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Cambray S, Dubreuil S, Tejedor I, Dulon J, Touraine P. Family building after diagnosis of premature ovarian insufficiency: a cross-sectional survey in 324 women. Eur J Endocrinol 2023; 188:7034158. [PMID: 36763040 DOI: 10.1093/ejendo/lvad018] [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: 10/28/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE The diagnosis of premature ovarian insufficiency (POI) is a traumatic event for many patients that involves poor fertility prognosis. After such diagnosis, spontaneous pregnancies are rare. The alternatives for building a family are oocyte donation, embryo donation, and adoption. However, we have few information on how many women with POI finally built a family after the diagnosis and which alternative they chose. DESIGN We performed a cross-sectional, descriptive study. METHODS We conducted a survey of all the women who consulted for POI in the department of endocrinology and reproductive medicine at la Pitié Salpêtrière between May 31, 1991, and January 12, 2021. We included patients who continued to be followed up regularly by our department or were contacted by mail or phone between June and September 2021. We excluded patients with Turner syndrome and POI secondary to oncological treatment and patients under 18 at the time of the survey. RESULTS 985 patients were referred to the department for POI, and 324 patients were finally analyzed. 41% of the women who wanted to build a family had children after the diagnosis: 53.9% by oocyte donation, 1 woman by embryo donation, 5.6% after ovarian stimulation, 13.5% by adoption, and 25.8% who had spontaneous pregnancy after a mean time of 2.5 years. Spontaneous pregnancy rate was 8.6% in the whole cohort. CONCLUSIONS Having children after a diagnosis of POI is not uncommon but more often results from oocyte donation. This study will provide enlightened information for newly diagnosed women on the possibilities to build a family after POI diagnosis.
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Affiliation(s)
- Solange Cambray
- Pitié Salpêtrière Hospital, Sorbonne Université Médecine, Department of Endocrinology and Reproductive Medicine, 75651 Paris cedex 13, France
| | - Sophie Dubreuil
- Pitié Salpêtrière Hospital, Sorbonne Université Médecine, Department of Endocrinology and Reproductive Medicine, 75651 Paris cedex 13, France
| | - Isabelle Tejedor
- Center for Rare Gynecologial Disorders, Pitié Salpêtrière Hospital, 75651 Paris cedex 13, France
| | - Jérôme Dulon
- Center for Endocrine Rare Disorders, Pitié Salpêtrière Hospital, 75651 Paris cedex 13, France
| | - Philippe Touraine
- Pitié Salpêtrière Hospital, Sorbonne Université Médecine, Department of Endocrinology and Reproductive Medicine, 75651 Paris cedex 13, France
- Center for Rare Gynecologial Disorders, Pitié Salpêtrière Hospital, 75651 Paris cedex 13, France
- Center for Endocrine Rare Disorders, Pitié Salpêtrière Hospital, 75651 Paris cedex 13, France
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Cambray S, Dubreuil S, Dulon J, Tejedor I, Touraine P. Parental project in 324 patients with premature ovarian failure. Annales d'Endocrinologie 2022. [DOI: 10.1016/j.ando.2022.09.008] [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: 12/14/2022]
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3
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Chougar T, Laanani M, Ferreux L, Chalas C, Wolf JP, Bertherat J, Bouvattier C, Polak M, Bachelot A, Dulon J, Touraine P, Patrat C, Drouineaud V. Sperm cryopreservation in young males with congenital adrenal hyperplasia (CAH). Clin Endocrinol (Oxf) 2022; 97:860-862. [PMID: 35746828 DOI: 10.1111/cen.14792] [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: 12/08/2021] [Revised: 05/23/2022] [Accepted: 06/13/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Taous Chougar
- Assistance publique, Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Cochin, Service de Biologie de la Reproduction, CECOS, Paris, France
| | - Moussa Laanani
- Assistance Publique-Hôpitaux de Paris (AP-HP), Centre-Université de Paris, Hôpital Hôtel Dieu, Service de Biostatistique et d'Epidémiologie, Paris, France
| | - Lucile Ferreux
- Assistance publique, Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Cochin, Service de Biologie de la Reproduction, CECOS, Paris, France
| | - Céline Chalas
- Assistance publique, Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Cochin, Service de Biologie de la Reproduction, CECOS, Paris, France
| | - Jean-Philippe Wolf
- Assistance publique, Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Cochin, Service de Biologie de la Reproduction, CECOS, Paris, France
- Université Paris Cité, UMR 1016, Institut Cochin, From Gametes to Birth, Paris, France
| | - Jérôme Bertherat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Centre-Université de Paris, Hôpital Cochin, Service d'Endocrinologie, Centre de Référence Maladies Rares de la Surrénale, Paris, France
- Service d'Endocrinologie, Sorbonne Université médecine, Paris, France
| | - Claire Bouvattier
- AP-HP, Université Paris-Saclay, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France
| | - Michel Polak
- Service d'Endocrinologie, Sorbonne Université médecine, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Centre-Université de Paris, Hôpital Necker, Service d'endocrinologie, diabétologie, gynécologie pédiatriques, Paris, France
| | - Anne Bachelot
- Service d'Endocrinologie, Sorbonne Université médecine, Paris, France
- AP-HP, Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service d'Endocrinologie et Médecine de la Reproduction, Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Pathologies Gynécologiques Rares, Paris, France
| | - Jérôme Dulon
- AP-HP, Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service d'Endocrinologie et Médecine de la Reproduction, Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Pathologies Gynécologiques Rares, Paris, France
| | - Philippe Touraine
- Service d'Endocrinologie, Sorbonne Université médecine, Paris, France
- AP-HP, Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service d'Endocrinologie et Médecine de la Reproduction, Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Pathologies Gynécologiques Rares, Paris, France
| | - Catherine Patrat
- Assistance publique, Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Cochin, Service de Biologie de la Reproduction, CECOS, Paris, France
- Université Paris Cité, UMR 1016, Institut Cochin, From Gametes to Birth, Paris, France
- FHU PREMA, Paris, France
| | - Véronique Drouineaud
- Assistance publique, Hôpitaux de Paris (AP-HP) Centre, Université de Paris, Cochin, Service de Biologie de la Reproduction, CECOS, Paris, France
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Kline BL, Jaillard S, Bell KM, Bakhshalizadeh S, Robevska G, van den Bergen J, Dulon J, Ayers KL, Christodoulou J, Tchan MC, Touraine P, Sinclair AH, Tucker EJ. Integral Role of the Mitochondrial Ribosome in Supporting Ovarian Function: MRPS7 Variants in Syndromic Premature Ovarian Insufficiency. Genes (Basel) 2022; 13:2113. [PMID: 36421788 PMCID: PMC9690861 DOI: 10.3390/genes13112113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 10/11/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 10/03/2023] Open
Abstract
The mitochondrial ribosome is critical to mitochondrial protein synthesis. Defects in both the large and small subunits of the mitochondrial ribosome can cause human disease, including, but not limited to, cardiomyopathy, hypoglycaemia, neurological dysfunction, sensorineural hearing loss and premature ovarian insufficiency (POI). POI is a common cause of infertility, characterised by elevated follicle-stimulating hormone and amenorrhea in women under the age of 40. Here we describe a patient with POI, sensorineural hearing loss and Hashimoto's disease. The co-occurrence of POI with sensorineural hearing loss indicates Perrault syndrome. Whole exome sequencing identified two compound heterozygous variants in mitochondrial ribosomal protein 7 (MRPS7), c.373A>T/p.(Lys125*) and c.536G>A/p.(Arg179His). Both novel variants are predicted to be pathogenic via in-silico algorithms. Variants in MRPS7 have been described only once in the literature and were identified in sisters, one of whom presented with congenital sensorineural hearing loss and POI, consistent with our patient phenotype. The other affected sister had a more severe disease course and died in early adolescence due to liver and renal failure before the reproductive phenotype was known. This second independent report validates that variants in MRPS7 are a cause of syndromic POI/Perrault syndrome. We present this case and review the current evidence supporting the integral role of the mitochondrial ribosome in supporting ovarian function.
