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Driessens N, Prasai M, Alexopoulou O, De Block C, Van Caenegem E, T’Sjoen G, Nobels F, Ghys C, Vroonen L, Jonas C, Corvilain B, Maiter D. PAI-BEL: a Belgian multicentre survey of primary adrenal insufficiency. Endocr Connect 2023; 12:e230044. [PMID: 36897769 PMCID: PMC10235922 DOI: 10.1530/ec-23-0044] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 03/10/2023] [Indexed: 03/11/2023]
Abstract
Objective Primary adrenal insufficiency (PAI) is a rare disease with an increasing prevalence, which may be complicated by life-threatening adrenal crisis (AC). Good quality epidemiological data remain scarce. We performed a Belgian survey to describe the aetiology, clinical characteristics, treatment regimens, comorbidities and frequency of AC in PAI. Methods A nationwide multicentre study involving 10 major university hospitals in Belgium collected data from adult patients with known PAI. Results Two hundred patients were included in this survey. The median age at diagnosis was 38 years (IQR 25-48) with a higher female prevalence (F/M sex ratio = 1.53). The median disease duration was 13 years (IQR 7-25). Autoimmune disease was the most common aetiology (62.5%) followed by bilateral adrenalectomy (23.5%) and genetic variations (8.5%). The majority (96%) of patients were treated with hydrocortisone at a mean daily dose of 24.5 ± 7.0 mg, whereas 87.5% of patients also received fludrocortisone. About one-third of patients experienced one or more AC over the follow-up period, giving an incidence of 3.2 crises per 100 patient-years. There was no association between the incidence of AC and the maintenance dose of hydrocortisone. As high as 27.5% of patients were hypertensive, 17.5% had diabetes and 17.5% had a diagnosis of osteoporosis. Conclusion This study provides the first information on the management of PAI in large clinical centres in Belgium, showing an increased frequency of postsurgical PAI, a nearly normal prevalence of several comorbidities and an overall good quality of care with a low incidence of adrenal crises, compared with data from other registries.
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Affiliation(s)
- Natacha Driessens
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Endocrinology, Route de Lennik, Brussels, Belgium
| | - Madhu Prasai
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Endocrinology, Route de Lennik, Brussels, Belgium
| | - Orsalia Alexopoulou
- Department of Endocrinology, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Christophe De Block
- Department of Endocrinology-Diabetology-Metabolism, Universitair Ziekenhuis Antwerpen & University of Antwerp, Drie Eikenstraat, Edegem, Belgium
| | - Eva Van Caenegem
- Department of Endocrinology, Academisch Ziekenhuis Sint-Jan Brugge – Oostende AV, Ruddershove, Brugge, Belgium
| | - Guy T’Sjoen
- Department of Endocrinology, Ghent Universitary Hospital, C. Heymanslaan, Gent, Belgium
| | - Frank Nobels
- Department of Endocrinology, Onze-Lieve Vrouw Ziekenhuis, Moorselbaan, Aalst, Belgium
| | - Christophe Ghys
- Department of Endocrinology, Universitair Ziekenhuis Brussel, Laarbeeklaan, Brussels, Belgium
| | - Laurent Vroonen
- Department of Endocrinology, Cliniques Universitaires de Liège, Avenue de l’hôpital, Liège, Belgium
| | - Corinne Jonas
- Department of Endocrinology, CHU UCL Namur - Godinne, Avenue Docteur Gaston Thérasse, Yvoir, Belgium
| | - Bernard Corvilain
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Endocrinology, Route de Lennik, Brussels, Belgium
| | - Dominique Maiter
- Department of Endocrinology, Cliniques Universitaires Saint Luc, Brussels, Belgium
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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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Carton T, Mathieu E, Wolff F, Bouziotis J, Corvilain B, Driessens N. Two-day low-dose dexamethasone suppression test more accurate than overnight 1-mg in women taking oral contraceptives. Endocrinol Diabetes Metab 2021; 4:e00255. [PMID: 34277979 PMCID: PMC8279609 DOI: 10.1002/edm2.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/10/2021] [Accepted: 03/30/2021] [Indexed: 11/06/2022]
