1
|
Bonnet-Serrano F, Devin-Genteuil C, Thomeret L, Laguillier-Morizot C, Leguy MC, Vaczlavik A, Bouys L, Zientek C, Bricaire L, Bessiène L, Guignat L, Libé R, Mosnier-Pudar H, Assié G, Groussin L, Guibourdenche J, Bertherat J. C-peptide level concomitant with hypoglycemia gives better performances than insulin for the diagnosis of endogenous hyperinsulinism: a single-center study of 159 fasting trials. Eur J Endocrinol 2023; 188:7032309. [PMID: 36756737 DOI: 10.1093/ejendo/lvad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/13/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Diagnosis of endogenous hyperinsulinism relies on the occurrence of a hypoglycemia, concomitant with inadequate high insulin and C-peptide levels. However, diagnostic cutoffs are not consensual among the different learned societies. The objective of this work was to propose optimized cutoffs for these three parameters for the diagnosis of endogenous hyperinsulinism. METHODS All the patients having performed a fasting trial in Cochin Hospital Endocrinology Department between February 2012 and August 2022 were included. The results of glycemia, insulin and C-peptide levels during fasting trial were collected and analyzed. RESULTS One hundred and fifty-nine patients were included: 26 with endogenous hyperinsulinism and 133 without endogenous hyperinsulinism. ROC analysis of glycemia nadir during fasting trial identified the value of 2.3 mmol/L as the optimal cutoff, ensuring a sensitivity of 100% associated with a specificity of 81%. ROC analysis of insulin and C-peptide levels concomitant with hypoglycemia <2.3 mmol/L showed very good diagnostic performances of both parameters with respective cutoffs of 3.1 mUI/L (=21.5 pmol/L; sensitivity = 96%; specificity = 92%) and 0.30 nmol/L (sensitivity = 96%; specificity = 100%). Insulin to glycemia ratio as well as C-peptide to glycemia ratio (in pmol/mmol) at the time of glycemia nadir did not show better diagnostic performances than C-peptide alone. CONCLUSION A C-peptide level 0.3 nmol/L concomitant with a hypoglycemia <2.3 mmol/L appears as the best criterion to make the diagnosis of endogenous hyperinsulinism. Insulin level can be underestimated on hemolyzed blood samples, frequently observed in fasting trial, and thus shows lower diagnostic performances.
Collapse
Affiliation(s)
- Fidéline Bonnet-Serrano
- Hormonology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
- Faculté de Médecine, Université Paris Cité, Paris 75005, France
- Inserm U1016-CNRS UMR8104, Institut Cochin, Paris 75014, France
| | | | - Louis Thomeret
- Faculté de Médecine, Université Paris Cité, Paris 75005, France
- Inserm U1016-CNRS UMR8104, Institut Cochin, Paris 75014, France
| | - Christelle Laguillier-Morizot
- Hormonology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
- Faculté de Médecine, Université Paris Cité, Paris 75005, France
- INSERM, Physiopathologie et pharmacotoxicologie placentaire humaine : Microbiote pré & post natal, F-75006 Paris, France
| | | | - Anna Vaczlavik
- Endocrinology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
| | - Lucas Bouys
- Faculté de Médecine, Université Paris Cité, Paris 75005, France
- Inserm U1016-CNRS UMR8104, Institut Cochin, Paris 75014, France
- Endocrinology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
| | - Corinne Zientek
- Hormonology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
| | - Léopoldine Bricaire
- Endocrinology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
| | - Laura Bessiène
- Endocrinology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
| | - Laurence Guignat
- Endocrinology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
| | - Rossela Libé
- Endocrinology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
| | - Helen Mosnier-Pudar
- Endocrinology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
| | - Guillaume Assié
- Faculté de Médecine, Université Paris Cité, Paris 75005, France
- Inserm U1016-CNRS UMR8104, Institut Cochin, Paris 75014, France
- Endocrinology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
| | - Lionel Groussin
- Faculté de Médecine, Université Paris Cité, Paris 75005, France
- Inserm U1016-CNRS UMR8104, Institut Cochin, Paris 75014, France
- Endocrinology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
| | - Jean Guibourdenche
- Hormonology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
- Faculté de Médecine, Université Paris Cité, Paris 75005, France
| | - Jérôme Bertherat
- Faculté de Médecine, Université Paris Cité, Paris 75005, France
- Inserm U1016-CNRS UMR8104, Institut Cochin, Paris 75014, France
- Endocrinology Department, Cochin Hospital, GHU APHP Centre, Paris 75014, France
| |
Collapse
|
2
|
Lugat A, Lasolle H, François M, Benhenda N, Bricaire L, Cornu E, Cristante J, Gitton A, Hadoux J, Kerlan V, Le Bras M, Mezzaroba V, Puerto M, Storey C, Ouzounian S, Donadille B, Raverot G, Drui D, Haissaguerre M. Pneumocystis pneumonia in patients with Cushing's syndrome: A French multicenter retrospective study. Ann Endocrinol (Paris) 2023; 84:37-44. [PMID: 36183804 DOI: 10.1016/j.ando.2022.09.020] [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] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Pneumocystis pneumonia (PcP) is an opportunistic infection occurring in immunocompromised patients. Cushing's syndrome (CS) impairs the immune system, and several authors have reported PcP in patients with CS. The present study aimed to characterize PcP occurring in a CS context and its management in French tertiary centers, in order to highlight the similarities in clinical presentation and treatment according to whether prophylaxis is implemented or not. METHODS This was a multicenter retrospective study conducted in several French University Hospitals and Cancer Centers. Patients with PcP and confirmed CS regardless of etiology were included. We excluded patients with other known causes of acquired immunodeficiency with increased risk of PcP. RESULTS Twenty-five patients were included. CS etiology was neoplastic in 84.0% of cases. CS clinical presentation associated predominant catabolic signs (76.0%), hypokalemia (91.7%) and lymphopenia (89.5%). CS was intense in most patients, with mean plasma cortisol levels at diagnosis of 2.424±1.102nmol/L and urinary free cortisol>10× the upper limit of normal in 85.0%. In all patients, PcP onset followed introduction of cortisol blockers, at a median 5.5 days. Patients were treated with 1 to 3 cortisol blockers, mainly metyrapone (88%), which significatively lowered plasma cortisol levels to 667±541nmol/L at the onset of PcP (P<0.001). PcP occurred in 7 patients despite prophylaxis. Finally, 60.0% patients were admitted to intensive care, and 20.0% died of PcP. CONCLUSION High mortality in patients with PcP implies that clinicians should be better informed about this rare infectious complication. Prophylaxis remains controversial, requiring comparative studies.
Collapse
Affiliation(s)
- Alexandre Lugat
- Medical Oncology Department, CHU de Nantes, 44000 Nantes, France; Nantes Université, Inserm 1307, CNRS 6075, Université d'Angers, CRCI2NA, Nantes, France
| | - Hélène Lasolle
- Endocrinology Department, Reference Centre for Rare Pituitary Diseases HYPO, "Groupement Hospitalier Est", Hospices Civils de Lyon, Bron, France; Lyon 1 University, Villeurbanne, France; INSERM U1052, CNRC UMR5286, Cancer Research Centre of Lyon (CRLC), Lyon, France
| | - Maud François
- Endocrinology, Diabetology and Nutrition, Centre Hospitalier Universitaire de Reims, Reims, France
| | | | - Léopoldine Bricaire
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance publique-Hôpitaux de Paris, 75014 Paris, France
| | - Erika Cornu
- Hypertension Unit, Hôpital Européen George-Pompidou, Paris, France
| | | | - Anne Gitton
- Endocrinology, Diabetology and Nutrition, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Julien Hadoux
- Department of Endocrine Oncology and Nuclear Medicine, Gustave-Roussy and University Paris-Saclay, Villejuif, France
| | - Véronique Kerlan
- Department of Endocrinology, Diabetes and Metabolic Diseases, Hôpital de la Cavale-Blanche, Brest, France
| | - Maëlle Le Bras
- Department of Endocrinology, Diabetology and Nutrition, l'institut du thorax, CHU Nantes, Nantes, France
| | - Vincent Mezzaroba
- Endocrinology Department, Reference Centre for Rare Pituitary Diseases HYPO, "Groupement Hospitalier Est", Hospices Civils de Lyon, Bron, France; Lyon 1 University, Villeurbanne, France; INSERM U1052, CNRC UMR5286, Cancer Research Centre of Lyon (CRLC), Lyon, France
| | - Marie Puerto
- Department of Endocrinology, Haut Levêque University Hospital, Bordeaux, France
| | - Caroline Storey
- Department of Paediatric Endocrinology and Diabetology, Robert-Debré Teaching Hospital, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Sophie Ouzounian
- Endocrinology Department, Saint-Antoine Hospital, Sorbonne Université, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Bruno Donadille
- Endocrinology Department, Saint-Antoine Hospital, Sorbonne Université, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Gérald Raverot
- Endocrinology Department, Reference Centre for Rare Pituitary Diseases HYPO, "Groupement Hospitalier Est", Hospices Civils de Lyon, Bron, France; Lyon 1 University, Villeurbanne, France; INSERM U1052, CNRC UMR5286, Cancer Research Centre of Lyon (CRLC), Lyon, France
| | - Delphine Drui
- Department of Endocrinology, Diabetology and Nutrition, l'institut du thorax, CHU Nantes, Nantes, France
| | - Magalie Haissaguerre
- Department of Endocrinology, Haut Levêque University Hospital, Bordeaux, France.
