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Sahakian N, Castinetti F, Romanet P, Reznik Y, Brue T. Updates on the genetics of multiple endocrine neoplasia. Ann Endocrinol (Paris) 2024; 85:127-135. [PMID: 38325596 DOI: 10.1016/j.ando.2023.11.005] [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] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/20/2023] [Indexed: 02/09/2024]
Abstract
Multiple endocrine neoplasia (MEN) is a group of syndromes with a genetic predisposition to the appearance of endocrine tumors, and shows autosomal dominant transmission. The advent of molecular genetics has led to improvements in the management of MEN in terms of diagnosis, prognosis and therapy. The genetics of MEN is the subject of regular updates, which will be presented throughout this paper. MEN1, the first to be described, is associated with the MEN1 gene. MEN1 is well known in terms of the observed phenotype, with genetic analysis being conclusive in 90% of patients with a typical phenotype, but is negative in around 10% of families with MEN1. Improvement in analysis techniques and the identification of other genes responsable for phenocopies allows the resolution of some, but not all, cases, notably non-familial forms suspected to be fortuitous assocations with tumors. MEN4 is a rare phenocopy of MEN1 linked to constitutional mutations in the CDKN1B gene. Though it closely resembles the phenotype of MEN1, published data suggests the appearance of tumors is later and less frequent in MEN4. MEN2, which results from mutations in the RET oncogene, shows a strong genotype-phenotype correlation. This correlation is particularly evident in the major manifestation of MEN2, medullary thyroid carcinoma (MTC), in which disease aggressiveness is dependent on the pathogenic variant of RET. However, recent studies cast doubt on this correlation between MTC and pathogenic variant. Lastly, the recent description of families carrying a mutation in MAX, which is known to predispose to the development of pheochromocytoma and paraganglioma, and presents a phenotypic spectrum that evokes MEN, suggests the existence of another syndrome, MEN5.
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Affiliation(s)
- Nicolas Sahakian
- Aix Marseille Univ, AP-HM, Inserm, MMG, MarMaRa, Marseille, France; Department of Endocrinology, CRMR HYPO, La Conception University Hospital, AP-HM, Marseille, France.
| | - Frederic Castinetti
- Aix Marseille Univ, AP-HM, Inserm, MMG, MarMaRa, Marseille, France; Department of Endocrinology, CRMR HYPO, La Conception University Hospital, AP-HM, Marseille, France
| | - Pauline Romanet
- Aix Marseille Univ, AP-HM, Inserm, MMG, MarMaRa, Marseille, France; Laboratory of Molecular Biology, Biogenopole, Timone University Hospital, AP-HM, Marseille, France
| | - Yves Reznik
- Department of endocrinology, diabetes, metabolic disorders, University Hospital Caen, Caen, France
| | - Thierry Brue
- Aix Marseille Univ, AP-HM, Inserm, MMG, MarMaRa, Marseille, France; Department of Endocrinology, CRMR HYPO, La Conception University Hospital, AP-HM, Marseille, France
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Gatta-Cherifi B, Mohammedi K, Cariou T, Poitou C, Touraine P, Raverot G, Brue T, Chanson P, Illouz F, Grunenwald S, Chabre O, Sonnet E, Cuny T, Bertherat J, Czernichow S, Frison E, Tabarin A. Impact of exenatide on weight loss and eating behavior in adults with craniopharyngioma-related obesity: the CRANIOEXE randomized placebo-controlled trial. Eur J Endocrinol 2024; 190:257-265. [PMID: 38450721 DOI: 10.1093/ejendo/lvae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/02/2024] [Accepted: 02/06/2024] [Indexed: 03/08/2024]
Abstract
IMPORTANCE A major issue in the management of craniopharyngioma-related obesity (CRO) is the ineffectiveness of the current therapeutic approaches. OBJECTIVE To study the efficacy of glucagon-like peptide-1 analogs compared with placebo in adults with obesity CRO. DESIGN A double-blind multicenter superiority randomized clinical in trial in two parallel arms. SETTING Eleven French University Hospital Centers. PARTICIPANTS Adults with CRO (body mass index > 30 kg/m²) without the sign of recurrence of craniopharyngioma in the past year. INTERVENTIONS Exenatide or placebo injected subcutaneously twice a day during 26 weeks. MAIN OUTCOMES AND MEASURES The primary outcome was the mean change in body weight at week 26 in the intention-to-treat population. Secondary outcomes were eating behavior, calories intake, energy expenditure, cardiovascular, metabolic risk factor, quality of life, and the tolerance profile. RESULTS At week 26, weight decreased from baseline by a mean of -3.8 (SD 4.3) kg for exenatide and -1.6 (3.8) kg for placebo. The adjusted mean treatment difference was -3.1 kg (95% confidence interval [CI] -7.0 to 0.7, P = 0.11). Results were compatible with a higher reduction of hunger score with exenatide compared with placebo (estimated treatment difference in change from baseline to week 26: -2.3, 95% CI -4.5 to -0.2), while all other outcomes did not significantly differ between groups. Adverse events were more common with exenatide versus placebo, and occurred in, respectively, 19 (95%) participants (108 events) and 14 (70%) participants (54 events). CONCLUSIONS AND RELEVANCE Combined with intensive lifestyle interventions, a 26-week treatment with exenatide was not demonstrated superior to placebo to treat craniopharyngioma-related obesity.
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Affiliation(s)
- Blandine Gatta-Cherifi
- CHU Bordeaux, Groupe Hospitalier Sud, Hopital Haut Lévêque Service Endocrinologie, Diabétologie, Nutrition, 33604 Pessac, France
- Neurocentre Magendie, Equipe «physiopathologie de la balance énergétique et obésité» INSERMU1215, Université de Bordeaux, 3300 Bordeaux, France
| | - Kamel Mohammedi
- CHU Bordeaux, Groupe Hospitalier Sud, Hopital Haut Lévêque Service Endocrinologie, Diabétologie, Nutrition, 33604 Pessac, France
- Université de Bordeaux, Inserm, Biology of Cardiovascular Diseases, 33000 Bordeaux, France
| | - Tanguy Cariou
- CHU Bordeaux, Service d'information médicale, Bordeaux 33000, France
| | - Christine Poitou
- Assistance Publique-Hôpitaux de Paris, Centre de référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et autres formes rares d'obésité avec troubles du comportement alimentaire), Service de Nutrition, Hôpital Pitié-Salpêtrière, 75013 Paris, France
- Sorbonne Université, INSERM, NutriOmics Research Unit, 75013 Paris, France
- ENDO-ERN (European Reference Network on Rare Endocrine Conditions)
| | - Philippe Touraine
- Department of Endocrinology and Reproductive Medicine, Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Sorbonne Université, Faculté de médecine, 75013 Paris Cedex 13, France
| | - Gerald Raverot
- Hospices Civils de Lyon, "Groupement Hospitalier Est," Fédération d'Endocrinologie, Centre de Référence des Maladies Rares de L'hypophyse HYPO, 69677 Bron, France
| | - Thierry Brue
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, 13005 Marseille, France
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), 13005 Marseille, France
| | - Philippe Chanson
- Université Paris Saclay, INSERM Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de paris, Hopital Bicêtre, Service d'endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
| | - Frédéric Illouz
- CHU Angers, Département d'Endocrinology, Centre de Référence des Maladies Rares de L'hypophyse, 49000 Angers, France
| | - Solange Grunenwald
- CHU Toulouse, Service d'endocrinologie, Centre de Référence des Maladies Rares de L'hypophyse, Centre de référence Maladies Rares PRADORT, 31000 Toulouse, France
| | - Olivier Chabre
- Université Grenoble Alpes, UMR 1292 INSERM-CEA-UGA, Endocrinologie CHU Grenoble Alpes, 38000 Grenoble, France
| | - Emmanuel Sonnet
- CHRU Brest, Service diabétologie-endocrinologie, 29000 Brest, France
| | - Thomas Cuny
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), 13005 Marseille, France
- Université Paris Saclay, INSERM Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de paris, Hopital Bicêtre, Service d'endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
| | - Jerôme Bertherat
- Department of Endocrinology, Hôpital Cochin, Reference and Competence Center Rare Adrenal Diseases and for Rare Pituitary Diseases, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, 75014 Paris, France
| | - Sébastien Czernichow
- Université Paris Cité, Paris, France
- AP-HP, Service de Nutrition, Centre Spécialisé Obésité, Hôpital Européen Georges Pompidou, 75015 Paris, France
| | - Eric Frison
- Assistance Publique-Hôpitaux de Paris, Centre de référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et autres formes rares d'obésité avec troubles du comportement alimentaire), Service de Nutrition, Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Antoine Tabarin
- CHU Bordeaux, Groupe Hospitalier Sud, Hopital Haut Lévêque Service Endocrinologie, Diabétologie, Nutrition, 33604 Pessac, France
- Neurocentre Magendie, Equipe «physiopathologie de la balance énergétique et obésité» INSERMU1215, Université de Bordeaux, 3300 Bordeaux, France
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Amodru V, Sahakian N, Piazzola C, Appay R, Graillon T, Cuny T, Morange I, Albarel F, Vermalle M, Regis J, Dufour H, Brue T, Castinetti F. Changes in multi-modality management of acromegaly in a tertiary centre over 2 decades. Pituitary 2024:10.1007/s11102-024-01387-y. [PMID: 38521837 DOI: 10.1007/s11102-024-01387-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE Acromegaly is a rare disease associated with chronic multisystem complications. New therapeutic strategies have emerged in the last decades, combining pituitary transsphenoidal surgery (TSS), radiotherapy or radiosurgery (RXT) and medical treatments. METHODS This retrospective monocentric study focused on presentation, management and outcome of acromegaly patients diagnosed between 2000 and 2020, still followed up in 2020, with a minimum follow-up of 1 year, and comparison of the first vs. second decade of the study. RESULTS 275 patients were included, 50 diagnosed before 2010 and 225 after 2010. 95% of them had normal IGF-1 levels (with or without treatment) at the last follow-up. Transsphenoidal surgery was more successful after 2010 (75% vs. 54%; p < 0.01), while tumor characteristics remained the same over time. The time from first treatment to biochemical control was shorter after 2010 than before (8 vs. 16 months; p = 0.03). Since 2010, RT was used less frequently (10% vs. 32%; p < 0.01) but more rapidly after surgery (26 vs. 53 months; p = 0.03). In patients requiring anti-secretory drugs after TSS, the time from first therapy to biochemical control was shorter after 2010 (16 vs. 29 months; p < 0.01). Tumor size, tumor invasiveness, baseline IGF-1 levels and Trouillas classification were identified as predictors of remission. CONCLUSION The vast majority of patients with acromegaly now have successful disease control with a multimodal approach. They reached biochemical control sooner in the most recent half of the study period. Future work should focus on those patients who are still uncontrolled and on the sequelae of the disease.
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Affiliation(s)
- V Amodru
- Marseille Medical Genetics, Institut MarMaRa, INSERM, UMR1251, Aix Marseille Univ, Marseille, France
- Department of Endocrinology, Hôpital La Conception, Service d'Endocrinologie, Institut MarMaRa, APHM, Aix Marseille Univ, 147 Boulevard Baille, 13005, Marseille, France
| | - N Sahakian
- Marseille Medical Genetics, Institut MarMaRa, INSERM, UMR1251, Aix Marseille Univ, Marseille, France
- Department of Endocrinology, Hôpital La Conception, Service d'Endocrinologie, Institut MarMaRa, APHM, Aix Marseille Univ, 147 Boulevard Baille, 13005, Marseille, France
| | - C Piazzola
- Marseille Medical Genetics, Institut MarMaRa, INSERM, UMR1251, Aix Marseille Univ, Marseille, France
- Department of Endocrinology, Hôpital La Conception, Service d'Endocrinologie, Institut MarMaRa, APHM, Aix Marseille Univ, 147 Boulevard Baille, 13005, Marseille, France
| | - R Appay
- Department of Pathology, Hôpital La Timone, APHM, Aix Marseille Univ, Marseille, France
| | - T Graillon
- Department of Endocrinology, Hôpital La Conception, Service d'Endocrinologie, Institut MarMaRa, APHM, Aix Marseille Univ, 147 Boulevard Baille, 13005, Marseille, France
- Department of Neurosurgery, Hôpital La Timone, APHM, Aix Marseille Univ, Marseille, France
| | - T Cuny
- Marseille Medical Genetics, Institut MarMaRa, INSERM, UMR1251, Aix Marseille Univ, Marseille, France
- Department of Endocrinology, Hôpital La Conception, Service d'Endocrinologie, Institut MarMaRa, APHM, Aix Marseille Univ, 147 Boulevard Baille, 13005, Marseille, France
| | - I Morange
- Marseille Medical Genetics, Institut MarMaRa, INSERM, UMR1251, Aix Marseille Univ, Marseille, France
- Department of Endocrinology, Hôpital La Conception, Service d'Endocrinologie, Institut MarMaRa, APHM, Aix Marseille Univ, 147 Boulevard Baille, 13005, Marseille, France
| | - F Albarel
- Marseille Medical Genetics, Institut MarMaRa, INSERM, UMR1251, Aix Marseille Univ, Marseille, France
- Department of Endocrinology, Hôpital La Conception, Service d'Endocrinologie, Institut MarMaRa, APHM, Aix Marseille Univ, 147 Boulevard Baille, 13005, Marseille, France
| | - M Vermalle
- Marseille Medical Genetics, Institut MarMaRa, INSERM, UMR1251, Aix Marseille Univ, Marseille, France
- Department of Endocrinology, Hôpital La Conception, Service d'Endocrinologie, Institut MarMaRa, APHM, Aix Marseille Univ, 147 Boulevard Baille, 13005, Marseille, France
| | - J Regis
- Department of Functional Neurosurgery, Hôpital La Timone, APHM, Aix Marseille Univ, Marseille, France
| | - H Dufour
- Department of Endocrinology, Hôpital La Conception, Service d'Endocrinologie, Institut MarMaRa, APHM, Aix Marseille Univ, 147 Boulevard Baille, 13005, Marseille, France
- Department of Neurosurgery, Hôpital La Timone, APHM, Aix Marseille Univ, Marseille, France
| | - T Brue
- Marseille Medical Genetics, Institut MarMaRa, INSERM, UMR1251, Aix Marseille Univ, Marseille, France
- Department of Endocrinology, Hôpital La Conception, Service d'Endocrinologie, Institut MarMaRa, APHM, Aix Marseille Univ, 147 Boulevard Baille, 13005, Marseille, France
| | - F Castinetti
- Marseille Medical Genetics, Institut MarMaRa, INSERM, UMR1251, Aix Marseille Univ, Marseille, France.
- Department of Endocrinology, Hôpital La Conception, Service d'Endocrinologie, Institut MarMaRa, APHM, Aix Marseille Univ, 147 Boulevard Baille, 13005, Marseille, France.
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Castets S, Albarel F, Bachelot A, Brun G, Bouligand J, Briet C, Bui Quoc E, Cazabat C, Chabbert-Buffet C, Christin-Maitre S, Courtillot C, Cuny T, De Filippo G, Donadille B, Illouz F, Pellegrini I, Reznik Y, Saveanu A, Teissier N, Touraine P, Vantyghem MC, Vergier J, Léger J, Brue T, Reynaud R. Position statement on the diagnosis and management of congenital pituitary deficiency in adults: the French National Diagnosis and Treatment Protocol (NDTP). Ann Endocrinol (Paris) 2024:S0003-4266(24)00035-0. [PMID: 38452869 DOI: 10.1016/j.ando.2024.03.001] [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] [Indexed: 03/09/2024]
Abstract
Pituitary deficiency, or hypopituitarism, is a rare chronic disease. It is defined by insufficient synthesis of one or more pituitary hormones (growth hormone, TSH, ACTH, LH-FSH, prolactin), whether or not associated with arginine vasopressin deficiency (formerly known as diabetes insipidus). In adult patients, it is usually acquired (notably during childhood), but can also be congenital, due to abnormal pituitary development. The present study focuses on congenital pituitary deficiency in adults, from diagnosis to follow-up, including special situations such as pregnancy or the elderly. The clinical presentation is highly variable, ranging from isolated deficit to multiple deficits, which may be part of a syndromic form or not. Diagnosis is based on a combination of clinical, biological (assessment of all hormonal axes), radiological (brain and hypothalamic-pituitary MRI) and genetic factors. Treatment consists in hormonal replacement therapy, adapted according to the period of life and the deficits, which may be progressive. Comorbidities, risk of complications and acute decompensation, and the impact on fertility and quality of life all require adaptative multidisciplinary care and long-term monitoring.
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Affiliation(s)
- S Castets
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service de Pédiatrie multidisciplinaire, Hôpital de la Timone Enfants, Centre de Référence des Maladies Rares de l'hypophyse HYPO, 13005 Marseille, France.
| | - F Albarel
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service d'Endocrinologie, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, 13005 Marseille, France
| | - A Bachelot
- AP-HP, IE3M, hôpital Pitié-Salpêtrière, department of endocrinology and reproductive medicine and Centre de référence des maladies endocriniennes rares de la croissance, center de référence des pathologies gynécologiques Rares, ICAN, Paris, France; Sorbonne Université, Paris, France
| | - G Brun
- Aix Marseille University, CNRS, CRMBM, Marseille, France
| | - J Bouligand
- Molecular Genetic, Pharmacogenetic and Hormonology, Paris-Saclay University, Kremlin Bicetre Hospital APHP, Le Kremlin Bicetre, France
| | - C Briet
- Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, F-94275 Le Kremlin Bicêtre, France; Institut MITOVASC, INSERM U1083, Université d'Angers, Département d'Endocrinologie, Diabétologie et Nutrition, Centre Hospitalier Universitaire d'Angers, F-49933 Angers, France
| | - E Bui Quoc
- Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Ophthalmology Department, Paris, France
| | - C Cazabat
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service de Pédiatrie multidisciplinaire, Hôpital de la Timone Enfants, Centre de Référence des Maladies Rares de l'hypophyse HYPO, 13005 Marseille, France
| | - C Chabbert-Buffet
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service de Pédiatrie multidisciplinaire, Hôpital de la Timone Enfants, Centre de Référence des Maladies Rares de l'hypophyse HYPO, 13005 Marseille, France
| | - S Christin-Maitre
- Sorbonne University, Department of Endocrinology, Diabetology and Reproductive Medicine, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Centre de référence des maladies endocriniennes rares de la croissance et du développement (CMERC) Centre de compétence HYPO 184 rue du faubourg St Antoine, 75012 Paris, France
| | - C Courtillot
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service de Pédiatrie multidisciplinaire, Hôpital de la Timone Enfants, Centre de Référence des Maladies Rares de l'hypophyse HYPO, 13005 Marseille, France
| | - T Cuny
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service de Pédiatrie multidisciplinaire, Hôpital de la Timone Enfants, Centre de Référence des Maladies Rares de l'hypophyse HYPO, 13005 Marseille, France
| | - G De Filippo
- Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Hôpital universitaire Robert Debré, Service d'Endocrinologie et Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes de la Croissance et du Développement, Paris, France
| | - B Donadille
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service de Pédiatrie multidisciplinaire, Hôpital de la Timone Enfants, Centre de Référence des Maladies Rares de l'hypophyse HYPO, 13005 Marseille, France
| | - F Illouz
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service de Pédiatrie multidisciplinaire, Hôpital de la Timone Enfants, Centre de Référence des Maladies Rares de l'hypophyse HYPO, 13005 Marseille, France
| | - I Pellegrini
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service de Pédiatrie multidisciplinaire, Hôpital de la Timone Enfants, Centre de Référence des Maladies Rares de l'hypophyse HYPO, 13005 Marseille, France
| | - Y Reznik
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service de Pédiatrie multidisciplinaire, Hôpital de la Timone Enfants, Centre de Référence des Maladies Rares de l'hypophyse HYPO, 13005 Marseille, France
| | - A Saveanu
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service de Pédiatrie multidisciplinaire, Hôpital de la Timone Enfants, Centre de Référence des Maladies Rares de l'hypophyse HYPO, 13005 Marseille, France
| | - N Teissier
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service de Pédiatrie multidisciplinaire, Hôpital de la Timone Enfants, Centre de Référence des Maladies Rares de l'hypophyse HYPO, 13005 Marseille, France
| | - P Touraine
- Service d'endocrinologie et médecine de la reproduction, Sorbonne Université Médecine-Hôpital Pitié Salpêtrière; Centre de maladies endocrinennes rares de la croissance et du développement, Paris, France
| | - M C Vantyghem
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service de Pédiatrie multidisciplinaire, Hôpital de la Timone Enfants, Centre de Référence des Maladies Rares de l'hypophyse HYPO, 13005 Marseille, France
| | - J Vergier
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service de Pédiatrie multidisciplinaire, Hôpital de la Timone Enfants, Centre de Référence des Maladies Rares de l'hypophyse HYPO, 13005 Marseille, France
| | - J Léger
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service de Pédiatrie multidisciplinaire, Hôpital de la Timone Enfants, Centre de Référence des Maladies Rares de l'hypophyse HYPO, 13005 Marseille, France
| | - T Brue
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service de Pédiatrie multidisciplinaire, Hôpital de la Timone Enfants, Centre de Référence des Maladies Rares de l'hypophyse HYPO, 13005 Marseille, France; Aix Marseille Univ, APHM, INSERM, MMG, Laboratory of Molecular Biology Hospital La Conception, Marseille, France
| | - R Reynaud
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service de Pédiatrie multidisciplinaire, Hôpital de la Timone Enfants, Centre de Référence des Maladies Rares de l'hypophyse HYPO, 13005 Marseille, France; Aix Marseille Univ, APHM, INSERM, MMG, Laboratory of Molecular Biology Hospital La Conception, Marseille, France
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5
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Rahabi H, Givony M, Demaret B, Albarel F, Aubron MR, Bartès B, Bernard L, Abdoul H, Bouazza N, Brun P, Drui D, Dujardin V, Lançon C, Malivoir S, Netchine I, Perrotin B, Picard V, Reynaud R, Ribeiro M, Tardy Guidollet V, Victor A, Bertherat J, Colin C, Brue T. The experience of diagnosis announcement in rare endocrine diseases: A survey of the French FIRENDO network. Ann Endocrinol (Paris) 2024; 85:27-35. [PMID: 37951412 DOI: 10.1016/j.ando.2023.10.008] [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] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
CONTEXT Diagnosis announcement of a chronic disease is a crucial moment for patients as well as for their families and an important step in the management of severe conditions such as rare endocrine diseases. Little is known of how diagnosis is communicated to patients and families. The FIRENDO network was created by the third French Plan for Rare Diseases, to promote autonomy, care and research on rare endocrine diseases. OBJECTIVES The aim of this study was to characterize, for the first time, the experience and needs of patients and/or their parents around the announcement of diagnosis to ensure optimal quality of care. METHODS A quantitative self-administered survey on diagnosis announcement procedures in rare endocrine diseases was launched in April 2017 by the ad hoc FIRENDO thematic working group in collaboration with its 11 partnering patient associations and support groups. The questionnaire was designed and revised by patient support group representatives, adult and pediatric endocrinologists, psychologists and biologists, all expert in rare endocrine diseases. It was made available on the FIRENDO network website and distributed mainly by email with electronic links on their respective websites to members of all affiliated patient support groups. RESULTS Questionnaires were filled out by 391 patients and 223 parents (median age of patients: 39 years). The following conditions were associated with at least 30 answers: Addison's disease, classical forms of congenital adrenal hyperplasia (CAH), Russell-Silver syndrome, Cushing's syndrome, acromegaly and craniopharyngioma. Overall, some announcement modalities were judged favorably by patients: physician's empathy, availability and use of clear terms, and presence of family at the time of announcement. However, a lack of psychological care and information documents was reported, as well as some inadequate procedures such as postal mail announcements. CONCLUSION This work suggests that better knowledge of the patient's experience is useful for improving the diagnosis announcement of rare endocrine disorders. The main recommendations derived from the survey were the need for several announcement visits, information on patient support groups and reference centers, imperatively avoiding impersonal announcement, and the usefulness of a written accompanying document.