Abstract
Introduction Late-night salivary cortisol (LSaC) and 24-h urinary free cortisol measurement, and overnight 1-mg dexamethasone suppression test (1 mg-DST) are the first-line screening tests recommended for Cushing's syndrome. Through elevations in the level of cortisol-binding globulin, oral contraceptive agents lead to increases in the total plasma cortisol concentration, yielding false-positive 1 mg-DST results. Objective To compare the accuracy of the overnight 1-mg DST and two-day low-dose DST (2d-DST) in female volunteers taking combined oestrogen-progestin oral contraceptives (COCs). Methods This prospective study enrolled 30 healthy participants. Their plasma cortisol response levels were compared after the 1-mg DST and 2d-DST and classified into three categories: normal (≤50 nmol/L), doubtful (51-138 nmol/L) and abnormal (>138 nmol/L). Salivary cortisol was also measured at late night and after the DSTs. Results Following the 1-mg DST and 2d-DST, the plasma cortisol concentrations decreased to a median of 69 nmol/L and 37 nmol/L, respectively (p < 0.001). A statistically significant higher proportion of unclear or abnormal results were observed after the 1-mg DST (63%) than after the 2d-DST (27%) (p = 0.004). None of the values were >138 nmol/L after the 2d-DST, while 11% of them were abnormal after the 1-mg DST (p = 0.25). No LSaC value was abnormal. Conclusion Our results suggest that, when late-night salivary cortisol is not available, the 2d-DST could be a better screening option than the 1-mg DST for women taking oral contraceptive agents who are reluctant to stop them. This finding requires confirmation in those with a suspicion of hypercortisolism.
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Affiliation(s)
- Tiphaine Carton
- Department of Endocrinology Cliniques Universitaires de Bruxelles Hôpital Erasme Université Libre de Bruxelles (ULB) Brussels Belgium
| | - Elise Mathieu
- Department of Clinical Chemistry Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB) Université Libre de Bruxelles (ULB) Brussels Belgium
| | - Fleur Wolff
- Department of Clinical Chemistry Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB) Université Libre de Bruxelles (ULB) Brussels Belgium
| | - Jason Bouziotis
- Service de la Recherche Biomédicale Cliniques Universitaires de Bruxelles Hôpital Erasme Université Libre de Bruxelles (ULB) Brussels Belgium
| | - Bernard Corvilain
- Department of Endocrinology Cliniques Universitaires de Bruxelles Hôpital Erasme Université Libre de Bruxelles (ULB) Brussels Belgium
| | - Natacha Driessens
- Department of Endocrinology Cliniques Universitaires de Bruxelles Hôpital Erasme Université Libre de Bruxelles (ULB) Brussels Belgium
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Nieman LK, Boscaro M, Scaroni CM, Deutschbein T, Mezosi E, Driessens N, Georgescu CE, Hubalewska-D A, Berker D, Jarzab BM, Maiter DM, Reincke M, Loli P, Zampetti B, Atmaca A, Badiu CP, Beckers AM, Bolanowski M, Cavagnini F, Unger N, Giordano R, Hanzu FA, Terzolo M, Bostnavaron M, Toth M. Metyrapone Treatment in Endogenous Cushing’s Syndrome: Results at Week 12 From PROMPT, a Prospective International Multicenter, Open-Label, Phase III/IV Study. J Endocr Soc 2021. [PMCID: PMC8090655 DOI: 10.1210/jendso/bvab048.1053] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Metyrapone is a steroidogenesis inhibitor approved in Europe for the treatment of endogenous Cushing’s syndrome (CS) based on observational retrospective studies published over more than 50 years. We present data from the first prospective study designed to confirm metyrapone efficacy and good tolerance in patients with CS. Methods: This single arm, open-label, multicenter, international trial enrolled 50 patients with CS who had three baseline 24 hours urine free cortisol (UFC) values at least 50% above the upper limit of normal (ULN=165 nmol/24h). Metyrapone was titrated over 12 weeks (W12) to achieve normal urine (mean of 3 values, mUFC) and serum cortisol levels. Patients whose