| |
Collapse
|
3
|
Assié G, Bertherat J, Bonnet-Serrano F, Borson-Chazot F, Bricaire L, Cavalcante IP, Chevalier N, Christin-Maitre S, Espiard S, Fassnacht M, Groussin L, Guignat L, Haissaguerre M, Jouinot A, Jublanc C, Kamenicky P, Kroiss M, Lefebvre H, Libé R, Maione L, North MO, Pasmant E, Perlemoine K, Raffin-Sanson ML, Ragazzon B, Raverot G, Reincke M, Tabarin A, Touraine P, Vaczlavik A, Vaduva P, Vantyghem MC, Vatier C, Bouys L. OR12-3 Identification of Predictive Criteria for the Primary Bilateral Macronodular Adrenal Hyperplasia Gene ARMC5: A European Series of 352 Unselected Patients. J Endocr Soc 2022; 6. [PMCID: PMC9627251 DOI: 10.1210/jendso/bvac150.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective Primary Bilateral Macronodular Adrenal Hyperplasia (PBMAH) is a heterogeneous disease characterized by adrenal macronodules and variable levels of cortisol excess, with not clearly established clinical diagnostic criteria. PBMAH can be caused by germline inactivating variants of the tumor suppressor gene ARMC5. We aimed to better characterize ARMC5-mutated and wild-type patients and to identify predictive criteria for ARMC5 variants. Methods We included 352 consecutive index patients from 12 European centers, sequenced for germline ARMC5alteration because of PBMAH suspicion, regardless their clinical presentation. Clinical, biological and imaging data were collected retrospectively. Sensitivity, specificity, negative and positive predictive values for the prediction of ARMC5variant were calculated for various parameters. Results 53 patients (15.1%) carried 40 different ARMC5 germline pathogenic variants and showed a more distinct phenotype than non-mutated patients for cortisol excess (24-hour urinary free cortisol 2.32 vs. 1.11-fold ULN, respectively, p<0.001; plasma cortisol after 1 mg dexamethasone suppression test 337.5 vs. 142.4 nmol/L, respectively, p<0.001) and adrenal morphology (maximal adrenal diameter 104 vs. 83 mm, respectively, p<0.001; 9.8 vs. 3.2 adrenal nodules, respectively, p<0.001), with more frequent metabolic complications such as diabetes (51.0 vs. 35.4%, respectively, p=0.038) and hypertension (88.0 vs. 70.6%, respectively, p=0.014). Thus, ARMC5-mutated patients were more often surgically or medically treated in order to control cortisol excess (67.9 vs. 36.8%, respectively, p<0.001). Among operated patients, a bilateral adrenalectomy was more often performed in those carrying an ARMC5 pathogenic variant than in wild-type patients (56.7 vs. 32.3%, respectively, p=0.019). Even if all patients were more often primarily investigated in front of adrenal incidentaloma than clinical evidence for Cushing's syndrome (73 vs. 27%, respectively), ARMC5 patients were more often referred for Cushing's syndrome than wild-type patients (44 vs. 24%, respectively, p=0.004). To improve the ARMC5 mutation rate, the association of a clear bilateral adrenal involvement with evidence for autonomous cortisol secretion (defined at least by a plasma cortisol after 1 mg dexamethasone suppression test above 50 nmol/L) holds the better yield with a 27% specificity and a 20% positive predictive value, and a 100% sensitivity and negative predictive value, meaning that a useless genotyping could have been avoided for more than 20% of negative patients, without missing any mutated patient. Conclusion We report the largest series of index case patients investigated for ARMC5 with clinical characterization and confirm that ARMC5 pathogenic variants are associated with a more severe phenotype. In order to minimize negative ARMC5 screening, genotyping could be limited to clear bilateral adrenal involvement on imaging and autonomous cortisol secretion, with an optimum yield for routine clinical practice. These findings will also help better define PBMAH diagnostic criteria. Presentation: Sunday, June 12, 2022 11:30 a.m. - 11:45 a.m.
Collapse
|
4
|
Bonnet-Serrano F, Poirier J, Vaczlavik A, Laguillier-Morizot C, Blanchet B, Baron S, Guignat L, Bessiene L, Bricaire L, Groussin L, Assié G, Guibourdenche J, Bertherat J. Differences in the spectrum of steroidogenic enzyme inhibition between Osilodrostat and Metyrapone in ACTH-dependent Cushing syndrome patients. Eur J Endocrinol 2022; 187:315-322. [PMID: 35699971 DOI: 10.1530/eje-22-0208] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/14/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Osilodrostat is a new 11β-hydroxylase inhibitor with a mode of action analogous to Metyrapone. The objective of this study was to compare steroidogenic profiles in patients treated with either Osilodrostat or Metyrapone for adrenocorticotrophic hormone (ACTH)-dependent Cushing's syndrome (CS). METHODS Patients followed up at Cochin hospital Endocrinology department between March 2019 and December 2021 for an ACTH-dependent CS, controlled by either Osilodrostat or Metyrapone, were included. A serum profile of five steroids (cortisol, 11-deoxycortisol, 17-hydroxyprogesterone, androstenedione and testosterone) was determined using UPLC- tandem mass spectrometry (UPLC-MS/MS). RESULTS Nineteen patients treated with Osilodrostat, eight patients treated with Metyrapone and six patients treated with consecutive Metyrapone then Osilodrostat were included. Hypocortisolism (basal cortisol <100 nmol/L) was found in 48% of patients treated with Osilodrostat and 7% of patients treated with Metyrapone. 11-deoxycortisol and androstenedione levels were higher in patients treated with Metyrapone (80.9 (2.2-688.4) and 14.9 (2.5-54.3) nmol/L, respectively) than in patients treated with Osilodrostat (10.3 (0.5-71.9) and 4.0 (0.3-13.3) nmol/L) (P = 0.0009 and P = 0.0005). Testosterone level in women was also higher in Metyrapone group (3.3 (0.93-4.82) nmol/L vs 1.31(0.13-5.09) nmol/L, P = 0.0146). CYP11B1 activity (11-deoxycortisol/cortisol) was not significantly different between the two groups. CYP21A2 activity (17OHprogesterone/11-deoxycortisol) and CYP17A1 activity (17OHprogesterone/androstenedione) were significantly decreased in Osilodrostat group (P < 0.0001). CONCLUSION In patients with ACTH-dependent CS, the use of CYP11B1 inhibitors in routine care suggests that Osilodrostat has a less specific effect on the inhibition of steroidogenic enzymes than Metyrapone. This might explain a smaller increase in 11-deoxycortisol and androgen levels in patients treated with Osilodrostat.