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Affiliation(s)
- Haifa Rahabi
- Service d'endocrinologie, hôpital de la Conception, centre de référence des maladies rares de l'hypophyse HYPO, Assistance Publique-Hôpitaux de Marseille (AP-HM), 13005 Marseille, France
| | - Maria Givony
- Service d'endocrinologie, filière santé maladies rares endocriniennes FIRENDO, Assistance Publique-Hôpitaux de Paris, Groupe hospitalo-universitaire AP-HP Centre, Hôpital Cochin, 75014 Paris, France
| | | | - Frédérique Albarel
- Service d'endocrinologie, hôpital de la Conception, centre de référence des maladies rares de l'hypophyse HYPO, Assistance Publique-Hôpitaux de Marseille (AP-HM), 13005 Marseille, France
| | | | - Beate Bartès
- Association Vivre sans Thyroïde, 31490 Léguevin, France
| | - Lucie Bernard
- MAIA: Association pour aider toutes personnes confrontées à l'infertilité, 61140 Bagnoles de l'Orne, France
| | - Hendy Abdoul
- URC Paris Descartes Necker/Cochin, hôpital Tarnier, 75006 Paris, France
| | - Naim Bouazza
- URC Paris Descartes Necker/Cochin, hôpital Tarnier, 75006 Paris, France
| | - Philippe Brun
- Association ASSYMCAL: Syndrome de Mc Cune Albright dysplasie fibreuse de l'os, 85000 La Roche sur Yon, France
| | - Delphine Drui
- Service d'endocrinologie, l'institut du thorax, centre hospitalier universitaire de Nantes, Boulevard Jacques Monod, 44093 Nantes Cedex, France
| | - Véronique Dujardin
- Valentin APAC: Association de Porteurs d'Anomalies Chromosomiques, 95610 Eragny-sur-Oise, France
| | - Catherine Lançon
- Acromégales, Pas Seulement..., association nationale de l'acromégalie reconnue d'intérêt général, 59234 Villers-au Tertre, France
| | - Sabine Malivoir
- Assistance Publique-Hôpitaux de Paris, hôpital Armand Trousseau, 75571 Paris, France
| | - Irène Netchine
- Assistance Publique-Hôpitaux de Paris, hôpital Armand Trousseau, 75571 Paris, France
| | - Bénédicte Perrotin
- AFIF SSR/PAG: Association Française des Familles touchées par le Syndrome de Silver Russell (SSR) et des personnes nées Petites pour l'Age Gestationnel (PAG) et leurs amis, 30390 Domazan, France
| | - Virginie Picard
- Association du Syndrome de Wolfram, 56390 Grand-Champ, France
| | - Rachel Reynaud
- Service de pédiatrie multidisciplinaire, hôpital de la Timone Enfants, centre de référence des maladies rares de l'hypophyse HYPO, Assistance Publique-Hôpitaux de Marseille (AP-HM), 13005 Marseille, France; Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (Inserm), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
| | - Murielle Ribeiro
- Plateforme PRIOR, Centre Hospitalier Universitaire d'Angers, 49000 Angers, France
| | - Véronique Tardy Guidollet
- Hospices Civils de Lyon (HCL), laboratoire de biologie médical multisites, centre de référence DEV-GEN, 69677 Bron, France
| | - Amélie Victor
- Association syndrome de Rokitansky- MRKH, 75013 Paris, France
| | - Jérôme Bertherat
- Service d'endocrinologie, filière santé maladies rares endocriniennes FIRENDO, Assistance Publique-Hôpitaux de Paris, Groupe hospitalo-universitaire AP-HP Centre, Hôpital Cochin, 75014 Paris, France; Service d'endocrinologie, centre de référence maladies rares de la Surrénale, 75014, Paris France. Université Paris Cité, Inserm U1016, CNRS UMR 8104, Institut Cochin, Génomique et Signalisation des Tumeurs Endocrines, Assistance Publique-Hôpitaux de Paris, Groupe hospitalo-universitaire AP-HP Centre, Hôpital Cochin, Paris, France
| | | | - Thierry Brue
- Service d'endocrinologie, hôpital de la Conception, centre de référence des maladies rares de l'hypophyse HYPO, Assistance Publique-Hôpitaux de Marseille (AP-HM), 13005 Marseille, France; Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (Inserm), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France.
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6
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Isand K, Feelders R, Brue T, Toth M, Deutschbein T, Reincke M, Kršek M, Santos A, Demtröder F, Chabre O, Strasburger CJ, Aulinas Maso A, Volke V, Pereira AM, Lohmann R, Gich Saladich I, Webb SM, Wass J, Valassi E. High prevalence of venous thrombotic events in Cushing's syndrome: data from ERCUSYN and details in relation to surgery. Eur J Endocrinol 2024; 190:75-85. [PMID: 38146835 DOI: 10.1093/ejendo/lvad176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the prevalence of venous thromboembolism (VTE) in patients included in the European Registry on Cushing's syndrome (ERCUSYN), compare their clinical characteristics with those who did not develop VTE and identify risk factors for VTE. DESIGN A retrospective observational cohort study. METHODS Data extraction from the registry was taken on February, 7, 2022. At the time there were 2174 patients diagnosed with Cushing's syndrome (CS) and 95 VTEs were reported in the database. RESULTS Of 95 VTE events 70 (74%) were in pituitary-dependent CS patients, 12 (12.5%) in adrenal-dependant CS, 10 (10.5%) in ectopic CS, and 3 (3%) in CS due to other causes. Sex, 24-hour urinary free cortisol (UFC) value at diagnosis, as well as the number of operations remained statistically significant predictors of VTE. Of patients who were treated with at least one surgery, 12 (13%) VTE occurred before and 80 (87%) after the surgery. Nearly half of these VTEs occurred within six months since the operation (36; 45%). Over half of the centers that reported VTE did not routinely anticoagulate CS patients. Anticoagulation schemes varied widely. CONCLUSION Patients with CS have an elevated risk of developing VTE for an extended period of time. From ERCUSYN cohort patients have higher risk for VTE if they need multiple surgeries to treat CS, are males and have high UFC values at the diagnosis of CS. Since there is no agreement on thromboprohpylaxis, a protocol for VTE prevention that is widely adopted appears to be necessary for patients with CS.
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Affiliation(s)
- Kristina Isand
- Institute of Biomedicine and Translational Medicine, University of Tartu, Ülikooli 18, 50090, Tartu, Estonia
| | - Richard Feelders
- Department of Internal Medicine, Section of Endocrinology, ENETS Center of Excellence, Erasmus MC and Erasmus Cancer Institute, 3015 Rotterdam, The Netherlands
| | - Thierry Brue
- Aix Marseille Univ, APHM, INSERM, MMG, Department of Endocrinology Hospital La Conception, MarMaRa Institute, 13305 Marseille, France
| | - Miklos Toth
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary
| | - Timo Deutschbein
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Michal Kršek
- Third Department of Internal Medicine, First Faculty of Medicine, Charles University, General University Hospital, 12808 Prague, Czech Republic
| | - Alicia Santos
- IIB-Sant Pau and Department of Endocrinology, Hospital Sant Pau, Dept Medicine, UAB, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, 08025 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), Barcelona, Spain
| | - Frank Demtröder
- Zentrum für Endokrinologie, Diabetologie, Rheumatologie Dr. Demtröder & Kollegen, 44137 Dortmund, Germany
| | - Olivier Chabre
- University Grenoble Alpes, UMR 1292 INSERM-CEA-UGA, Endocrinologie CHU Grenoble Alpes, F-38000 Grenoble, France
| | | | - Anna Aulinas Maso
- IIB-Sant Pau and Department of Endocrinology, Hospital Sant Pau, Dept Medicine, UAB, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, 08025 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), Barcelona, Spain
| | - Vallo Volke
- Institute of Biomedicine and Translational Medicine, University of Tartu, Ülikooli 18, 50090, Tartu, Estonia
| | - Alberto M Pereira
- Department of Endocrinology & Metabolism, Amsterdam University Medical Center, and University of Amsterdam, 1081 Amsterdam, Netherlands
| | - Rüdiger Lohmann
- Health Care Consulting GmbH, Lohmann & Birkner Health Care Consulting GmbH, 13407 Berlin, Germany
| | - Ignasi Gich Saladich
- Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), 08025 Barcelona, Spain
| | - Susan M Webb
- IIB-Sant Pau and Department of Endocrinology, Hospital Sant Pau, Dept Medicine, UAB, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, 08025 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), Barcelona, Spain
| | - John Wass
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals, OX37LE Oxford, United Kingdom
| | - Elena Valassi
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), Barcelona, Spain
- Endocrinology and Nutrition Department, Germans Trias i Pujol Hospital and Research Institute, Badalona 08916, Spain
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7
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Boukerrouni A, Cuny T, Anjou T, Raingeard I, Ferrière A, Grunenwald S, Maïza JC, Marquant E, Sahakian N, Fodil-Cherif S, Salle L, Niccoli P, Randrianaivo H, Sonnet E, Chevalier N, Thuillier P, Vezzosi D, Reynaud R, Dufour H, Brue T, Tabarin A, Delemer B, Kerlan V, Castinetti F, Barlier A, Romanet P. Genetic testing in prolactinomas: a cohort study. Eur J Endocrinol 2023; 189:567-574. [PMID: 37956455 DOI: 10.1093/ejendo/lvad148] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/28/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Prolactinomas represent 46%-66% of pituitary adenomas, but the prevalence of germline mutations is largely unknown. We present here the first study focusing on hereditary predisposition to prolactinoma. OBJECTIVE We studied the prevalence of germline mutations in a large cohort of patients with isolated prolactinomas. MATERIALS AND METHODS A retrospective study was performed combining genetic and clinical data from patients referred for genetic testing of MEN1, AIP, and CDKN1B between 2003 and 2020. SF3B1 was Sanger sequenced in genetically negative patients. RESULTS About 506 patients with a prolactinoma were included: 80 with microprolactinoma (15.9%), 378 with macroprolactinoma (74.7%), 48 unknown; 49/506 in a familial context (9.7%). Among these, 14 (2.8%) had a (likely) pathogenic variant (LPV) in MEN1 or AIP, and none in CDKN1B. All positive patients had developed a macroprolactinoma before age 30. The prevalence of germline mutations in patients with isolated macroprolactinoma under 30 was 4% (11/258) in a sporadic context and 15% (3/20) in a familial context. Prevalence in sporadic cases younger than 18 was 15% in men (5/33) and 7% in women (4/57). No R625H SF3B1 germline mutation was identified in 264 patients with macroprolactinomas. CONCLUSIONS We did not identify any LPVs in patients over 30 years of age, either in a familial or in a sporadic context, and in a sporadic context in our series or the literature. Special attention should be paid to young patients and to familial context.
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Affiliation(s)
- Amina Boukerrouni
- Aix Marseille Univ, APHM, INSERM, MMG, Laboratory of Molecular Biology Hospital La Conception, MarMaRa Institute, 13005 Marseille, France
| | - Thomas Cuny
- Aix Marseille Univ, APHM, INSERM, MMG, Department of Endocrinology Hospital La Conception, MarMaRa Institute, 13305 Marseille, France
| | - Thibaut Anjou
- Aix Marseille Univ, APHM, INSERM, MMG, Laboratory of Molecular Biology Hospital La Conception, MarMaRa Institute, 13005 Marseille, France
| | - Isabelle Raingeard
- CHRU de Montpellier, Service d'Endocrinologie, Diabète, Maladies Métaboliques, 34000 Montpellier, France
| | - Amandine Ferrière
- Department of Endocrinology, University Hospital of Bordeaux, Haut Lévêque, 33318 Pessac, France
| | - Solange Grunenwald
- Department of Endocrinology and Metabolic Disease, Hospital Larrey CHU (University Hospital Centre), 31029 Toulouse, France
| | - Jean-Christophe Maïza
- Department of Endocrinology, Diabetes and Nutrition, GHSR, Centre Hospitalo-Universitaire de la Réunion, 97416 Saint-Pierre, La Réunion, France
| | - Emeline Marquant
- Aix Marseille Univ, APHM, INSERM, MMG, Department of pediatrics, hospital La Timone Enfants, MarMaRa Institute, 13005 Marseille, France
| | - Nicolas Sahakian
- Aix Marseille Univ, APHM, INSERM, MMG, Department of Endocrinology Hospital La Conception, MarMaRa Institute, 13305 Marseille, France
| | - Sarah Fodil-Cherif
- CHRU de Montpellier, Service d'Endocrinologie, Diabète, Maladies Métaboliques, 34000 Montpellier, France
| | - Laurence Salle
- Inserm, University Limoges, CHU de Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, 87000 Limoges, France
| | | | - Hanitra Randrianaivo
- UF de Génétique Médicale, GHSR, CHU de La Réunion, 97416 Saint Pierre, La Réunion, France
| | - Emmanuel Sonnet
- Department of Endocrinology and Diabetes, Brest University Hospital, Boulevard Tanguy Prigent, 29200 Brest, France
| | - Nicolas Chevalier
- Centre Hospitalier Universitaire de Nice, Hôpital de l'Archet 2, Service d'Endocrinologie, Diabétologie et Médecine de la Reproduction, 151 route de Saint-Antoine de Ginestière, CS 23079, Nice 06202 Cedex 3, France
| | - Philippe Thuillier
- Department of Endocrinology and Diabetes, Brest University Hospital, Boulevard Tanguy Prigent, 29200 Brest, France
| | - Delphine Vezzosi
- Institut CardioMet, 31000 Toulouse, France
- Service d'endocrinologie, Hôpital Larrey, 24, Chemin de Pouvourville, Toulouse 31029 Cedex 9, France
| | - Rachel Reynaud
- Aix Marseille Univ, APHM, INSERM, MMG, Department of pediatrics, hospital La Timone Enfants, MarMaRa Institute, 13005 Marseille, France
| | - Henry Dufour
- Aix Marseille Univ, APHM, INSERM, MMG, Department of Neurosurgery Hospital la Timone Adulte, MarMaRa Institute, 13005 Marseille, France
| | - Thierry Brue
- Aix Marseille Univ, APHM, INSERM, MMG, Department of Endocrinology Hospital La Conception, MarMaRa Institute, 13305 Marseille, France
| | - Antoine Tabarin
- Department of Endocrinology, University Hospital of Bordeaux, Haut Lévêque, 33318 Pessac, France
| | - Brigitte Delemer
- Endocrinology, Diabetology and Nutrition Unit, University Hospital of Reims, 51454 Reims, France
| | - Véronique Kerlan
- Department of Endocrinology and Diabetes, Brest University Hospital, Boulevard Tanguy Prigent, 29200 Brest, France
| | - Frédéric Castinetti
- Aix Marseille Univ, APHM, INSERM, MMG, Department of Endocrinology Hospital La Conception, MarMaRa Institute, 13305 Marseille, France
| | - Anne Barlier
- Aix Marseille Univ, APHM, INSERM, MMG, Laboratory of Molecular Biology Hospital La Conception, MarMaRa Institute, 13005 Marseille, France
| | - Pauline Romanet
- Aix Marseille Univ, APHM, INSERM, MMG, Laboratory of Molecular Biology Hospital La Conception, MarMaRa Institute, 13005 Marseille, France
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8
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Brue T, Rahabi H, Barry A, Barlier A, Bertherat J, Borson-Chazot F, Castinetti F, Cazabat L, Chabre O, Chevalier N, Christin-Maitre S, Cortet C, Drui D, Kamenicky P, Lançon C, Lioté F, Pellegrini I, Reynaud R, Salenave S, Tauveron I, Touraine P, Vantyghem MC, Vergès B, Vezzosi D, Villa C, Raverot G, Coutant R, Chanson P, Albarel F. Position statement on the diagnosis and management of acromegaly: The French National Diagnosis and Treatment Protocol (NDTP). Ann Endocrinol (Paris) 2023; 84:697-710. [PMID: 37579837 DOI: 10.1016/j.ando.2023.08.003] [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] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
Acromegaly is a rare disease with prevalence of approximately 60 cases per million, slight female predominance and peak onset in adults in the fourth decade. Clinical diagnosis is often delayed by several years due to the slowly progressive onset of symptoms. There are multiple clinical criteria that define acromegaly: dysmorphic syndrome of insidious onset, symptoms related to the pituitary tumor (headaches, visual disorders), general signs (sweating, carpal tunnel syndrome, joint pain, etc.), complications of the disease (musculoskeletal, cardiovascular, pneumological, dental, metabolic comorbidities, thyroid nodules, colonic polyps, etc.) or sometimes clinical signs of associated prolactin hypersecretion (erectile dysfunction in men or cycle disorder in women) or concomitant mass-induced hypopituitarism (fatigue and other symptoms related to pituitary hormone deficiencies). Biological confirmation is based initially on elevated IGF-I and lack of GH suppression on oral glucose tolerance test or an elevated mean GH on repeated measurements. In confirmed cases, imaging by pituitary MRI identifies the causal tumor, to best determine management. In a minority of cases, acromegaly can be linked to a genetic predisposition, especially when it occurs at a young age or in a familial context. The first-line treatment is most often surgical removal of the somatotroph pituitary tumor, either immediately or after transient medical treatment. Medical treatments are most often proposed in patients not controlled by surgical removal. Conformal or stereotactic radiotherapy may be discussed on a case-by-case basis, especially in case of drug inefficacy or poor tolerance. Acromegaly should be managed by a multidisciplinary team, preferably within an expert center such as a reference or skill center for rare pituitary diseases.
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Affiliation(s)
- Thierry Brue
- Service d'endocrinologie, centre de référence des maladies rares de l'hypophyse HYPO, assistance publique-hôpitaux de Marseille (AP-HM), hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France; Aix Marseille université, INSERM, MMG, Marseille Medical Genetics, Marseille, France.
| | - Haïfa Rahabi
- Service d'endocrinologie, centre de référence des maladies rares de l'hypophyse HYPO, assistance publique-hôpitaux de Marseille (AP-HM), hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France
| | - Abdoulaye Barry
- Service d'endocrinologie, centre de référence des maladies rares de l'hypophyse HYPO, assistance publique-hôpitaux de Marseille (AP-HM), hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France
| | - Anne Barlier
- Service d'endocrinologie, centre de référence des maladies rares de l'hypophyse HYPO, assistance publique-hôpitaux de Marseille (AP-HM), hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France; Aix Marseille université, INSERM, MMG, Marseille Medical Genetics, Marseille, France
| | - Jérôme Bertherat
- Service d'endocrinologie, hôpital Cochin, AP-HP centre université Paris Cité, France
| | - Françoise Borson-Chazot
- Service d'endocrinologie, centre de référence des maladies rares de l'hypophyse HYPO « groupement hospitalier Est » hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron, France
| | - Frédéric Castinetti
- Service d'endocrinologie, centre de référence des maladies rares de l'hypophyse HYPO, assistance publique-hôpitaux de Marseille (AP-HM), hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France; Aix Marseille université, INSERM, MMG, Marseille Medical Genetics, Marseille, France
| | - Laure Cazabat
- Hôpital Foch, service de neurochirurgie, UMR 1198 BREED, UFR Simone Veil Santé, UVSQ-Paris Saclay, 40, rue Worth, 92150 Suresnes, France
| | - Olivier Chabre
- University Grenoble Alpes, UMR 1292 Inserm-CEA-UGA, endocrinologie CHU de Grenoble Alpes, 38000 Grenoble, France
| | - Nicolas Chevalier
- Université Côte d'Azur, CHU, Inserm U1065, C3M, équipe 5, Nice, France
| | - Sophie Christin-Maitre
- Service d'endocrinologie, diabétologie et médecine de la reproduction, centre de référence des maladies endocriniennes rares de la croissance et du développement (CMERC) Centre de compétence HYPO, Sorbonne université, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Christine Cortet
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHRU de Lille, rue Polonowski, Lille cedex, France
| | - Delphine Drui
- Service d'endocrinologie, l'institut du thorax, centre hospitalier universitaire de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex, France
| | - Peter Kamenicky
- Service d'endocrinologie et des maladies de la reproduction, centre de référence des maladies rares de l'hypophyse, université Paris-Saclay, Inserm, physiologie et physiopathologie endocriniennes, AP-HP, hôpital BicêtreLe Kremlin-Bicêtre, France
| | - Catherine Lançon
- « Acromégales, pas seulement… », association nationale de l'acromégalie reconnue d'intérêt général, 59234 Villers-Au-Tertre, France
| | - Frédéric Lioté
- Centre Viggo Petersen, faculté de santé, université Paris Cité, Inserm UMR 1132 Bioscar et service de rhumatologie, DMU Locomotion, AP-HP, hôpital Lariboisière, 75475 Paris cedex 10, France
| | - Isabelle Pellegrini
- Service d'endocrinologie, centre de référence des maladies rares de l'hypophyse HYPO, assistance publique-hôpitaux de Marseille (AP-HM), hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France
| | - Rachel Reynaud
- Aix Marseille université, INSERM, MMG, Marseille Medical Genetics, Marseille, France; Service de pédiatrie multidisciplinaire, centre de référence des maladies rares de l'hypophyse HYPO, Assistance publique-Hôpitaux de Marseille (AP-HM), hôpital de la Timone enfants, 13005 Marseille, France
| | - Sylvie Salenave
- Service d'endocrinologie et des maladies de la reproduction, centre de référence des maladies rares de l'hypophyse, université Paris-Saclay, Inserm, physiologie et physiopathologie endocriniennes, AP-HP, hôpital BicêtreLe Kremlin-Bicêtre, France
| | - Igor Tauveron
- Service d'endocrinologie diabétologie, institut génétique, reproduction & développement (iGReD), CHU de Clermont-Ferrand, CNRS, Inserm, université Clermont-Auvergne, Clermont-Ferrand, France
| | - Philippe Touraine
- Service d'endocrinologie et médecine de la reproduction, centre de maladies endocrinennes rares de la croissance et du développement, Sorbonne université médecine, hôpital Pitié Salpêtrière, Paris, France
| | - Marie-Christine Vantyghem
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHRU de Lille, rue Polonowski, Lille cedex, France; Service d'endocrinologie, l'institut du thorax, centre hospitalier universitaire de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex, France
| | - Bruno Vergès
- Service d'endocrinologie, CHU de Dijon, centre Inserm LNC-UMR1231, 14, rue Gaffarel, 21000 Dijon, France
| | - Delphine Vezzosi
- Service d'endocrinologie, hôpital Larrey, CHU Toulouse, 24 chemin de Pouvourville, TSA 30030, université Paul Sabatier, 21059 Toulouse cedex 9, France
| | - Chiara Villa
- Département de neuropathologie de la Pitié Salpêtrière, hôpital de la Pitié-Salpêtrière - AP-HP, Sorbonne université, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - Gérald Raverot
- Service d'endocrinologie, centre de référence des maladies rares de l'hypophyse HYPO « groupement hospitalier Est » hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron, France
| | - Régis Coutant
- Service d'endocrinologie-diabétologie-nutrition, centre de référence des maladies rares de l'hypophyse, université d'Angers, CHU d'Angers, Angers, France
| | - Philippe Chanson
- Service d'endocrinologie et des maladies de la reproduction, centre de référence des maladies rares de l'hypophyse, université Paris-Saclay, Inserm, physiologie et physiopathologie endocriniennes, AP-HP, hôpital BicêtreLe Kremlin-Bicêtre, France
| | - Frédérique Albarel
- Service d'endocrinologie, centre de référence des maladies rares de l'hypophyse HYPO, assistance publique-hôpitaux de Marseille (AP-HM), hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France
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Vroonen L, Beckers A, Camby S, Cuny T, Beckers P, Jaffrain-Rea ML, Cogne M, Naves L, Ferriere A, Romanet P, Elenkova A, Karhu A, Brue T, Barlier A, Pétrossians P, Daly AF. The clinical and therapeutic profiles of prolactinomas associated with germline pathogenic variants in the aryl hydrocarbon receptor interacting protein (AIP) gene. Front Endocrinol (Lausanne) 2023; 14:1242588. [PMID: 37711900 PMCID: PMC10498111 DOI: 10.3389/fendo.2023.1242588] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/17/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction Prolactinomas are the most frequent type of pituitary adenoma encountered in clinical practice. Dopamine agonists (DA) like cabergoline typically provide sign/ symptom control, normalize prolactin levels and decrease tumor size in most patients. DA-resistant prolactinomas are infrequent and can occur in association with some genetic causes like MEN1 and pathogenic germline variants in the AIP gene (AIPvar). Methods We compared the clinical, radiological, and therapeutic characteristics of AIPvar-related prolactinomas (n=13) with unselected hospital-treated prolactinomas ("unselected", n=41) and genetically-negative, DA-resistant prolactinomas (DA-resistant, n=39). Results AIPvar-related prolactinomas occurred at a significantly younger age than the unselected or DA-resistant prolactinomas (p<0.01). Males were more common in the AIPvar (75.0%) and DA- resistant (49.7%) versus unselected prolactinomas (9.8%; p<0.001). AIPvar prolactinomas exhibited significantly more frequent invasion than the other groups (p<0.001) and exhibited a trend to larger tumor diameter. The DA-resistant group had significantly higher prolactin levels at diagnosis than the AIPvar group (p<0.001). Maximum DA doses were significantly higher in the AIPvar and DA-resistant groups versus unselected. DA-induced macroadenoma shrinkage (>50%) occurred in 58.3% in the AIPvar group versus 4.2% in the DA-resistant group (p<0.01). Surgery was more frequent in the AIPvar and DA- resistant groups (43.8% and 61.5%, respectively) versus unselected (19.5%: p<0.01). Radiotherapy was used only in AIPvar (18.8%) and DA-resistant (25.6%) groups. Discussion AIPvar confer an aggressive phenotype in prolactinomas, with invasive tumors occurring at a younger age. These characteristics can help differentiate rare AIPvar related prolactinomas from DA-resistant, genetically-negative tumors.