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Affiliation(s)
- Brianna L. Kline
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, VIC 3052, Australia
| | - Sylvie Jaillard
- IRSET (Institut de Recherche en Santé, Environnement et Travail), INSERM/EHESP/Univ Rennes/CHU Rennes–UMR_S 1085, F-35000 Rennes, France
- CHU Rennes, Service de Cytogénétique et Biologie Cellulaire, F-35033 Rennes, France
| | - Katrina M. Bell
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, VIC 3052, Australia
| | - Shabnam Bakhshalizadeh
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Gorjana Robevska
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, VIC 3052, Australia
| | - Jocelyn van den Bergen
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, VIC 3052, Australia
| | - Jérôme Dulon
- Department of Endocrinology and Reproductive Medicine, AP-HP, Sorbonne University Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement, Centre des Pathologies Gynécologiques Rares, 75231 Paris, France
| | - Katie L. Ayers
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
| | - John Christodoulou
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Michel C. Tchan
- Department of Genetic Medicine, Westmead Hospital, Sydney, NSW 2145, Australia
| | - Philippe Touraine
- Department of Endocrinology and Reproductive Medicine, AP-HP, Sorbonne University Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement, Centre des Pathologies Gynécologiques Rares, 75231 Paris, France
| | - Andrew H. Sinclair
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Elena J. Tucker
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
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5
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Carrière C, Sarfati C, Téjédor I, Dulon J, Chakhtoura Z, Courtillot C, Bachelot A. Classical and non-classical congenital adrenal hyperplasia: what is the difference in subsequent fertility? Ann Endocrinol (Paris) 2022; 83:181-185. [PMID: 35489415 DOI: 10.1016/j.ando.2022.04.007] [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: 10/18/2022]
Abstract
21-Hydroxylase deficiency (21OHD) is the most common cause of congenital adrenal hyperplasia. Increased production of adrenal-derived androgens and progesterone in 21OHD women interfere with their reproductive function and their fertility in many different ways, depending on the severity of the disease. Sexuality and fertility in women with classic 21OHD is impaired, due to several issues such as disrupted gonadotropic axis due to androgen and progesterone overproduction, and mechanical, psychological factors related to genital surgery. Fertility and fecundity in these women get better over the years. Subfertility seems contrariwise to be relative in non-classic 21OHD women. Before pregnancy, genotyping the partner and genetic counselling is mandatory.
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Affiliation(s)
- Camille Carrière
- AP-HP, IE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine and Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Centre de Référence des Pathologies Gynécologiques Rares, ICAN, Paris, France
| | - Cynthia Sarfati
- AP-HP, IE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine and Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Centre de Référence des Pathologies Gynécologiques Rares, ICAN, Paris, France; UPMC Université Pierre et Marie Curie, Univ Paris 06, Paris, France
| | - Isabelle Téjédor
- AP-HP, IE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine and Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Centre de Référence des Pathologies Gynécologiques Rares, ICAN, Paris, France
| | - Jérôme Dulon
- AP-HP, IE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine and Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Centre de Référence des Pathologies Gynécologiques Rares, ICAN, Paris, France
| | - Zeina Chakhtoura
- AP-HP, IE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine and Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Centre de Référence des Pathologies Gynécologiques Rares, ICAN, Paris, France
| | - Carine Courtillot
- AP-HP, IE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine and Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Centre de Référence des Pathologies Gynécologiques Rares, ICAN, Paris, France
| | - Anne Bachelot
- AP-HP, IE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine and Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Centre de Référence des Pathologies Gynécologiques Rares, ICAN, Paris, France; UPMC Université Pierre et Marie Curie, Univ Paris 06, Paris, France.
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6
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Sreenivasan R, Bell K, van den Bergen J, Robevska G, Belluoccio D, Dahiya R, Leong GM, Dulon J, Touraine P, Tucker EJ, Ayers K, Sinclair A. Whole exome sequencing reveals copy number variants in individuals with disorders of sex development. Mol Cell Endocrinol 2022; 546:111570. [PMID: 35051551 DOI: 10.1016/j.mce.2022.111570] [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: 06/02/2021] [Revised: 12/31/2021] [Accepted: 01/14/2022] [Indexed: 11/19/2022]
Abstract
Complete androgen insensitivity syndrome (CAIS), where 46,XY individuals present as female, is caused by variants in the androgen receptor gene (AR). We analyzed the DNA of a patient with suspected CAIS using a targeted gene sequencing panel and whole exome sequencing (WES) but did not detect any small nucleotide variants in AR. Analysis of WES data using our bioinformatics pipeline designed to detect copy number variations (CNV) uncovered a rare duplication of exon 2 of AR. Using array comparative genomic hybridization, the duplication was found to span 43.6 kb and is predicted to cause a frameshift and loss of AR protein. We confirmed the power of our WES-CNV detection protocol by identifying pathogenic CNVs in FSHR and NR5A1 in previously undiagnosed patients with disorders of sex development. Our findings illustrate the usefulness of CNV analysis in WES data to detect pathogenic genomic changes that may go undetected using only standard analysis protocols.
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Affiliation(s)
- Rajini Sreenivasan
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Katrina Bell
- Murdoch Children's Research Institute, Melbourne, Australia
| | | | | | | | - Rachana Dahiya
- Queensland Children's Hospital, Brisbane, Australia; The University of Queensland, Brisbane, Australia
| | - Gary M Leong
- Department of Paediatrics, Nepean Hospital and Charles Perkins Centre Nepean Research Hub, University of Sydney, NSW, Australia
| | - Jérôme Dulon
- Department of Endocrinology and Reproductive Medicine, AP-HP, Sorbonne University Medicine, Centre de Référence desMaladies Endocriniennes Rares de la Croissance et du Développement, Centre des Pathologies Gynécologiques Rares, Paris, France
| | - Philippe Touraine
- Department of Endocrinology and Reproductive Medicine, AP-HP, Sorbonne University Medicine, Centre de Référence desMaladies Endocriniennes Rares de la Croissance et du Développement, Centre des Pathologies Gynécologiques Rares, Paris, France
| | - Elena J Tucker
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Katie Ayers
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Andrew Sinclair
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia.