Collapse
Affiliation(s)
- Fidéline Bonnet-Serrano
- Assistance Publique - Hôpitaux de Paris, UF d'Hormonologie - Hôpitaux Universitaires Paris-Centre, Paris, France
- Institut Cochin, Inserm U1016-CNRS UMR8104-Université de Paris, Paris, France
| | - Jonathan Poirier
- Assistance Publique - Hôpitaux de Paris, Service d'Endocrinologie et Maladies Métaboliques - Hôpitaux Universitaires Paris-Centre, Paris, France
| | - Anna Vaczlavik
- Institut Cochin, Inserm U1016-CNRS UMR8104-Université de Paris, Paris, France
- Assistance Publique - Hôpitaux de Paris, Service d'Endocrinologie et Maladies Métaboliques - Hôpitaux Universitaires Paris-Centre, Paris, France
| | - Christelle Laguillier-Morizot
- Assistance Publique - Hôpitaux de Paris, UF d'Hormonologie - Hôpitaux Universitaires Paris-Centre, Paris, France
- Faculté de Pharmacie Paris Centre, Université de Paris, Paris, France
| | - Benoît Blanchet
- Assistance Publique - Hôpitaux de Paris, Department of Pharmacokinetics and Pharmacochemistry, Cochin Hospital, Paris, France
- UMR8038 CNRS, U1268 INSERM, Faculty of Pharmacy, PRES Sorbonne Paris Cité, University of Paris, Paris, France
| | - Stéphanie Baron
- Hopital Europeen Georges Pompidou, Physiology, Paris, France
| | - Laurence Guignat
- Assistance Publique - Hôpitaux de Paris, Service d'Endocrinologie et Maladies Métaboliques - Hôpitaux Universitaires Paris-Centre, Paris, France
| | - Laura Bessiene
- Assistance Publique - Hôpitaux de Paris, Service d'Endocrinologie et Maladies Métaboliques - Hôpitaux Universitaires Paris-Centre, Paris, France
| | - Léopoldine Bricaire
- Assistance Publique - Hôpitaux de Paris, Service d'Endocrinologie et Maladies Métaboliques - Hôpitaux Universitaires Paris-Centre, Paris, France
| | - Lionel Groussin
- Institut Cochin, Inserm U1016-CNRS UMR8104-Université de Paris, Paris, France
- Assistance Publique - Hôpitaux de Paris, Service d'Endocrinologie et Maladies Métaboliques - Hôpitaux Universitaires Paris-Centre, Paris, France
| | - Guillaume Assié
- Institut Cochin, Inserm U1016-CNRS UMR8104-Université de Paris, Paris, France
- Assistance Publique - Hôpitaux de Paris, Service d'Endocrinologie et Maladies Métaboliques - Hôpitaux Universitaires Paris-Centre, Paris, France
| | - Jean Guibourdenche
- Assistance Publique - Hôpitaux de Paris, UF d'Hormonologie - Hôpitaux Universitaires Paris-Centre, Paris, France
- Faculté de Pharmacie Paris Centre, Université de Paris, Paris, France
| | - Jérôme Bertherat
- Institut Cochin, Inserm U1016-CNRS UMR8104-Université de Paris, Paris, France
- Assistance Publique - Hôpitaux de Paris, Service d'Endocrinologie et Maladies Métaboliques - Hôpitaux Universitaires Paris-Centre, Paris, France
| |
Collapse
|
5
|
Bouys L, Vaczlavik A, Jouinot A, Vaduva P, Espiard S, Assié G, Libé R, Perlemoine K, Ragazzon B, Guignat L, Groussin L, Bricaire L, Cavalcante IP, Bonnet-Serrano F, Lefebvre H, Raffin-Sanson ML, Chevalier N, Touraine P, Jublanc C, Vatier C, Raverot G, Haissaguerre M, Maione L, Kroiss M, Fassnacht M, Christin-Maitre S, Pasmant E, Borson-Chazot F, Tabarin A, Vantyghem MC, Reincke M, Kamenicky P, North MO, Bertherat J. Identification of predictive criteria for pathogenic variants of primary bilateral macronodular adrenal hyperplasia (PBMAH) gene ARMC5 in 352 unselected patients. Eur J Endocrinol 2022; 187:123-134. [PMID: 35521700 DOI: 10.1530/eje-21-1032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 04/14/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Primary bilateral macronodular adrenal hyperplasia (PBMAH) is a heterogeneous disease characterized by adrenal macronodules and variable levels of cortisol excess, with not clearly established clinical diagnostic criteria. It can be caused by ARMC5 germline pathogenic variants. In this study, we aimed to identify predictive criteria for ARMC5 variants. METHODS We included 352 consecutive index patients from 12 European centers, sequenced for germline ARMC5 alteration. Clinical, biological and imaging data were collected retrospectively. RESULTS 52 patients (14.8%) carried ARMC5 germline pathogenic variants and showed a more distinct phenotype than non-mutated patients for cortisol excess (24-h urinary free cortisol 2.32 vs 1.11-fold ULN, respectively, P < 0.001) and adrenal morphology (maximal adrenal diameter 104 vs 83 mm, respectively, P < 0.001) and were more often surgically or medically treated (67.9 vs 36.8%, respectively, P < 0.001). ARMC5-mutated patients showed a constant, bilateral adrenal involvement and at least a possible autonomous cortisol secretion (defined by a plasma cortisol after 1 mg dexamethasone suppression above 50 nmol/L), while these criteria were not systematic in WT patients (78.3%). The association of these two criteria holds a 100% sensitivity and a 100% negative predictive value for ARMC5 pathogenic variant. CONCLUSION We report the largest series of index patients investigated for ARMC5 and confirm that ARMC5 pathogenic variants are associated with a more severe phenotype in most cases. To minimize negative ARMC5 screening, genotyping should be limited to clear bilateral adrenal involvement and autonomous cortisol secretion, with an optimum sensitivity for routine clinical practice. These findings will also help to better define PBMAH diagnostic criteria.
Collapse
Affiliation(s)
- Lucas Bouys
- Université Paris-Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France
| | - Anna Vaczlavik
- Université Paris-Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Anne Jouinot
- Université Paris-Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
- Institut Curie, INSERM U900, MINES ParisTech, PSL-Research University, CBIO-Centre for Computational Biology, Paris, France
| | - Patricia Vaduva
- Université Paris-Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France
- Department of Endocrinology, Diabetology and Nutrition, CHU Rennes, Rennes, France
| | - Stéphanie Espiard
- Department of Endocrinology, Diabetology, Metabolism and Nutrition, CHU Lille, Inserm U1190, Lille, France
| | - Guillaume Assié
- Université Paris-Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Rossella Libé
- Université Paris-Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Karine Perlemoine
- Université Paris-Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France
| | - Bruno Ragazzon
- Université Paris-Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France
| | - Laurence Guignat
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Lionel Groussin
- Université Paris-Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Léopoldine Bricaire
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Fidéline Bonnet-Serrano
- Université Paris-Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France
- Unit of Hormonology, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Hervé Lefebvre
- Department of Endocrinology, Diabetes and Metabolic Diseases, CHU Rouen, Rouen, France
| | - Marie-Laure Raffin-Sanson
- Department of Endocrinology, Diabetology and Nutrition, Hôpital Ambroise Paré, Assistance Publique Hôpitaux de Paris, Boulogne-Billancourt, France
| | - Nicolas Chevalier
- Department of Endocrinology, Diabetology and Reproduction, CHU Nice, Nice, France
| | - Philippe Touraine
- Department of Endocrinology and Reproduction, Hôpital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Christel Jublanc
- Department of Endocrinology and Metabolism, Hôpital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Camille Vatier
- Department of Endocrinology, Diabetology and Reproduction, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Gérald Raverot
- Department of Endocrinology, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Magalie Haissaguerre
- Department of Endocrinology, Diabetology and Nutrition, Hôpital Haut-Lévêque, CHU Bordeaux, Bordeaux, France
| | - Luigi Maione
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Department of Endocrinology and Reproduction, Reference Center for Rare Pituitary Diseases, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Matthias Kroiss
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital of Würzburg, University of Würzburg, Würzburg, Germany
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital of Würzburg, University of Würzburg, Würzburg, Germany
| | - Sophie Christin-Maitre
- Department of Endocrinology, Diabetology and Reproduction, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Eric Pasmant
- Université Paris-Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France
- Unit of Oncogenetics, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Françoise Borson-Chazot
- Department of Endocrinology, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Antoine Tabarin
- Department of Endocrinology, Diabetology and Nutrition, Hôpital Haut-Lévêque, CHU Bordeaux, Bordeaux, France
| | - Marie-Christine Vantyghem
- Department of Endocrinology, Diabetology, Metabolism and Nutrition, CHU Lille, Inserm U1190, Lille, France
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Peter Kamenicky
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Department of Endocrinology and Reproduction, Reference Center for Rare Pituitary Diseases, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Marie-Odile North
- Unit of Oncogenetics, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jérôme Bertherat
- Université Paris-Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Paris, France
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| |
Collapse
|
6
|
Gauthé M, Dierick-Gallet A, Delbot T, Bricaire L, Bertherat J, North MO, Cochand-Priollet B, Bouchard P, Talbot JN, Groussin L, Gaujoux S. 18F-fluorocholine PET/CT in MEN1 Patients with Primary Hyperparathyroidism. World J Surg 2020; 44:3761-3769. [PMID: 32681321 DOI: 10.1007/s00268-020-05695-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Primary hyperparathyroidism (HPT1) is the most frequent endocrinopathy in multiple endocrine neoplasia type 1 (MEN1). Its surgical management is challenging. We aimed to describe and compare the imaging findings of parathyroid ultrasound (US), sestaMIBI scintigraphy (sestaMIBI), and 18F-fluorocholine (FCH) PET/CT in a series of MEN1 patients with HPT1. METHODS Retrospective analysis of a cohort of MEN1 patients with HPT1 assessed by parathyroid US, sestaMIBI scintigraphy and SPECT/CT, and FCH-PET/CT for potential surgery between 2015 and 2019. RESULTS Twenty-two patients with a confirmed diagnosis of MEN1 who presented with HPT1 and were assessed by the 3 imaging modalities were included. After imaging workups, 11 patients were operated on for the first time, 4 underwent a redo surgery, and 7 did not undergo an operation. The overall patient-based positivity rate of imaging was 91% (20 of 22) for parathyroid US and 96% (21 of 22) for both sestaMIBI and FCH-PET/CT. The 3 imaging modalities demonstrated negative findings in 1/22 patient who did not undergo surgery. Overall, 3 pathologic glands were not detected by any imaging technique. SestaMIBI and FCH-PET/CT both resulted in the same 3 false-positive results in ectopic areas with a significant uptake on two thymic carcinoid tumors and one inflammatory lymph node. FCH-PET/CT provided more surgically relevant data than sestaMIBI in 4/11 patients with initial surgery and in 1/4 patient who underwent redo surgery. CONCLUSIONS Compared to sestaMIBI scintigraphy, FCH-PET/CT provides additional information regarding the number of pathologic parathyroid glands and their localization in MEN1 patients with HPT1.