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Affiliation(s)
- Laurent Vroonen
- Department of Endocrinology, Centre Hospitalier Universitaire de Liège, University of Liège, Liège, Belgium
| | - Albert Beckers
- Department of Endocrinology, Centre Hospitalier Universitaire de Liège, University of Liège, Liège, Belgium
| | - Severine Camby
- Department of Otorhinolaryngology, Centre Hospitalier Universitaire de Liège, University of Liège, Liège, Belgium
| | - Thomas Cuny
- Department of Endocrinology, Aix Marseille University, Assistance publique Hôpitaux de Marseille (APHM), INSERM, Marseille Medical Genetics (MMG), Hopital La Conception, Institut MarMaRa, Marseille, France
| | - Pablo Beckers
- Department of Human Genetics, Centre Hospitalier Universitaire de Liège, University of Liège, Liège, Belgium
| | - Marie-Lise Jaffrain-Rea
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
- Department of Neuroendocrinology, Neuromed IRCCS, Pozzilli, Italy
| | - Muriel Cogne
- Department of Endocrinology, Diabetes and Nutrition, Centre Hospitalo-Universitaire de la Réunion, Saint-Pierre, France
| | - Luciana Naves
- Department of Endocrinology, University of Brasilia, Brasilia, Brazil
| | - Amandine Ferriere
- Department of Endocrinology, Hopital Haut-Leveque, Centre Hospitalier Universitaire (CHU) de Bordeaux, Pessac, France
| | - Pauline Romanet
- Laboratory of Molecular Biology, Aix Marseille University, Assistance publique Hôpitaux de Marseille (APHM), INSERM, Marseille Medical Genetics (MMG), Hospital La Conception, Institut MarMaRa, Marseille, France
| | - Atanaska Elenkova
- Department of Endocrinology, Medical University of Sofia, Sofia, Bulgaria
| | - Auli Karhu
- Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
- Applied Tumor Genomics Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - Thierry Brue
- Department of Endocrinology, Aix Marseille University, Assistance publique Hôpitaux de Marseille (APHM), INSERM, Marseille Medical Genetics (MMG), Hopital La Conception, Institut MarMaRa, Marseille, France
- Laboratory of Molecular Biology, Aix Marseille University, Assistance publique Hôpitaux de Marseille (APHM), INSERM, Marseille Medical Genetics (MMG), Hospital La Conception, Institut MarMaRa, Marseille, France
| | - Anne Barlier
- Laboratory of Molecular Biology, Aix Marseille University, Assistance publique Hôpitaux de Marseille (APHM), INSERM, Marseille Medical Genetics (MMG), Hospital La Conception, Institut MarMaRa, Marseille, France
| | - Patrick Pétrossians
- Department of Endocrinology, Centre Hospitalier Universitaire de Liège, University of Liège, Liège, Belgium
| | - Adrian F. Daly
- Department of Endocrinology, Centre Hospitalier Universitaire de Liège, University of Liège, Liège, Belgium
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10
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Fleseriu M, Barkan A, Brue T, Duquesne E, Houchard A, del Pilar Schneider M, Ribeiro-Oliveira A, Melmed S. Treatment Patterns, Adherence, Persistence, and Health Care Resource Utilization in Acromegaly: A Real-World Analysis. J Endocr Soc 2023; 7:bvad104. [PMID: 37705695 PMCID: PMC10496868 DOI: 10.1210/jendso/bvad104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Indexed: 09/15/2023] Open
Abstract
Context Treatment of acromegaly is multimodal for many patients, and medical treatments include somatostatin receptor ligands (SRLs), dopamine agonists (DAs), and growth hormone receptor antagonists (GHRAs). However, recent real-world evidence on treatment patterns for patients with acromegaly is limited. Objective This study evaluated medication usage, treatment changes, adherence, persistence, comorbidities, and health care resource utilization using deidentified data from MarketScan, a US claims database. Methods Eligible patients (n = 882) were those receiving monotherapy or combination therapy for ≥90 days without treatment gaps. Results Mean age at diagnosis was 48.6 years; 50.1% of patients were female. Over half (59.4%) had 1 line of treatment (LOT); 23.1% had 2 LOTs; 17.5% had at least 3 LOTs. Most patients (94.6%) initiated treatment with monotherapies. The most common first-line monotherapy treatments were cabergoline (DA, 36.8%), octreotide long-acting release (first-generation SRL, 29.5%), and lanreotide depot (first-generation SRL, 22.5%). Adherence for first-line treatments (proportion of days covered) was higher for first-generation SRLs (lanreotide depot: 0.8) compared with DAs (0.7). Treatment persistence (time between the first treatment record and a change in LOT/censoring) in LOT 1 was higher for GHRAs (24.8 months) and first-generation SRLs (20.0 months) compared with DAs (14.4 months). Female patients and those diagnosed at a younger age were more likely to have shorter treatment persistence. The most prevalent comorbidities were hyperlipidemia, essential hypertension, and sleep apnea. Conclusion Patients with more comorbidities had more health care visits during the first year after diagnosis, suggesting increased disease burden. Real-world evidence on treatment patterns provides insights into recommendations for individualized therapy.
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Affiliation(s)
- Maria Fleseriu
- Pituitary Center, Departments of Medicine and Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, USA
| | - Ariel Barkan
- A. Alfred Taubman Health Care Center, University of Michigan, Ann Arbor, MI 48109, USA
| | - Thierry Brue
- Faculté de Médecine, Aix-Marseille University, Marseille 13385, France
| | | | - Aude Houchard
- Ipsen, HEOR Oncology Department, Boulogne–Billancourt 92100, France
| | | | | | - Shlomo Melmed
- Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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11
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Sahakian N, Dufour H, Brue T, Cuny T. Pituitary tumor prognostication: WHO is really the best? Eur J Endocrinol 2023; 189:R1-R3. [PMID: 37440700 DOI: 10.1093/ejendo/lvad080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023]
Affiliation(s)
- Nicolas Sahakian
- Department of Endocrinology, Aix Marseille University, MMG, INSERM U1251, MARMARA Institute, APHM, Hôpital de la Conception, CRMR HYPO, Marseille 13005, France
| | - Henry Dufour
- Department of Neurosurgery, Aix Marseille University, MMG, INSERM U1251, MARMARA Institute, APHM, Hôpital de la Timone, CRMR HYPO, Marseille 13005, France
| | - Thierry Brue
- Department of Endocrinology, Aix Marseille University, MMG, INSERM U1251, MARMARA Institute, APHM, Hôpital de la Conception, CRMR HYPO, Marseille 13005, France
| | - Thomas Cuny
- Department of Endocrinology, Aix Marseille University, MMG, INSERM U1251, MARMARA Institute, APHM, Hôpital de la Conception, CRMR HYPO, Marseille 13005, France
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12
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Mac TT, Castinetti F, Bar C, Julia S, Pasquet M, Romanet P, Saveanu A, Mougel G, Fauquier T, Jullien N, Barlier A, Reynaud R, Brue T. Deficient anterior pituitary with common variable immune deficiency (DAVID syndrome): a new case and literature reports. J Neuroendocrinol 2023; 35:e13287. [PMID: 37322808 DOI: 10.1111/jne.13287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/29/2023] [Accepted: 04/28/2023] [Indexed: 06/17/2023]
Abstract
Deficient anterior pituitary with common variable immune deficiency (DAVID) syndrome is a rare condition characterized by adrenocorticotropic hormone (ACTH) deficiency and primary hypogammaglobulinemia. It is due to heterozygous mutations of the nuclear factor kappa-B subunit 2 (NFKB2) gene. Only a few isolated cases have been reported since its first description by our team. Through the international multicenter GENHYPOPIT network, we identified a new case of DAVID syndrome. We then conducted an extensive review of the DAVID syndrome cases published from 2012 to 2022. A 7-year-old boy was diagnosed with symptomatic hypoglycemia revealing ACTH deficiency. Laboratory tests showed asymptomatic hypogammaglobulinemia. He harbored a heterozygous point mutation in NFKB2 gene (c.2600C > T, p.Ala867Val). His management included hydrocortisone replacement treatment, and he also received subcutaneous immunoglobulins during the Covid-19 pandemic. We analyzed 28 cases of DAVID syndrome with ACTH deficiency. ACTH deficiency was the only hormone deficiency in 79% of patients, but some patients harbored growth hormone (GH) and thyroid stimulating hormone (TSH) deficiencies. The first presenting symptoms were sinus/pulmonary infections (82%, mean age of 3 years) and alopecia (mean age of 4.7 years). ACTH deficiency was the third presenting condition (mean age at diagnosis of 8.6 years). All patients had hypogammaglobulinemia (decreased IgA and IgM levels), and 57% of patients had at least one autoimmune manifestation. Heterozygous mutations at the 3'end of the NFKB2 gene, coding for the C-terminal domain of the protein, were identified in all cases. Better knowledge of DAVID syndrome will help clinicians make an early diagnosis to avoid life-threatening complications.
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Affiliation(s)
- Thi Thom Mac
- Aix Marseille University, UMR1251, MMG - Marseille Medical Genetics - MarMaRa Institute, Faculty of Medicine, Marseille, France
- Endocrinology Department, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Frederic Castinetti
- Aix Marseille University, UMR1251, MMG - Marseille Medical Genetics - MarMaRa Institute, Faculty of Medicine, Marseille, France
- Endocrinology Department, Conception Hospital - APHM, Marseille, France
| | - Céline Bar
- Department of Endocrinology and Metabolic Diseases, Children's Hospital, Toulouse Cedex 9, France
| | - Sophie Julia
- Department of Medical Genetics, Purpan Hospital, Pavillon Lefèbvre, Place du Docteur Baylac, Toulouse Cedex 9, France
| | - Marlene Pasquet
- Department of Hematology Oncology Immunology, Children's Hospital, Toulouse Cedex 9, France
| | - Pauline Romanet
- Aix Marseille University, UMR1251, MMG - Marseille Medical Genetics - MarMaRa Institute, Faculty of Medicine, Marseille, France
- Department of Molecular Biology, Conception Hospital - APHM, Marseille, France
| | - Alexandru Saveanu
- Aix Marseille University, UMR1251, MMG - Marseille Medical Genetics - MarMaRa Institute, Faculty of Medicine, Marseille, France
- Department of Molecular Biology, Conception Hospital - APHM, Marseille, France
| | - Gregory Mougel
- Aix Marseille University, UMR1251, MMG - Marseille Medical Genetics - MarMaRa Institute, Faculty of Medicine, Marseille, France
- Department of Molecular Biology, Conception Hospital - APHM, Marseille, France
| | - Teddy Fauquier
- Aix Marseille University, UMR1251, MMG - Marseille Medical Genetics - MarMaRa Institute, Faculty of Medicine, Marseille, France
| | - Nicolas Jullien
- INP - Institute of Neurophysiopathology, UMR 7051, Faculty of Medicine, Marseille, France
| | - Anne Barlier
- Aix Marseille University, UMR1251, MMG - Marseille Medical Genetics - MarMaRa Institute, Faculty of Medicine, Marseille, France
- Department of Molecular Biology, Conception Hospital - APHM, Marseille, France
| | - Rachel Reynaud
- Aix Marseille University, UMR1251, MMG - Marseille Medical Genetics - MarMaRa Institute, Faculty of Medicine, Marseille, France
- Multidisciplinary Pediatrics Department, Timone Hospital, Marseille, France
| | - Thierry Brue
- Aix Marseille University, UMR1251, MMG - Marseille Medical Genetics - MarMaRa Institute, Faculty of Medicine, Marseille, France
- Endocrinology Department, Conception Hospital - APHM, Marseille, France
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13
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Castinetti F, Amodru V, Brue T. Osilodrostat in Cushing's disease: The risk of delayed adrenal insufficiency should be carefully monitored. Clin Endocrinol (Oxf) 2023; 98:629-630. [PMID: 34219265 DOI: 10.1111/cen.14551] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 05/20/2021] [Revised: 06/09/2021] [Accepted: 06/17/2021] [Indexed: 12/01/2022]
Abstract
Antisecretory data shows a highly effective and prolonged blockade of cortisol secretion with osilodrostat. The drawback is the occurrence of adrenal insufficiency (AI) in roughly a quarter of treated patients. In this short manuscript, we report three cases of atypical adrenal insufficiency with osilodrostat.
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Affiliation(s)
- Frederic Castinetti
- Department of Endocrinology, Aix Marseille Univ, APHM, INSERM, MMG, Marmara Institute, La Conception Hospital, Marseille, France
| | - Vincent Amodru
- Department of Endocrinology, Aix Marseille Univ, APHM, INSERM, MMG, Marmara Institute, La Conception Hospital, Marseille, France
| | - Thierry Brue
- Department of Endocrinology, Aix Marseille Univ, APHM, INSERM, MMG, Marmara Institute, La Conception Hospital, Marseille, France
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Abstract
Over the past decade, the development of ICI (immune checkpoint inhibitors) has constituted a revolution in the treatment of many cancers, but with a specific toxicity profile including endocrine IRAEs (immune-related adverse events). As the indications for these molecules are constantly increasing due to their efficacy, it is important that endocrinologists and oncologists know how to detect, manage and monitor this type of toxicity. Many guidelines and recommendations have been proposed in the last few years for the management of endocrinopathies. French guidelines on immunotherapy-related endocrine IRAEs were published in 2018, with a specific algorithm for hypophysitis and primary adrenal insufficiency (PAI), based on clinical suspicion followed by biochemical and imaging evaluation, and are still relevant today. Here we present the general pathophysiological mechanisms of these toxicities, and discuss the incidence, diagnosis, treatment, progression, management and monitoring of pituitary and adrenal disorders in patients treated by immunotherapy, with emphasis on hypophysitis, which is much more frequent than PAI with this type of molecule. We also highlight several key points, such as the need for emergency treatment by hydrocortisone with the possibility of continuing immunotherapy in these endocrinopathies, and the long-term persistence of corticotropin or adrenal deficiency in most cases, requiring specific "hydrocortisone education‿. These points should be kept in mind by oncologists and endocrinologists who treat and monitor patients treated by immunotherapy.
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Affiliation(s)
- Frédérique Albarel
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Marseille, France and Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, 13005 Marseille, France.
| | - Thierry Brue
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Marseille, France and Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, 13005 Marseille, France
| | - Frédéric Castinetti
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Marseille, France and Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, 13005 Marseille, France
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15
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Pivonello R, Zacharieva S, Elenkova A, Tóth M, Shimon I, Stigliano A, Badiu C, Brue T, Georgescu CE, Tsagarakis S, Cohen F, Fleseriu M. Levoketoconazole in the treatment of patients with endogenous Cushing's syndrome: a double-blind, placebo-controlled, randomized withdrawal study (LOGICS). Pituitary 2022; 25:911-926. [PMID: 36085339 PMCID: PMC9675660 DOI: 10.1007/s11102-022-01263-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE The efficacy of levoketoconazole for endogenous Cushing's syndrome was demonstrated in a phase 3, open-label study (SONICS). This study (LOGICS) evaluated drug-specificity of cortisol normalization. METHODS LOGICS was a phase 3, placebo-controlled, randomized-withdrawal study with open-label titration-maintenance (14-19 weeks) followed by double-blind, randomized-withdrawal (~ 8 weeks), and restoration (~ 8 weeks) phases. RESULTS 79 patients received levoketoconazole during titration-maintenance; 39 patients on a stable dose (~ 4 weeks or more) proceeded to randomization. These and 5 SONICS completers who did not require dose titration were randomized to levoketoconazole (n = 22) or placebo (n = 22). All patients with loss of response (the primary endpoint) met the prespecified criterion of mean urinary free cortisol (mUFC) > 1.5 × upper limit of normal. During randomized-withdrawal, 21 patients withdrawn to placebo (95.5%) lost mUFC response compared with 9 patients continuing levoketoconazole (40.9%); treatment difference: - 54.5% (95% CI - 75.7, - 27.4; P = 0.0002). At the end of randomized-withdrawal, mUFC normalization was observed among 11 (50.0%) patients receiving levoketoconazole and 1 (4.5%) receiving placebo; treatment difference: 45.5% (95% CI 19.2, 67.9; P = 0.0015). Restoration of levoketoconazole reversed loss of cortisol control in most patients who had received placebo. Adverse events were reported in 89% of patients during treatment with levoketoconazole (dose-titration, randomized-withdrawal, and restoration phases combined), most commonly nausea (29%) and hypokalemia (26%). Prespecified adverse events of special interest with levoketoconazole were liver-related (10.7%), QT interval prolongation (10.7%), and adrenal insufficiency (9.5%). CONCLUSIONS Levoketoconazole reversibly normalized urinary cortisol in patients with Cushing's syndrome. No new risks of levoketoconazole treatment were identified.
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Affiliation(s)
| | | | | | | | - Ilan Shimon
- Rabin Medical Center and Tel Aviv University, Tel Aviv, Israel
| | | | - Corin Badiu
- National Institute of Endocrinology CI Parhon and "C. Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Thierry Brue
- Aix-Marseille Université and Assistance Publique - Hôpitaux de Marseille, Hôpital de la Conception, Marseille, France
| | - Carmen Emanuela Georgescu
- Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Endocrinology Clinical Unit, Cluj County Emergency Hospital, Cluj-Napoca, Romania
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Sahakian N, Appay R, Resseguier N, Graillon T, Piazzola C, Laure C, Figarella-Branger D, Régis J, Castinetti F, Brue T, Dufour H, Cuny T. Real-life clinical impact of a five-tiered classification of pituitary tumors. Eur J Endocrinol 2022; 187:893-904. [PMID: 36315463 DOI: 10.1530/eje-22-0812] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 09/16/2022] [Accepted: 10/31/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Usually benign, pituitary tumors (PT) can be invasive and aggressive with a propensity to progress and/or recur. Trouillas's clinicopathological classification attempts to predict the evolutionary risk of a PT. In this study, we assessed the prognostic value of this classification in an independent patient cohort and analyzed its impact on treatment strategies. PATIENTS AND METHODS In this study, 607 patients operated on between 2008 and 2018 for a PT were included. Grading was established based on invasion, proliferative activity (Ki-67, mitotic index) and p53 positivity. The therapeutic management following surgery was analyzed. Progression-free survival (PFS) of the graded tumors was estimated (Kaplan-Meier method and log-rank test) and a multivariate analysis was performed (Cox regression model). RESULTS Grading identified non-invasive PT without (grade 1a: 303 cases) or with proliferative activity (grade 1b: 53 cases) and invasive PT without (grade 2a: 202 cases) or with proliferative activity (grade 2b: 49 cases). The mean follow-up was 47 ± 30 months (median: 38 months). Progression/recurrence occurred in 127 cases. Grades were significant and independent predictors of PFS (P < 0.001) with a 4.8-fold higher risk of progression/recurrence in grade 2b as compared to grade 1a. As second-line therapy, gamma knife or conventional radiotherapy controlled tumor growth in 91.6 and 100% of cases, respectively, irrespective of the grade. Proliferative tumors exposed the patient to a 9.5-fold higher risk of having ≥3 adjuvant therapeutic lines as compared to non-proliferative tumors. DISCUSSION Grading of a PT according to Trouillas's classification predicts its risk of progression and should advocate for a personalized therapeutic approach in invasive and proliferative tumors. SIGNIFICANCE STATEMENT This is the first study to assess, on a cohort of 607 well-characterized patients, the real-life therapeutic impact of the five-tiered clinicopathological classification of pituitary tumors. First, we validate that pituitary tumor grades predict the evolutionary risk of the tumor, with a significant higher risk of progression/recurrence in invasive and/or proliferative tumors (mean follow-up: 47 ± 30 months, median: 38 months). Moreover, our study provides evidence that patients with proliferative tumors have a higher risk to be retreated after primary surgery and point toward the fact that radiotherapy can successfully control tumor growth in case of progression or recurrence. Our findings advocate for a personalized therapeutic approach in clinically aggressive pituitary tumors.
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Affiliation(s)
- Nicolas Sahakian
- Aix Marseille Univ, MMG, INSERM U1251, MARMARA Institute, APHM, Hôpital de la Conception, Department of Endocrinology, CRMR HYPO, Marseille, France
| | - Romain Appay
- APHM, CHU Timone, Service d'Anatomie Pathologique et de Neuropathologie, Marseille, France
| | - Noémie Resseguier
- Aix Marseille Univ, APHM, Hôpital de la Timone, Service d'Epidemiologie et d'Economie de la Santé, Unité de Recherche Clinique, Direction de la Recherche en Santé, Marseille, France
- EA3279, CEReSS, Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Thomas Graillon
- Aix Marseille University, MMG, INSERM U1251, MARMARA Institute, APHM, Hôpital de la Timone Department of Neurosurgery, CRMR HYPO, Marseille, France
| | - Cécilia Piazzola
- Aix Marseille Univ, MMG, INSERM U1251, MARMARA Institute, APHM, Hôpital de la Conception, Department of Endocrinology, CRMR HYPO, Marseille, France
| | - Cécilia Laure
- Department of Endocrinology, University Hospital of Montpellier, France
| | | | - Jean Régis
- Aix Marseille University, INS-UMR1106, Department of Functional and Stereotactic Neurosurgery, CHU Timone, Marseille, France
| | - Frédéric Castinetti
- Aix Marseille Univ, MMG, INSERM U1251, MARMARA Institute, APHM, Hôpital de la Conception, Department of Endocrinology, CRMR HYPO, Marseille, France
| | - Thierry Brue
- Aix Marseille Univ, MMG, INSERM U1251, MARMARA Institute, APHM, Hôpital de la Conception, Department of Endocrinology, CRMR HYPO, Marseille, France
| | - Henry Dufour
- Aix Marseille University, MMG, INSERM U1251, MARMARA Institute, APHM, Hôpital de la Timone Department of Neurosurgery, CRMR HYPO, Marseille, France
| | - Thomas Cuny
- Aix Marseille Univ, MMG, INSERM U1251, MARMARA Institute, APHM, Hôpital de la Conception, Department of Endocrinology, CRMR HYPO, Marseille, France
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17
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Fourneaux R, Reynaud R, Mougel G, Castets S, Bretones P, Dauriat B, Edouard T, Raverot G, Barlier A, Brue T, Castinetti F, Saveanu A. IGSF1 mutations are the most frequent genetic aetiology of thyrotropin deficiency. Eur J Endocrinol 2022; 187:787-795. [PMID: 36201163 DOI: 10.1530/eje-22-0520] [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: 06/14/2022] [Accepted: 10/05/2022] [Indexed: 11/08/2022]
Abstract
DESIGN Thyroid-stimulating hormone deficiency (TSHD) is a rare disease. It may be isolated, secondary to abnormalities of genes involved in TSH biosynthesis, or associated with other pituitary deficits or abnormalities of genes involved in pituitary ontogenesis. Several genes are involved in thyrotroph development and function. OBJECTIVE Our aim was to determine the genetic causes of TSHD, either isolated (ITSHD) or associated with somatotroph deficiency (TSHD-GHD), in the cohort of patients from the GENHYPOPIT network. METHODS Next-generation sequencing (NGS) analyses were performed as a panel of genes on a cohort of patients with non-syndromic ITSHD or TSHGHD. The variants were classified according to the American College of Medical Genetics classification reviewed by the NGS-Diag network and correlated with the phenotype. Class 3, 4, and 5 single-nucleotide variants were checked by Sanger sequencing and copy number variants by multiplex ligation-dependent probe amplification (MLPA). RESULTS A total of 64 index cases (22 ITSHD and 42 TSHD-GHD) were included in this cohort. A genetic cause was identified in 26.5% of patients, with 36.3% in the ITSHD group (variants in TSHβ and IGSF1) and 21.4% in TSHD-GHD (variants in IGSF1, TSHβ, TRHR, GH1, POU1F1, and PROP1). Among the pathogenic and likely pathogenic variants identified, 42% were in IGSF1, including six not previously reported. CONCLUSION Our results show that IGSF1 variants represent the most frequent aetiology of TSH deficiency. Despite a systematic NGS approach and the identification of new variants, most patients remain without a molecular diagnosis. Larger scale studies, such as exome or genome studies, should be considered in the future.