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Tucker EJ, Bell KM, Robevska G, van den Bergen J, Ayers KL, Listyasari N, Faradz SMH, Dulon J, Bakhshalizadeh S, Sreenivasan R, Nouyou B, Carre W, Akloul L, Duros S, Domin-Bernhard M, Belaud-Rotureau MA, Touraine P, Jaillard S, Sinclair AH. Meiotic genes in premature ovarian insufficiency: variants in HROB and REC8 as likely genetic causes. Eur J Hum Genet 2022; 30:219-228. [PMID: 34707299 PMCID: PMC8821714 DOI: 10.1038/s41431-021-00977-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 06/29/2021] [Revised: 08/29/2021] [Accepted: 09/27/2021] [Indexed: 02/03/2023] Open
Abstract
Premature ovarian insufficiency (POI), affecting 1 in 100 women, is characterised by loss of ovarian function associated with elevated gonadotropin, before the age of 40. In addition to infertility, patients face increased risk of comorbidities such as heart disease, osteoporosis, cancer and/or early mortality. We used whole exome sequencing to identify the genetic cause of POI in seven women. Each had biallelic candidate variants in genes with a primary role in DNA damage repair and/or meiosis. This includes two genes, REC8 and HROB, not previously associated with autosomal recessive POI. REC8 encodes a component of the cohesin complex and HROB encodes a factor that recruits MCM8/9 for DNA damage repair. In silico analyses, combined with concordant mouse model phenotypes support these as new genetic causes of POI. We also identified novel variants in MCM8, NUP107, STAG3 and HFM1 and a known variant in POF1B. Our study highlights the pivotal role of meiosis in ovarian function. We identify novel variants, consolidate the pathogenicity of variants previously considered of unknown significance, and propose HROB and REC8 variants as new genetic causes while exploring their link to pathogenesis.
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Affiliation(s)
- Elena J. Tucker
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, University of Melbourne, Melbourne, VIC Australia
| | - Katrina M. Bell
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Melbourne, VIC Australia
| | - Gorjana Robevska
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Melbourne, VIC Australia
| | - Jocelyn van den Bergen
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Melbourne, VIC Australia
| | - Katie L. Ayers
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, University of Melbourne, Melbourne, VIC Australia
| | - Nurin Listyasari
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Melbourne, VIC Australia ,grid.412032.60000 0001 0744 0787Division of Human Genetics, Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University/Diponegoro National Hospital, Semarang, Indonesia
| | - Sultana MH Faradz
- grid.412032.60000 0001 0744 0787Division of Human Genetics, Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University/Diponegoro National Hospital, Semarang, Indonesia
| | - Jérôme Dulon
- grid.50550.350000 0001 2175 4109Department of Endocrinology and Reproductive Medicine, AP‐HP, Sorbonne University Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement, Centre des Pathologies Gynécologiques Rares, Paris, France
| | - Shabnam Bakhshalizadeh
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, University of Melbourne, Melbourne, VIC Australia
| | - Rajini Sreenivasan
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, University of Melbourne, Melbourne, VIC Australia
| | - Benedicte Nouyou
- grid.411154.40000 0001 2175 0984CHU Rennes, Service de Cytogénétique et Biologie Cellulaire, F-35033 Rennes, France
| | - Wilfrid Carre
- grid.411154.40000 0001 2175 0984CHU Rennes, UF Bioinformatique et Génétique Computationnelle, Service de Génétique Moléculaire et Génomique, F-35033 Rennes, France
| | - Linda Akloul
- grid.411154.40000 0001 2175 0984CHU Rennes, Service de Génétique Clinique, CLAD Ouest, F-35033 Rennes, France
| | - Solène Duros
- grid.411154.40000 0001 2175 0984CHU Rennes, Département de Gynécologie Obstétrique et Reproduction Humaine, F-35033 Rennes, France
| | - Mathilde Domin-Bernhard
- grid.411154.40000 0001 2175 0984CHU Rennes, Département de Gynécologie Obstétrique et Reproduction Humaine, F-35033 Rennes, France
| | - Marc-Antoine Belaud-Rotureau
- grid.411154.40000 0001 2175 0984CHU Rennes, Service de Cytogénétique et Biologie Cellulaire, F-35033 Rennes, France ,grid.411154.40000 0001 2175 0984Univ Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) – UMR_S 1085, F-35000 Rennes, France
| | - Philippe Touraine
- grid.50550.350000 0001 2175 4109Department of Endocrinology and Reproductive Medicine, AP‐HP, Sorbonne University Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement, Centre des Pathologies Gynécologiques Rares, Paris, France
| | - Sylvie Jaillard
- grid.411154.40000 0001 2175 0984CHU Rennes, Service de Cytogénétique et Biologie Cellulaire, F-35033 Rennes, France ,grid.411154.40000 0001 2175 0984Univ Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) – UMR_S 1085, F-35000 Rennes, France
| | - Andrew H. Sinclair
- grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, University of Melbourne, Melbourne, VIC Australia
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Bachelot A, Lapoirie M, Dulon J, Leban M, Renard Penna R, Touraine P. Effects of mitotane on testicular adrenal rest tumors in congenital adrenal hyperplasia due to 21-hydroxylase deficiency: a retrospective series of five patients. Eur J Endocrinol 2021; 184:365-371. [PMID: 33444225 DOI: 10.1530/eje-20-0787] [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: 07/10/2020] [Accepted: 01/12/2021] [Indexed: 11/08/2022]
Abstract
We conducted a retrospective study on the long-term effect of mitotane treatment on testicular adrenal rest tumors (TARTs) in five adult patients with classic 21-hydroxylase deficiency. After 60 months of mitotane treatment, a decrease in adrenal steroids was observed in four patients. Testicular ultrasonography showed complete disappearance of TART in two patients, stabilization in two patients and a halving of TART volume in the remaining patient. Sperm count improved notably in two patients who had normal baseline inhibin B levels and small inclusions, thus enabling cryopreservation of the subjects' semen. Four years of follow-up of these two patients after the withdrawal of mitotane showed no recurrence of TART and persistent normal testicular function. In conclusion, mitotane could be used as a last resort in CAH patients in the cases of azoospermia associated with TARTs but normal inhibin B levels, as it can improve long-term endocrine and exocrine testicular function.