Collapse
Affiliation(s)
- Mathieu Gauthé
- Department of Nuclear Medicine, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France.,AP-HP Health Economics Research Unit, INSERM UMR 1153-CRESS METHODS, Paris, France
| | - Anne Dierick-Gallet
- Department of Endocrinology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université de Paris, 27, rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Thierry Delbot
- Department of Nuclear Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Léopoldine Bricaire
- Department of Endocrinology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université de Paris, 27, rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Jérôme Bertherat
- Department of Endocrinology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université de Paris, 27, rue du Faubourg Saint Jacques, 75014, Paris, France.,Université de Paris, Paris, France.,Institut Cochin, Inserm Unité 1016, Centre National de La Recherche Scientifique Unité Mixte de Recherche 8104, Université de Paris, 75014, Paris, France
| | - Marie-Odile North
- Department of Genetic, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Phillipe Bouchard
- Department of Endocrinology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Noël Talbot
- Department of Nuclear Medicine, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Lionel Groussin
- Department of Endocrinology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université de Paris, 27, rue du Faubourg Saint Jacques, 75014, Paris, France. .,Université de Paris, Paris, France. .,Institut Cochin, Inserm Unité 1016, Centre National de La Recherche Scientifique Unité Mixte de Recherche 8104, Université de Paris, 75014, Paris, France.
| | - Sébastien Gaujoux
- Université de Paris, Paris, France.,Institut Cochin, Inserm Unité 1016, Centre National de La Recherche Scientifique Unité Mixte de Recherche 8104, Université de Paris, 75014, Paris, France.,Department of Pancreatic and Endocrine Surgery, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| |
Collapse
|
7
|
Cottereau AS, Bricaire L, Arrondeau J, Dechmi A, Montravers F, Coriat R, Clerc J, Groussin L, Tenenbaum F. Prolonged response to 177Lu-DOTATATE therapy of a bone marrow infiltration in a refractory thymic neuro endocrine tumor. Invest New Drugs 2019; 38:1196-1199. [PMID: 31650444 DOI: 10.1007/s10637-019-00865-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
Thymic neuro endocrine tumor (tNET) are extremely rare malignancies with poor prognosis, requiring investigation of novel therapeutic approaches. 177Lu-DOTATATE is a successful systemic treatment modality in patients with metastatic gastroenteropancreatic but it role in tNET is not yet well established. Here we report a case of a 39-year-old man with refractory bone marrow infiltration of a tNET, treated by 4 cycles of peptide receptor radionuclide therapy (PRRT) with 177Lu DOTATATE. Since the first cycle, clinical symptoms were substantially decreased, without any severe subacute haematological toxicity. Three months after the end of PRRT, both 68Ga-DOTATOC and 18F-FDG PET confirmed a partial response, already suggested by 177Lu-DOTATATE treatment scan with a significant decrease of the bone marrow uptake between the first and fourth cycle. This report highlights that PRRT could be an effective therapeutic option for advanced bone metastatic disease tNET, with the significant benefit of alleviation of bone pain and radiologic response, without severe or irreversible haematotoxicity.
Collapse
Affiliation(s)
- Anne Ségolène Cottereau
- Department of Nuclear Medicine, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France. .,René Descartes University, Paris, France.
| | - Léopoldine Bricaire
- René Descartes University, Paris, France.,Department of Endocrinology, Cochin Hospital, AP-HP, Paris, France
| | - Jennifer Arrondeau
- René Descartes University, Paris, France.,Department of Medical Oncology, Cochin Hospital, AP-HP, Paris, France
| | - Amina Dechmi
- Department of Nuclear Medicine, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.,René Descartes University, Paris, France
| | | | - Romain Coriat
- René Descartes University, Paris, France.,Department of Gastro Enterology, Cochin Hospital, AP-HP, Paris, France
| | - Jerome Clerc
- Department of Nuclear Medicine, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.,René Descartes University, Paris, France
| | - Lionel Groussin
- René Descartes University, Paris, France.,Department of Endocrinology, Cochin Hospital, AP-HP, Paris, France
| | - Florence Tenenbaum
- Department of Nuclear Medicine, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.,René Descartes University, Paris, France
| |
Collapse
|
8
|
Garinet S, Nectoux J, Neou M, Pasmant E, Jouinot A, Sibony M, Orhant L, Pipoli da Fonseca J, Perlemoine K, Bricaire L, Groussin L, Soubrane O, Dousset B, Libe R, Letourneur F, Bertherat J, Assié G. Detection and monitoring of circulating tumor DNA in adrenocortical carcinoma. Endocr Relat Cancer 2018; 25:L13-L17. [PMID: 29212777 DOI: 10.1530/erc-17-0467] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 12/06/2017] [Indexed: 02/02/2023]
Affiliation(s)
- Simon Garinet
- Institut Cochin INSERM U1016/UMR8104 and CNRS UMR-S8104Paris, France
| | - Juliette Nectoux
- Laboratory of Genetics and Molecular BiologyHôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Mario Neou
- Institut Cochin INSERM U1016/UMR8104 and CNRS UMR-S8104Paris, France
| | - Eric Pasmant
- Laboratory of Genetics and Molecular BiologyHôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France
- INSERM UMR745Biological and Pharmaceutical Sciences University, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Anne Jouinot
- Institut Cochin INSERM U1016/UMR8104 and CNRS UMR-S8104Paris, France
- Department of Medical OncologyHôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Mathilde Sibony
- Department of PathologyHôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Lucie Orhant
- Laboratory of Genetics and Molecular BiologyHôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France
| | | | - Karine Perlemoine
- Institut Cochin INSERM U1016/UMR8104 and CNRS UMR-S8104Paris, France
| | - Léopoldine Bricaire
- Department of EndocrinologyCochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Lionel Groussin
- Institut Cochin INSERM U1016/UMR8104 and CNRS UMR-S8104Paris, France
- Department of EndocrinologyCochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Olivier Soubrane
- Department of Hepato-Pancreato-Biliary SurgeryHôpital Beaujon, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Bertrand Dousset
- Department of Digestive and Endocrine SurgeryAssistance Publique - Hôpitaux de Paris, Paris, France
| | - Rossella Libe
- Institut Cochin INSERM U1016/UMR8104 and CNRS UMR-S8104Paris, France
- Department of EndocrinologyCochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | | | - Jérome Bertherat