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Affiliation(s)
- Rachel Fourneaux
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences Médicales et Paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
- Centre de Référence des Maladies Rares de l'Hypophyse, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - Rachel Reynaud
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences Médicales et Paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Centre de Référence des Maladies Rares de l'Hypophyse, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
- Department of Paediatrics, Paediatric Endocrinology Unit, CHU Timone Enfants, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - Gregory Mougel
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences Médicales et Paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Centre de Référence des Maladies Rares de l'Hypophyse, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
- Laboratory of Molecular Biology, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - Sarah Castets
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences Médicales et Paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Centre de Référence des Maladies Rares de l'Hypophyse, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
- Department of Paediatrics, Paediatric Endocrinology Unit, CHU Timone Enfants, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | | | - Benjamin Dauriat
- Department of Cytogenetics and Genetics, CHU Limoges, Limoges, France
| | - Thomas Edouard
- Department of Pediatric Endocrinology, CHU Toulouse, Toulouse, France
| | | | - Anne Barlier
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences Médicales et Paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Centre de Référence des Maladies Rares de l'Hypophyse, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
- Laboratory of Molecular Biology, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - Thierry Brue
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences Médicales et Paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
- Centre de Référence des Maladies Rares de l'Hypophyse, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - Frederic Castinetti
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences Médicales et Paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
- Centre de Référence des Maladies Rares de l'Hypophyse, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - Alexandru Saveanu
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences Médicales et Paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Centre de Référence des Maladies Rares de l'Hypophyse, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
- Laboratory of Molecular Biology, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
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Bando H, Brinkmeier ML, Castinetti F, Fang Q, Lee MS, Saveanu A, Albarel F, Dupuis C, Brue T, Camper SA. Heterozygous variants in SIX3 and POU1F1 cause pituitary hormone deficiency in mouse and man. Hum Mol Genet 2022; 32:367-385. [PMID: 35951005 PMCID: PMC9851746 DOI: 10.1093/hmg/ddac192] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/22/2022] [Accepted: 08/09/2022] [Indexed: 01/24/2023] Open
Abstract
Congenital hypopituitarism is a genetically heterogeneous condition that is part of a spectrum disorder that can include holoprosencephaly. Heterozygous mutations in SIX3 cause variable holoprosencephaly in humans and mice. We identified two children with neonatal hypopituitarism and thin pituitary stalk who were doubly heterozygous for rare, likely deleterious variants in the transcription factors SIX3 and POU1F1. We used genetically engineered mice to understand the disease pathophysiology. Pou1f1 loss-of-function heterozygotes are unaffected; Six3 heterozygotes have pituitary gland dysmorphology and incompletely ossified palate; and the Six3+/-; Pou1f1+/dw double heterozygote mice have a pronounced phenotype, including pituitary growth through the palate. The interaction of Pou1f1 and Six3 in mice supports the possibility of digenic pituitary disease in children. Disruption of Six3 expression in the oral ectoderm completely ablated anterior pituitary development, and deletion of Six3 in the neural ectoderm blocked the development of the pituitary stalk and both anterior and posterior pituitary lobes. Six3 is required in both oral and neural ectodermal tissues for the activation of signaling pathways and transcription factors necessary for pituitary cell fate. These studies clarify the mechanism of SIX3 action in pituitary development and provide support for a digenic basis for hypopituitarism.
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Affiliation(s)
| | | | - Frederic Castinetti
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l’hypophyse HYPO, Marseille, France,Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille, Maladies Rares (MarMaRa), Marseille, France
| | - Qing Fang
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Mi-Sun Lee
- Michigan Neuroscience Institute, Department of Biological Chemistry, University of Michigan, Ann Arbor, MI, USA
| | - Alexandru Saveanu
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l’hypophyse HYPO, Marseille, France,Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille, Maladies Rares (MarMaRa), Marseille, France
| | - Frédérique Albarel
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l’hypophyse HYPO, Marseille, France,Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille, Maladies Rares (MarMaRa), Marseille, France
| | - Clémentine Dupuis
- Department of Pediatrics, Centre Hospitalier Universitaire de Grenoble-Alpes, site Nord, Hôpital Couple Enfants, Grenoble, France
| | - Thierry Brue
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l’hypophyse HYPO, Marseille, France,Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille, Maladies Rares (MarMaRa), Marseille, France
| | - Sally A Camper
- To whom correspondence should be addressed at: Department of Human Genetics, University of Michigan Medical School, 5704 Medical Science Building II, 1241 Catherine St., Ann Arbor, MI 48109, USA. Tel: +1-734-763-0682; Fax: +1-734-763-3784;
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19
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Albarel F, Cuny T, Graillon T, Dufour H, Brue T, Castinetti F. Preoperative Medical Treatment for Patient with Acromegaly: yes or no? J Endocr Soc 2022; 6:bvac114. [PMID: 35965944 PMCID: PMC9368018 DOI: 10.1210/jendso/bvac114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Indexed: 11/19/2022] Open
Abstract
Transsphenoidal surgery is the first-line treatment for acromegaly. However, several factors can modify surgical remission rates, such as the initial hormone levels, the size and invasiveness of the tumor, and the degree of experience of the surgeon. Physicians treating patients with acromegaly should thus consider how to improve surgical remission rates. As stated in recent guidelines, the major point is to consider that any patient with acromegaly should be referred to an expert neurosurgeon to maximize the chances of surgical sure. The benefits of presurgical medical treatment, mainly using somatostatin receptor ligands (SRLs), given 3 to 6 months before surgery, remain controversial. By normalizing growth hormone and insulin-like growth factor 1 levels, SRLs may improve the overall condition of the patient, thus decreasing anesthetic and surgical complications. By decreasing the tumor size and modifying the consistency of the tumor, SRLs might also make surgical excision easier. This is however theoretical as published data are contradictory on both points, and only limited data support the use of a systematical presurgical medical treatment. The aim of this review is to analyze the potential benefits and pitfalls of using presurgical medical treatment in acromegaly in view of the contradictory literature data. We also attempt to determine the profile of patients who might most benefit from this presurgical medical treatment approach as an individualized therapeutic management of acromegaly.
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Affiliation(s)
- Frederique Albarel
- Aix Marseille Univ, INSERM, MMG, Marseille, France and French Reference Center for rare Pituitary Diseases, Department of Endocrinology, La Conception Hospital , Marseille, France
- Department of Endocrinology, Assistance Publique Hopitaux de Marseille , Marseille, France
| | - Thomas Cuny
- Aix Marseille Univ, INSERM, MMG, Marseille, France and French Reference Center for rare Pituitary Diseases, Department of Endocrinology, La Conception Hospital , Marseille, France
- Department of Endocrinology, Assistance Publique Hopitaux de Marseille , Marseille, France
| | - Thomas Graillon
- Aix Marseille Univ, INSERM, MMG, Marseille, France and French Reference Center for rare Pituitary Diseases, Department of Endocrinology, La Conception Hospital , Marseille, France
- Department of Neurosurgery, Assistance Publique Hopitaux de Marseille , Marseille, France
| | - Henry Dufour
- Aix Marseille Univ, INSERM, MMG, Marseille, France and French Reference Center for rare Pituitary Diseases, Department of Endocrinology, La Conception Hospital , Marseille, France
- Department of Neurosurgery, Assistance Publique Hopitaux de Marseille , Marseille, France
| | - Thierry Brue
- Aix Marseille Univ, INSERM, MMG, Marseille, France and French Reference Center for rare Pituitary Diseases, Department of Endocrinology, La Conception Hospital , Marseille, France
- Department of Endocrinology, Assistance Publique Hopitaux de Marseille , Marseille, France
| | - Frederic Castinetti
- Aix Marseille Univ, INSERM, MMG, Marseille, France and French Reference Center for rare Pituitary Diseases, Department of Endocrinology, La Conception Hospital , Marseille, France
- Department of Endocrinology, Assistance Publique Hopitaux de Marseille , Marseille, France
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20
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Raverot V, Perrin P, Chanson P, Jouanneau E, Brue T, Raverot G. Prolactin immunoassay: does the high-dose hook effect still exist? Pituitary 2022; 25:653-657. [PMID: 35793045 DOI: 10.1007/s11102-022-01246-8] [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: 05/12/2022] [Accepted: 06/22/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Measurement of prolactin in clinical laboratories is an important component in the management of patients with pituitary adenoma. Prolactin measurement is known to be sensitive to the high-dose hook effect, in the presence of extremely high prolactin concentrations. This interference is referred to in most recent articles discussing prolactin assays and the management of prolactin-secreting pituitary adenomas. The objective of our study was to evaluate if the high-dose hook effect remains relevant in current practice, when using currently available assays. METHODS Serum from a patient with a giant macroprolactinoma was assayed using all of the available prolactin assays in France in 2020, using native serum and after dilution. Technical inserts from assays were reviewed to assess the information on analytical principles, numbers of steps, and any reference to high dose hook effect. RESULTS Fourteen assay kits were studied by 16 laboratories; all were two-site immunometric assays, mostly using one step (11/14). Results obtained after dilution varied from 17,900 µg/L to 86,900 µg/L depending on the assay used. One tested assay was sensitive to the high-dose hook effect leading to a falsely lower prolactin concentration when measuring native serum (150 µg/L compared to 17,900 µg/L after dilution). CONCLUSION The high-dose hook effect still exists in a very small minority of prolactin assays. The evolution of assay methods may lead to new assays that remain sensitive to this effect in the future. We therefore advise that the hook effect should still be mentioned in prolactin assay recommendations.
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Affiliation(s)
- Véronique Raverot
- Service de Biochimie et biologie moléculaire, Hospices Civils de Lyon, LBMMS, F-69677, Hormonologie, Bron cedex, France.
- Neuroscience Research Center (CRNL), Inserm UMRS 1028, Université de Lyon, Waking team, 69500, Bron, France.
| | - Pauline Perrin
- Service de Biochimie et biologie moléculaire, Hospices Civils de Lyon, LBMMS, F-69677, Hormonologie, Bron cedex, France
- Neuroscience Research Center (CRNL), Inserm UMRS 1028, Université de Lyon, Waking team, 69500, Bron, France
| | - Philippe Chanson
- Physiologie et Physiopathologie Endocriniennes, Hôpital Bicêtre, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Service d'Endocrinologie et des Maladies de la Reproduction, Université Paris-Saclay, Inserm, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Emmanuel Jouanneau
- Service de neurochirurgie, Hospices Civils de Lyon, Groupement Hospitalier Est, F-69677, Bron cedex, France
| | - Thierry Brue
- Department of Endocrinology, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Centre de Référence des Maladies Rares de l'hypophyse HYPO, 13005, Marseille, France
- Aix-Marseille Université, Marseille Medical Genetics (MMG), Faculté des Sciences médicales et paramédicales, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
| | - Gérald Raverot
- Fédération d'endocrinologie, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Faculté de Médecine Lyon Est, Hospices Civils de Lyon, Groupement Hospitalier Est, Université Claude Bernard Lyon1, F-69677, Bron cedex, France
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21
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Salvatori R, Maffei P, Webb SM, Brue T, Loftus J, Valluri SR, Gomez R, Wajnrajch MP, Fleseriu M. Patient-reported outcomes in patients with acromegaly treated with pegvisomant in the ACROSTUDY extension: A real-world experience. Pituitary 2022; 25:420-432. [PMID: 35022929 DOI: 10.1007/s11102-022-01206-2] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To report the effects of pegvisomant (PEGV) treatment on patient-reported outcomes in acromegaly patients. METHODS We conducted an extension study of an open-label, multinational, non-interventional study (ACROSTUDY) evaluating the long-term safety and efficacy of PEGV for acromegaly in routine clinical practice. Enrolled patients were rollover patients from ACROSTUDY, or treatment naïve/semi-naïve (NSN; no PEGV within 6 months of enrollment). Exploratory efficacy endpoints were changes in symptoms with the Patient-Assessed Acromegaly Symptom Questionnaire (PASQ) and quality of life with the Acromegaly Quality of Life questionnaire (AcroQoL) analyzed by controlled or uncontrolled IGF-I levels. Results were analyzed in all patients, in NSN patient subgroup, and by diabetes status. RESULTS A total of 544 patients with acromegaly were enrolled, including 434 rollover subjects from ACROSTUDY and 110 NSN patients. Mean PEGV treatment duration was 7.8 years (range, 0-19.6 years). Overall, the majority of PASQ scores improved over time, but there was no significant difference between IGF-I controlled or uncontrolled groups. In the NSN subgroup, most PASQ and AcroQoL scores remained similar to baseline up to 1 year, regardless of IGF-I control. Patients with diabetes reported better PASQ scores over time with PEGV treatment, regardless of IGF-I control. IGF-I normalization increased from 10% of patients at baseline to more than 78% at year 10, with a mean daily PEGV dose of 18.7 mg. CONCLUSIONS Overall, patients treated with PEGV had small improvements in PASQ. While IGF-I normalization increased with PEGV treatment, IGF-I control had no effects on PASQ and AcroQoL scores.
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Affiliation(s)
- Roberto Salvatori
- Division of Endocrinology and Metabolism and Pituitary Center, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Pietro Maffei
- Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Susan M Webb
- Department of Endocrinology/Medicine, Centro de Investigación Biomédica en Red de Enfermedades Raras, Hospital Sant Pau, Universitat Autónoma de Barcelona, Carrer de Sant Quintí 89, 08041, Barcelona, Spain
| | - Thierry Brue
- Hopital de la Conception, and Aix-Marseille Université, Marseille Medical Genetics, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | | | | | | | - Michael P Wajnrajch
- , Pfizer, New York, NY, USA
- Division of Pediatric Endocrinology, Grossman School of Medicine, New York University, New York, NY, USA
| | - Maria Fleseriu
- Pituitary Center, Departments of Medicine, Division of Endocrinology, Diabetes, & Clinical Nutrition) and Neurological Surgery, Oregon Health & Science University, Portland, OR, USA
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22
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Castinetti F, Brue T. L’impact du syndrome de Cushing sur la fertilité et la grossesse. Annales d'Endocrinologie 2022; 83:188-190. [DOI: 10.1016/j.ando.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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23
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Tabarin A, Assié G, Barat P, Bonnet F, Bonneville JF, Borson-Chazot F, Bouligand J, Boulin A, Brue T, Caron P, Castinetti F, Chabre O, Chanson P, Corcuff JB, Cortet C, Coutant R, Dohan A, Drui D, Espiard S, Gaye D, Grunenwald S, Guignat L, Hindie E, Illouz F, Kamenicky P, Lefebvre H, Linglart A, Martinerie L, North MO, Raffin-Samson ML, Raingeard I, Raverot G, Raverot V, Reznik Y, Taieb D, Vezzosi D, Young J, Bertherat J. Consensus statement by the French Society of Endocrinology (SFE) and French Society of Pediatric Endocrinology & Diabetology (SFEDP) on diagnosis of Cushing's syndrome. Ann Endocrinol (Paris) 2022; 83:119-141. [PMID: 35192845 DOI: 10.1016/j.ando.2022.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Cushing's syndrome is defined by prolonged exposure to glucocorticoids, leading to excess morbidity and mortality. Diagnosis of this rare pathology is difficult due to the low specificity of the clinical signs, the variable severity of the clinical presentation, and the difficulties of interpretation associated with the diagnostic methods. The present consensus paper by 38 experts of the French Society of Endocrinology and the French Society of Pediatric Endocrinology and Diabetology aimed firstly to detail the circumstances suggesting diagnosis and the biologic diagnosis tools and their interpretation for positive diagnosis and for etiologic diagnosis according to ACTH-independent and -dependent mechanisms. Secondly, situations making diagnosis complex (pregnancy, intense hypercortisolism, fluctuating Cushing's syndrome, pediatric forms and genetically determined forms) were detailed. Lastly, methods of surveillance and diagnosis of recurrence were dealt with in the final section.
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Affiliation(s)
- Antoine Tabarin
- Service Endocrinologie, Diabète et Nutrition, Université, Hôpital Haut-Leveque CHU de Bordeaux, 33604 Pessac, France.
| | - Guillaume Assié
- Centre de Référence Maladies Rares de la Surrénale (CRMRS), Service d'Endocrinologie, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
| | - Pascal Barat
- Unité d'Endocrinologie-Diabétologie-Gynécologie-Obésité Pédiatrique, Hôpital des Enfants CHU Bordeaux, Bordeaux, France
| | - Fidéline Bonnet
- UF d'Hormonologie Hôpital Cochin, Université de Paris, Institut Cochin Inserm U1016, CNRS UMR8104, Paris, France
| | | | - Françoise Borson-Chazot
- Fédération d'Endocrinologie, Hôpital Louis-Pradel, Hospices Civils de Lyon, INSERM U1290, Université Lyon1, 69002 Lyon, France
| | - Jérôme Bouligand
- Faculté de Médecine Paris-Saclay, Unité Inserm UMRS1185 Physiologie et Physiopathologie Endocriniennes, Paris, France
| | - Anne Boulin
- Service de Neuroradiologie, Hôpital Foch, 92151 Suresnes, France
| | - Thierry Brue
- Aix-Marseille Université, Institut National de la Recherche Scientifique (INSERM) U1251, Marseille Medical Genetics, Marseille, France; Assistance publique-Hôpitaux de Marseille, Service d'Endocrinologie, Hôpital de la Conception, Centre de Référence Maladies Rares HYPO, 13005 Marseille, France
| | - Philippe Caron
- Service d'Endocrinologie et Maladies Métaboliques, Pôle Cardiovasculaire et Métabolique, CHU Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France
| | - Frédéric Castinetti
- Aix-Marseille Université, Institut National de la Recherche Scientifique (INSERM) U1251, Marseille Medical Genetics, Marseille, France; Assistance publique-Hôpitaux de Marseille, Service d'Endocrinologie, Hôpital de la Conception, Centre de Référence Maladies Rares HYPO, 13005 Marseille, France
| | - Olivier Chabre
- Université Grenoble Alpes, UMR 1292 INSERM-CEA-UGA, Endocrinologie, CHU Grenoble Alpes, 38000 Grenoble, France
| | - Philippe Chanson
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Le Kremlin-Bicêtre, France
| | - Jean Benoit Corcuff
- Laboratoire d'Hormonologie, Service de Médecine Nucléaire, CHU Bordeaux, Laboratoire NutriNeuro, UMR 1286 INRAE, Université de Bordeaux, Bordeaux, France
| | - Christine Cortet
- Service d'Endocrinologie, Diabétologie, Métabolisme et Nutrition, CHU de Lille, Lille, France
| | - Régis Coutant
- Service d'Endocrinologie Pédiatrique, CHU Angers, Centre de Référence, Centre Constitutif des Maladies Rares de l'Hypophyse, CHU Angers, Angers, France
| | - Anthony Dohan
- Department of Radiology A, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Delphine Drui
- Service Endocrinologie-Diabétologie et Nutrition, l'institut du Thorax, CHU Nantes, 44092 Nantes cedex, France
| | - Stéphanie Espiard
- Service d'Endocrinologie, Diabétologie, Métabolisme et Nutrition, INSERM U1190, Laboratoire de Recherche Translationnelle sur le Diabète, 59000 Lille, France
| | - Delphine Gaye
- Service de Radiologie, Hôpital Haut-Lêveque, CHU de Bordeaux, 33604 Pessac, France
| | - Solenge Grunenwald
- Service d'Endocrinologie, Hôpital Larrey, CHU Toulouse, Toulouse, France
| | - Laurence Guignat
- Centre de Référence Maladies Rares de la Surrénale (CRMRS), Service d'Endocrinologie, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
| | - Elif Hindie
- Service de Médecine Nucléaire, CHU de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Frédéric Illouz
- Centre de Référence Maladies Rares de la Thyroïde et des Récepteurs Hormonaux, Service Endocrinologie-Diabétologie-Nutrition, CHU Angers, 49933 Angers cedex 9, France
| | - Peter Kamenicky
- Assistance publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
| | - Hervé Lefebvre
- Service d'Endocrinologie, Diabète et Maladies Métaboliques, CHU de Rouen, Rouen, France
| | - Agnès Linglart
- Paris-Saclay University, AP-HP, Endocrinology and Diabetes for Children, Reference Center for Rare Disorders of Calcium and Phosphate Metabolism, Filière OSCAR, and Platform of Expertise for Rare Disorders, INSERM, Physiologie et Physiopathologie Endocriniennes, Bicêtre Paris-Saclay Hospital, Le Kremlin-Bicêtre, France
| | - Laetitia Martinerie
- Service d'Endocrinologie Pédiatrique, CHU Robert-Debré, AP-HP, Paris, France; Université de Paris, Paris, France
| | - Marie Odile North
- Service de Génétique et Biologie Moléculaire, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
| | - Marie Laure Raffin-Samson
- Service d'Endocrinologie Nutrition, Hôpital Ambroise-Paré, GHU Paris-Saclay, AP-HP Boulogne, EA4340, Université de Versailles-Saint-Quentin, Paris, France
| | - Isabelle Raingeard
- Maladies Endocriniennes, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France
| | - Gérald Raverot
- Fédération d'Endocrinologie, Centre de Référence Maladies Rares Hypophysaires, "Groupement Hospitalier Est", Hospices Civils de Lyon, Lyon, France
| | - Véronique Raverot
- Hospices Civils de Lyon, LBMMS, Centre de Biologie Est, Service de Biochimie et Biologie Moléculaire, 69677 Bron cedex, France
| | - Yves Reznik
- Department of Endocrinology and Diabetology, CHU Côte-de-Nacre, 14033 Caen cedex, France; University of Caen Basse-Normandie, Medical School, 14032 Caen cedex, France
| | - David Taieb
- Aix-Marseille Université, CHU La Timone, AP-HM, Marseille, France
| | - Delphine Vezzosi
- Service d'Endocrinologie, Hôpital Larrey, CHU Toulouse, Toulouse, France
| | - Jacques Young
- Assistance publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
| | - Jérôme Bertherat
- Centre de Référence Maladies Rares de la Surrénale (CRMRS), Service d'Endocrinologie, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
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Aouchiche K, Reynaud R, Amodru V, Brue T, Cuny T. Teriparatide administration by the Omnipod pump: preliminary experience from two cases with refractory hypoparathyroidism. Endocrine 2022; 76:179-188. [PMID: 34984624 DOI: 10.1007/s12020-021-02978-6] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/27/2021] [Indexed: 11/03/2022]
Abstract
CONTEXT Hypoparathyroidism (hypoPTH) in adults is mainly due to total thyroidectomy. Conventional therapies (calcium, active vitamin D) can fail to normalize calcemia, expose the patient to hypercalciuria and impact quality-of-life. Human parathormone (PTH) replacement therapy is a suitable option in these cases, although few clinical reports have been published so far. METHODS We describe two cases of patients with refractory postsurgical hypoPTH, in whom subcutaneous infusion of recombinant PTH (teriparatide) through the Omnipod® pump was initiated after failure of all other therapeutic options. Besides, we performed a review of literature of hypoPTH cases treated by continuous infusion of teriparatide. RESULTS Two women aged 46 and 61 years old failed to normalize calcemia either with conventional treatments (calcium 8 g/day + calcitriol 9 mcg/day and calcium 5 g/day + calcitriol 12 mcg/day) or with thrice daily subcutaneous injections of teriparatide. As a last resort, teriparatide infusion via Omnipod® device normalized their calcemia and allowed calcium/vitamin D withdrawal, with average teriparatide dose of 23 and 32 mcg/day, respectively. The flow of teriparatide was adapted according to a protocol based on measured calcemia, under medical supervision. In the literature, 15 adult cases (13 women, mean age 44.5 ± 5.2 years old) are reported. HypoPTH was consecutive to surgery in all of them. Mean dose of teriparatide administered was 25 ± 6 mcg/day with improvement of calcemia level and quality-of-life in all patients. CONCLUSIONS Continuous administration of teriparatide through Omnipod® appears as an efficient therapeutic option in refractory hypoPTH, whose administration to the patient can be assisted by medically-supervised protocol.