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Affiliation(s)
- Anne Bachelot
- AP-HP, IE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine and Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement, Paris, France
- Sorbonne Université, Paris, France
| | - Marion Lapoirie
- Department of Endocrinology, Hospices Civils de Lyon, Fédération d'Endocrinologie, Bron, France
| | - Jérôme Dulon
- AP-HP, IE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine and Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement, Paris, France
| | - Monique Leban
- AP-HP, Hôpital Pitié-Salpêtrière, Department of Hormonal Biochemistry
| | - Raphaële Renard Penna
- Sorbonne Université, Paris, France
- AP-HP, Hôpital Pitié-Salpêtrière, Department of Radiology, Paris, France
| | - Philippe Touraine
- AP-HP, IE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine and Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement, Paris, France
- Sorbonne Université, Paris, France
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Tucker EJ, Jaillard S, Grover SR, van den Bergen J, Robevska G, Bell KM, Sadedin S, Hanna C, Dulon J, Touraine P, Sinclair AH. TP63-truncating variants cause isolated premature ovarian insufficiency. Hum Mutat 2019; 40:886-892. [PMID: 30924587 DOI: 10.1002/humu.23744] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 12/10/2018] [Revised: 03/05/2019] [Accepted: 03/13/2019] [Indexed: 12/21/2022]
Abstract
Premature ovarian insufficiency involves amenorrhea and elevated follicle-stimulating hormone before age 40, and its genetic basis is poorly understood. Here, we study 13 premature ovarian insufficiency (POI) patients using whole-exome sequencing. We identify PREPL and TP63 causative variants, and variants in other potentially novel POI genes. PREPL deficiency is a known cause of syndromic POI, matching the patients' phenotype. A role for TP63 in ovarian biology has previously been proposed but variants have been described in multiorgan syndromes, and not isolated POI. One patient with isolated POI harbored a de novo nonsense TP63 variant in the terminal exon and an unrelated patient had a different nonsense variant in the same exon. These variants interfere with the repression domain while leaving the activation domain intact. We expand the phenotypic spectrum of TP63-related disorders, provide a new genotype:phenotype correlation for TP63 and identify a new genetic cause of isolated POI.
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Affiliation(s)
- Elena J Tucker
- Reproductive Development, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Sylvie Jaillard
- Reproductive Development, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,CHU Rennes, Service de Cytogénétique et Biologie Cellulaire, F-35033, Rennes, France.,INSERM U1085-IRSET, Université de Rennes1, Frances Pathologies Gynécologiques Rares, F-35042, Rennes, Paris, France
| | - Sonia R Grover
- Reproductive Development, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Paediatric and Adolescent Gynaecology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jocelyn van den Bergen
- Reproductive Development, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Gorjana Robevska
- Reproductive Development, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Katrina M Bell
- Bioinformatics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Simon Sadedin
- Bioinformatics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Chloe Hanna
- Reproductive Development, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatric and Adolescent Gynaecology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jérôme Dulon
- Department of Endocrinology and Reproductive Medicine, AP-HP, Sorbonne University Medicine, Centre de Référence desMaladies Endocriniennes Rares de laCroissance et du Développement, Centre des Pathologies Gynécologiques Rares, Paris, France
| | - Philippe Touraine
- Department of Endocrinology and Reproductive Medicine, AP-HP, Sorbonne University Medicine, Centre de Référence desMaladies Endocriniennes Rares de laCroissance et du Développement, Centre des Pathologies Gynécologiques Rares, Paris, France
| | - Andrew H Sinclair
- Reproductive Development, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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10
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Rosenbaum D, Gallo A, Lethielleux G, Bruckert E, Levy BI, Tanguy ML, Dulon J, Dahmoune N, Salem JE, Bittar R, Leban M, Girerd X, Touraine P, Bachelot A. Early central blood pressure elevation in adult patients with 21-hydroxylase deficiency. J Hypertens 2019; 37:175-181. [PMID: 30036269 DOI: 10.1097/hjh.0000000000001850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
CONTEXT Controversial data exist on cardiovascular damages in patients with congenital adrenal hyperplasia (CAH). OBJECTIVE To assess blood pressure and early cardiovascular damages on a large cohort of adult CAH patients and control individuals. DESIGN Case-control study. SETTING Referral Center for Rare Disease, Pitié Salpêtrière Hospital, Paris, France. PATIENTS OR OTHER PARTICIPANTS Fifty-eight women and 26 men with CAH diagnosed in childhood and 85 controls matched-paired for sex, age and smoking status were prospectively included. INTERVENTION Measurement of large arteries and microcirculatory anatomical and functional indices as well as hormonal status and cardiovascular risk factors evaluation. MAIN OUTCOME MEASURE The primary objective was to compare carotid intima-media thickness (cIMT) in CAH patients and controls. The secondary objectives were to compare blood pressure (BP), radial augmentation index (rAI), central BP, carotid-femoral pulse wave velocity (PWV), skin microcirculation indices and inflammation parameters in CAH patients and controls. RESULTS Although PWV and cIMT were identical in patients and controls, higher rAI (64.6 ± 1.7 vs. 59.9 ± 1.6%, P = 0.02) and higher central SBP (101.8 ± 1.5 vs. 95.1 ± 1.5 mmHg, P < 0.001) were observed in CAH patients. Regarding microcirculatory indices, there was a higher functional resting capacity and a lower anatomical capillary density in CAH patients. In multivariate analysis, we found an independant association between CAH and central SBP elevation. CONCLUSION We found an early rise in central SBP in CAH patients whereas sublinical arterial damages markers were normal. Our study suggest that vascular damages and increased cardiovascular risk could be mainly BP-driven.
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Affiliation(s)
- David Rosenbaum
- AP-HP, Endocrinology - Metabolism and Prevention of Cardiovascular Diseases, Groupe Hospitalier Pitié-Salpêtrière - Université Pierre et Marie Curie
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146 - CNRS 7371, Laboratoire d'imagerie Biomédicale, F-75013
- Imaging Core Lab, Institute of Cardiometabolism and Nutrition
| | - Antonio Gallo
- AP-HP, Endocrinology - Metabolism and Prevention of Cardiovascular Diseases, Groupe Hospitalier Pitié-Salpêtrière - Université Pierre et Marie Curie
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146 - CNRS 7371, Laboratoire d'imagerie Biomédicale, F-75013
- Imaging Core Lab, Institute of Cardiometabolism and Nutrition
| | - Gaelle Lethielleux
- AP-HP, IE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Centre de Référence des Pathologies Gynécologiques Rares, ICAN
| | - Eric Bruckert
- AP-HP, Endocrinology - Metabolism and Prevention of Cardiovascular Diseases, Groupe Hospitalier Pitié-Salpêtrière - Université Pierre et Marie Curie