- Institut Cochin INSERM U1016/UMR8104 and CNRS UMR-S8104Paris, France
- Department of EndocrinologyCochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
- Reference Center for Rare Adrenal DiseasesReference Center for Rare Adrenal Cancer Network COMETE, Hôpital Cochin, AssistancePublique - Hôpitaux de Paris, Paris, France
| | - Guillaume Assié
- Institut Cochin INSERM U1016/UMR8104 and CNRS UMR-S8104Paris, France
- Department of EndocrinologyCochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
- Reference Center for Rare Adrenal DiseasesReference Center for Rare Adrenal Cancer Network COMETE, Hôpital Cochin, AssistancePublique - Hôpitaux de Paris, Paris, France
| |
Collapse
|
9
|
Buffet C, Hecale-Perlemoine K, Bricaire L, Dumont F, Baudry C, Tissier F, Bertherat J, Cochand-Priollet B, Raffin-Sanson ML, Cormier F, Groussin L. DUSP5 and DUSP6, two ERK specific phosphatases, are markers of a higher MAPK signaling activation in BRAF mutated thyroid cancers. PLoS One 2017; 12:e0184861. [PMID: 28910386 PMCID: PMC5599027 DOI: 10.1371/journal.pone.0184861] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 09/03/2017] [Indexed: 02/05/2023] Open
Abstract
Background Molecular alterations of the MAPK pathway are frequently observed in papillary thyroid carcinomas (PTCs). It leads to a constitutive activation of the signalling pathway through an increase in MEK and ERK phosphorylation. ERK is negatively feedback-regulated by Dual Specificity Phosphatases (DUSPs), especially two ERK-specific DUSPs, DUSP5 (nuclear) and DUSP6 (cytosolic). These negative MAPK regulators may play a role in thyroid carcinogenesis. Methods MAPK pathway activation was analyzed in 11 human thyroid cancer cell lines. Both phosphatases were studied in three PCCL3 rat thyroid cell lines that express doxycycline inducible PTC oncogenes (RET/PTC3, H-RASV12 or BRAFV600E). Expression levels of DUSP5 and DUSP6 were quantified in 39 human PTCs. The functional role of DUSP5 and DUSP6 was investigated through their silencing in two human BRAFV600E carcinoma cell lines. Results BRAFV600E human thyroid cancer cell lines expressed higher phospho-MEK levels but not higher phospho-ERK levels. DUSP5 and DUSP6 are specifically induced by the MEK-ERK pathway in the three PTC oncogenes inducible thyroid cell lines. This negative feedback loop explains the tight regulation of p-ERK levels. DUSP5 and DUSP6 mRNA are overexpressed in human PTCs, especially in BRAFV600E mutated PTCs. DUSP5 and/or DUSP6 siRNA inactivation did not affect proliferation in two BRAFV600E mutated cell lines, which may be explained by a compensatory increase in other phosphatases. In the light of this, we observed a marked DUSP6 upregulation upon DUSP5 inactivation. Despite this, DUSP5 and DUSP6 positively control cell migration and invasion. Conclusions Our results are in favor of a stronger activation of the MAPK pathway in BRAFV600E PTCs. DUSP5 and DUSP6 have pro-tumorigenic properties in two BRAFV600E PTC cell line models.
Collapse
Affiliation(s)
- Camille Buffet
- INSERM, U1016, Institut Cochin, Paris, France
- CNRS, UMR8104, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, France
- * E-mail:
| | - Karine Hecale-Perlemoine
- INSERM, U1016, Institut Cochin, Paris, France
- CNRS, UMR8104, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, France
| | - Léopoldine Bricaire
- INSERM, U1016, Institut Cochin, Paris, France
- CNRS, UMR8104, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, France
| | - Florent Dumont
- INSERM, U1016, Institut Cochin, Paris, France
- CNRS, UMR8104, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, France
| | - Camille Baudry
- INSERM, U1016, Institut Cochin, Paris, France
- CNRS, UMR8104, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, France
| | - Frédérique Tissier
- INSERM, U1016, Institut Cochin, Paris, France
- CNRS, UMR8104, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, France
- Department of Pathology, Pitié-Salpêtrière Hospital, Paris, France
| | - Jérôme Bertherat
- INSERM, U1016, Institut Cochin, Paris, France
- CNRS, UMR8104, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, France
- Department of Endocrinology, Cochin Hospital, Paris, France
| | | | | | - Françoise Cormier
- INSERM, U1016, Institut Cochin, Paris, France
- CNRS, UMR8104, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, France
| | - Lionel Groussin
- INSERM, U1016, Institut Cochin, Paris, France
- CNRS, UMR8104, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, France
- Department of Endocrinology, Cochin Hospital, Paris, France
| |
Collapse
|
10
|
Paepegaey AC, Cochand-Priollet B, Louiset E, Sarfati PO, Alifano M, Burnichon N, Bienvenu-Perrard M, Lahlou N, Bricaire L, Groussin L. Long-Term Control of Hypercortisolism by Vandetanib in a Case of Medullary Thyroid Carcinoma with a Somatic RET Mutation. Thyroid 2017; 27:587-590. [PMID: 28068878 DOI: 10.1089/thy.2016.0334] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Medullary thyroid carcinomas (MTCs) complicated by ectopic Cushing's syndrome (CS) have a poor prognosis, partially due to the difficulty in controlling hypercortisolism by adrenal blocking drugs. Recent reports (including the initial follow-up of this patient) have suggested that tyrosine kinase inhibitors (TKIs) may be a therapeutic option due to an anti-secretory action on ACTH. However, there is a lack of long-term follow-up studies. PATIENT FINDINGS The case is reported of a 58-year-old man with MTC-related CS resistant to a combination of several anti-cortisolic drugs. Vandetanib, an oral multi-TKI that targets RET in particular, was initiated, and a rapid reversal of the hypercortisolism was observed without any change in tumor size. Vandetanib was briefly interrupted twice, once for 45 days because of side effects and a second time for 10 days to schedule surgical debulking. Each time, plasma cortisol and calcitonin levels increased after TKI withdrawal and were rapidly lowered by vandetanib reintroduction. As described in other cases of CS caused by MTC, a marked ACTH increase after desmopressin stimulation was observed before vandetanib therapy. In contrast, a blunted ACTH response to desmopressin was documented throughout the course of vandetanib treatment. This modulation of the tumoral ACTH production is a strong argument in favor of a TKI anti-secretory action. A left thyroid lobectomy and a modified neck dissection were performed one year after the initiation of vandetanib in order to reduce the tumor mass. An activating M918T RET (c.2753T>C) somatic mutation was identified in a lymph node metastasis. CONCLUSION Three years and eight months after vandetanib initiation, there was no sign of recurrence of hypercortisolism. This case illustrates the long-term effectiveness of vandetanib in maintaining the control of hypercortisolism in MTC-related CS.