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Affiliation(s)
- Karine Aouchiche
- Assistance-Publique des Hôpitaux de Marseille (AP-HM), Department of Pediatrics, Hôpital de la Timone Enfants, Marseille, France
| | - Rachel Reynaud
- Assistance-Publique des Hôpitaux de Marseille (AP-HM), Department of Pediatrics, Hôpital de la Timone Enfants, Marseille, France
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Marseille, France
| | - Vincent Amodru
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Marseille, France
- Assistance-Publique des Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Marseille, France
| | - Thierry Brue
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Marseille, France
- Assistance-Publique des Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Marseille, France
| | - Thomas Cuny
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Marseille, France.
- Assistance-Publique des Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Marseille, France.
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d'Artigues J, Graillon T, Boissonneau S, Farah K, Amodru V, Brue T, Fuentes S, Dufour H. Fully endoscopic endonasal approach for the treatment of intrasellar arachnoid cysts. Pituitary 2022; 25:191-200. [PMID: 34609694 DOI: 10.1007/s11102-021-01187-8] [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] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To report our experience of endoscopic endonasal obliteration of symptomatic sellar arachnoid cyst (SAC). METHODS From 2002 to 2019, we retrospectively reported the data of 17 cases of SAC operated in Timone University Hospital, Marseille, France. Preoperative clinical findings were collected including main symptoms, visual function and endocrinological assessment. Surgical procedure was homogeneous and consisted in endonasal fully endoscopic surgical obliteration of the cyst cavity with fat graft. Post-operative outcomes, complication and follow-up was reported. RESULTS Visual disorders and/or headaches were the main symptoms. Our technique provided improvement for 83.3% of the patients suffering from visual disturbance and for 87.5% of those suffering from headaches. We reported 2 cases of cerebrospinal fluid (CSF) leakage (11.8%), but no meningitis. One case of definitive diabetes insipidus occurred and one case of postoperative syndrome of inappropriate antidiuretic hormone secretion was temporary. There was one case of recurrence reported. The mean follow-up was 39 months. CONCLUSION Patients with symptomatic SAC can be treated successfully by endoscopic endonasal obliteration of the cyst. This simple technique offers true benefits for the patients without craniotomy, but the complication rate remains high especially with the risk of CSF leakage. Special attention to skull base opening and closing could reduce this risk.
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Affiliation(s)
- Jean d'Artigues
- Department of Neurosurgery, Hôpital de La Timone, Marseille, France.
| | - Thomas Graillon
- Department of Neurosurgery, Hôpital de La Timone, Marseille, France
| | | | - Kaissar Farah
- Department of Neurosurgery, Hôpital de La Timone, Marseille, France
| | - Vincent Amodru
- Department of Endocrinology, Hôpital de La Conception, Marseille, France
| | - Thierry Brue
- Department of Endocrinology, Hôpital de La Conception, Marseille, France
| | - Stéphane Fuentes
- Department of Neurosurgery, Hôpital de La Timone, Marseille, France
| | - Henry Dufour
- Department of Neurosurgery, Hôpital de La Timone, Marseille, France
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Castets S, Villanueva C, Vergier J, Brue T, Saveanu A, Reynaud R. Clinical, radiological, and molecular diagnosis of congenital pituitary diseases causing short stature. Arch Pediatr 2022; 28:8S33-8S38. [PMID: 37870532 DOI: 10.1016/s0929-693x(22)00041-0] [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] [Indexed: 10/19/2022]
Abstract
Short stature in children can be caused by congenital pituitary disorders involving at least one form of growth hormone deficiency. Clinical and radiological evaluations of the index case and family history assessments are essential to guide genetic diagnostic testing and interpret results. The first-line approach is panel testing of genes involved in pituitary development with variants known to be pathogenic in this context. It identifies a genetic cause in less than 10% of cases, however. Whole-exome and whole-genome sequencing techniques may provide original information but also raise new questions regarding the pathophysiological role of identified variants. These new tools can make genetic counselling more complex. The role of clinicians in these interpretations is therefore important. © 2022 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.
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Affiliation(s)
- S Castets
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, Marseille, France; Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Marseille, France.
| | - C Villanueva
- Hospices Civils de Lyon (HCL), Hôpital Femme Mère Enfant (HFME), Service d'Endocrinologie pédiatrique, Bron, France; Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Marseille, France
| | - J Vergier
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, Marseille, France; Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Marseille, France
| | - T Brue
- Hospices Civils de Lyon (HCL), Hôpital Femme Mère Enfant (HFME), Service d'Endocrinologie pédiatrique, Bron, France; Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Marseille, France; Assistance Publique-Hôpitaux de Marseille (AP-HM), Service d'Endocrinologie, Hôpital de la Conception, Marseille, France; Institut Marseille Maladies Rares (MarMaRa), Marseille, France
| | - A Saveanu
- Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Marseille, France; Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Marseille Medical Genetics (MMG), U 1251, Marseille, France; Institut Marseille Maladies Rares (MarMaRa), Marseille, France; Assistance Publique-Hôpitaux de Marseille (AP-HM), Laboratoire de Biologie Moléculaire, Hôpital de la Conception, Marseille, France
| | - R Reynaud
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital Timone Enfants, Service de Pédiatrie Multidisciplinaire, Marseille, France; Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Marseille, France; Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Marseille Medical Genetics (MMG), U 1251, Marseille, France; Institut Marseille Maladies Rares (MarMaRa), Marseille, France
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Rouen A, Rogers E, Kerlan V, Delemer B, Catteau-Jonard S, Reznik Y, Gompel A, Cedrin I, Guedj AM, Grouthier V, Brue T, Pienkowski C, Bachelot A, Chantot-Bastaraud S, Rousseau A, Simon T, Kott E, Siffroi JP, Touraine P, Christin-Maitre S. Whole exome sequencing in a cohort of familial premature ovarian insufficiency cases reveals a broad array of pathogenic or likely pathogenic variants in 50% of families. Fertil Steril 2022; 117:843-853. [PMID: 35115167 DOI: 10.1016/j.fertnstert.2021.12.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To study the diagnostic yield, including variants in genes yet to be incriminated, of whole exome sequencing (WES) in familial cases of premature ovarian insufficiency (POI). DESIGN Cross-sectional study. SETTING Endocrinology and reproductive medicine teaching hospital departments. PATIENTS Familial POI cases were recruited as part of a nationwide multicentric cohort. A total of 36 index cases in 36 different families were studied. Fifty-two relatives were available, including 25 with POI and 27 affectedwho were nonaffected. Karyotype analysis, FMR1 screening, single nucleotide polymorphism array analysis, and WES were performed in all subjects. INTERVENTIONS None. MAIN OUTCOME MEASURES The primary outcome was a molecular etiology, as diagnosed by karyotype, FMR1 screening, single nucleotide polymorphism array, and WES. RESULTS A likely molecular etiology (pathogenic or likely pathogenic variant) was identified in 18 of 36 index cases (50% diagnostic yield). In 12 families, we found a pathogenic or likely pathogenic variant in a gene previously incriminated in POI, and in 6 families, we found a pathogenic or likely pathogenic variant in new candidate genes. Most of the variants identified were located in genes involved in cell division and meiosis (n = 11) or DNA repair (n = 4). CONCLUSIONS The genetic etiologic diagnosis in POI allows for genetic familial counseling, anticipated pregnancy planning, and ovarian tissue preservation or oocyte preservation. Identifying new genes may lead to future development of therapeutics in reproduction based on disrupted molecular pathways. CLINICAL TRIAL REGISTRATION NUMBER NCT 01177891.
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Affiliation(s)
- Alexandre Rouen
- Département de Génétique Médicale, Unité INSERM U933, Hôpital Armand-Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Eli Rogers
- Département de Génétique Médicale, Unité INSERM U933, Hôpital Armand-Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Véronique Kerlan
- Service d'Endocrinologie, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Brigitte Delemer
- Service d'Endocrinologie, Diabète, Nutrition, Centre Hospitalier Universitaire de Reims, Reims, France
| | | | - Yves Reznik
- Service d'Endocrinologie, Hôpital Caen, France
| | - Anne Gompel
- Université de Paris, Unité de Gynécologie Médicale, Hôpital Port-Royal, France
| | - Isabelle Cedrin
- Service de Médecine de la Reproduction, Hôpital Jean Verdier, France
| | | | | | - Thierry Brue
- Assistance Publique-Hôpitaux de Marseille, Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'Hypophyse, Marseille, France, and Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale, Marseille Medical Genetics, Institut Marseille Maladies Rares, Marseille, France
| | | | - Anne Bachelot
- Service d'Endocrinologie et Médecine de la Reproduction, Centre Constitutif des Maladies Endocriniennes Rares de la Croissance et du Développement, Centre Constitutif du Centre des Pathologies Gynécologiques Rares, Sorbonne Université, Hôpital de la Pitié-Salpétrière, Paris, France; Sorbonne Université, Paris, France
| | - Sandra Chantot-Bastaraud
- Département de Génétique Médicale, Unité INSERM U933, Hôpital Armand-Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alexandra Rousseau
- Unité de Recherche Clinique de l'Est Parisien, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris, France
| | - Tabassome Simon
- Unité de Recherche Clinique de l'Est Parisien, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris, France
| | - Esther Kott
- Département de Génétique Médicale, Unité INSERM U933, Hôpital Armand-Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Pierre Siffroi
- Département de Génétique Médicale, Unité INSERM U933, Hôpital Armand-Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France; Sorbonne Université, Paris, France
| | - Philippe Touraine
- Service d'Endocrinologie et Médecine de la Reproduction, Centre Constitutif des Maladies Endocriniennes Rares de la Croissance et du Développement, Centre Constitutif du Centre des Pathologies Gynécologiques Rares, Sorbonne Université, Hôpital de la Pitié-Salpétrière, Paris, France; Sorbonne Université, Paris, France
| | - Sophie Christin-Maitre
- Département de Génétique Médicale, Unité INSERM U933, Hôpital Armand-Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France; Sorbonne Université, Paris, France; Service d'Endocrinologie, Diabétologie et Médecine de la Reproduction, Centre Constitutif des Maladies Endocriniennes Rares de la Croissance et du Développement, Sorbonne Université, Hôpital Saint-Antoine, Paris, France
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Charnay T, Mougel G, Amouroux C, Gueorguieva I, Joubert F, Pertuit M, Reynaud R, Barlier A, Brue T, Saveanu A. A novel TBX19 gene mutation in patients with isolated ACTH deficiency from distinct families with a common geographical origin. Front Endocrinol (Lausanne) 2022; 13:1080649. [PMID: 36890856 PMCID: PMC9987334 DOI: 10.3389/fendo.2022.1080649] [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: 10/26/2022] [Accepted: 12/28/2022] [Indexed: 02/22/2023] Open
Abstract
Isolated ACTH deficiency (IAD) is a life-threatening condition, particularly in the neonatal period, while a main consequence of undiagnosed isolated ACTH deficiency in survivors is cognitive impairment. TBX19 is involved in the differentiation and proliferation of corticotropic cells and TBX19 mutations are responsible for more than 60% of neonatal cases of IAD. We describe a new variant of the main TBX19 transcript (NM 005149.3, c.840del (p.(Glu280Asp fs*27)), classified as pathogenic, whose pathogenicity is assumed to be due to nonsense mediated decay leading to non-expression of T-box transcription factor TBX19. Moreover we summarize the TBX19 mutations published as individual cases since our last large cohort. Interestingly, this pathogenic variant was identified in four patients from three apparently unrelated families. Two of these families were consanguineous, and after investigations all of three were discovered to have roots in the same mountainous region of northern Morocco, suggesting a founder effect. Early diagnosis, timely treatment (hydrocortisone therapy) and preventive education allowed normal development, growth and quality of life in all patients.
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Affiliation(s)
- Théo Charnay
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Aix-Marseille Université, Marseille, France
- Laboratory of Molecular Biology, Centre Hospitalier Universitaire Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Gregory Mougel
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Aix-Marseille Université, Marseille, France
- Laboratory of Molecular Biology, Centre Hospitalier Universitaire Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Cyril Amouroux
- Paediatric Department, Endocrinology Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital, Montpellier, France
| | - Iva Gueorguieva
- Paediatric Department, Endocrinology Unit, Children’s Center, Jeanne-de-Flandre Hospital, Lille University Hospital, Lille, France
| | - Florence Joubert
- Department of Pediatrics, Centre Hospitalier d’Avignon, Avignon, France
| | - Morgane Pertuit
- Laboratory of Molecular Biology, Centre Hospitalier Universitaire Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Rachel Reynaud
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Aix-Marseille Université, Marseille, France
- Department of Multidisciplinary Peadiatrics, Centre de Référence des Maladies Rares d’origine hypophysaire HYPO, Hôpital Timone-Enfants, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Anne Barlier
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Aix-Marseille Université, Marseille, France
- Laboratory of Molecular Biology, Centre Hospitalier Universitaire Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Thierry Brue
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Aix-Marseille Université, Marseille, France
- Department of Endocrinology, Centre de Référence des Maladies Rares de l’hypophyse HYPO, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Alexandru Saveanu
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Aix-Marseille Université, Marseille, France
- Laboratory of Molecular Biology, Centre Hospitalier Universitaire Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- *Correspondence: Alexandru Saveanu,
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Rodier C, Courbière B, Fernandes S, Vermalle M, Florence B, Resseguier N, Brue T, Cuny T. Metoclopramide Test in Hyperprolactinemic Women With Polycystic Ovarian Syndrome: Old Wine Into New Bottles? Front Endocrinol (Lausanne) 2022; 13:832361. [PMID: 35250884 PMCID: PMC8895271 DOI: 10.3389/fendo.2022.832361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Polycystic ovarian syndrome (PCOS) is the most frequent etiology of anovulation, hyperandrogenism and infertility in women. Its pathophysiology remains poorly elucidated. Hyperprolactinemia (hPRL) is common in women of reproductive age and may partially mimic the clinical phenotype of PCOS. The simultaneous finding of both conditions is therefore not rare, however there are conflicting studies on whether a link exists between them. MATERIALS AND METHODS We conducted a retrospective monocentric study between 2015 and 2021 and among women who were referred for possible PCOS, we selected those who met the ESHRE/Rotterdam definition criteria. hPRL was defined as two values above the upper limit of normal with at least one measurement in our centre. RESULTS A total of 430 women were selected, of whom 179 met the PCOS criteria. 50 out of 179 patients (27.9%) had at least one elevated value of PRL and 21 (11.7%) had hPRL according to our definition. Among the 21 women of the PCOS/hPRL cohort, 5 (23.8%) had a microprolactinoma and all of them had PRL level ≥ 60 ng/ml. The remaining cases were macroprolactinemia (n=5), iatrogenic hPRL (n=4), primary hypothyroidism (n=1) or unexplained (n=6) despite exhaustive investigations. The metoclopramide test resulted in an increase of basal PRL < 300% in all prolactinomas and ≥ 300% in all the other etiologies. CONCLUSION hPRL was a common finding in PCOS women, secondary to a microprolactinoma in a quarter of cases. Metoclopramide test performed in women with hPRL below 60 ng/ml appeared as a helpful tool 1) to discriminate pituitary causes from others etiologies, 2) to potentially avoid unnecessary pituitary MRI.
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Affiliation(s)
- Claire Rodier
- Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception, Marseille, France
| | - Blandine Courbière
- Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception, Marseille, France
- CNRS, IRD, IMBE, Avignon Université, Aix Marseille Univ, Marseille, France
| | - Sara Fernandes
- Aix Marseille Univ, APHM, Hôpital de la Timone, Service d’Epidemiologie et d’Economie de la Santé, Unité de Recherche Clinique, Direction de la Recherche en Santé, Marseille, France
- EA3279, CEReSS, Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Marie Vermalle
- Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception, Marseille, France
- Aix Marseille Univ, APHM, Marseille Medical Genetics, Inserm U1251 and Hôpital de la Conception, Service d’Endocrinologie, Marseille, France
| | - Bretelle Florence
- Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception, Marseille, France
| | - Noémie Resseguier
- Aix Marseille Univ, APHM, Hôpital de la Timone, Service d’Epidemiologie et d’Economie de la Santé, Unité de Recherche Clinique, Direction de la Recherche en Santé, Marseille, France
- EA3279, CEReSS, Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Thierry Brue
- Aix Marseille Univ, APHM, Marseille Medical Genetics, Inserm U1251 and Hôpital de la Conception, Service d’Endocrinologie, Marseille, France
| | - Thomas Cuny
- Aix Marseille Univ, APHM, Marseille Medical Genetics, Inserm U1251 and Hôpital de la Conception, Service d’Endocrinologie, Marseille, France
- *Correspondence: Thomas Cuny,
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Amodru V, Brue T, Castinetti F. Synergistic cortisol suppression by ketoconazole-osilodrostat combination therapy. Endocrinol Diabetes Metab Case Rep 2021; 2021:EDM-21-0071. [PMID: 34877930 PMCID: PMC8686175 DOI: 10.1530/edm-21-0071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/16/2021] [Indexed: 01/23/2023] Open
Abstract
SUMMARY Here, we describe a case of a patient presenting with adrenocorticotrophic hormone-independent Cushing's syndrome in a context of primary bilateral macronodular adrenocortical hyperplasia. While initial levels of cortisol were not very high, we could not manage to control hypercortisolism with ketoconazole monotherapy, and could not increase the dose due to side effects. The same result was observed with another steroidogenesis inhibitor, osilodrostat. The patient was finally successfully treated with a well-tolerated synergitic combination of ketoconazole and osilodrostat. We believe this case provides timely and original insights to physicians, who should be aware that this strategy could be considered for any patients with uncontrolled hypercortisolism and delayed or unsuccessful surgery, especially in the context of the COVID-19 pandemic. LEARNING POINTS Ketoconazole-osilodrostat combination therapy appears to be a safe, efficient and well-tolerated strategy to supress cortisol levels in Cushing syndrome. Ketoconazole and osilodrostat appear to act in a synergistic manner. This strategy could be considered for any patient with uncontrolled hypercortisolism and delayed or unsuccessful surgery, especially in the context of the COVID-19 pandemic. Considering the current cost of newly-released drugs, such a strategy could lower the financial costs for patients and/or society.
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Affiliation(s)
- Vincent Amodru
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics, Institut MarMaRa, Marseille, France
- Assistance Publique – Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Marseille, France
| | - Thierry Brue
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics, Institut MarMaRa, Marseille, France
- Assistance Publique – Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Marseille, France
| | - Frederic Castinetti
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics, Institut MarMaRa, Marseille, France
- Assistance Publique – Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Marseille, France
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Castinetti F, Caron P, Raingeard I, Amodru V, Albarel F, Morange I, Chanson P, Calvo J, Graillon T, Baumstarck K, Dufour H, Regis J, Brue T. Lack of delayed neurocognitive side effects of Gamma Knife radiosurgery in acromegaly: the Later-Ac study. Eur J Endocrinol 2021; 186:37-44. [PMID: 34714763 DOI: 10.1530/eje-21-0826] [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: 08/12/2021] [Accepted: 10/28/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Persistent growth hormone hypersecretion can be observed in roughly 50% of patients operated for somatotroph adenomas, requiring additional treatments. Despite its proven antisecretory efficacy, the use of Gamma Knife radiosurgery (GK) is limited probably due to the lack of data on long-term side effects, including potential cognitive consequences. METHODS The LATe Effects of Radiosurgery in Acromegaly study was a cross-sectional exposed/unexposed non-randomized study. The primary objective was to determine the long-term neurocognitive effects of GK focusing on memory, executive functions, and calculation ability. Exposed patients had been treated by GK for acromegaly at least 5 years before inclusion. Unexposed patients (paired for age) had to be cured or controlled at last follow-up without any radiation technique. Patients of both groups were cured or controlled at the last follow-up. RESULTS Sixty-four patients were evaluated (27 exposed and 37 unexposed). Mean follow-up after GK was 13 ± 6 years (including 24 patients followed for at least 10 years). While up to 23.8% of the patients of the whole cohort presented at least one abnormal cognitive test, we did not observe any significant difference in neurocognitive function between both groups. During the follow-up, 11 patients presented at least one new pituitary deficiency (P = 0.009 for thyroid-stimulating hormone deficiency with a higher rate in exposed patients), two presented a stroke (1 in each group), and one presented a meningioma (12 years after GK). CONCLUSIONS While GK exposes patients to a well-known risk of pituitary deficiency, it does not seem to induce long-term cognitive consequences in patients treated for acromegaly.
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Affiliation(s)
- Frederic Castinetti
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Department of Endocrinology, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | - Philippe Caron
- Service d'Endocrinologie, Hôpital Larrey, Toulouse, France
| | | | - Vincent Amodru
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Department of Endocrinology, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | - Frederique Albarel
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Department of Endocrinology, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | - Isabelle Morange
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Department of Endocrinology, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse and Université Paris-Saclay, Univ. Paris-Sud, Inserm, Signalisation Hormonale, Physiopathologie Endocrinienne et Métabolique, Le Kremlin-Bicêtre, France
| | - Julie Calvo
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Department of Endocrinology, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | - Thomas Graillon
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Department of Neurosurgery, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital de la Timone, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | | | - Henry Dufour
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Department of Neurosurgery, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital de la Timone, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | - Jean Regis
- Department of Functional Neurosurgery, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital de la Timone, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | - Thierry Brue
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Department of Endocrinology, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
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Brue T, Camper SA. Novel mechanism of pituitary hormone deficiency: genetic variants shift splicing to produce a dominant negative transcription factor isoform. Eur J Endocrinol 2021; 185:C19-C25. [PMID: 34597272 DOI: 10.1530/eje-21-0949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/27/2021] [Indexed: 11/08/2022]
Abstract
Recent studies have shown a novel mechanism of combined pituitary hormone deficiency associated with mutations in POU1F1, altering the balance of alternative-splicing, which results in over-expression of the beta isoform of POU1F1. These studies underscore the need for biologists, in the context of routine molecular diagnosis of this condition, to investigate alternative splicing in POU1F1 as well as in other genes.
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Affiliation(s)
- Thierry Brue
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
| | - Sally A Camper
- Department of Human Genetics, University of Michigan, Ann Arbor, Michigan, USA
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Abstract
Although usually benign, anterior pituitary tumours occasionally exhibit aggressive behaviour, with invasion of surrounding tissues, rapid growth, resistance to conventional treatments and multiple recurrences. In very rare cases, they metastasize and are termed pituitary carcinomas. The time between a 'classical' pituitary tumour and a pituitary carcinoma can be years, which means that monitoring should be performed regularly in patients with clinical (invasion and/or tumour growth) or pathological (Ki67 index, mitotic count and/or p53 detection) markers suggesting aggressiveness. However, although both invasion and proliferation have prognostic value, such parameters cannot predict outcome or malignancy without metastasis. Future research should focus on the biology of both tumour cells and their microenvironment, hopefully with improved therapeutic outcomes. Currently, the initial therapeutic approach for aggressive pituitary tumours is generally to repeat surgery or radiotherapy in expert centres. Standard medical treatments usually have no effect on tumour progression but they can be maintained on a long-term basis to, at least partly, control hypersecretion. In cases where standard treatments prove ineffective, temozolomide, the sole formally recommended treatment, is effective in only one-third of patients. Personalized use of emerging therapies, including peptide receptor radionuclide therapy, angiogenesis-targeted therapy and immunotherapy, will hopefully improve the outcomes of patients with this severe condition.