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146 - CNRS 7371, Laboratoire d'imagerie Biomédicale, F-75013
- Imaging Core Lab, Institute of Cardiometabolism and Nutrition
- Dyslipoproteinemia and Atherosclerosis Research Unit, UMRS 939, National Institute for Health and Medical Research (INSERM) and Pierre et Marie Curie University (UPMC - Paris VI)
| | - Bernard I Levy
- AP-HP, Physiologie clinique - Explorations fonctionnelles Lariboisière Hospital
| | | | - Jérôme Dulon
- AP-HP, IE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Centre de Référence des Pathologies Gynécologiques Rares, ICAN
| | - Nora Dahmoune
- AP-HP, IE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Centre de Référence des Pathologies Gynécologiques Rares, ICAN
| | - Joe Elie Salem
- AP-HP, Pitié-Salpêtrière Hospital, Department of Pharmacology and CIC-1421
- INSERM, CIC-1421 and UMR ICAN 1166
- Sorbonne Universités
- UPMC Univ Paris 06
| | - Randa Bittar
- AP-HP, Hôpital Pitié-Salpêtrière, Department of Hormonal Biochemistry, Paris, France
| | - Monique Leban
- AP-HP, Hôpital Pitié-Salpêtrière, Department of Hormonal Biochemistry, Paris, France
| | - Xavier Girerd
- AP-HP, Endocrinology - Metabolism and Prevention of Cardiovascular Diseases, Groupe Hospitalier Pitié-Salpêtrière - Université Pierre et Marie Curie
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146 - CNRS 7371, Laboratoire d'imagerie Biomédicale, F-75013
- Imaging Core Lab, Institute of Cardiometabolism and Nutrition
- Dyslipoproteinemia and Atherosclerosis Research Unit, UMRS 939, National Institute for Health and Medical Research (INSERM) and Pierre et Marie Curie University (UPMC - Paris VI)
| | - Philippe Touraine
- AP-HP, IE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Centre de Référence des Pathologies Gynécologiques Rares, ICAN
- Sorbonne Universités
- UPMC Univ Paris 06
| | - Anne Bachelot
- AP-HP, IE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Centre de Référence des Pathologies Gynécologiques Rares, ICAN
- Sorbonne Universités
- UPMC Univ Paris 06
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11
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Bachelot A, Grouthier V, Courtillot C, Dulon J, Touraine P. MANAGEMENT OF ENDOCRINE DISEASE: Congenital adrenal hyperplasia due to 21-hydroxylase deficiency: update on the management of adult patients and prenatal treatment. Eur J Endocrinol 2017; 176:R167-R181. [PMID: 28115464 DOI: 10.1530/eje-16-0888] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 10/26/2016] [Revised: 01/03/2017] [Accepted: 01/20/2017] [Indexed: 12/28/2022]
Abstract
Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency is characterized by cortisol and in some cases aldosterone deficiency associated with androgen excess. Goals of treatment are to replace deficient hormones and control androgen excess, while avoiding the adverse effects of exogenous glucocorticoid. Over the last 5 years, cohorts of adults with CAH due to 21-hydroxylase deficiency from Europe and the United States have been described, allowing us to have a better knowledge of long-term complications of the disease and its treatment. Patients with CAH have increased mortality, morbidity and risk for infertility and metabolic disorders. These comorbidities are due in part to the drawbacks of the currently available glucocorticoid therapy. Consequently, novel therapies are being developed and studied in an attempt to improve patient outcomes. New management strategies in the care of pregnancies at risk for congenital adrenal hyperplasia using fetal sex determination and dexamethasone have also been described, but remain a subject of debate. We focused the present overview on the data published in the last 5 years, concentrating on studies dealing with cardiovascular risk, fertility, treatment and prenatal management in adults with classic CAH to provide the reader with an updated review on this rapidly evolving field of knowledge.
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Affiliation(s)
- Anne Bachelot
- AP-HPIE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine and Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Centre de Référence des Pathologies Gynécologiques Rares, ICAN, Paris, France
- UPMC Université Pierre et Marie CurieUniv Paris 06, Paris, France
| | - Virginie Grouthier
- AP-HPIE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine and Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Centre de Référence des Pathologies Gynécologiques Rares, ICAN, Paris, France
- UPMC Université Pierre et Marie CurieUniv Paris 06, Paris, France
| | - Carine Courtillot
- AP-HPIE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine and Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Centre de Référence des Pathologies Gynécologiques Rares, ICAN, Paris, France
| | - Jérôme Dulon
- AP-HPIE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine and Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Centre de Référence des Pathologies Gynécologiques Rares, ICAN, Paris, France
| | - Philippe Touraine
- AP-HPIE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine and Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Centre de Référence des Pathologies Gynécologiques Rares, ICAN, Paris, France
- UPMC Université Pierre et Marie CurieUniv Paris 06, Paris, France
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12
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Bachelot A, Nicolas C, Bidet M, Dulon J, Leban M, Golmard JL, Polak M, Touraine P. Long-term outcome of ovarian function in women with intermittent premature ovarian insufficiency. Clin Endocrinol (Oxf) 2017; 86:223-228. [PMID: 27177971 DOI: 10.1111/cen.13105] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 12/23/2015] [Revised: 04/16/2016] [Accepted: 05/03/2016] [Indexed: 11/29/2022]
Abstract
CONTEXT Spontaneous resumption of ovarian function is not a rare phenomenon in patients with premature ovarian insufficiency (POI). The outcome of this resumption is not known. OBJECTIVE To describe the outcome following the resumption of ovarian function in POI patients. DESIGN Cross-sectional study. SETTING University medical centre. PATIENTS AND MAIN OUTCOME MEASURES Cumulative incidence of ovarian function resumption and risk factors arresting this resumption during follow-up were determined in a large cohort of POI women. RESULTS Five hundred and seven patients were included in the study, with a follow-up of 3·44 ± 4·05 years (0-29). Of these, 117 (23%) had features of ovarian function resumption. The cumulative incidence of pregnancy was 3·5% among the whole cohort and 15·3% among patients with resumption of ovarian function. Fifty-five patients (47%) experienced an arrest of their resumption during the follow-up period. In univariate analysis, high FSH and DHEA levels at initial evaluation were risk factors for the arrest of the resumption of ovarian function. In multivariate analysis, high FSH levels at the initial evaluation [1·89 (1·10-3·23), P = 0·03] and older age at diagnosis [1·53 (1·01-2·33), P = 0·04] were risk factors for the arrest of this resumption. CONCLUSION Resumption of ovarian function is not a rare or brief phenomenon in POI women. The identification of predictive factors of this resumption, as well as its duration, increases our knowledge of the natural history of POI, and will improve the medical management, especially infertility counselling of these patients.