mUFC did not exceed 2-fold the ULN could enter a 6-month extension period. The primary efficacy endpoint was the proportion of patients with mUFC ≤ ULN at W12 assessed in a central laboratory using LC-MS/MS. The most important secondary endpoint was mUFC decrease of ≥ 50% at W12. Results: At baseline: mean age was 47 years, median mUFC (range) was 570 (291 - 8476) nmol/24h (3.5 x ULN). Hypercortisolism was in 96% of patients either moderate (mUFC ≥ 2xULN; < 5x ULN) in 63% or severe (≥5 x ULN) in 33%. Hypertension (69%) and diabetes mellitus (47%) were the most common comorbidities. At W12: 47% (23/ 49) met primary endpoint. Another 40% (19 / 49) had mUFC ≤ 2xULN. Median percentage decrease in mUFC from baseline to W12 was -74%. Secondary endpoint was met by 80% of patients who had a mUFC decrease of 50%. Final median metyrapone dose was 1500 (250; 5500) mg/day. Physical signs and symptoms were normalized or improved in 66% of patients. Circulating cholesterol, HbA1C and fasting glucose and insulin improved with median decrease of 12%, 3%, 5% and 9% respectively and median systolic and diastolic blood pressure also decreased by 4 and 5mmHg respectively. Among patients with antihypertensive treatments, 10 (31%) had a decrease in number of drugs and 5 (16%) had an increase in number of drugs during the study. Median ACTH increased by 11 % from baseline. Twenty six (52%) patients experienced mild to moderate study drug related adverse events (AEs). One patient discontinued before W12 because of an unrelated SAE on day 2 (pneumonia with septic shock). The most common AEs were nausea (24%), decreased appetite (18%), fatigue (14%), headache (10%), peripheral edema (6.0%), hypokalemia (6.0%) and hypertension (6.0%). Reversible adrenal insufficiency occurred in 6 (12%) patients. Few patients 14% (7/50) experienced at least one AE that led to a dose interruption or dose adjustment. Cushing Quality of Life Questionnaire increased of 10 points from baseline which is close to minimal clinically important difference = 10.1. Conclusions: This prospective study in patients with CS confirms that metyrapone effectively lowers UFC levels with a tolerability profile similar to the previously reported safety profile and improves QoL, at Week 12.
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Affiliation(s)
- Lynnette K Nieman
- National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD, USA
| | - Marco Boscaro
- Endocrinology department, University Hospital, Padova, Italy
| | | | - Timo Deutschbein
- Dept. of Internal Medicine, Div. of Endocrinology and Diabetes, University Hospital, University of Würzburg, Wurzburg, Germany
| | - Emese Mezosi
- Department of Internal Medicine, University Medical School, Pecs, Hungary
| | - Natacha Driessens
- CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Carmen Emanuela Georgescu
- Dept of Endocrinology, Cluj County Emergency Hospital, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Alicja Hubalewska-D
- Chair and Department of Endocrinology, Jagiellonian University, Medical College, Krakow, Poland
| | - Dilek Berker
- Endocrinology department, Numune Training and Research Hospital, Ankara, Turkey
| | - Barbara Maria Jarzab
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Dominique M Maiter
- Endocrinology department, University Hospital Saint Luc, Brussels, Belgium
| | - Martin Reincke
- Endocrinology department, University Clinic, Munich, Germany
| | - Paola Loli
- Clinica San Carlo, Endocrinology department, Milan, Italy
| | | | - Ayşegül Atmaca
- Endocrinology department, Ondokuz Mayıs University, Samsun, Turkey
| | - Corin P Badiu
- ”C.I Parhon”, National Institute of Endocrinology, University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Marek Bolanowski
- Dept. of Endocrinology, Diabetes and Isotope Therapy, Medical University, Wroclaw, Poland
| | | | - Nicole Unger
- Department of Endocrinology and Metabolism, University Hospital, Essen, Germany
| | | | | | - Massimo Terzolo
- Dept. of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, Orbassano, Italy
| | | | - Miklos Toth