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Affiliation(s)
- 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, CNRS UMR5286, Cancer Research Centre of Lyon (CRLC), Lyon, France
| | - Mirela Diana Ilie
- Lyon 1 University, Villeurbanne, France
- INSERM U1052, CNRS UMR5286, Cancer Research Centre of Lyon (CRLC), Lyon, France
- Endocrinology Department, "C.I.Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - 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, CNRS UMR5286, Cancer Research Centre of Lyon (CRLC), Lyon, France
| | - Vincent Amodru
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Endocrinology Department, Hôpital de la Conception, Reference Centre for Rare Pituitary Diseases HYPO, Marseille, France
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
| | | | - Frédéric Castinetti
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Endocrinology Department, Hôpital de la Conception, Reference Centre for Rare Pituitary Diseases HYPO, Marseille, France
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
| | - Thierry Brue
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Endocrinology Department, Hôpital de la Conception, Reference Centre for Rare Pituitary Diseases HYPO, Marseille, France.
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France.
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Fourneaux R, Vermalle M, Albarel F, Morange I, Graillon T, Amodru V, Cuny T, Dufour H, Brue T, Castinetti F. Acromegaly in remission: a view from the partner. Eur J Endocrinol 2021; 185:K19-K23. [PMID: 34586080 DOI: 10.1530/eje-21-0537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/19/2021] [Accepted: 09/29/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE A relative can be an asset in dealing with chronic illnesses, such as acromegaly, where quality of life (QoL) is altered even after remission. However, it has been shown that quality of life of caregivers can also be impacted. Our main objective was to compare the perception of acromegaly in remission in the patient-relative dyad. METHODS In this observational study, 27 patients in remission and relatives were first asked to complete QoL, anxiety/depression and coping strategy questionnaires. Then, the patient's body image and self-esteem were evaluated from both the patient's and the relative's point of view using the same questionnaires with modified instructions. RESULTS Relatives had overall an accurate estimation of patient body image using the Figure Rating Scale by Stunkard. However, there were wide variations between the patient's and the relative's responses regarding self-esteem and body perception. The QoL of relatives was not altered and was significantly higher in the social domain than for the patient. CONCLUSIONS Our results show that relatives require education concerning all the steps involved in the management of acromegaly, as they likely do not fully understand the sequelae of acromegaly.
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Affiliation(s)
- Rachel Fourneaux
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | - Marie Vermalle
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | - Frederique Albarel
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | - Isabelle Morange
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | - Thomas Graillon
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Neurosurgery, Hôpital de la Timone, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | - Vincent Amodru
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | - Thomas Cuny
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | - Henry Dufour
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Neurosurgery, Hôpital de la Timone, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | - Thierry Brue
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | - Frederic Castinetti
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
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Brue T, Chanson P, Rodien P, Delemer B, Drui D, Marié L, Juban L, Salvi L, Henocque R, Raverot G. Cost-Utility of Acromegaly Pharmacological Treatments in a French Context. Front Endocrinol (Lausanne) 2021; 12:745843. [PMID: 34690933 PMCID: PMC8531881 DOI: 10.3389/fendo.2021.745843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/08/2021] [Indexed: 12/17/2022] Open
Abstract
Objective Efficacy of pharmacological treatments for acromegaly has been assessed in many clinical or real-world studies but no study was interested in economics evaluation of these treatments in France. Therefore, the objective of this study was to estimate the cost-utility of second-line pharmacological treatments in acromegaly patients. Methods A Markov model was developed to follow a cohort of 1,000 patients for a lifetime horizon. First-generation somatostatin analogues (FGSA), pegvisomant, pasireotide and pegvisomant combined with FGSA (off label) were compared. Efficacy was defined as the normalization of insulin-like growth factor-1 (IGF-1) concentration and was obtained from pivotal trials and adjusted by a network meta-analysis. Costs data were obtained from French databases and literature. Utilities from the literature were used to estimate quality-adjusted life year (QALY). Results The incremental cost-utility ratios (ICUR) of treatments compared to FGSA were estimated to be 562,463 € per QALY gained for pasireotide, 171,332 € per QALY gained for pegvisomant, and 186,242 € per QALY gained for pegvisomant + FGSA. Pasireotide seems to be the least cost-efficient treatment. Sensitivity analyses showed the robustness of the results. Conclusion FGSA, pegvisomant and pegvisomant + FGSA were on the cost-effective frontier, therefore, depending on the willingness-to-pay for an additional QALY, they are the most cost-effective treatments. This medico-economic analysis highlighted the consistency of the efficiency results with the efficacy results assessed in the pivotal trials. However, most recent treatment guidelines recommend an individualized treatment strategy based on the patient and disease profile.
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Affiliation(s)
- Thierry Brue
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l’hypophyse HYPO, Marseille, France
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
| | - Philippe Chanson
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l’Hypophyse, Le Kremlin-Bicêtre, France
| | - Patrice Rodien
- Université d’Angers, CHU d’Angers, service d’Endocrinologie-Diabétologie-Nutrition, Centre de Référence des Maladies Rares de l’Hypophyse, Angers, France
| | - Brigitte Delemer
- CHU de Reims - Hôpital Robert Debré, Service d’Endocrinologie – Diabète – Nutrition, Reims Cedex, France
| | - Delphine Drui
- Endocrinology Department, L’institut du thorax, University Hospital of Nantes, Nantes Cedex, France
| | | | | | - Lara Salvi
- Rare Disease, Pfizer France, Paris Cedex, France
| | | | - Gérald Raverot
- Endocrinology Department, “Groupement Hospitalier Est” Hospices Civils de Lyon, Bron, France
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Fleseriu M, Führer-Sakel D, van der Lely AJ, De Marinis L, Brue T, van der Lans-Bussemaker J, Hey-Hadavi J, Camacho-Hubner C, Wajnrajch MP, Valluri SR, Palladino AA, Gomez R, Salvatori R. More than a decade of real-world experience of pegvisomant for acromegaly: ACROSTUDY. Eur J Endocrinol 2021; 185:525-538. [PMID: 34342594 PMCID: PMC8428076 DOI: 10.1530/eje-21-0239] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/03/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To report the final long-term safety and efficacy analyses of patients with acromegaly treated with pegvisomant from the ACROSTUDY. DESIGN Global (15 countries), multicentre, non-interventional study (2004-2017). METHODS The complete ACROSTUDY cohort comprised patients with acromegaly, who were being treated with pegvisomant (PEGV) prior to the study or at enrolment. The main endpoints were long-term safety (comorbidities, adverse events (AEs), pituitary tumour volumes, liver tests) and efficacy (IGF1 changes). RESULTS Patients (n = 2221) were treated with PEGV for a median of 9.3 years (range, 0-20.8 years) and followed up for a median of 7.4 years (range, 0-13.9 years). Before PEGV, 96.3% had received other acromegaly treatments (surgery/radiotherapy/medications). Before PEGV treatment, 87.2% of patients reported comorbidities. During ACROSTUDY, 5567 AEs were reported in 56.5% of patients and of these 613 were considered treatment-related (in 16.5% of patients) and led to drug withdrawal in 1.3%. Pituitary imaging showed a tumour size increase in 7.1% of patients; the majority (71.1%) reported no changes. Abnormal AST or ALT liver tests occurred in 3.2% of patients. IGF1 normalization rate improved over time, increasing from 11.4% at PEGV start to 53.7% at year 1, and reaching 75.4% at year 10 with the use of ≥30 mg PEGV/day in an increasing proportion of patients. CONCLUSION This comprehensive review of the complete cohort in ACROSTUDY confirmed the overall favourable benefit-to-risk profile and high efficacy of PEGV as mono- and combination therapy in patients with an aggressive course/uncontrolled/active acromegaly requiring long-term medical therapy for control.
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Affiliation(s)
- Maria Fleseriu
- Pituitary CenterDivision of Endocrinology, Diabetes, & Clinical Nutrition, Department of Medicine
- Pituitary Center, Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
- Correspondence should be addressed to M Fleseriu Email
| | - Dagmar Führer-Sakel
- Department of Endocrinology Diabetology and Metabolism, Endocrine Tumour Center at West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Aart J van der Lely
- Division of Endocrinology, Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Laura De Marinis
- Pituitary Unit, Department of Endocrinology, Fondazione A Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Thierry Brue
- Assistance Publique-Hôpitaux de Marseille, Hopital de la Conception, and Aix-Marseille Université, Marseille Medical Genetics, Marseille, France
| | | | | | | | - Michael P Wajnrajch
- Pfizer, New York, New York, USA
- Division of Pediatric Endocrinology, Department of Pediatrics, New York University Langone Medical Center, New York, New York, USA
| | | | | | | | - Roberto Salvatori
- Division of Endocrinology and Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Maraninchi M, Calabrese A, Nogueira JP, Castinetti F, Mancini J, Mourre F, Piétri L, Bénamo E, Albarel F, Morange I, Dupont-Roussel J, Nicolay A, Brue T, Béliard S, Valéro R. Role of growth hormone in hepatic and intestinal triglyceride-rich lipoprotein metabolism. J Clin Lipidol 2021; 15:712-723. [PMID: 34462238 DOI: 10.1016/j.jacl.2021.08.003] [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: 03/01/2021] [Revised: 07/23/2021] [Accepted: 08/09/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Elevated plasma concentrations of hepatic- and intestinally-derived triglyceride-rich lipoproteins (TRL) are implicated in the pathogenesis of atherosclerotic cardiovascular disease and all-cause mortality. Excess of TRL is the driving cause of atherogenic dyslipidemia commonly occurring in insulin-resistant individuals such as patients with obesity, type 2 diabetes and metabolic syndrome. Interestingly, growth hormone (GH)-deficient individuals display similar atherogenic dyslipidemia, suggesting an important role of GH and GH deficiency in the regulation of TRL metabolism. OBJECTIVE We aimed to examine the direct and/or indirect role of GH on TRL metabolism. METHODS We investigated the effect on fasting and postprandial hepatic-TRL and intestinal-TRL metabolism of short-term (one month) withdrawal of GH in 10 GH-deficient adults. RESULTS After GH withdrawal, we found a reduction in fasting plasma TRL concentration (significant decrease in TRL-TG, TRL-cholesterol, TRL-apoB-100, TRL-apoC-III and TRL-apoC-II) but not in postprandial TRL response. This reduction was due to fewer fasting TRL particles without a change in TG per particle and was not accompanied by a change in postprandial TRL-apoB-48 response. Individual reductions in TRL correlated strongly with increases in insulin sensitivity and decreases in TRL-apoC-III. CONCLUSION In this relatively short term 'loss of function' human experimental model, we have shown an unanticipated reduction of hepatic-TRL particles despite increase in total body fat mass and reduction in lean mass. These findings contrast with the atherogenic dyslipidemia previously described in chronic GH deficient states, providing a new perspective for the role of GH in lipoprotein metabolism.
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Affiliation(s)
- Marie Maraninchi
- Aix Marseille Univ, APHM, INSERM, INRAE, C2VN, University Hospital La Conception, Department of Nutrition, Metabolic Diseases and Endocrinology, 147 boulevard Baille, Marseille 13005, France
| | - Anastasia Calabrese
- Aix Marseille Univ, APHM, INSERM, INRAE, C2VN, University Hospital La Conception, Department of Nutrition, Metabolic Diseases and Endocrinology, 147 boulevard Baille, Marseille 13005, France
| | - Juan-Patricio Nogueira
- Docencia e Investigacion, Hospital Central de Formosa, Salta 555, Formosa CP 3600, Argentina; Facultad de Ciencias de la Salud, Universidad Nacional de Formosa, Gutnisky 3200, Formosa CP 3600, Argentina
| | - Frédéric Castinetti
- INSERM, U1251, Marseille Medical Genetics (MMG), Faculté des Sciences médicales et paramédicales, France and AP-HM, Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Institut Marseille Maladies Rares (MarMaRa), Aix-Marseille Univ, Marseille 13005, France
| | - Julien Mancini
- INSERM, IRD, UMR1252, SESSTIM, Aix-Marseille Univ, Marseille F-13273, France; APHM, Timone Hospital, Public Health Department (BIOSTIC), Marseille, F-13385, France
| | - Florian Mourre
- Aix Marseille Univ, APHM, INSERM, INRAE, C2VN, University Hospital La Conception, Department of Nutrition, Metabolic Diseases and Endocrinology, 147 boulevard Baille, Marseille 13005, France
| | - Léa Piétri
- Aix Marseille Univ, APHM, INSERM, INRAE, C2VN, University Hospital La Conception, Department of Nutrition, Metabolic Diseases and Endocrinology, 147 boulevard Baille, Marseille 13005, France
| | - Eric Bénamo
- Department of Endocrinology and Metabolic Diseases, Hospital d'Avignon Henri Duffaut, 205 rue Raoul Follereau, Avignon 84000, France
| | - Frédérique Albarel
- INSERM, U1251, Marseille Medical Genetics (MMG), Faculté des Sciences médicales et paramédicales, France and AP-HM, Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Institut Marseille Maladies Rares (MarMaRa), Aix-Marseille Univ, Marseille 13005, France
| | - Isabelle Morange
- INSERM, U1251, Marseille Medical Genetics (MMG), Faculté des Sciences médicales et paramédicales, France and AP-HM, Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Institut Marseille Maladies Rares (MarMaRa), Aix-Marseille Univ, Marseille 13005, France
| | - Jeanine Dupont-Roussel
- Aix Marseille Univ, APHM, INSERM, INRAE, C2VN, University Hospital La Conception, Department of Nutrition, Metabolic Diseases and Endocrinology, 147 boulevard Baille, Marseille 13005, France
| | - Alain Nicolay
- APHM, Laboratory of Endocrine Biochemistry, La Conception Hospital, Marseille, France
| | - Thierry Brue
- INSERM, U1251, Marseille Medical Genetics (MMG), Faculté des Sciences médicales et paramédicales, France and AP-HM, Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Institut Marseille Maladies Rares (MarMaRa), Aix-Marseille Univ, Marseille 13005, France
| | - Sophie Béliard
- Aix Marseille Univ, APHM, INSERM, INRAE, C2VN, University Hospital La Conception, Department of Nutrition, Metabolic Diseases and Endocrinology, 147 boulevard Baille, Marseille 13005, France
| | - René Valéro
- Aix Marseille Univ, APHM, INSERM, INRAE, C2VN, University Hospital La Conception, Department of Nutrition, Metabolic Diseases and Endocrinology, 147 boulevard Baille, Marseille 13005, France.
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Gergics P, Smith C, Bando H, Jorge AAL, Rockstroh-Lippold D, Vishnopolska SA, Castinetti F, Maksutova M, Carvalho LRS, Hoppmann J, Martínez Mayer J, Albarel F, Braslavsky D, Keselman A, Bergadá I, Martí MA, Saveanu A, Barlier A, Abou Jamra R, Guo MH, Dauber A, Nakaguma M, Mendonca BB, Jayakody SN, Ozel AB, Fang Q, Ma Q, Li JZ, Brue T, Pérez Millán MI, Arnhold IJP, Pfaeffle R, Kitzman JO, Camper SA. High-throughput splicing assays identify missense and silent splice-disruptive POU1F1 variants underlying pituitary hormone deficiency. Am J Hum Genet 2021; 108:1526-1539. [PMID: 34270938 DOI: 10.1016/j.ajhg.2021.06.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/18/2021] [Indexed: 12/13/2022] Open
Abstract
Pituitary hormone deficiency occurs in ∼1:4,000 live births. Approximately 3% of the cases are due to mutations in the alpha isoform of POU1F1, a pituitary-specific transcriptional activator. We found four separate heterozygous missense variants in unrelated individuals with hypopituitarism that were predicted to affect a minor isoform, POU1F1 beta, which can act as a transcriptional repressor. These variants retain repressor activity, but they shift splicing to favor the expression of the beta isoform, resulting in dominant-negative loss of function. Using a high-throughput splicing reporter assay, we tested 1,070 single-nucleotide variants in POU1F1. We identified 96 splice-disruptive variants, including 14 synonymous variants. In separate cohorts, we found two additional synonymous variants nominated by this screen that co-segregate with hypopituitarism. This study underlines the importance of evaluating the impact of variants on splicing and provides a catalog for interpretation of variants of unknown significance in POU1F1.
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Affiliation(s)
- Peter Gergics
- Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109-5618, USA
| | - Cathy Smith
- Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109-5618, USA; Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109-2218, USA
| | - Hironori Bando
- Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109-5618, USA
| | - Alexander A L Jorge
- Genetic Endocrinology Unit (LIM25), Division of Endocrinology, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil
| | - Denise Rockstroh-Lippold
- Department of Women's and Child Health, Division of Pediatric Endocrinology, University Hospital Leipzig, Leipzig 04103, Germany
| | - Sebastian A Vishnopolska
- Instituto de Biociencias, Biotecnología y Biología Traslacional, Departamento de Fisiología, Biología Molecular y Celular, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad de Buenos Aires, CABA CE1428EHA, Argentina
| | - Frederic Castinetti
- Aix Marseille University, AP-HM, INSERM, Marseille Medical Genetics, Marmara Institute, La Conception Hospital, Department of Endocrinology, Marseille 13005, France
| | - Mariam Maksutova
- Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109-5618, USA
| | - Luciani Renata Silveira Carvalho
- Developmental Endocrinology Unit, Laboratory of Hormones and Molecular Genetics LIM/42, Division of Endocrinology, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-900, Brazil
| | - Julia Hoppmann
- Department of Women's and Child Health, Division of Pediatric Endocrinology, University Hospital Leipzig, Leipzig 04103, Germany
| | - Julián Martínez Mayer
- Instituto de Biociencias, Biotecnología y Biología Traslacional, Departamento de Fisiología, Biología Molecular y Celular, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad de Buenos Aires, CABA CE1428EHA, Argentina
| | - Frédérique Albarel
- Aix Marseille University, AP-HM, INSERM, Marseille Medical Genetics, Marmara Institute, La Conception Hospital, Department of Endocrinology, Marseille 13005, France
| | - Debora Braslavsky
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá," FEI - CONICET - División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, CABA CE1428EHA, Argentina
| | - Ana Keselman
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá," FEI - CONICET - División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, CABA CE1428EHA, Argentina
| | - Ignacio Bergadá
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá," FEI - CONICET - División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Ciudad de Buenos Aires, CABA CE1428EHA, Argentina
| | - Marcelo A Martí
- Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires e Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales CONICET, Pabellòn 2 de Ciudad Universitaria, Ciudad de Buenos Aires, CABA C1428EHA, Argentina
| | - Alexandru Saveanu
- Aix Marseille University, AP-HM, INSERM, Marseille Medical Genetics, Marmara Institute, La Conception Hospital, Laboratory of Molecular Biology, Marseille 13385, France
| | - Anne Barlier
- Aix Marseille University, AP-HM, INSERM, Marseille Medical Genetics, Marmara Institute, La Conception Hospital, Laboratory of Molecular Biology, Marseille 13385, France
| | - Rami Abou Jamra
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig 04103, Germany
| | - Michael H Guo
- Division of Endocrinology, Boston Children's Hospital and Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Andrew Dauber
- Cincinnati Center for Growth Disorders, Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Marilena Nakaguma
- Developmental Endocrinology Unit, Laboratory of Hormones and Molecular Genetics LIM/42, Division of Endocrinology, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-900, Brazil
| | - Berenice B Mendonca
- Developmental Endocrinology Unit, Laboratory of Hormones and Molecular Genetics LIM/42, Division of Endocrinology, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-900, Brazil
| | - Sajini N Jayakody
- Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109-5618, USA
| | - A Bilge Ozel
- Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109-5618, USA
| | - Qing Fang
- Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109-5618, USA
| | - Qianyi Ma
- Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109-5618, USA
| | - Jun Z Li
- Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109-5618, USA
| | - Thierry Brue
- Aix Marseille University, AP-HM, INSERM, Marseille Medical Genetics, Marmara Institute, La Conception Hospital, Department of Endocrinology, Marseille 13005, France
| | - María Ines Pérez Millán
- Instituto de Biociencias, Biotecnología y Biología Traslacional, Departamento de Fisiología, Biología Molecular y Celular, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad de Buenos Aires, CABA CE1428EHA, Argentina
| | - Ivo J P Arnhold
- Developmental Endocrinology Unit, Laboratory of Hormones and Molecular Genetics LIM/42, Division of Endocrinology, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-900, Brazil
| | - Roland Pfaeffle
- Department of Women's and Child Health, Division of Pediatric Endocrinology, University Hospital Leipzig, Leipzig 04103, Germany; Institute of Human Genetics, University of Leipzig Medical Center, Leipzig 04103, Germany
| | - Jacob O Kitzman
- Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109-5618, USA; Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109-2218, USA.
| | - Sally A Camper
- Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109-5618, USA.
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Barraud S, Caron P, Raingeard I, Lefebvre H, Raverot G, Cortet-Rudelli C, Desailloud R, Henocque R, Brault Y, Brue T, Chanson P, Delemer B. Pegvisomant treatment in acromegaly in clinical practice: Final results of the French ACROSTUDY (312 patients). Ann Endocrinol (Paris) 2021; 82:582-589. [PMID: 34256010 DOI: 10.1016/j.ando.2021.05.004] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/19/2021] [Accepted: 05/21/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We report the final analysis of the French ACROSTUDY, using data revised and enriched since the 2013 interim analysis. Our objective was to validate the use of pegvisomant (PEGV) in the treatment of acromegaly and to determine efficacy and safety. PATIENTS AND METHODS Patients with acromegaly treated with PEGV and followed up for at least 5 years were included. Eighty-eight investigators from 62 clinical centers in France included patients from April 2007 to April 2014. PEGV dose and administration frequency were determined by the physicians, based on their clinical evaluation and local habits. No additional examinations beyond those performed in normal follow-up were required. Minimum recommended follow-up included check-ups at treatment initiation, 6 months, 12 months and then annually. RESULTS In total, 312 patients were enrolled. Mean age was 46.1±14.3 years at introduction of PEGV. Median PEGV treatment duration was 6.3 years and median follow-up was 5.6 years. Median dose at initiation was 10mg/day. The percentages of patients with IGF-1 ≤ ULN (upper limit of normal) were 10% (n=300) at baseline, 54% at 6 months (n=278), and 61.7% (n=253) at 2 years, then stabilizing at 64.4% (n=180) at 5 years. Mean PEGV dose was 17.4±11.7mg in patients with controlled disease versus 21.1±17.3mg in those without control at 5 years. At 5 years, 21.8% of patients (54/248) were receiving >30mg PEGV per day. In patients with at least one pituitary imaging procedure during the 5-year follow-up (n=292), the most recent image showed stable tumor volume in 212 subjects (72.6%), increased volume in 13 (4.5%), and decreased volume in 30 (10.3%). No PEGV treatments were permanently discontinued due to transaminase elevation. There were no cases of liver failure. CONCLUSION The French ACROSTUDY showed normalization of IGF-1 levels in 64.4% of a real-life cohort of patients, mostly with uncontrolled disease despite multiple prior therapies. Long-term follow-up showed a sustained effectiveness and good long-term safety.