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Affiliation(s)
- Anne Bachelot
- AP-HP, IE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine and Centre de Référence des Maladies Endocriniennes Rares de la croissance et Centre des Pathologies gynécologiques Rares, ICAN, Paris, France
- UPMC Univ Paris 06, Paris, France
| | - Carole Nicolas
- AP-HP, IE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine and Centre de Référence des Maladies Endocriniennes Rares de la croissance et Centre des Pathologies gynécologiques Rares, ICAN, Paris, France
- UPMC Univ Paris 06, Paris, France
| | - Maud Bidet
- AP-HP, Department of Pediatric Endocrinology, Gynecology and Diabetology, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et Centre des pathologies gynécologiques Rares, Hôpital Universitaire Necker Enfants malades, Paris, France
| | - Jérôme Dulon
- AP-HP, IE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine and Centre de Référence des Maladies Endocriniennes Rares de la croissance et Centre des Pathologies gynécologiques Rares, ICAN, Paris, France
| | - Monique Leban
- AP-HP, Hôpital Pitié-Salpêtrière, Department of Hormonal Biochemistry, Paris, France
| | - Jean Louis Golmard
- UPMC Univ Paris 06, Paris, France
- AP-HP, Hôpital Pitié-Salpêtrière, Clinical Research Unit, Paris, France
| | - Michel Polak
- AP-HP, Department of Pediatric Endocrinology, Gynecology and Diabetology, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et Centre des pathologies gynécologiques Rares, Hôpital Universitaire Necker Enfants malades, Paris, France
- Université Paris Descartes, Paris 05, Paris, France
| | - Philippe Touraine
- AP-HP, IE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine and Centre de Référence des Maladies Endocriniennes Rares de la croissance et Centre des Pathologies gynécologiques Rares, ICAN, Paris, France
- UPMC Univ Paris 06, Paris, France
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13
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Bachelot A, Nicolas C, Gricourt S, Dulon J, Leban M, Golmard JL, Touraine P. Poor Compliance to Hormone Therapy and Decreased Bone Mineral Density in Women with Premature Ovarian Insufficiency. PLoS One 2016; 11:e0164638. [PMID: 27906970 PMCID: PMC5132216 DOI: 10.1371/journal.pone.0164638] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/28/2016] [Indexed: 01/15/2023] Open
Abstract
Premature ovarian insufficiency leads to through infertility and estrogen deficiency. Optimal management encompasses estrogen replacement therapy. Long-term outcome of women with POI is not known. We design a study to evaluate the medical care, hormone replacement therapy compliance and bone mineral density (BMD) in POI women with at least a five-year follow-up after the first evaluation. One hundred and sixty-two patients (37.3±8.0 years) were evaluated (follow-up 7.9±2.8 years). Sixty-nine patients (42.6%) had stopped their hormone replacement therapy (HRT) for at least one year during the follow up period. BMD determination at initial evaluation and at follow-up visit was completed in 92 patients. At first evaluation, 28 patients (30%) had osteopenia and 7 (8%) had osteoporosis. At follow up, 31 women (34%) had BMD impairment with osteopenia in 61% and osteoporosis in 5%. In univariate analysis and multivariate analysis, there was a significant loss of femoral BMD in women who had stopped their HRT for over a year. In conclusion, this first study concerning long-term follow-up of POI patients shows the poor compliance to their HRT, despite its importance in the prevention of bone demineralization. This study reinforces the need for follow up and specific care for POI women.
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Affiliation(s)
- Anne Bachelot
- AP-HP, IE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Centre de Référence des Pathologies Gynécologiques Rares, Paris, France
- Université Pierre et Marie Curie, Univ Paris, Paris, France
| | - Carole Nicolas
- AP-HP, IE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Centre de Référence des Pathologies Gynécologiques Rares, Paris, France
- Université Pierre et Marie Curie, Univ Paris, Paris, France
| | - Solenne Gricourt
- AP-HP, IE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Centre de Référence des Pathologies Gynécologiques Rares, Paris, France
| | - Jérôme Dulon
- AP-HP, IE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Centre de Référence des Pathologies Gynécologiques Rares, Paris, France
| | - Monique Leban
- AP-HP, Hôpital Pitié-Salpêtrière, Department of Hormonal Biochemistry, Paris, France
| | - Jean Louis Golmard
- Université Pierre et Marie Curie, Univ Paris, Paris, France
- AP-HP, Hôpital Pitié-Salpêtrière, Clinical Research Unit, Paris, France
| | - Philippe Touraine
- AP-HP, IE3M, Hôpital Pitié-Salpêtrière, Department of Endocrinology and Reproductive Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Centre de Référence des Pathologies Gynécologiques Rares, Paris, France
- Université Pierre et Marie Curie, Univ Paris, Paris, France
- * E-mail:
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14
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Bachelot A, Golmard JL, Dulon J, Dahmoune N, Leban M, Bouvattier C, Cabrol S, Leger J, Polak M, Touraine P. Determining clinical and biological indicators for health outcomes in adult patients with childhood onset of congenital adrenal hyperplasia. Eur J Endocrinol 2015; 173:175-84. [PMID: 25947139 DOI: 10.1530/eje-14-0978] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 05/06/2015] [Indexed: 11/08/2022]
Abstract
AIM Adverse outcomes in adult congenital adrenal hyperplasia (CAH) patients are frequent. The determinants of them have not yet been established. OBJECTIVE To establish the prevalence of adverse outcomes and to find determining factors for each of them. DESIGN, PATIENTS, AND METHODS Cross-sectional monocentric study of 104 patients with childhood onset of CAH (71 women, 33 men). Analysis established first the determinants of clinical, hormonal, genetic variables and second a composite criterion for some of the outcomes and determinants. RESULTS BMI was above 25 kg/m(2) in 44% of the cohort, adrenal hyperplasia and/or nodules were present in 45% of the patients, and irregular menstrual cycles and hyperandrogenism were found in 50 and 35% of the women respectively. In univariate analysis, the determinants of these outcomes were all linked to disease control, especially 17-hydroxyprogesterone (17OHP) and androstenedione concentrations. Low weight was a determinant of abnormal bone mineral density (BMD) (60% of the cohort). Multivariate analysis confirmed these data. A classic form (CF) of CAH was a determinant of testicular adrenal rest tumors (TARTs) (36% of the men). Total cumulative glucocorticoid dose was a determinant of BMI and TART, whereas fludrocortisone dose was a determinant of TART (P=0.03). In men, the composite criterion was associated with androstenedione concentration and CF. In women, the composite criterion was associated with total testosterone concentration. CONCLUSION The present study confirms the high prevalence of adverse outcomes in CAH patients. These are, most often, related to disease control. The impaired health status of adults with CAH could therefore be improved through the modification of treatment.