- Semmelweis University, Department of Internal Medicine and Oncology, Budapest, Hungary
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Constantinescu SM, Driessens N, Lefebvre A, Furnica RM, Corvilain B, Maiter D. Etomidate infusion at low doses is an effective and safe treatment for severe Cushing's syndrome outside intensive care. Eur J Endocrinol 2020; 183:161-167. [PMID: 32449698 DOI: 10.1530/eje-20-0380] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 04/16/2020] [Accepted: 05/20/2020] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Intravenous etomidate infusion is effective to rapidly lower cortisol levels in severe Cushing's syndrome (CS) in the intensive care unit (ICU). Recently, etomidate treatment has also been proposed at lower doses in non-ICU wards, but it is not yet clear how this approach compares to ICU treatment. METHODS We compared data from patients with severe CS treated with high starting doses of etomidate (median: 0.30 mg/kg BW/day) in ICU or with lower starting doses (median: 0.025 mg/kg BW/day) in non-ICU medical wards. RESULTS Fourteen patients were included, among which ten were treated with low starting doses (LD) and four with high starting doses etomidate (HD). All patients had severe and complicated CS related to adrenal carcinoma (n = 8) or ectopic ACTH secretion (n = 6). Etomidate was effective in reducing cortisol levels below 500 nmol/L in a median of 1 day in the HD group compared to 3 days in the LD group (P = 0.013). However, all patients of the HD group had etomidate-induced cortisol insufficiency and needed frequent monitoring, while no patient from the LD group required hydrocortisone supplementation. No patient in either group died from complications of CS or etomidate treatment, but final outcome was poor as six patients in the LD group and all four patients in the HD group died from their cancer during follow-up. CONCLUSION Our study suggests that, for patients with severe CS who do not require intensive organ-supporting therapy, the use of very low doses of etomidate in medical wards should be considered.
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Affiliation(s)
| | - Natacha Driessens
- Endocrinology Department, Cliniques Universitaires de Bruxelles Hôpital Erasme, Bruxelles, Belgium
| | - Aurélie Lefebvre
- Endocrinology Department, Cliniques Saint Pierre, Ottignies, Belgium
| | - Raluca M Furnica
- Endocrinology Department, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Bernard Corvilain
- Endocrinology Department, Cliniques Universitaires de Bruxelles Hôpital Erasme, Bruxelles, Belgium
| | - Dominique Maiter
- Endocrinology Department, Cliniques Universitaires Saint Luc, Brussels, Belgium
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Ghaddhab C, Kyrilli A, Driessens N, Van Den Eeckhaute E, Hancisse O, De Deken X, Dumont JE, Detours V, Miot F, Corvilain B. Factors contributing to the resistance of the thyrocyte to hydrogen peroxide. Mol Cell Endocrinol 2019; 481:62-70. [PMID: 30476559 DOI: 10.1016/j.mce.2018.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 08/16/2018] [Revised: 11/12/2018] [Accepted: 11/22/2018] [Indexed: 11/18/2022]
Abstract
We studied the mechanism that may explain the relative resistance of thyrocytes to H2O2 compared to other cell types. Ability to degrade H2O2, glutathione peroxidase (GPx) activity, heme oxygenase-1 (HO-1) expression, cell survival and capacity to repair DNA damage after H2O2 exposure or irradiation were measured in human thyrocytes in primary culture and compared to the values obtained in human T-cells and different cell lines. Compared to other cell types, thyrocytes presented a low mortality rate after H2O2 exposure, rapidly degraded extracellular H2O2 and presented a high basal seleno-dependent GPx activity. Only in thyrocytes, H2O2 up-regulated GPx activity and expression of HO-1 mRNA. These effects were not reproduced by irradiation. DNA damage caused by H2O2 was more slowly repaired than that caused by irradiation and not repaired at all in T-cells. Our study demonstrates that the thyrocyte has specific protective mechanisms against H2O2 and its mutagenic effects.