Collapse
Affiliation(s)
- Anne-Cécile Paepegaey
- 1 Department of Endocrinology, Cochin Hospital , Assistance Publique Hôpitaux de Paris, Paris, France
- 2 Université Paris Descartes , PRES Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Béatrix Cochand-Priollet
- 2 Université Paris Descartes , PRES Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- 3 Department of Pathology, Cochin Hospital , Assistance Publique Hôpitaux de Paris, Paris, France
| | - Estelle Louiset
- 4 INSERM, Unité 982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Mont-Saint-Aignan, France; Institute for Research and Innovation in Biomedicine, Normandie Rouen University , Mont-Saint-Aignan, France
| | - Pierre-Olivier Sarfati
- 5 Department of Digestive and Endocrine Surgery, Cochin Hospital , Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marco Alifano
- 2 Université Paris Descartes , PRES Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- 6 Department of Thoracic Surgery, Cochin Hospital , Assistance Publique Hôpitaux de Paris, Paris, France
| | - Nelly Burnichon
- 2 Université Paris Descartes , PRES Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- 7 INSERM, UMR970, Paris-Cardiovascular Research Center , Paris, France
- 8 Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou , Service de Génétique, Paris, France
| | - Marie Bienvenu-Perrard
- 9 Department of Nuclear Medicine, Cochin Hospital , Assistance Publique Hôpitaux de Paris, Paris, France
| | - Najiba Lahlou
- 2 Université Paris Descartes , PRES Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- 10 Department of Hormonal Biology, Cochin Hospital , Assistance Publique Hôpitaux de Paris, Paris, France
| | - Léopoldine Bricaire
- 1 Department of Endocrinology, Cochin Hospital , Assistance Publique Hôpitaux de Paris, Paris, France
| | - Lionel Groussin
- 1 Department of Endocrinology, Cochin Hospital , Assistance Publique Hôpitaux de Paris, Paris, France
- 2 Université Paris Descartes , PRES Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| |
Collapse
|
11
|
Bricaire L, Villa C, Brière M, Edjlali M, Larousserie F, d'Ussel M, Bertherat J, Boudou-Rouquette P, Groussin L. Pituitary Lesion of Unknown Origin: Think Epithelioid Angiosarcoma. J Endocr Soc 2017; 1:72-74. [PMID: 29264447 PMCID: PMC5677211 DOI: 10.1210/js.2016-1010] [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: 10/04/2016] [Accepted: 12/13/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Chiara Villa
- Department of Pathology, Hôpital Foch, 92151, Suresnes, France.,Institut Cochin, Inserm Unité 1016, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8104, Descartes University, 75014, Paris, France
| | | | - Myriam Edjlali
- Université Paris Descartes, Sorbonne Paris Cité, 75005, Paris, France.,Department of Neuroradiology, INSERM UMR894, Hôpital Sainte-Anne, 75013, Paris, France
| | - Frédérique Larousserie
- Oncology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, 75005, Paris, France
| | - Marguerite d'Ussel
- Department of Emergency Unit, Hôpital Saint-Joseph, Paris, 75015, France; and
| | - Jérôme Bertherat
- Departments of Endocrinology.,Université Paris Descartes, Sorbonne Paris Cité, 75005, Paris, France.,Institut Cochin, Inserm Unité 1016, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8104, Descartes University, 75014, Paris, France
| | | | - Lionel Groussin
- Departments of Endocrinology.,Université Paris Descartes, Sorbonne Paris Cité, 75005, Paris, France.,Institut Cochin, Inserm Unité 1016, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8104, Descartes University, 75014, Paris, France
| |
Collapse
|
12
|
Buffet C, Catelli MG, Hecale-Perlemoine K, Bricaire L, Garcia C, Gallet-Dierick A, Rodriguez S, Cormier F, Groussin L. Dual Specificity Phosphatase 5, a Specific Negative Regulator of ERK Signaling, Is Induced by Serum Response Factor and Elk-1 Transcription Factor. PLoS One 2015; 10:e0145484. [PMID: 26691724 PMCID: PMC4687125 DOI: 10.1371/journal.pone.0145484] [Citation(s) in RCA: 21] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 10/29/2015] [Indexed: 12/11/2022] Open
Abstract
Serum stimulation of mammalian cells induces, via the MAPK pathway, the nuclear protein DUSP5 (dual-specificity phosphatase 5), which specifically interacts with and inactivates the ERK1/2 MAP kinases. However, molecular mechanisms underlying DUSP5 induction are not well known. Here, we found that the DUSP5 mRNA induction depends on a transcriptional regulation by the MAPK pathway, without any modification of the mRNA stability. Two contiguous CArG boxes that bind serum response factor (SRF) were found in a 1 Kb promoter region, as well as several E twenty-six transcription factor family binding sites (EBS). These sites potentially bind Elk-1, a transcription factor activated by ERK1/2. Using wild type or mutated DUSP5 promoter reporters, we demonstrated that SRF plays a crucial role in serum induction of DUSP5 promoter activity, the proximal CArG box being important for SRF binding in vitro and in living cells. Moreover, in vitro and in vivo binding data of Elk-1 to the same promoter region further demonstrate a role for Elk-1 in the transcriptional regulation of DUSP5. SRF and Elk-1 form a ternary complex (Elk-1-SRF-DNA) on DUSP5 promoter, consequently providing a link to an important negative feedback tightly regulating phosphorylated ERK levels.
Collapse
Affiliation(s)
- Camille Buffet
- Endocrinology-Metabolism-Diabetes Department, Institut Cochin, Université Paris Descartes, CNRS (UMR8104), INSERM U1016, Paris, France
| | - Maria-Grazia Catelli
- Endocrinology-Metabolism-Diabetes Department, Institut Cochin, Université Paris Descartes, CNRS (UMR8104), INSERM U1016, Paris, France
| | - Karine Hecale-Perlemoine
- Endocrinology-Metabolism-Diabetes Department, Institut Cochin, Université Paris Descartes, CNRS (UMR8104), INSERM U1016, Paris, France
| | - Léopoldine Bricaire
- Endocrinology-Metabolism-Diabetes Department, Institut Cochin, Université Paris Descartes, CNRS (UMR8104), INSERM U1016, Paris, France
| | - Camille Garcia
- Endocrinology-Metabolism-Diabetes Department, Institut Cochin, Université Paris Descartes, CNRS (UMR8104), INSERM U1016, Paris, France
| | - Anne Gallet-Dierick
- Endocrinology-Metabolism-Diabetes Department, Institut Cochin, Université Paris Descartes, CNRS (UMR8104), INSERM U1016, Paris, France
| | - Stéphanie Rodriguez
- Endocrinology-Metabolism-Diabetes Department, Institut Cochin, Université Paris Descartes, CNRS (UMR8104), INSERM U1016, Paris, France
| | - Françoise Cormier
- Endocrinology-Metabolism-Diabetes Department, Institut Cochin, Université Paris Descartes, CNRS (UMR8104), INSERM U1016, Paris, France
| | - Lionel Groussin
- Endocrinology-Metabolism-Diabetes Department, Institut Cochin, Université Paris Descartes, CNRS (UMR8104), INSERM U1016, Paris, France
- Department of Endocrinology, Cochin Hospital, Paris, France
- * E-mail:
| |
Collapse
|
13
|
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]
|
14
|
Bricaire L, Van Haecke C, Laurent-Roussel S, Jrad G, Bertherat J, Bernier M, Gaillard S, Groussin L, Dupin N. The Great Imitator in Endocrinology: A Painful Hypophysitis Mimicking a Pituitary Tumor. J Clin Endocrinol Metab 2015; 100:2837-40. [PMID: 26030326 DOI: 10.1210/jc.2015-2049] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT The incidence of syphilis has been increasing in recent decades in Western countries. Pituitary involvement is very unusual in syphilis. This infectious disease is not often considered in the workup of a patient with hypophysitis. CASE We report the case of a 28-year-old man who was admitted for headaches worsening over 1 month that became resistant to paracetamol. A magnetic resonance imaging scan revealed a heterogeneous pituitary mass suggesting a pituitary tumor. Hormonal investigations showed partial corticotropic and thyrotropic deficiencies. Headaches required high doses of morphine. Transsphenoidal surgery was performed, and histological examination revealed an aspect of hypophysitis. One month later, clinical reexamination showed skin and tongue lesions very suggestive of a syphilis infection, which was serologically confirmed. Immunohistochemistry on paraffin sections of the resected pituitary revealed an abundant presence of Treponema pallidum, confirming the diagnosis of a syphilitic hypophysitis. Intravenous therapy by benzylpenicillin for 14 days was rapidly efficient. Headaches stopped within a few days, and the skin and tongue lesions disappeared during the following month. Thyrotropic deficiency resolved in 2 weeks, but partial corticotropic deficiency persisted at 3 months. CONCLUSION This is the first case of a pituitary involvement in acquired syphilis, pathologically proven, in a non-HIV-infected patient. In a context of the resurgence of syphilis, this diagnosis should be considered in the case of a pituitary lesion with unusually intense headaches.