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Affiliation(s)
- Anne Bachelot
- Department of Endocrinology and Reproductive MedicineCentre de Référence des Maladies Endocriniennes Rares de la Croissance, AP-HP, IE3M, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, FranceUPMC Univ Paris 06Paris, FranceClinical Research UnitAP-HP, Hôpital Pitié-Salpêtrière, Paris, FranceDepartment of Hormonal BiochemistryAP-HP, Hôpital Pitié-Salpêtrière, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Bicêtre, Le Kremlin Bicêtre, FranceFaculté de Médecine Paris-SudUniversité Paris-Sud 11, Le Kremlin-Bicêtre F-94276, FrancePediatric EndocrinologyAP-HP, Hôpital Trousseau, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Robert Debré, Paris, FranceUniversité Paris Diderot Paris 07Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Necker Enfants-Malades, Paris, FranceUniversité Paris Descartes Paris 05Paris, France Department of Endocrinology and Reproductive MedicineCentre de Référence des Maladies Endocriniennes Rares de la Croissance, AP-HP, IE3M, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, FranceUPMC Univ Paris 06Paris, FranceClinical Research UnitAP-HP, Hôpital Pitié-Salpêtrière, Paris, FranceDepartment of Hormonal BiochemistryAP-HP, Hôpital Pitié-Salpêtrière, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Bicêtre, Le Kremlin Bicêtre, FranceFaculté de Médecine Paris-SudUniversité Paris-Sud 11, Le Kremlin-Bicêtre F-94276, FrancePediatric EndocrinologyAP-HP, Hôpital Trousseau, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Robert Debré, Paris, FranceUniversité Paris Diderot Paris 07Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Necker Enfants-Malades, Paris, FranceUniversité Paris Descartes Paris 05Paris, France
| | - Jean Louis Golmard
- Department of Endocrinology and Reproductive MedicineCentre de Référence des Maladies Endocriniennes Rares de la Croissance, AP-HP, IE3M, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, FranceUPMC Univ Paris 06Paris, FranceClinical Research UnitAP-HP, Hôpital Pitié-Salpêtrière, Paris, FranceDepartment of Hormonal BiochemistryAP-HP, Hôpital Pitié-Salpêtrière, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Bicêtre, Le Kremlin Bicêtre, FranceFaculté de Médecine Paris-SudUniversité Paris-Sud 11, Le Kremlin-Bicêtre F-94276, FrancePediatric EndocrinologyAP-HP, Hôpital Trousseau, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Robert Debré, Paris, FranceUniversité Paris Diderot Paris 07Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Necker Enfants-Malades, Paris, FranceUniversité Paris Descartes Paris 05Paris, France Department of Endocrinology and Reproductive MedicineCentre de Référence des Maladies Endocriniennes Rares de la Croissance, AP-HP, IE3M, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, FranceUPMC Univ Paris 06Paris, FranceClinical Research UnitAP-HP, Hôpital Pitié-Salpêtrière, Paris, FranceDepartment of Hormonal BiochemistryAP-HP, Hôpital Pitié-Salpêtrière, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Bicêtre, Le Kremlin Bicêtre, FranceFaculté de Médecine Paris-SudUniversité Paris-Sud 11, Le Kremlin-Bicêtre F-94276, FrancePediatric EndocrinologyAP-HP, Hôpital Trousseau, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Robert Debré, Paris, FranceUniversité Paris Diderot Paris 07Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Necker Enfants-Malades, Paris, FranceUniversité Paris Descartes Paris 05Paris, France
| | - Jérôme Dulon
- Department of Endocrinology and Reproductive MedicineCentre de Référence des Maladies Endocriniennes Rares de la Croissance, AP-HP, IE3M, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, FranceUPMC Univ Paris 06Paris, FranceClinical Research UnitAP-HP, Hôpital Pitié-Salpêtrière, Paris, FranceDepartment of Hormonal BiochemistryAP-HP, Hôpital Pitié-Salpêtrière, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Bicêtre, Le Kremlin Bicêtre, FranceFaculté de Médecine Paris-SudUniversité Paris-Sud 11, Le Kremlin-Bicêtre F-94276, FrancePediatric EndocrinologyAP-HP, Hôpital Trousseau, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Robert Debré, Paris, FranceUniversité Paris Diderot Paris 07Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Necker Enfants-Malades, Paris, FranceUniversité Paris Descartes Paris 05Paris, France
| | - Nora Dahmoune
- Department of Endocrinology and Reproductive MedicineCentre de Référence des Maladies Endocriniennes Rares de la Croissance, AP-HP, IE3M, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, FranceUPMC Univ Paris 06Paris, FranceClinical Research UnitAP-HP, Hôpital Pitié-Salpêtrière, Paris, FranceDepartment of Hormonal BiochemistryAP-HP, Hôpital Pitié-Salpêtrière, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Bicêtre, Le Kremlin Bicêtre, FranceFaculté de Médecine Paris-SudUniversité Paris-Sud 11, Le Kremlin-Bicêtre F-94276, FrancePediatric EndocrinologyAP-HP, Hôpital Trousseau, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Robert Debré, Paris, FranceUniversité Paris Diderot Paris 07Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Necker Enfants-Malades, Paris, FranceUniversité Paris Descartes Paris 05Paris, France
| | - Monique Leban
- Department of Endocrinology and Reproductive MedicineCentre de Référence des Maladies Endocriniennes Rares de la Croissance, AP-HP, IE3M, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, FranceUPMC Univ Paris 06Paris, FranceClinical Research UnitAP-HP, Hôpital Pitié-Salpêtrière, Paris, FranceDepartment of Hormonal BiochemistryAP-HP, Hôpital Pitié-Salpêtrière, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Bicêtre, Le Kremlin Bicêtre, FranceFaculté de Médecine Paris-SudUniversité Paris-Sud 11, Le Kremlin-Bicêtre F-94276, FrancePediatric EndocrinologyAP-HP, Hôpital Trousseau, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Robert Debré, Paris, FranceUniversité Paris Diderot Paris 07Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Necker Enfants-Malades, Paris, FranceUniversité Paris Descartes Paris 05Paris, France
| | - Claire Bouvattier
- Department of Endocrinology and Reproductive MedicineCentre de Référence des Maladies Endocriniennes Rares de la Croissance, AP-HP, IE3M, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, FranceUPMC Univ Paris 06Paris, FranceClinical Research UnitAP-HP, Hôpital Pitié-Salpêtrière, Paris, FranceDepartment of Hormonal BiochemistryAP-HP, Hôpital Pitié-Salpêtrière, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Bicêtre, Le Kremlin Bicêtre, FranceFaculté de Médecine Paris-SudUniversité Paris-Sud 11, Le Kremlin-Bicêtre F-94276, FrancePediatric EndocrinologyAP-HP, Hôpital Trousseau, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Robert Debré, Paris, FranceUniversité Paris Diderot Paris 07Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Necker Enfants-Malades, Paris, FranceUniversité Paris Descartes Paris 05Paris, France Department of Endocrinology and Reproductive MedicineCentre de Référence des Maladies Endocriniennes Rares de la Croissance, AP-HP, IE3M, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, FranceUPMC Univ Paris 06Paris, FranceClinical Research UnitAP-HP, Hôpital Pitié-Salpêtrière, Paris, FranceDepartment of Hormonal BiochemistryAP-HP, Hôpital Pitié-Salpêtrière, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Bicêtre, Le Kremlin Bicêtre, FranceFaculté de Médecine Paris-SudUniversité Paris-Sud 11, Le Kremlin-Bicêtre F-94276, FrancePediatric EndocrinologyAP-HP, Hôpital Trousseau, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Robert Debré, Paris, FranceUniversité Paris Diderot Paris 07Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Necker Enfants-Malades, Paris, FranceUniversité Paris Descartes Paris 05Paris, France
| | - Sylvie Cabrol