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Affiliation(s)
- Sara Barraud
- CRESTIC EA 3804, université de Reims Champagne Ardenne, UFR Sciences Exactes et Naturelles, Moulin de la Housse, BP 1039, 51687 Reims cedex 2, France; Service d'Endocrinologie-Diabète-Nutrition, CHU de Reims, hôpital Robert Debré, avenue du Général Koenig, 51092 Reims cedex, France.
| | - Philippe Caron
- Service d'endocrinologie et maladies métaboliques, pôle cardio-vasculaire et métabolique, hôpital Larrey, CHU de Toulouse, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex 9, France.
| | - Isabelle Raingeard
- Maladies endocriniennes, hôpital Lapeyronie, CHRU de Montpellier, 295, avenue du Doyen Gaston Giraud, 34295 Montpellier cedex 5, France.
| | - Hervé Lefebvre
- CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
| | - Gérald Raverot
- Hospices civils de Lyon, hôpital Louis-Pradel, 59, boulevard Pinel, 69677 Bron cedex, France.
| | | | - Rachel Desailloud
- CHU d'Amiens, hôpital Nord, place Victor Pauchet, 80054 Amiens cedex 1, France.
| | - Robin Henocque
- Pfizer France, 23-25, avenue du Docteur Lannelongue, 75668 Paris cedex 14, France.
| | - Yves Brault
- Pfizer France, 23-25, avenue du Docteur Lannelongue, 75668 Paris cedex 14, France.
| | - Thierry Brue
- Department of Endocrinology, Centre de référence des maladies rares de l'hypophyse HYPO, hôpital de la Conception, AP-HM, 13005 Marseille, France; INSERM, U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Aix-Marseille université, Marseille, France.
| | - Philippe Chanson
- Centre de référence des maladies rares de l'hypophyse HYPO, AP-HP, Hôpital Bicêtre, 94275 Le Kremlin-Bicêtre, France; Signalisation Hormonale, Physiopathologie Endocrinienne et Métabolique, Université Paris-Saclay, university Paris-Sud, Inserm, Le Kremlin-Bicêtre, France.
| | - Brigitte Delemer
- CRESTIC EA 3804, université de Reims Champagne Ardenne, UFR Sciences Exactes et Naturelles, Moulin de la Housse, BP 1039, 51687 Reims cedex 2, France; Service d'Endocrinologie-Diabète-Nutrition, CHU de Reims, hôpital Robert Debré, avenue du Général Koenig, 51092 Reims cedex, France.
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Cuny T, Graillon T, Defilles C, Datta R, Zhang S, Figarella-Branger D, Dufour H, Mougel G, Brue T, Landsman T, Halem HA, Culler MD, Barlier A, Saveanu A. Characterization of the ability of a, second-generation SST-DA chimeric molecule, TBR-065, to suppress GH secretion from human GH-secreting adenoma cells. Pituitary 2021; 24:351-358. [PMID: 33433890 DOI: 10.1007/s11102-020-01113-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Accepted: 11/17/2020] [Indexed: 12/19/2022]
Abstract
CONTEXT Somatostatin (SST) and dopamine (DA) inhibit growth hormone (GH) secretion and proliferation of GH-secreting pituitary adenomas (GHomas) through binding to SSTR2 and D2R receptors. Chimeric SST-DA compounds (Dopastatins) display increased potency in inhibiting GH secretion, as compared with individual SST or DA analogs (alone or combined). OBJECTIVE To assess the efficacy of a second-generation dopastatin, TBR-065, in suppressing GH secretion from human GH- and GH/prolactin(PRL)-omas. DESIGN We compared the ability of TBR-065 to inhibit GH secretion from primary cultures of human GH- or GH/PRLoma cells to that of the first generation dopastatin, TBR-760 (formerly BIM-23A760), octreotide (OCT) and cabergoline (CAB), the later either alone or combined. We investigated whether there was any impact of BIM-133, the metabolite of TBR-065, on the ability of TBR-065 to inhibit GH in these cultures. METHODS 17 GH- and GH/PRLomas were included in this study. Inhibition of GH secretion by TBR-065, TBR-760, OCT and CAB (0.1 pM to 0.1 µM) was assessed over a period of 8 h. RESULTS All tumors expressed SSTR2 and D2R mRNAs. GH suppression was higher with TBR-065 as compared with TBR-760 (Emax = 57 ± 5.6% vs. 41.1 ± 12.5%, respectively, p < 0.001) or with OCT + CAB (Emax = 56.8 ± 7.2% vs. 44.4 ± 9.4%, p < 0.001). BIM-133 did not have any impact on the activity of TBR-065. CONCLUSION TBR-065 has significantly improved efficacy in suppressing GH secretion as compared to current available therapies and may represent a new promising option for the treatment of acromegaly.
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Affiliation(s)
- Thomas Cuny
- Service d'Endocrinologie, Aix Marseille University, APHM, Marseille Medical Genetics, Inserm U1251, Hôpital de la Conception, 147 Boulevard Baille, 13005, Marseille, France.
| | - Thomas Graillon
- Service de Neurochirurgie, Aix Marseille University, APHM, Marseille Medical Genetics, Inserm U1251, Hôpital de la Timone, Marseille, France
| | - Célines Defilles
- Aix Marseille University, APHM, Marseille Medical Genetics, Inserm U1251, Marseille, France
| | - Rakesh Datta
- Ipsen Bioscience (Formers Employees), Cambridge, MA, USA
| | - Shengwen Zhang
- Ipsen Bioscience (Formers Employees), Cambridge, MA, USA
| | | | - Henry Dufour
- Service de Neurochirurgie, Aix Marseille University, APHM, Marseille Medical Genetics, Inserm U1251, Hôpital de la Timone, Marseille, France
| | - Grégory Mougel
- Laboratoire de Biologie Moléculaire et Biochimie, Aix Marseille University, APHM, Marseille Medical Genetics, Inserm U1251, Hôpital de la Conception, Marseille, France
| | - Thierry Brue
- Service d'Endocrinologie, Aix Marseille University, APHM, Marseille Medical Genetics, Inserm U1251, Hôpital de la Conception, 147 Boulevard Baille, 13005, Marseille, France
| | - Tanya Landsman
- Ipsen Bioscience (Formers Employees), Cambridge, MA, USA
| | | | | | - Anne Barlier
- Laboratoire de Biologie Moléculaire et Biochimie, Aix Marseille University, APHM, Marseille Medical Genetics, Inserm U1251, Hôpital de la Conception, Marseille, France
| | - Alexandru Saveanu
- Laboratoire de Biologie Moléculaire et Biochimie, Aix Marseille University, APHM, Marseille Medical Genetics, Inserm U1251, Hôpital de la Conception, Marseille, France
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Graillon T, Boissonneau S, Appay R, Boucekine M, Peyrière H, Meyer M, Farah K, Albarel F, Morange I, Castinetti F, Brue T, Fuentes S, Figarella-Branger D, Cuny T, Dufour H. Meningiomas in patients with long-term exposition to progestins: Characteristics and outcome. Neurochirurgie 2021; 67:556-563. [PMID: 33989642 DOI: 10.1016/j.neuchi.2021.04.018] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/17/2021] [Accepted: 04/18/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to describe progestin-associated meningiomas' characteristics, outcome and management. MATERIAL AND METHODS We included 53 patients operated on and/or followed in the department for meningioma with progestin intake longer than one year and with recent drug discontinuation. RESULTS Cyproterone acetate (CPA), nomegestrol acetate (NomA), and chlormadinone acetate (ChlA) were involved in most cases. Mean duration of progestin drugs intake was 17.5 years. Tumors were multiple in 66% of cases and were located in the anterior and the medial skull base in 71% of cases. Transitional subtype represented 16/25 tumors; 19 meningiomas were WHO grade I and 6 were grade II. The rate of transitional subtype and skull base location was significantly higher compared to matched operated meningioma general population. No difference was observed given WHO classification. But Ki67 proliferation index tends to be lower and 5/6 of the WHO grade II meningiomas were classified as WHO grade II because of brain invasion. Strong progesterone receptors expression was observed in most cases. After progestin discontinuation, a spontaneous visual recovery was observed in 6/10 patients. Under CPA (n=24) and ChlA/NomA (n=11), tumor volume decreased in 71% and 18% of patients, was stabilized in 25% and 64% of patients, and increased in 4% and 18% of patients, respectively. Volume outcome was related to meningioma location. CONCLUSIONS Outcome at progestins discontinuation is favorable but different comparing CPA versus ChlA-NomA and comparing tumor location. Long-term follow-up is required. In most cases, simple observation is recommended and surgery should be avoided.
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Affiliation(s)
- T Graillon
- Aix Marseille Univ, AP-HM, INSERM, MMG, Department of Neursurgery, CHU Timone, La Timone Hospital, 264, rue Saint-Pierre, 13005 Marseille, France.
| | - S Boissonneau
- Aix-Marseille Univ, AP-HM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service de Neuro-chirurgie, Marseille, France
| | - R Appay
- Aix-Marseille Univ, AP-HM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service d'Anatomie Pathologique et de Neuropathologie, Marseille, France
| | - M Boucekine
- Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279 CEReSS - Health Service Research and Quality of Life Center, 27, bd Jean Moulin cedex 05, 13385 Marseille, France
| | - H Peyrière
- Aix Marseille Univ, AP-HM, Department of Neurosurgery, Hospital La Timone, Marseille, France
| | - M Meyer
- Aix Marseille Univ, AP-HM, Department of Neurosurgery, Hospital La Timone, Marseille, France
| | - K Farah
- Aix Marseille Univ, AP-HM, Department of Neurosurgery, Hospital La Timone, Marseille, France
| | - F Albarel
- Aix Marseille Univ, AP-HM, INSERM, MMG, Department of Endocrinology, Hospital La Conception, Marseille, France
| | - I Morange
- Aix Marseille Univ, AP-HM, INSERM, MMG, Department of Endocrinology, Hospital La Conception, Marseille, France
| | - F Castinetti
- Aix Marseille Univ, AP-HM, INSERM, MMG, Department of Endocrinology, Hospital La Conception, Marseille, France
| | - T Brue
- Aix Marseille Univ, AP-HM, INSERM, MMG, Department of Endocrinology, Hospital La Conception, Marseille, France
| | - S Fuentes
- Aix Marseille Univ, AP-HM, Department of Neurosurgery, Hospital La Timone, Marseille, France
| | - D Figarella-Branger
- Aix-Marseille Univ, AP-HM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service d'Anatomie Pathologique et de Neuropathologie, Marseille, France
| | - T Cuny
- Aix Marseille Univ, AP-HM, INSERM, MMG, Department of Endocrinology, Hospital La Conception, Marseille, France
| | - H Dufour
- Aix Marseille Univ, AP-HM, INSERM, MMG, Department of Neursurgery, CHU Timone, La Timone Hospital, 264, rue Saint-Pierre, 13005 Marseille, France
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42
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Eydoux R, Castinetti F, Authier M, Vialle M, Albarel F, Brue T, Courbiere B. Women's perceptions of femininity after craniopharyngioma: a qualitative study. Clin Endocrinol (Oxf) 2021; 94:880-887. [PMID: 33296092 DOI: 10.1111/cen.14378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/21/2020] [Accepted: 11/15/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Previous quantitative studies have shown a reduced quality of life in patients treated for craniopharyngioma (CP). However, few have assessed their sexual quality of life and other issues related to patient intimacy have not yet been addressed. Standardized questionnaires limit the approach to sexuality and the exploration of patient experiences. A qualitative study, which allows in-depth analysis, may represent an interesting approach to explore intimacy in women with a history of CP. OBJECTIVE To assess the impact of a CP history on femininity and relationships in women. DESIGN AND PATIENTS A qualitative study with semi-structured interviews was conducted with 15 adult women treated for CP during childhood, adolescence or at childbearing age up to 40 years of age. Interviews were audio recorded, anonymized and transcribed literally. Data analysis was carried out with an inductive approach according to the grounded theory method. RESULTS Three main themes were identified: (a) apparent changes leading to altered self-perception that may impact on femininity and generate lower self-esteem; (b) managing the hidden disabilities of the disease inducing a need for permanent control; and (c) building parenthood and couple relationships: coping with sexual dysfunction and infertility. CONCLUSIONS Our study highlighted alterations in self-perception and femininity due to body change and disability resulting from CP treatment, impacting both couple and social relationships. Interviewing women who underwent CP surgery at different ages highlighted specific needs and different expectations of medical professionals which emphasize the importance of offering both global and personalized care.
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Affiliation(s)
- Raphaëlle Eydoux
- Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception-Hôpital Nord, Marseille, France
| | - Frédéric Castinetti
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
- INSERM, U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Aix-Marseille Univ, Marseille, France
| | - Magali Authier
- Faculté des sciences médicales et paramédicales-Timone, Département de Médecine Générale, Aix-Marseille Université, Marseille, France
| | - Manon Vialle
- Centre Norbert Elias-UMR 8562, École des Hautes Études en Sciences Sociales, CNRS, Aix Marseille Univ, Marseille, France
| | - Frédérique Albarel
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
- INSERM, U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Aix-Marseille Univ, Marseille, France
| | - Thierry Brue
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
- INSERM, U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Aix-Marseille Univ, Marseille, France
| | - Blandine Courbiere
- Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception-Hôpital Nord, Marseille, France
- Aix Marseille Univ, IMBE, CNRS, IRD, Avignon Université, Marseille, France
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Castets S, Roucher-Boulez F, Saveanu A, Mallet-Motak D, Chabre O, Amati-Bonneau P, Bonneau D, Girardin C, Morel Y, Villanueva C, Brue T, Reynaud R, Nicolino M. Hypopituitarism in Patients with Blepharophimosis and FOXL2 Mutations. Horm Res Paediatr 2021; 93:30-39. [PMID: 32454486 DOI: 10.1159/000507249] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/12/2019] [Accepted: 03/15/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND FOXL2 is the gene involved in blepharophimosis, ptosis, and epicanthus inversus syndrome (BPES). There have been few single case reports of growth hormone deficiency (GHD) with this syndrome, and Foxl2 is known to be involved in pituitary development in mice. Our aim was to analyze the prevalence of FOXL2 gene alteration in a series of patients with congenital hypopituitarism and eyelid anomalies. METHODS FOXL2 was analyzed in 10 patients with hypopituitarism (ranging from isolated GHD to complete pituitary hormone deficiency) and eyelid anomalies (typical BPES in 4 patients and milder anomalies in 6 patients). In patients with an FOXL2 mutation, we ruled out other possible molecular explanations by analyzing a panel of 20 genes known to be associated with hypopituitarism, and a candidate gene approach was used for patients without an FOXL2mutation. RESULTS Three patients had an FOXL2mutation. All 3 had typical BPES. Their pituitary phenotype varied from GHD to complete pituitary hormone deficiency and their pituitary morphology ranged from normal to an interrupted pituitary stalk. No mutations were found in genes previously associated with hypopituitarism. CONCLUSION Our study shows that some patients with BPES have hypopituitarism with no molecular explanation other than FOXL2 mutation. This points toward an involvement of FOXL2 in human pituitary development.
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Affiliation(s)
- Sarah Castets
- Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Service d'Endocrinologie Pédiatrique, Bron, France, .,Aix-Marseille Université, AP-HM, Centre de Référence des Maladies Rares D'origine Hypophysaire HYPO, Marseille, France,
| | - Florence Roucher-Boulez
- Hospices Civils de Lyon, Groupement Hospitalier Est, Laboratoire de Biochimie et Biologie Moléculaire Grand Est, UM Pathologies Endocriniennes Rénales Musculaires et Mucoviscidose, Bron, France.,Centre de Référence du Développement Génital: du Fœtus à l'Adulte, Filière Maladies Rares Endocriniennes, Bron, France.,Univ Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Alexandru Saveanu
- Aix-Marseille Université, AP-HM, Centre de Référence des Maladies Rares D'origine Hypophysaire HYPO, Marseille, France.,Aix Marseille Université, INSERM, MMG, U 1251, Marseille, France
| | - Delphine Mallet-Motak
- Hospices Civils de Lyon, Groupement Hospitalier Est, Laboratoire de Biochimie et Biologie Moléculaire Grand Est, UM Pathologies Endocriniennes Rénales Musculaires et Mucoviscidose, Bron, France.,Centre de Référence du Développement Génital: du Fœtus à l'Adulte, Filière Maladies Rares Endocriniennes, Bron, France
| | - Olivier Chabre
- CHU de Grenoble Alpes et Université Grenoble Alpes, CS 10217 38043, Service d'Endocrinologie, Grenoble, France
| | - Patrizia Amati-Bonneau
- MitoLab Team, UMR CNRS 6015 - INSERM U1083, Institut MitoVasc, Université et Hôpital d'Angers, Angers, France.,Département de Biochimie et Génétique, Université et Hôpital d'Angers, Angers, France
| | - Dominique Bonneau
- MitoLab Team, UMR CNRS 6015 - INSERM U1083, Institut MitoVasc, Université et Hôpital d'Angers, Angers, France.,Département de Biochimie et Génétique, Université et Hôpital d'Angers, Angers, France
| | - Celine Girardin
- Hôpitaux Universitaires de Genève, Endocrinologie Pédiatrique, Genève, Switzerland
| | - Yves Morel
- Hospices Civils de Lyon, Groupement Hospitalier Est, Laboratoire de Biochimie et Biologie Moléculaire Grand Est, UM Pathologies Endocriniennes Rénales Musculaires et Mucoviscidose, Bron, France.,Univ Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Carine Villanueva
- Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Service d'Endocrinologie Pédiatrique, Bron, France.,Centre de Référence du Développement Génital: du Fœtus à l'Adulte, Filière Maladies Rares Endocriniennes, Bron, France
| | - Thierry Brue
- Aix-Marseille Université, AP-HM, Centre de Référence des Maladies Rares D'origine Hypophysaire HYPO, Marseille, France.,Aix Marseille Université, INSERM, MMG, U 1251, Marseille, France
| | - Rachel Reynaud
- Aix-Marseille Université, AP-HM, Centre de Référence des Maladies Rares D'origine Hypophysaire HYPO, Marseille, France.,Aix Marseille Université, INSERM, MMG, U 1251, Marseille, France
| | - Marc Nicolino
- Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Service d'Endocrinologie Pédiatrique, Bron, France.,Centre de Référence du Développement Génital: du Fœtus à l'Adulte, Filière Maladies Rares Endocriniennes, Bron, France.,Univ Lyon, Université Claude Bernard Lyon 1, Lyon, France
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Hochman C, Cristante J, Geslot A, Salenave S, Sonnet E, Briet C, Bachelot A, Chevalier N, Gilly O, Brue T, Hadjadj S, Kerlan V, Chanson P, Vezzosi D, Chabre O, Drui D, Castinetti F. Pre-term birth in women exposed to Cushing's disease: the baby-cush study. Eur J Endocrinol 2021; 184:469-476. [PMID: 33486470 DOI: 10.1530/eje-20-1224] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/22/2021] [Indexed: 11/08/2022]
Abstract
DESIGN Hypercortisolism during pregnancy is a risk factor for prematurity. Long-term exposure to hypercortisolism may lead to permanent comorbidities, such as hypertension or diabetes, even after remission. Our aim was to determine whether women with a history of Cushing's disease (and being eu-, hypo- or hypercortisolic at the time of pregnancy) had the same risks of comorbidities, and especially prematurity, during pregnancy. METHODS It was a retrospective multicentric study focusing on mothers with a history of Cushing's disease or diagnosed during pregnancy, followed in French tertiary referral centers. We compared the outcomes of pregnancies depending on the cortisolic status at the time of pregnancy. RESULTS A total of 60 patients (78 pregnancies including 21 with hypercortisolism, 32 with hypocortisolism and 25 in eucortisolism in 25) were evaluated. The overall rate of preterm birth was 24.3%, with a peak in women diagnosed during pregnancy (62.5%), a high risk in hypercortisolic (33%) and hypocortisolic (19.3%), and a low risk (8%) in eucortisolic women Gestational diabetes and hypertension were observed in 21% and 10.4% of the whole cohort, with a higher risk in hypercortisolic women. Cesarean delivery was performed in 33.7% of the cohort. CONCLUSIONS Being non-eucortisolic at the time of pregnancy increases the risk of prematurity and comorbidities compared to the general population. Women with a history of Cushing's disease should thus be carefully monitored during pregnancy. The high rate of cesarean delivery emphasizes the fact that these pregnancies should always be considered at risk.
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Affiliation(s)
- Clarisse Hochman
- Service d'Endocrinologie, L'institut du thorax, CHU de Nantes, Nantes, Pays de la Loire, France
| | - Justine Cristante
- Endocrinologie, Diabétologie et Maladies Métaboliques, CHU de Grenoble, Grenoble, France
| | - Aurore Geslot
- Service d'Endocrinologie, Hôpital Larrey, Toulouse, France
| | - Sylvie Salenave
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse and Université Paris-Saclay, Univ. Paris-Sud, Inserm, Signalisation Hormonale, Physiopathologie Endocrinienne et Métabolique, Le Kremlin-Bicêtre, Paris, France
| | - Emmanuel Sonnet
- Service d'Endocrinologie-Diabète et Maladies Métaboliques, Hôpital de la Cavale Blanche, CHU de Brest, Brest, France
| | - Claire Briet
- Service Endocrinologie, Diabétologie et Nutrition, Institut Mitovasc, CHU d'Angers, Angers, France
| | - Anne Bachelot
- Service d'Endocrinologie et Médecine de la Reproduction, IE3M, Hôpital Universitaire Pitié Salpêtrière, Sorbonne Université, Paris, France
| | | | - Olivier Gilly
- Service des Maladies Métaboliques et Endocriniennes, CHU Nîmes, Nimes, France
| | - Thierry Brue
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | - Samy Hadjadj
- Service d'Endocrinologie, L'institut du thorax, CHU de Nantes, Nantes, Pays de la Loire, France
| | - Veronique Kerlan
- Service d'Endocrinologie-Diabète et Maladies Métaboliques, Hôpital de la Cavale Blanche, CHU de Brest, Brest, France
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse and Université Paris-Saclay, Univ. Paris-Sud, Inserm, Signalisation Hormonale, Physiopathologie Endocrinienne et Métabolique, Le Kremlin-Bicêtre, Paris, France
| | | | - Olivier Chabre
- Endocrinologie, Diabétologie et Maladies Métaboliques, CHU de Grenoble, Grenoble, France
| | - Delphine Drui
- Service d'Endocrinologie, L'institut du thorax, CHU de Nantes, Nantes, Pays de la Loire, France
| | - Frederic Castinetti
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
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Reincke M, Albani A, Assie G, Bancos I, Brue T, Buchfelder M, Chabre O, Ceccato F, Daniele A, Detomas M, Di Dalmazi G, Elenkova A, Findling J, Grossman AB, Gomez-Sanchez CE, Heaney AP, Honegger J, Karavitaki N, Lacroix A, Laws ER, Losa M, Murakami M, Newell-Price J, Pecori Giraldi F, Pérez-Rivas LG, Pivonello R, Rainey WE, Sbiera S, Schopohl J, Stratakis CA, Theodoropoulou M, van Rossum EFC, Valassi E, Zacharieva S, Rubinstein G, Ritzel K. Corticotroph tumor progression after bilateral adrenalectomy (Nelson's syndrome): systematic review and expert consensus recommendations. Eur J Endocrinol 2021; 184:P1-P16. [PMID: 33444221 PMCID: PMC8060870 DOI: 10.1530/eje-20-1088] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Corticotroph tumor progression (CTP) leading to Nelson's syndrome (NS) is a severe and difficult-to-treat complication subsequent to bilateral adrenalectomy (BADX) for Cushing's disease. Its characteristics are not well described, and consensus recommendations for diagnosis and treatment are missing. METHODS A systematic literature search was performed focusing on clinical studies and case series (≥5 patients). Definition, cumulative incidence, treatment and long-term outcomes of CTP/NS after BADX were analyzed using descriptive statistics. The results were presented and discussed at an interdisciplinary consensus workshop attended by international pituitary experts in Munich on October 28, 2018. RESULTS Data covered definition and cumulative incidence (34 studies, 1275 patients), surgical outcome (12 studies, 187 patients), outcome of radiation therapy (21 studies, 273 patients), and medical therapy (15 studies, 72 patients). CONCLUSIONS We endorse the definition of CTP-BADX/NS as radiological progression or new detection of a pituitary tumor on thin-section MRI. We recommend surveillance by MRI after 3 months and every 12 months for the first 3 years after BADX. Subsequently, we suggest clinical evaluation every 12 months and MRI at increasing intervals every 2-4 years (depending on ACTH and clinical parameters). We recommend pituitary surgery as first-line therapy in patients with CTP-BADX/NS. Surgery should be performed before extrasellar expansion of the tumor to obtain complete and long-term remission. Conventional radiotherapy or stereotactic radiosurgery should be utilized as second-line treatment for remnant tumor tissue showing extrasellar extension.
