Faculté de Médecine Paris Descartes, Université Paris Descartes, Paris, France
| | - Delphine Vezzosi
- 3INSERM U1016, CNRS UMR 8104, Institut Cochin, Faculté de Médecine Paris Descartes, Université Paris Descartes, Paris, France
| | - Marthe Rizk-Rabbin
- 3INSERM U1016, CNRS UMR 8104, Institut Cochin, Faculté de Médecine Paris Descartes, Université Paris Descartes, Paris, France
| | - Ulrike Zabel
- 4Rudolf Virchow Center for Experimental Biomedicine, University of Würzburg, Würzburg, Germany
| | | | | | - Antonella Forlino
- 7Dipartimento di Medicina Molecolare, Genetica Medica, University of Pavia, Pavia, Italy
| | - Annalisa Vetro
- 7Dipartimento di Medicina Molecolare, Genetica Medica, University of Pavia, Pavia, Italy
| | - Orsetta Zuffardi
- 7Dipartimento di Medicina Molecolare, Genetica Medica, University of Pavia, Pavia, Italy
| | - Caroline Kisker
- 4Rudolf Virchow Center for Experimental Biomedicine, University of Würzburg, Würzburg, Germany
| | - Susanne Diener
- 6Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Thomas Meitinger
- 6Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Martin J. Lohse
- 4Rudolf Virchow Center for Experimental Biomedicine, University of Würzburg, Würzburg, Germany
| | - Martin Reincke
- 2Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, München, Germany
| | - Jerome Bertherat
- 3INSERM U1016, CNRS UMR 8104, Institut Cochin, Faculté de Médecine Paris Descartes, Université Paris Descartes, Paris, France
| | - Tim M. Strom
- 6Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Bruno Allolio
- 8Department of Medicine I, Endocrine and Diabetes Unit, University Hospital, University of Würzburg, Würzburg, Germany
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Poukoulidou T, Maiter D, Bertherat J, Beauloye V. A rare case of familial Cushing's syndrome with a common presentation of weight gain due to a mutation of the PRKAR1A gene causing isolated primary pigmented nodular adrenocortical disease. J Pediatr Endocrinol Metab 2014; 27:1005-9. [PMID: 24859511 DOI: 10.1515/jpem-2014-0018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/22/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cushing's syndrome (CS) is uncommon in childhood and adolescence. Variable presentation with subtle symptoms and signs can make diagnosis difficult. CASE REPORT We report the case of a 17-year-old girl referred for acne and progressive weight gain with an adrenocorticotropic hormone-independent CS. A computed tomography scan of the adrenals showed normal-sized adrenal glands with discrete bilateral shape irregularity. Bilateral adrenalectomy was performed and the histopathological findings were characteristic of primary pigmented nodular adrenocortical disease (PPNAD). Genetic analysis confirmed a germline mutation of the PRKAR1A gene. The same mutation was found in her sister, mother, and maternal grandfather. Endocrine tests showed that the sister of our patient also presented PPNAD requiring bilateral adrenalectomy and a similar histopathological pattern was observed. No other features of Carney complex was found among all affected members of the family. CONCLUSION It is exceptional for PPNAD to be an isolated phenomenon as well as being revealed by progressive weight gain in adolescence.
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