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Affiliation(s)
- Chiraz Ghaddhab
- Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire, IRIBHM, B-1070, Brussels, Belgium.
| | - Aglaia Kyrilli
- Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire, IRIBHM, B-1070, Brussels, Belgium
| | - Natacha Driessens
- Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire, IRIBHM, B-1070, Brussels, Belgium; Department of Endocrinology of Erasme Hospital, Faculty of Medicine, Université libre de Bruxelles, B-1070, Brussels, Belgium
| | - Emmanuel Van Den Eeckhaute
- Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire, IRIBHM, B-1070, Brussels, Belgium
| | - Olivier Hancisse
- Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire, IRIBHM, B-1070, Brussels, Belgium
| | - Xavier De Deken
- Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire, IRIBHM, B-1070, Brussels, Belgium
| | - Jacques-Emile Dumont
- Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire, IRIBHM, B-1070, Brussels, Belgium
| | - Vincent Detours
- Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire, IRIBHM, B-1070, Brussels, Belgium
| | - Françoise Miot
- Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire, IRIBHM, B-1070, Brussels, Belgium
| | - Bernard Corvilain
- Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire, IRIBHM, B-1070, Brussels, Belgium; Department of Endocrinology of Erasme Hospital, Faculty of Medicine, Université libre de Bruxelles, B-1070, Brussels, Belgium
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Kyrilli A, Lytrivi M, Bouquegneau MS, Demetter P, Lucidi V, Garcia C, Moreno-Reyes R, Tabarin A, Corvilain B, Driessens N. Unilateral Adrenalectomy Could Be a Valid Option for Primary Nodular Adrenal Disease: Evidence From Twins. J Endocr Soc 2018; 3:129-134. [PMID: 30591956 PMCID: PMC6302904 DOI: 10.1210/js.2018-00261] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 08/21/2018] [Accepted: 10/19/2018] [Indexed: 01/25/2023] Open
Abstract
Primary pigmented nodular adrenal disease (PPNAD) accounts for <1% of ACTH-independent Cushing syndrome. We describe the case of twin female patients with PPNAD who both had sustainable disease control after unilateral adrenalectomy, which corroborates current evidence in favor of unilateral adrenalectomy for a subset of patients with PPNAD. Patient A presented with a 10-kg weight gain over the past year and facial plethora. Diagnostic evaluation revealed abolition of normal cortisol rhythm with suppressed ACTH levels, normal adrenal CT and MRI imaging and a slightly left-predominant adrenal uptake on 131I iodomethyl norcholesterol scintigraphy coupled with single-photon emission CT/CT. PPNAD was confirmed after genetic testing revealed a known pathogenic PRKA1A mutation (c.709 (-7-2) del6). At that time, her twin sister (patient B) was asymptomatic. Patient A underwent successful unilateral adrenalectomy and histology confirmed PPNAD. Two years after initial onset of symptoms in patient A, patient B was seen for the same subtle symptoms of progressive weight gain. Diagnostic test results were identical, revealing the same clinical features and mutational status as patient A. Patient B also underwent unilateral adrenalectomy with a favorable outcome. Follow-up 3 years after surgery for patient A and 18 months for patient B showed sustained disease control without recurrence and uncompromised quality of life, with no adrenal insufficiency having occurred. Unilateral adrenalectomy can be a successful therapeutic approach for patients with PPNAD with a mild phenotype without the risk and the inconvenience of subsequent adrenal insufficiency, which alters quality of life.