Collapse
Affiliation(s)
- Léopoldine Bricaire
- Department of Endocrinology, Referral Center for Rare Adrenal Diseases (L.B., G.J., J.B., L.G.), and Departments of Dermatology (C.V.H., N.D.) and Pathology (S.L.-R.), Assistance Publique Hôpitaux de Paris, Hôpital Cochin, 75014 Paris, France; Inserm U1016 (J.B., L.G., N.D.), Centre National de la Recherche Scientifique UMR 8104, Université Paris-Descartes, Institut Cochin, 75014 Paris, France; Departments of Pathology (M.B.) and Neurosurgery (S.G.), Hôpital Foch, 92151 Suresnes, France; and Syphilis National Reference Center (N.D.), Hôpital Cochin, 75014 Paris, France
| | - Clélia Van Haecke
- Department of Endocrinology, Referral Center for Rare Adrenal Diseases (L.B., G.J., J.B., L.G.), and Departments of Dermatology (C.V.H., N.D.) and Pathology (S.L.-R.), Assistance Publique Hôpitaux de Paris, Hôpital Cochin, 75014 Paris, France; Inserm U1016 (J.B., L.G., N.D.), Centre National de la Recherche Scientifique UMR 8104, Université Paris-Descartes, Institut Cochin, 75014 Paris, France; Departments of Pathology (M.B.) and Neurosurgery (S.G.), Hôpital Foch, 92151 Suresnes, France; and Syphilis National Reference Center (N.D.), Hôpital Cochin, 75014 Paris, France
| | - Sara Laurent-Roussel
- Department of Endocrinology, Referral Center for Rare Adrenal Diseases (L.B., G.J., J.B., L.G.), and Departments of Dermatology (C.V.H., N.D.) and Pathology (S.L.-R.), Assistance Publique Hôpitaux de Paris, Hôpital Cochin, 75014 Paris, France; Inserm U1016 (J.B., L.G., N.D.), Centre National de la Recherche Scientifique UMR 8104, Université Paris-Descartes, Institut Cochin, 75014 Paris, France; Departments of Pathology (M.B.) and Neurosurgery (S.G.), Hôpital Foch, 92151 Suresnes, France; and Syphilis National Reference Center (N.D.), Hôpital Cochin, 75014 Paris, France
| | - Grace Jrad
- Department of Endocrinology, Referral Center for Rare Adrenal Diseases (L.B., G.J., J.B., L.G.), and Departments of Dermatology (C.V.H., N.D.) and Pathology (S.L.-R.), Assistance Publique Hôpitaux de Paris, Hôpital Cochin, 75014 Paris, France; Inserm U1016 (J.B., L.G., N.D.), Centre National de la Recherche Scientifique UMR 8104, Université Paris-Descartes, Institut Cochin, 75014 Paris, France; Departments of Pathology (M.B.) and Neurosurgery (S.G.), Hôpital Foch, 92151 Suresnes, France; and Syphilis National Reference Center (N.D.), Hôpital Cochin, 75014 Paris, France
| | - Jérôme Bertherat
- Department of Endocrinology, Referral Center for Rare Adrenal Diseases (L.B., G.J., J.B., L.G.), and Departments of Dermatology (C.V.H., N.D.) and Pathology (S.L.-R.), Assistance Publique Hôpitaux de Paris, Hôpital Cochin, 75014 Paris, France; Inserm U1016 (J.B., L.G., N.D.), Centre National de la Recherche Scientifique UMR 8104, Université Paris-Descartes, Institut Cochin, 75014 Paris, France; Departments of Pathology (M.B.) and Neurosurgery (S.G.), Hôpital Foch, 92151 Suresnes, France; and Syphilis National Reference Center (N.D.), Hôpital Cochin, 75014 Paris, France
| | - Michèle Bernier
- Department of Endocrinology, Referral Center for Rare Adrenal Diseases (L.B., G.J., J.B., L.G.), and Departments of Dermatology (C.V.H., N.D.) and Pathology (S.L.-R.), Assistance Publique Hôpitaux de Paris, Hôpital Cochin, 75014 Paris, France; Inserm U1016 (J.B., L.G., N.D.), Centre National de la Recherche Scientifique UMR 8104, Université Paris-Descartes, Institut Cochin, 75014 Paris, France; Departments of Pathology (M.B.) and Neurosurgery (S.G.), Hôpital Foch, 92151 Suresnes, France; and Syphilis National Reference Center (N.D.), Hôpital Cochin, 75014 Paris, France
| | - Stephan Gaillard
- Department of Endocrinology, Referral Center for Rare Adrenal Diseases (L.B., G.J., J.B., L.G.), and Departments of Dermatology (C.V.H., N.D.) and Pathology (S.L.-R.), Assistance Publique Hôpitaux de Paris, Hôpital Cochin, 75014 Paris, France; Inserm U1016 (J.B., L.G., N.D.), Centre National de la Recherche Scientifique UMR 8104, Université Paris-Descartes, Institut Cochin, 75014 Paris, France; Departments of Pathology (M.B.) and Neurosurgery (S.G.), Hôpital Foch, 92151 Suresnes, France; and Syphilis National Reference Center (N.D.), Hôpital Cochin, 75014 Paris, France
| | - Lionel Groussin
- Department of Endocrinology, Referral Center for Rare Adrenal Diseases (L.B., G.J., J.B., L.G.), and Departments of Dermatology (C.V.H., N.D.) and Pathology (S.L.-R.), Assistance Publique Hôpitaux de Paris, Hôpital Cochin, 75014 Paris, France; Inserm U1016 (J.B., L.G., N.D.), Centre National de la Recherche Scientifique UMR 8104, Université Paris-Descartes, Institut Cochin, 75014 Paris, France; Departments of Pathology (M.B.) and Neurosurgery (S.G.), Hôpital Foch, 92151 Suresnes, France; and Syphilis National Reference Center (N.D.), Hôpital Cochin, 75014 Paris, France
| | - Nicolas Dupin
- Department of Endocrinology, Referral Center for Rare Adrenal Diseases (L.B., G.J., J.B., L.G.), and Departments of Dermatology (C.V.H., N.D.) and Pathology (S.L.-R.), Assistance Publique Hôpitaux de Paris, Hôpital Cochin, 75014 Paris, France; Inserm U1016 (J.B., L.G., N.D.), Centre National de la Recherche Scientifique UMR 8104, Université Paris-Descartes, Institut Cochin, 75014 Paris, France; Departments of Pathology (M.B.) and Neurosurgery (S.G.), Hôpital Foch, 92151 Suresnes, France; and Syphilis National Reference Center (N.D.), Hôpital Cochin, 75014 Paris, France
| |
Collapse
|
15
|
|
16
|
Bricaire L, Laroche E, Bourcigaux N, Donadille B, Christin-Maitre S. [Premature ovarian failures]. Presse Med 2013; 42:1500-7. [PMID: 24157186 DOI: 10.1016/j.lpm.2013.04.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 03/09/2013] [Accepted: 04/29/2013] [Indexed: 11/25/2022] Open
Abstract
Premature ovarian failure (POF) is clinically suspected by amenorrhea and confirmed by an elevated FSH serum level above 40 mUI/L (even 20 mUI/L) twice, in a woman before the age of 40. Prevalence of POF is between 1 to 2% in women. In 90% of cases, no aetiology is identified. Obvious causes are chemotherapy, pelvic radiotherapy, ovarian surgery and diethylstilbestrol exposure in utero. A karyotype should be performed as Turner Syndrome is the most frequent genetic cause of POF. Some X abnormalities such as X deletion or X autosome translocation can be found. FMR1 pre-mutation (fragile X syndrome) should be searched for, even though no cases of mental retardation are known, in the family. Other genetic abnormalities can be suggested by associated symptoms (i.e.: FOXL2, SF1 mutations). Auto-immune aetiology can be suspected if other auto-immune features are present, however, there are no reliable auto-antibodies to confirm auto-immunity in POF. Treatment of POF is based on hormonal replacement therapy in order to avoid estrogen deficiency, suppress vasomotor symptoms and avoid bone loss as well as cardiovascular risk. Estrogens should be associated with progesterone or a progestin, at least up to the age of 51. Patients with POF should be informed that spontaneous pregnancies may occur (in 5% of cases). In case of desire of pregnancy, the patient should be oriented to a specialized unit for in vitro fertilization with oocyte donation. Psychological support is essential and should be part of the treatment. POF is associated with an increased risk of emotional distress and depression. No preventive treatment of POF is available so far.
Collapse
Affiliation(s)
- Léopoldine Bricaire
- Hôpital Saint-Antoine, endocrinologie de la reproduction, Centre des maladies endocriniennes rares de la croissance (CMERC), 75012 Paris, France
| | | | | | | | | |
Collapse
|
17
|
Laroche E, Bricaire L, Christin-Maitre S. Diagnostic et prise en charge d’une aménorrhée chez l’adolescente. Arch Pediatr 2013; 20:817-22. [PMID: 23727374 DOI: 10.1016/j.arcped.2013.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 04/18/2013] [Indexed: 11/19/2022]
Affiliation(s)
- E Laroche
- Service d'endocrinologie, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
| | | | | |
Collapse
|
18
|
Bricaire L, Laroche E, Christin-Maitre S. [Meno-metrorrhagia, dysmenorrhea in adolescents]. Arch Pediatr 2013; 20:910-4. [PMID: 23727373 DOI: 10.1016/j.arcped.2013.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 04/05/2013] [Accepted: 04/19/2013] [Indexed: 11/16/2022]
Abstract
Menometrorrhagia is a common symptom in adolescents. It is idiopathic in most cases. In case of menometrorrhagia, it is necessary to exclude a pregnancy, a disorder of hemostasis, particularly the von Willebrand disease, as it represents the most common inherited disorder, and more rarely a chronic disease or an endocrinopathy. History of the bleedings, menstrual blood loss quantification by the Higham score and tolerance of the bleedings (blood pressure) should be evaluated. Laboratory testing includes hCG, ferritin level, a complete blood count, a prothrombin time, an activated partial thromboplastin. Management of menometrorrhagia is related to the severity of the blood loss. It associates antifibrinolytics or non-steroidal anti-inflammatory agents (NSAIDS) with hormonal treatments, such as estrogen-progestin oral contraceptive pill or cyclic oral progestins. Primary or functional dysmenorrhea concerns 40 to 90% of the teenagers and represents a frequent cause of school absenteeism. Management of primary dysmenorrhea is primarily based on a treatment by NSAIDS. In case of its inefficacy or if contraception is needed hormonal treatments, such as estrogen-progestin combined pill should be prescribed. It is very important when pelvic pain is chronic and not soothed by simple medications to look for a secondary dysmenorrhea, mainly endometriosis. In such cases, pelvic magnetic resonance imaging should be performed.