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Affiliation(s)
- Martin Reincke
- Klinikum der Ludwig-Maximilians-Universität München, Medizinische Klinik und Poliklinik IV, Munich, Germany
| | - Adriana Albani
- Klinikum der Ludwig-Maximilians-Universität München, Medizinische Klinik und Poliklinik IV, Munich, Germany
| | - Guillaume Assie
- Department of Endocrinology, Université de Paris, Institut Cochin, INSERM, CNRS, Center for Rare Adrenal Diseases, Hôpital Cochin, Paris, France
| | - Irina Bancos
- Division of Endocrinology, Mayo Clinic Minnesota, Diabetes, Metabolism, Nutrition, Rochester, Minnesota, USA
| | - Thierry Brue
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut MarMaRa and Endocrinology Department, Conception Hospital, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - Michael Buchfelder
- Universitätsklinikum Erlangen, Neurochirurgische Klinik, Erlangen, Germany
| | - Olivier Chabre
- CHU Grenoble-Alpes, Unit of Endocrinology, Pavillon des Ecrins, Grenoble, France
| | - Filippo Ceccato
- Department of Medicine, University of Padova, Padova, Veneto, Italy
| | - Andrea Daniele
- Department of Medicine, University of Padova, Padova, Veneto, Italy
| | - Mario Detomas
- Division of Endocrinology and Diabetology, Department of Internal Medicine, University of Würzburg, Wurzburg, Bayern, Germany
| | - Guido Di Dalmazi
- Department of Medical and Surgical Sciences, Endocrinology and Diabetes Prevention and Care Unit, University of Bologna, S. Orsola Policlinic, Bologna, Italy
| | - Atanaska Elenkova
- Department of Endocrinology, Medical University Sofia, Sofia, Bulgaria
| | - James Findling
- Division of Endocrinology and Molecular Medicine, Medical College of Wisconsin, Menomonee Falls, Wisconsin, USA
| | - Ashley B Grossman
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Centre for Endocrinology, Barts and the London School of Medicine, Queen Mary University of London, UK
| | - Celso E Gomez-Sanchez
- Department of Pharmacology and Toxicology and Medicine, Endocrine Service, G.V. Montgomery VA Medical Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Anthony P Heaney
- Division of Endocrinology, Medical Director, Pituitary & Neuroendocrine Tumor Program, UCLA School of Medicine, Los Angeles, California, USA
| | - Juergen Honegger
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Niki Karavitaki
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Andre Lacroix
- Division of Endocrinology, Department of Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Edward R Laws
- Pituitary/Neuroendocrine Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marco Losa
- Department of Neurosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milano, Italy
| | - Masanori Murakami
- Klinikum der Ludwig-Maximilians-Universität München, Medizinische Klinik und Poliklinik IV, Munich, Germany
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - John Newell-Price
- Dept of Oncology and Metabolism, The Medical School University of Sheffield, Sheffield, UK
| | - Francesca Pecori Giraldi
- Department of Clinical Sciences & Community Health, University of Milan Neuroendocrinology Research Laboratory, Instituto Auxologico Italiano IRCCS, Milan, Italy
| | - Luis G Pérez-Rivas
- Klinikum der Ludwig-Maximilians-Universität München, Medizinische Klinik und Poliklinik IV, Munich, Germany
| | - Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - William E Rainey
- Departments of Molecular & Integrative Physiology and Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Silviu Sbiera
- Division of Endocrinology and Diabetology, Department of Internal Medicine, University of Würzburg, Wurzburg, Bayern, Germany
| | - Jochen Schopohl
- Klinikum der Ludwig-Maximilians-Universität München, Medizinische Klinik und Poliklinik IV, Munich, Germany
| | - Constantine A Stratakis
- Section on Genetics & Endocrinology Eunice Kennedy Shriver National Insitute of Child Health & Human Development (NICHD) National Institute of Health (NIH), NIH Clinical Research Center, Bethesda, Maryland, USA
| | - Marily Theodoropoulou
- Klinikum der Ludwig-Maximilians-Universität München, Medizinische Klinik und Poliklinik IV, Munich, Germany
| | - Elisabeth F C van Rossum
- Department of Internal Medicine, division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Elena Valassi
- IIB-Sant Pau and Department of Endocrinology/Medicine, Hospital Sant Pau, UAB, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, Barcelona, Spain
| | - Sabina Zacharieva
- Department of Endocrinology, Medical University Sofia, Sofia, Bulgaria
| | - German Rubinstein
- Klinikum der Ludwig-Maximilians-Universität München, Medizinische Klinik und Poliklinik IV, Munich, Germany
| | - Katrin Ritzel
- Klinikum der Ludwig-Maximilians-Universität München, Medizinische Klinik und Poliklinik IV, Munich, Germany
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Ho K, Fleseriu M, Kaiser U, Salvatori R, Brue T, Lopes MB, Kunz P, Molitch M, Camper SA, Gadelha M, Syro LV, Laws E, Reincke M, Nishioka H, Grossman A, Barkan A, Casanueva F, Wass J, Mamelak A, Katznelson L, van der Lely AJ, Radovick S, Bidlingmaier M, Boguszewski M, Bollerslev J, Hoffman AR, Oyesiku N, Raverot G, Ben-Shlomo A, Fowkes R, Shimon I, Fukuoka H, Pereira AM, Greenman Y, Heaney AP, Gurnell M, Johannsson G, Osamura RY, Buchfelder M, Zatelli MC, Korbonits M, Chanson P, Biermasz N, Clemmons DR, Karavitaki N, Bronstein MD, Trainer P, Melmed S. Pituitary Neoplasm Nomenclature Workshop: Does Adenoma Stand the Test of Time? J Endocr Soc 2021; 5:bvaa205. [PMID: 33604494 PMCID: PMC7874572 DOI: 10.1210/jendso/bvaa205] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Indexed: 12/12/2022] Open
Abstract
The WHO Classification of Endocrine Tumours designates pituitary neoplasms as adenomas. A proposed nomenclature change to pituitary neuroendocrine tumors (PitNETs) has been met with concern by some stakeholder groups. The Pituitary Society coordinated the Pituitary Neoplasm Nomenclature (PANOMEN) workshop to address the topic. Experts in pituitary developmental biology, pathology, neurosurgery, endocrinology, and oncology, including representatives nominated by the Endocrine Society, European Society of Endocrinology, European Neuroendocrine Association, Growth Hormone Research Society, and International Society of Pituitary Surgeons. Clinical epidemiology, disease phenotype, management, and prognosis of pituitary adenomas differ from that of most NETs. The vast majority of pituitary adenomas are benign and do not adversely impact life expectancy. A nomenclature change to PitNET does not address the main challenge of prognostic prediction, assigns an uncertain malignancy designation to benign pituitary adenomas, and may adversely affect patients. Due to pandemic restrictions, the workshop was conducted virtually, with audiovisual lectures and written précis on each topic provided to all participants. Feedback was collated and summarized by Content Chairs and discussed during a virtual writing meeting moderated by Session Chairs, which yielded an evidence-based draft document sent to all participants for review and approval. There is not yet a case for adopting the PitNET nomenclature. The PANOMEN Workshop recommends that the term adenoma be retained and that the topic be revisited as new evidence on pituitary neoplasm biology emerges.
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Affiliation(s)
- Ken Ho
- The Garvan Institute of Medical Research, Sydney, Australia
| | | | | | | | | | - M Beatriz Lopes
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Mark Molitch
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sally A Camper
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Mônica Gadelha
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luis V Syro
- Hospital Pablo Tobon Uribe and Clinica Medellin-Grupo Quirónsalud, Medellin, Colombia
| | - Edward Laws
- Brigham and Women's Hospital, Boston, MA, USA
| | - Martin Reincke
- Klinikum der Universität, Ludwig-Maximilians-Universität, München, Germany
| | | | - Ashley Grossman
- University of Oxford, Oxford, and Barts and the London School of Medicine, London, UK
| | - Ariel Barkan
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Felipe Casanueva
- Santiago de Compostela University, Santiago de Compostela, Spain
| | | | - Adam Mamelak
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Sally Radovick
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | | | | | | | | | - Gerald Raverot
- Hospices Civils de Lyon and Lyon 1 University, Lyon, France
| | | | - Rob Fowkes
- Royal Veterinary College, University of London, London, UK
| | - Ilan Shimon
- Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | | | | | - Yona Greenman
- Tel Aviv-Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Anthony P Heaney
- David Geffen School of Medicine University of California, Los Angeles, CA, USA
| | - Mark Gurnell
- University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
| | - Gudmundur Johannsson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Robert Y Osamura
- Nippon Koukan Hospital Kawasaki & Keio University School of Medicine, Tokyo, Japan
| | | | | | | | - Philippe Chanson
- University Paris-Saclay & Assistance Publique Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | | | - David R Clemmons
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Jullien N, Saveanu A, Vergier J, Marquant E, Quentien MH, Castinetti F, Galon-Faure N, Brauner R, Marrakchi Turki Z, Tauber M, El Kholy M, Linglart A, Rodien P, Fedala NS, Bergada I, Cortet-Rudelli C, Polak M, Nicolino M, Stuckens C, Barlier A, Brue T, Reynaud R. Clinical lessons learned in constitutional hypopituitarism from two decades of experience in a large international cohort. Clin Endocrinol (Oxf) 2021; 94:277-289. [PMID: 33098107 DOI: 10.1111/cen.14355] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 05/10/2020] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 01/05/2023]
Abstract
CONTEXT The international GENHYPOPIT network collects phenotypical data and screens genetic causes of non-acquired hypopituitarism. AIMS To describe main phenotype patterns and their evolution through life. DESIGN Patients were screened according to their phenotype for coding sequence variations in 8 genes: HESX1, LHX3, LHX4, PROP1, POU1F1, TBX19, OTX2 and PROKR2. RESULTS Among 1213 patients (1143 index cases), the age of diagnosis of hypopituitarism was congenital (24%), in childhood (28%), at puberty (32%), in adulthood (7.2%) or not available (8.8%). Noteworthy, pituitary hormonal deficiencies kept on evolving during adulthood in 49 of patients. Growth Hormone deficiency (GHD) affected 85.8% of patients and was often the first diagnosed deficiency. AdrenoCorticoTropic Hormone deficiency rarely preceded GHD, but usually followed it by over 10 years. Pituitary Magnetic Resonance Imaging (MRI) abnormalities were common (79.7%), with 39.4% pituitary stalk interruption syndrome (PSIS). The most frequently associated extrapituitary malformations were ophthalmological abnormalities (16.1%). Prevalence of identified mutations was 7.3% of index cases (84/1143) and 29.5% in familial cases (n = 146). Genetic analysis in 449 patients without extrapituitary phenotype revealed 36 PROP1, 2 POU1F1 and 17 TBX19 mutations. CONCLUSION This large international cohort highlights atypical phenotypic presentation of constitutional hypopituitarism, such as post pubertal presentation or adult progression of hormonal deficiencies. These results justify long-term follow-up, and the need for systematic evaluation of associated abnormalities. Genetic defects were rarely identified, mainly PROP1 mutations in pure endocrine phenotypes.
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Affiliation(s)
- Nicolas Jullien
- Aix-Marseille Univ, CNRS, INP, Inst Neurophysiopathol, Marseille, France
| | - Alexandru Saveanu
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences médicales et paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Department of Endocrinology, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Centre de Référence des Maladies Rares de l'Hypophyse, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
- Laboratory of Molecular Biology, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - Julia Vergier
- Paediatric Endocrinology Unit, Department of Paediatrics, CHU Timone Enfants, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - Emeline Marquant
- Paediatric Endocrinology Unit, Department of Paediatrics, CHU Timone Enfants, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - Marie Helene Quentien
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences médicales et paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
| | - Frederic Castinetti
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences médicales et paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Department of Endocrinology, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Centre de Référence des Maladies Rares de l'Hypophyse, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - Noémie Galon-Faure
- Department of Paediatrics, Centre Hospitalier du Pays d'Aix, Aix-En-Provence, France
| | - Raja Brauner
- Fondation Ophtalmologique Adolphe de Rothschild and Université Paris Descartes, Paris, France
| | | | - Maité Tauber
- Paediatric Endocrinology Unit, Department of Paediatrics, Children Hospital, Toulouse University Hospital, Toulouse, France
| | | | - Agnès Linglart
- Paediatric Endocrinology Unit, Department of Paediatrics, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Patrice Rodien
- Endocrinology Department, Angers University Hospital, Angers, France
| | | | - Ignacio Bergada
- Children Hospital "Ricardo Gutierrez", Bueno-Aires, Argentina
| | | | - Michel Polak
- Paediatric Endocrinology Unit, Department of Paediatrics, Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), INSERM U1016, Institut IMAGINE, Paris, France
| | - Marc Nicolino
- Paediatric Endocrinology Unit, Department of Paediatrics, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon (HCL), Bron, France
| | - Chantal Stuckens
- Department of Paediatrics, Hôpital Jeanne de Flandre, Lille University Hospital, Lille, France
| | - Anne Barlier
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences médicales et paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Department of Endocrinology, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Centre de Référence des Maladies Rares de l'Hypophyse, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
- Laboratory of Molecular Biology, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - Thierry Brue
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences médicales et paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Department of Endocrinology, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Centre de Référence des Maladies Rares de l'Hypophyse, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - Rachel Reynaud
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Faculté des Sciences médicales et paramédicales, Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Centre de Référence des Maladies Rares de l'Hypophyse, CHU Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
- Paediatric Endocrinology Unit, Department of Paediatrics, CHU Timone Enfants, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
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Kuhn E, Caron P, Delemer B, Raingeard I, Lefebvre H, Raverot G, Cortet-Rudelli C, Desailloud R, Geffroy C, Henocque R, Brault Y, Brue T, Chanson P. Pegvisomant in combination or pegvisomant alone after failure of somatostatin analogs in acromegaly patients: an observational French ACROSTUDY cohort study. Endocrine 2021; 71:158-167. [PMID: 32986202 PMCID: PMC7835180 DOI: 10.1007/s12020-020-02501-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/14/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE After surgery, when somatostatin analogs (SAs) do not normalise IGF-I, pegvisomant (PEG) is indicated. Our aim was to define the medical reasons for the treatment of patients with PEG as monotherapy (M) or combined with SA, either as primary bitherapy, PB (PEG is secondarily introduced after SA) or as secondary bitherapy, SB (SAs secondarily introduced after PEG). METHODS We retrospectively analysed French data from ACROSTUDY. RESULTS 167, 88 and 57 patients were treated with M, PB or SB, respectively, during a median time of 80, 42 and 70 months. The median PEG dose was respectively 15, 10 and 20 mg. Before PEG, the mean IGF-I level did not differ between M and PB but the proportion of patients with suprasellar tumour extension was higher in PB group (67.5% vs. 44.4%, P = 0.022). SB regimen was used preferentially in patients with tumour increase and IGF-I level difficult to normalise under PEG. In both secondary regimens, the decrease of the frequency of PEG's injections, compared to monotherapy was confirmed. However, the mean weekly dose of PEG between M and PB remained the same. CONCLUSIONS The medical rationale for continuing SAs rather than switching to PEG alone in patients who do not normalise IGF-I under SAs was a tumour concern with suprasellar extension and tumour shrinkage under SA. A potential explanation for introducing SA in association with PEG appears to be a tumour enlargement and difficulties to normalise IGF-I levels under PEG given alone. In both regimens, the prospect of lowering PEG injection frequency favoured the choice.
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Affiliation(s)
- Emmanuelle Kuhn
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, 94275, Le Kremlin-Bicêtre, France
- Université Paris-Saclay (Université Paris-Sud), Inserm, Signalisation Hormonale, Physiopathologie Endocrinienne et Métabolique, Le Kremlin-Bicêtre, France
| | - Philippe Caron
- CHU de Toulouse, Hôpital Larrey, 24 Chemin de Pouvourville, TSA 30030, 31059, Toulouse Cedex 9, France
| | - Brigitte Delemer
- CHU de Reims-Hôpital Robert Debré, Avenue du Général Koenig, 51092, Reims Cedex, France
| | - Isabelle Raingeard
- CHRU de Montpellier, Maladies Endocriniennes, Hopital Lapeyronie, 295 Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Hervé Lefebvre
- CHU de Rouen, 1 Rue de Germont, 76031, Rouen Cedex, France
| | - Gérald Raverot
- Hospices civils de Lyon, Hôpital Louis Pradel, 59 Boulevard Pinel, 69677, Bron Cedex, France
| | | | - Rachel Desailloud
- CHU d'Amiens, Hôpital Nord, Place Victor Pauchet, 80054, Amiens Cedex 1, France
| | - Clementine Geffroy
- Pfizer France, 23-25 Avenue du Docteur Lannelongue, 75668, Paris Cedex 14, France
| | - Robin Henocque
- Pfizer France, 23-25 Avenue du Docteur Lannelongue, 75668, Paris Cedex 14, France
| | - Yves Brault
- Pfizer France, 23-25 Avenue du Docteur Lannelongue, 75668, Paris Cedex 14, France
| | - Thierry Brue
- CHU de Marseille, Hôpital de la Conception, 147 boulevard Baille, 13385, Marseille Cedex 5, France
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, 94275, Le Kremlin-Bicêtre, France.
- Université Paris-Saclay (Université Paris-Sud), Inserm, Signalisation Hormonale, Physiopathologie Endocrinienne et Métabolique, Le Kremlin-Bicêtre, France.
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Illouz F, Chanson P, Sonnet E, Brue T, Ferriere A, Raffin Sanson ML, Vantyghem MC, Raverot G, Munier M, Rodien P, Briet C. Somatostatin receptor ligands induce TSH deficiency in thyrotropin-secreting pituitary adenoma. Eur J Endocrinol 2021; 184:1-8. [PMID: 33112257 DOI: 10.1530/eje-20-0484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/05/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Somatostatin receptor ligands (SRL) are useful to control central hyperthyroidism in patients with thyrotropin-secreting pituitary adenoma (TSH pituitary adenoma). The aim of this study was to describe the frequency of thyrotropin deficiency (TSH deficiency) in patients with TSH pituitary adenoma treated by SRL. DESIGN Retrospective study. METHODS Patients with central hyperthyroidism due to TSH pituitary adenoma treated by short or long-acting SRL were retrospectively included. TSH deficiency was defined by a low FT4 associated with non-elevated TSH concentrations during SRL therapy. We analysed the frequency of TSH deficiency and the characteristics of patients with or without TSH deficiency. RESULTS Forty-six patients were included. SRL were used as the first-line therapy in 21 of 46 patients (46%). Central hyperthyroidism was controlled in 36 of 46 patients (78%). TSH deficiency appeared in 7 of 46 patients (15%) after a median time of 4 weeks (4-7) and for a median duration of 3 months (2.5-3). The TSH deficiency occurred after one to three injections of long-acting SRL used as first-line therapy in 6/7 cases. There were no differences in terms of clinical and hormonal features, size of adenomas or doses of SRL between patients with or without TSH deficiency. CONCLUSIONS SRL can induce TSH deficiency in patients with central hyperthyroidism due to TSH pituitary adenoma. Thyrotropic function should be assessed before the first three injections of SRL in order to track TSH deficiency and reduce the frequency of injections when control of thyrotoxicosis rather than tumour reduction is the aim of the treatment.
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Affiliation(s)
- Frédéric Illouz
- Centre de Référence des Maladies Rares de la Thyroïde et des Récepteurs Hormonaux TRH, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Service d'Endocrinologie, Diabétologie et Nutrition, CHU d'Angers, Angers Cedex, France
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Le Kremlin-Bicêtre, France
- UMR S-1185, Fac Med Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Emmanuel Sonnet
- Service d'Endocrinologie Diabétologie Nutrition, CHU de BREST, BREST Cedex, France
| | - Thierry Brue
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service d'Endocrinologie, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Institut National de la Santé et de la Recherche Médicale (INSERM), Marseille, France
| | - Amandine Ferriere
- Service d'Endocrinologie, Diabétologie et Nutrition, Hôpital Haut Lévêque, CHU Bordeaux, Pessac, France
- INSERM, Neurocentre Magendie, Physiopathologie de la Plasticité Neuronale, Bordeaux, France
- Université de Bordeaux, Neurocentre Magendie, Physiopathologie de la Plasticité Neuronale, Bordeaux, France
| | - Marie-Laure Raffin Sanson
- Service d'Endocrinologie et Nutrition, CHU Ambroise-Paré, AP-HP, Boulogne-Billancourt, France
- Inserm U1173, Université Versailles-Saint-Quentin, Montigny-Le-Bretonneux, France
| | - Marie-Christine Vantyghem
- Service d'Endocrinologie et Métabolisme, CHU Lille, Lille, France
- UMR 1190 Translational Research in Diabetes INSERM, Lille, France
| | - Gérald Raverot
- Université de Lyon, Lyon1, Lyon, France
- Inserm U1052, CNRS UMR5286, Cancer Research Center of Lyon, Lyon, France
- Fédération d'Endocrinologie, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron Cedex, France
| | - Mathilde Munier
- Centre de Référence des Maladies rares de la Thyroïde et des Récepteurs Hormonaux, Institut MITOVASC, Université d'Angers, Angers, France
| | - Patrice Rodien
- Centre de Référence des Maladies Rares de la Thyroïde et des Récepteurs Hormonaux TRH, Centre de Référence des Maladies Rares de l'Hypophyse HYPO Service d'Endocrinologie, Diabétologie et Nutrition, CHU d'Angers, Institut MITOVASC, Université d'Angers, Angers, France
| | - Claire Briet
- Centre de Référence des Maladies Rares de la Thyroïde et des Récepteurs Hormonaux TRH Centre de Référence des Maladies Rares de l'Hypophyse HYPO Service d'Endocrinologie, Diabétologie et Nutrition, CHU d'Angers, Institut MITOVASC, Université d'Angers, Angers, France
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50
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Kuhn E, Caron P, Delemer B, Raingeard I, Lefebvre H, Raverot G, Cortet-Rudelli C, Desailloud R, Geffroy C, Henocque R, Brault Y, Brue T, Chanson P. Correction to: Pegvisomant in combination or pegvisomant alone after failure of somatostatin analogs in acromegaly patients: an observational French ACROSTUDY cohort study. Endocrine 2021; 71:265. [PMID: 33156493 PMCID: PMC7835287 DOI: 10.1007/s12020-020-02532-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Affiliation(s)
- Emmanuelle Kuhn
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, 94275, Le Kremlin-Bicêtre, France
- Université Paris-Saclay (Université Paris-Sud), Inserm, Signalisation Hormonale, Physiopathologie Endocrinienne et Métabolique, Le Kremlin-Bicêtre, France
| | - Philippe Caron
- CHU de Toulouse, Hôpital Larrey, 24 Chemin de Pouvourville, TSA 30030, 31059, Toulouse Cedex 9, France
| | - Brigitte Delemer
- CHU de Reims-Hôpital Robert Debré, Avenue du Général Koenig, 51092, Reims Cedex, France
| | - Isabelle Raingeard
- CHRU de Montpellier, Maladies Endocriniennes, Hopital Lapeyronie, 295 Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Hervé Lefebvre
- CHU de Rouen, 1 Rue de Germont, 76031, Rouen Cedex, France
| | - Gérald Raverot
- Hospices civils de Lyon, Hôpital Louis Pradel, 59 Boulevard Pinel, 69677, Bron Cedex, France
| | | | - Rachel Desailloud
- CHU d'Amiens, Hôpital Nord, Place Victor Pauchet, 80054, Amiens Cedex 1, France
| | - Clementine Geffroy
- Pfizer France, 23-25 Avenue du Docteur Lannelongue, 75668, Paris Cedex 14, France
| | - Robin Henocque
- Pfizer France, 23-25 Avenue du Docteur Lannelongue, 75668, Paris Cedex 14, France
| | - Yves Brault
- Pfizer France, 23-25 Avenue du Docteur Lannelongue, 75668, Paris Cedex 14, France
| | - Thierry Brue
- CHU de Marseille, Hôpital de la Conception, 147 boulevard Baille, 13385, Marseille Cedex 5, France
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, 94275, Le Kremlin-Bicêtre, France.
- Université Paris-Saclay (Université Paris-Sud), Inserm, Signalisation Hormonale, Physiopathologie Endocrinienne et Métabolique, Le Kremlin-Bicêtre, France.
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