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Affiliation(s)
- Aglaia Kyrilli
- Division of Endocrinology, Hôpital Erasme, Brussels, Belgium
| | - Maria Lytrivi
- Division of Endocrinology, Hôpital Erasme, Brussels, Belgium
| | | | - Pieter Demetter
- Division of Anatomopathology, Hôpital Erasme, Brussels, Belgium
| | - Valerio Lucidi
- Division of Digestive Surgery, Hôpital Erasme, Brussels, Belgium
| | - Camilo Garcia
- Division of Nuclear Medicine, Bordet Institut, Brussels, Belgium
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Azzi AS, Driessens N. [Adrenal disease diagnosis: management of adrenal incidentaloma]. Rev Med Brux 2017; 38:325-333. [PMID: 28981236] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Adrenal glands are specialized in biosynthesis of several hormones correlated to different clinical phenotypes in case of excess or lack of production. In addition to secretion disorders, tumors, secreting or not, can take place in adrenal glands. Incidentalomas are the most common adrenal diseases in clinical practice. The challenge of the management is to determine whether the lesion is benign or malignant and secreting or not in order to direct therapeutic management towards surgical option, pharmacotherapy or clinical follow-up. Several radiographic characteristics allow to predict the benign or malignant nature of a lesion (size and density of the tumor, fat content,...). Adrenal carcinoma is a very rare cancer but should be excluded because its extremely poor prognosis. If most incidentalomas are non-secreting, it is important to ensure that there is no Cushing syndrome, even subclinical (± 10 % of incidentalomas) or pheochromocytoma (± 10 % of incidentalomas), pathologies associated with a higher incidence of cardiovascular complications. Careful clinical evaluation for symptoms and signs related to excessive adrenal hormones production is recommended to prescribe appropriate hormone assays. Finally, the surgical indication will be guided by the probability of malignancy, the presence and the degree of hypersecretion but also the age, the general health and the choice of the patient.
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Affiliation(s)
- A S Azzi
- Service d'Endocrinologie, Hôpital Erasme, ULB
| | - N Driessens
- Service d'Endocrinologie, Hôpital Erasme, ULB
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Versteyhe S, Driessens N, Ghaddhab C, Tarabichi M, Hoste C, Dumont JE, Miot F, Corvilain B, Detours V. Comparative analysis of the thyrocytes and T cells: responses to H2O2 and radiation reveals an H2O2-induced antioxidant transcriptional program in thyrocytes. J Clin Endocrinol Metab 2013; 98:E1645-54. [PMID: 23666977 DOI: 10.1210/jc.2013-1266] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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: 02/13/2023]
Abstract
CONTEXT Radiation is an established cause of thyroid cancer, and growing evidence supports a role for hydrogen peroxide (H2O2) in spontaneous thyroid carcinogenesis. Little is known about the molecular programs activated by these agents in thyrocytes. OBJECTIVE The purpose of this study was to compare the responses of thyrocytes and T cells to H2O2 and radiation. METHODS We profiled the DNA damage and cell death induced by γ-radiation (0.1-5 Gy) and H2O2 (0.0025-0.3 mM) in primary human thyrocytes and T cells. We next prepared thyroid and T-cell primary cultures from 8 donors operated for noncancerous thyroid pathological conditions and profiled their genome-wide transcriptional response 4 hours after (1) exposure to 1-Gy radiation, (2) treatment with H2O2 and (3) no treatment. Two H2O2 concentrations were investigated, calibrated in each cell type to elicit levels of single- and double-strand breaks equivalent to 1-Gy γ-radiation. RESULTS Although thyrocytes and T cells had comparable radiation responses, 3- to 10-fold more H2O2 was needed to induce detectable DNA damage in thyrocytes. At H2O2 and radiation doses inducing double-strand breaks, cell death occurred after 24 hours in T cells but not in thyrocytes. The transcriptional responses of thyrocytes and T cells to radiation were similar, involving DNA repair and cell death genes. In addition to this transcriptional program, H2O2 also up-regulated antioxidant genes in thyrocytes, including glutathione peroxidases and heme oxygenase at the double-strand breaks-inducing concentration. In contrast, a transcriptional storm involving thousands of genes was raised in T cells. Finally, we showed that inhibiting glutathione peroxidases activity increased the DNA damaging effect of H2O2 in thyrocytes. CONCLUSION We propose that high H2O2 production in thyrocytes is matched with specific transcriptionally regulated antioxidant protection.
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Affiliation(s)
- Soetkin Versteyhe
- Universite Libre de Bruxelles-Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire, B1070 Brussels, Belgium.