Collapse
Affiliation(s)
- L Bricaire
- Service d'endocrinologie et médecine de la reproduction, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
| | | | | |
Collapse
|
19
|
Bricaire L, Odou MF, Cardot-Bauters C, Delemer B, North MO, Salenave S, Vezzosi D, Kuhn JM, Murat A, Caron P, Sadoul JL, Silve C, Chanson P, Barlier A, Clauser E, Porchet N, Groussin L. Frequent large germline HRPT2 deletions in a French National cohort of patients with primary hyperparathyroidism. J Clin Endocrinol Metab 2013; 98:E403-8. [PMID: 23293331 DOI: 10.1210/jc.2012-2789] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [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] [Indexed: 02/11/2023]
Abstract
CONTEXT Hyperparathyroidism-jaw tumor syndrome (HPT-JT) is an autosomal dominant syndrome with incomplete penetrance that can associate in a single patient parathyroid adenoma or carcinoma, fibro-osseous jaw tumor, cystic kidney lesion, and uterine tumor. Germline mutations of the HRPT2 gene (CDC73) coding for parafibromin are identified in approximately 50%-75% of HPT-JT cases and in approximately 14% of familial isolated hyperparathyroidism. A whole deletion of this gene has recently been reported in 1 sporadic case and in a family presenting with HPT-JT. OBJECTIVE The objective of the study was to report molecular abnormalities of the HRPT2 gene in patients with primary hyperparathyroidism in a French National cohort from the Groupe d'Étude des Tumeurs Endocrines. METHODS Patients' genomic DNA was screened by PCR-based sequencing for point mutations affecting HRPT2 and real-time quantitative PCR analysis for gross deletions. RESULTS We report 20 index patients with a germinal HRPT2 abnormality. Median age at diagnosis of primary hyperparathyroidism was 23 years (range 14-65 years). Median serum total calcium level at diagnosis was 3.19 mmol/L (range 2.8-4.3 mmol/L). Thirteen different mutations were identified by routine sequencing, including 7 mutations never reported. Seven patients (35%) carried a gross deletion of this gene (3 complete and 4 partial deletions). No genotype-phenotype correlation could be identified. A gross deletion of the HRPT2 gene was identified in 7% of patients for whom a routine screening by direct sequencing came up as negative. CONCLUSION Gross deletion analysis of the HRPT2 gene is indicated for all patients negative for mutation, presenting with HPT-JT or familial isolated hyperparathyroidism, parathyroid carcinoma, or in patients with apparently sporadic parathyroid adenoma diagnosed at a young age, having a severe hypercalcemia.
Collapse
Affiliation(s)
- Léopoldine Bricaire
- Faculté de Médecine, Université Pierre et Marie Curie, Paris VI, 75005 Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Christin-Maitre S, Laroche E, Bricaire L. A New Contraceptive Pill Containing 17β-Estradiol and Nomegestrol Acetate. Womens Health (Lond Engl) 2013; 9:13-23. [DOI: 10.2217/whe.12.70] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Most combined oral contraceptive pills contain ethinyl estradiol (EE) with progestins. In order to minimize the pill's cardiovascular risks, the concept of using 17β-estradiol (E2), the endogenous estradiol, arose in the 1970s. Many attempts to develop a pill containing 17β-E2 have failed as cycle control was low. The first pill containing 17β-E2 was launched in 2011. This monophasic pill contains 24 pills with 1.5 mg 17β-E2 and 2.5 mg nomegestrol acetate, and four placebo pills. Studies conducted in Europe and the USA demonstrate that its Pearl index is 0.38 and 1.13, respectively. It has less influence on hemostasis, fibrinolysis markers, lipids and carbohydrate metabolism than the combined oral contraceptive levonorgestrel/EE (150 g/30 g and 100 μg/20 μg). Withdrawal bleedings are shorter and lighter as compared with women using drospirenone/EE (3 mg/30 μg). The number of women without withdrawal bleeding is approximately 30% after 12 months. Even though its contraindications are identical to other combined oral contraceptives, this nomegestrol acetate/E2 pill should be considered to be of interest for many women.
Collapse
Affiliation(s)
- Sophie Christin-Maitre
- Reproductive Endocrine Unit, Hôpital Saint-Antoine, Université Pierre et Marie Curie, 75012 Paris, France
| | - Emmanuelle Laroche
- Reproductive Endocrine Unit, Hôpital Saint-Antoine, Université Pierre et Marie Curie, 75012 Paris, France
| | - Léopoldine Bricaire
- Reproductive Endocrine Unit, Hôpital Saint-Antoine, Université Pierre et Marie Curie, 75012 Paris, France
| |
Collapse
|
21
|
Bricaire L, Brue T. [Endocannabinoid system: from metabolic to neuroendocrine effects]. Ann Endocrinol (Paris) 2007; 68 Suppl 1:12-7. [PMID: 17961655 DOI: 10.1016/s0003-4266(07)80004-7] [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] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The endocannabinoid system associates the cannabinoid receptors (CB1 and CB2), largely expressed in the central nervous system as well as in the peripheric one, the endocannabinoids (the two main ones being anandamine and the 2 arachidonoyl glycerol), the endocannabinoid-degrading enzymes, and the synthetic antagonists of the CB1 receptor, such as SR141716 (rimonabant). Mechoulam and his team have evidenced the neuroprotector role of endocannabinoids in case of cranial traumatism. As regards the hypothalamo-pituitary-gonadal axis, the administration of endocannabinoids in women would induce a lowering of the LH levels correlating with a loss of its pulsativity. The endocannabinoid system might also play a part in fecondation. In men, endocannabinoids have also been reported as inducing a lowering of LH and as impairing both the motility of the spermatozoa and the acrosomal reaction--a disorder which would be relieved by the administration of the SR141716 antagonist. The endocannabinoid system seems to modulate negatively the activation of the hypothalamo-pituitary-adrenal system. Therefore its stimulation by pharmacological means may suggest new therapies for states of anxiety. Likewise, stimulation of the CB1 receptors might play a role in the activation of the ACTH-secreting cells by CRH. On the peripheric level it is not to be questioned that endocannabinoids play a part in the energetic homeostasis.
Collapse
Affiliation(s)
- L Bricaire
- Service d'endocrinologie, CHU St Antoine, 184 rue du Fbg St. Antoine, 75571 Paris 12, France.
| | | |
Collapse
|
22
|
Bricaire L, Brue T. [Familial pituitary adenomas: clinical and genetic aspects]. Ann Endocrinol (Paris) 2007; 68 Suppl 1:9-11. [PMID: 17961654 DOI: 10.1016/s0003-4266(07)80003-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Pituitary adenomas can occur in a familial context, or they can be isolated cases, sometimes due to a predisposing syndrome. In multiple endocrine neoplasia type 1, they often associate with a mutation of the menin gene, a tumor-suppressing gene. A new germinal mutation predisposing to the development of multiple endocrine neoplasias has recently been identified in MENI-negative subjects on the gene CDKN1B encoding for p27(kip1)protein. Carney Complex syndrome--a rare disease--is in more than 60% of the cases linked to the inactivation mutation of a gene located on 17q22-24 that encodes the regulatory subunit 1 of protein kinase A, PRKARIA. Isolated familial pituitary adenomas represent 1.9 to 3.2% of the population of subjects presenting a pituitary adenoma. Low penetrance non-sense mutations, Q14X, IVS3-IG>A and R304X, in 11q12-11q13 region encoding AIP protein, (Aryl hydrocarbon receptor Interacting Protein), have been described by Vierimaa et al, in Finish patients with pituitary adenoma predispositions.
Collapse
Affiliation(s)
- L Bricaire
- Service d'endocrinologie, CHU St Antoine, 184 rue du Fbg St. Antoine, 75571 Paris 12, France.
| | | |
Collapse
|