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10
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Driessens N, Versteyhe S, Ghaddhab C, Burniat A, De Deken X, Van Sande J, Dumont JE, Miot F, Corvilain B. Hydrogen peroxide induces DNA single- and double-strand breaks in thyroid cells and is therefore a potential mutagen for this organ. Endocr Relat Cancer 2009; 16:845-56. [PMID: 19509065 DOI: 10.1677/erc-09-0020] [Citation(s) in RCA: 140] [Impact Index Per Article: 9.3] [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] [Indexed: 11/27/2022]
Abstract
DNA double-strand breaks (DSBs) are considered as one of the primary causes of cancer but their induction by hydrogen peroxide (H(2)O(2)) is still controversial. In this work, we studied whether the high levels of H(2)O(2) produced in the thyroid to oxidize iodide could induce DNA modifications. Scores of DNA damage, in terms of strand breaks, were obtained by comet assay (alkaline condition for single-strand breaks (SSBs) and neutral condition for DSBs). We demonstrated that in a rat thyroid cell line (PCCl3), non-lethal concentrations of H(2)O(2) (0.1-0.5 mmol/l) as well as irradiation (1-10 Gy) provoked a large number of SSBs ( approximately 2-3 times control DNA damage values) but also high levels of DSBs (1.2-2.3 times control DNA damage values). We confirmed the generation of DSBs in this cell line and also in human thyroid in primary culture and in pig thyroid slices by measuring phosphorylation of histone H2AX. L-Buthionine-sulfoximine, an agent that depletes cells of glutathione, decreased the threshold to observe H(2)O(2)-induced DNA damage. Moreover, we showed that DNA breaks induced by H(2)O(2) were more slowly repaired than those induced by irradiation. In conclusion, H(2)O(2) causes SSBs and DSBs in thyroid cells. DSBs are produced in amounts comparable with those observed after irradiation but with a slower repair. These data support the hypothesis that the generation of H(2)O(2) in thyroid could also play a role in mutagenesis particularly in the case of antioxidant defense deficiency.
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Affiliation(s)
- Natacha Driessens
- Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire, Faculty of Medicine, Université Libre de Bruxelles, Bat C Local C4.145, Campus Erasme, 808, Route de Lennik, B-1070 Brussels, Belgium.
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11
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Burniat A, Jin L, Detours V, Driessens N, Goffard JC, Santoro M, Rothstein J, Dumont JE, Miot F, Corvilain B. Gene expression in RET/PTC3 and E7 transgenic mouse thyroids: RET/PTC3 but not E7 tumors are partial and transient models of human papillary thyroid cancers. Endocrinology 2008; 149:5107-17. [PMID: 18583418 DOI: 10.1210/en.2008-0531] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [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: 11/19/2022]
Abstract
We studied gene expression profiles in two mouse models of human thyroid carcinoma: the Tg-RET/PTC3 (RP3) and Tg-E7 mice. RP3 fusion gene is the most frequent mutation found in the first wave post-Chernobyl papillary thyroid cancers (PTCs). E7 is an oncoprotein derived from the human papillomavirus 16 responsible for most cervical carcinoma in women. Both transgenic mice develop thyroid hyperplasia followed by solid differentiated carcinoma in older animals. To understand the different steps leading to carcinoma, we analyzed thyroid gene expression in both strains at different ages by microarray technology. Important biological processes were differentially regulated in the two tumor types. In E7 thyroids, cell cycle was the most up-regulated process, an observation consistent with the huge size of these tumors. In RP3 thyroids, contrary to E7 tumors, several human PTC characteristics were observed: overexpression of many immune-related genes, regulation of human PTC markers, up-regulation of EGF-like growth factors and significant regulation of angiogenesis and extracellular matrix remodeling-related genes. However, similarities were incomplete; they did not concern the overall gene expression and were not conserved in old animals. Therefore, RP3 tumors are partial and transient models of human PTC. They constitute a good model, especially in young animals, to study the respective role of the biological processes shared with human PTC and will allow testing drugs targeting these validated variables.
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MESH Headings
- Animals
- Biomarkers, Tumor
- Carcinoma, Papillary/genetics
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/physiopathology
- Cell Cycle/physiology
- Cell Division/physiology
- Disease Models, Animal
- Extracellular Space
- Female
- Gene Expression Profiling
- Gene Expression Regulation, Neoplastic
- Humans
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Transgenic
- Neovascularization, Pathologic/genetics
- Neovascularization, Pathologic/pathology
- Neovascularization, Pathologic/physiopathology
- Oncogene Proteins, Viral/genetics
- Papillomavirus E7 Proteins
- Phenotype
- Proto-Oncogene Proteins c-ret/genetics
- Thyroid Gland/immunology
- Thyroid Gland/pathology
- Thyroid Gland/physiology
- Thyroid Neoplasms/genetics
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/physiopathology
- Up-Regulation/physiology
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Affiliation(s)
- Agnès Burniat
- Institute of Interdisciplinary Research, School of Medicine, Department of Endocrinology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
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12
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Song Y, Driessens N, Costa M, De Deken X, Detours V, Corvilain B, Maenhaut C, Miot F, Van Sande J, Many MC, Dumont JE. Roles of hydrogen peroxide in thyroid physiology and disease. J Clin Endocrinol Metab 2007; 92:3764-73. [PMID: 17666482 DOI: 10.1210/jc.2007-0660] [Citation(s) in RCA: 154] [Impact Index Per Article: 9.1] [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: 02/04/2023]
Abstract
CONTEXT The long-lived thyroid cell generates, for the synthesis of thyroid hormones, important amounts of H2O2 that are toxic in other cell types. This review analyzes the protection mechanisms of the cell and the pathological consequences of disorders of this system. EVIDENCE ACQUISITION The literature on H2O2 generation and disposal, thyroid hormone synthesis, and their control in the human thyroid is analyzed. EVIDENCE SYNTHESIS In humans, H2O2 production by dual-oxidases and consequently thyroid hormone synthesis by thyroperoxidase are controlled by the phospholipase C-Ca2+-diacylglycerol arm of TSH receptor action. H2O2 in various cell types, and presumably in thyroid cells, is a signal, a mitogen, a mutagen, a carcinogen, and a killer. The various protection mechanisms of the thyroid cell against H2O2 are analyzed. They include the separation of the generating enzymes (dual-oxidases), their coupling to thyroperoxidase in a proposed complex, the thyroxisome, and H2O2 degradation systems. CONCLUSIONS It is proposed that various pathologies can be explained, at least in part, by overproduction and lack of degradation of H2O2 (tumorigenesis, myxedematous cretinism, and thyroiditis) and by failure of the H2O2 generation or its positive control system (congenital hypothyroidism).
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Affiliation(s)
- Y Song
- Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire (IRIBHM), School of Medicine, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium
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Guillaume MP, Driessens N, Libert M, De Bels D, Corazza F, Karmali R. Hemophagocytic syndrome associated with extracerebral toxoplasmosis in an HIV-infected patient. Eur J Intern Med 2006; 17:503-4. [PMID: 17098596 DOI: 10.1016/j.ejim.2006.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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: 12/14/2005] [Accepted: 04/03/2006] [Indexed: 11/19/2022]
Abstract
Hemophagocytic syndrome (HPS) is a clinical entity that combines non-specific clinical and biological features. The diagnosis is usually confirmed by a bone marrow examination. HPS may be primary or secondary to a malignancy or to an infectious or autoimmune disease. Since it was first described, various agents have been implicated, including viruses, bacteria, and parasites. In HIV patients, many cases occur with lymphoma or with a variety of opportunistic infections due to CMV, HHV8, Pneumocystis carinii, Mycobacterium tuberculosis, MAC, toxoplasmosis, and even pneumococcus. We report here a case of an AIDS patient presenting a HPS secondary to an extracerebral form of systemic toxoplasmosis that was only revealed by specific PCR in tissue other than the CNS.
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Affiliation(s)
- M-P Guillaume
- Department of Medicine, Brugmann University Hospital, Free University of Brussels, 4 Van Gehuchten Plein, B 1020 Brussels, Belgium
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