- Department of Endocrinology and Reproductive MedicineCentre de Référence des Maladies Endocriniennes Rares de la Croissance, AP-HP, IE3M, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, FranceUPMC Univ Paris 06Paris, FranceClinical Research UnitAP-HP, Hôpital Pitié-Salpêtrière, Paris, FranceDepartment of Hormonal BiochemistryAP-HP, Hôpital Pitié-Salpêtrière, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Bicêtre, Le Kremlin Bicêtre, FranceFaculté de Médecine Paris-SudUniversité Paris-Sud 11, Le Kremlin-Bicêtre F-94276, FrancePediatric EndocrinologyAP-HP, Hôpital Trousseau, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Robert Debré, Paris, FranceUniversité Paris Diderot Paris 07Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Necker Enfants-Malades, Paris, FranceUniversité Paris Descartes Paris 05Paris, France Department of Endocrinology and Reproductive MedicineCentre de Référence des Maladies Endocriniennes Rares de la Croissance, AP-HP, IE3M, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, FranceUPMC Univ Paris 06Paris, FranceClinical Research UnitAP-HP, Hôpital Pitié-Salpêtrière, Paris, FranceDepartment of Hormonal BiochemistryAP-HP, Hôpital Pitié-Salpêtrière, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Bicêtre, Le Kremlin Bicêtre, FranceFaculté de Médecine Paris-SudUniversité Paris-Sud 11, Le Kremlin-Bicêtre F-94276, FrancePediatric EndocrinologyAP-HP, Hôpital Trousseau, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Robert Debré, Paris, FranceUniversité Paris Diderot Paris 07Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Necker Enfants-Malades, Paris, FranceUniversité Paris Descartes Paris 05Paris, France
| | - Juliane Leger
- Department of Endocrinology and Reproductive MedicineCentre de Référence des Maladies Endocriniennes Rares de la Croissance, AP-HP, IE3M, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, FranceUPMC Univ Paris 06Paris, FranceClinical Research UnitAP-HP, Hôpital Pitié-Salpêtrière, Paris, FranceDepartment of Hormonal BiochemistryAP-HP, Hôpital Pitié-Salpêtrière, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Bicêtre, Le Kremlin Bicêtre, FranceFaculté de Médecine Paris-SudUniversité Paris-Sud 11, Le Kremlin-Bicêtre F-94276, FrancePediatric EndocrinologyAP-HP, Hôpital Trousseau, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Robert Debré, Paris, FranceUniversité Paris Diderot Paris 07Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Necker Enfants-Malades, Paris, FranceUniversité Paris Descartes Paris 05Paris, France Department of Endocrinology and Reproductive MedicineCentre de Référence des Maladies Endocriniennes Rares de la Croissance, AP-HP, IE3M, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, FranceUPMC Univ Paris 06Paris, FranceClinical Research UnitAP-HP, Hôpital Pitié-Salpêtrière, Paris, FranceDepartment of Hormonal BiochemistryAP-HP, Hôpital Pitié-Salpêtrière, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Bicêtre, Le Kremlin Bicêtre, FranceFaculté de Médecine Paris-SudUniversité Paris-Sud 11, Le Kremlin-Bicêtre F-94276, FrancePediatric EndocrinologyAP-HP, Hôpital Trousseau, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Robert Debré, Paris, FranceUniversité Paris Diderot Paris 07Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Necker Enfants-Malades, Paris, FranceUniversité Paris Descartes Paris 05Paris, France
| | - Michel Polak
- Department of Endocrinology and Reproductive MedicineCentre de Référence des Maladies Endocriniennes Rares de la Croissance, AP-HP, IE3M, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, FranceUPMC Univ Paris 06Paris, FranceClinical Research UnitAP-HP, Hôpital Pitié-Salpêtrière, Paris, FranceDepartment of Hormonal BiochemistryAP-HP, Hôpital Pitié-Salpêtrière, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Bicêtre, Le Kremlin Bicêtre, FranceFaculté de Médecine Paris-SudUniversité Paris-Sud 11, Le Kremlin-Bicêtre F-94276, FrancePediatric EndocrinologyAP-HP, Hôpital Trousseau, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Robert Debré, Paris, FranceUniversité Paris Diderot Paris 07Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Necker Enfants-Malades, Paris, FranceUniversité Paris Descartes Paris 05Paris, France Department of Endocrinology and Reproductive MedicineCentre de Référence des Maladies Endocriniennes Rares de la Croissance, AP-HP, IE3M, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, FranceUPMC Univ Paris 06Paris, FranceClinical Research UnitAP-HP, Hôpital Pitié-Salpêtrière, Paris, FranceDepartment of Hormonal BiochemistryAP-HP, Hôpital Pitié-Salpêtrière, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Bicêtre, Le Kremlin Bicêtre, FranceFaculté de Médecine Paris-SudUniversité Paris-Sud 11, Le Kremlin-Bicêtre F-94276, FrancePediatric EndocrinologyAP-HP, Hôpital Trousseau, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Robert Debré, Paris, FranceUniversité Paris Diderot Paris 07Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Necker Enfants-Malades, Paris, FranceUniversité Paris Descartes Paris 05Paris, France
| | - Philippe Touraine
- Department of Endocrinology and Reproductive MedicineCentre de Référence des Maladies Endocriniennes Rares de la Croissance, AP-HP, IE3M, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, FranceUPMC Univ Paris 06Paris, FranceClinical Research UnitAP-HP, Hôpital Pitié-Salpêtrière, Paris, FranceDepartment of Hormonal BiochemistryAP-HP, Hôpital Pitié-Salpêtrière, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Bicêtre, Le Kremlin Bicêtre, FranceFaculté de Médecine Paris-SudUniversité Paris-Sud 11, Le Kremlin-Bicêtre F-94276, FrancePediatric EndocrinologyAP-HP, Hôpital Trousseau, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Robert Debré, Paris, FranceUniversité Paris Diderot Paris 07Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Necker Enfants-Malades, Paris, FranceUniversité Paris Descartes Paris 05Paris, France Department of Endocrinology and Reproductive MedicineCentre de Référence des Maladies Endocriniennes Rares de la Croissance, AP-HP, IE3M, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, FranceUPMC Univ Paris 06Paris, FranceClinical Research UnitAP-HP, Hôpital Pitié-Salpêtrière, Paris, FranceDepartment of Hormonal BiochemistryAP-HP, Hôpital Pitié-Salpêtrière, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Bicêtre, Le Kremlin Bicêtre, FranceFaculté de Médecine Paris-SudUniversité Paris-Sud 11, Le Kremlin-Bicêtre F-94276, FrancePediatric EndocrinologyAP-HP, Hôpital Trousseau, Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Robert Debré, Paris, FranceUniversité Paris Diderot Paris 07Paris, FrancePediatric EndocrinologyAP-HP, Hôpital Necker Enfants-Malades, Paris, FranceUniversité Paris Descartes Paris 05Paris, France
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Voican A, Bachelot A, Bouligand J, Francou B, Dulon J, Lombès M, Touraine P, Guiochon-Mantel A. NR5A1 (SF-1) mutations are not a major cause of primary ovarian insufficiency. J Clin Endocrinol Metab 2013; 98:E1017-21. [PMID: 23543655 DOI: 10.1210/jc.2012-4111] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Primary ovarian insufficiency (POI) is a disorder affecting approximately 1% of women under the age of 40 years. NR5A1 (SF-1) mutations have been recently reported in association with POI. OBJECTIVE Our objective was to evaluate the frequency and functional impact of NR5A1 variants in POI. PATIENTS AND METHODS One hundred eighty patients diagnosed with idiopathic POI were screened for NR5A1 mutations and functional analysis was performed for the identified variants. The DNA-binding capacity of the variants was evaluated by means of EMSA, while their transcriptional activity was assessed using luciferase reporter assays. RESULTS Sequencing the NR5A1 gene revealed 4 missense variants in 3 patients. These patients were aged 20, 25, and 33 years at diagnosis and presented with secondary amenorrhea. None of them presented a syndromic form, although 2 had a familial history of POI. The functional analysis carried out for these missense variants showed no significant difference in DNA binding capacity or in transcriptional activity compared to wild-type NR5A1. CONCLUSIONS Our study in a large cohort of patients with POI showed the prevalence of NR5A1 mutations to be low (1.6%, upper 95% confidence interval 3.5%). Moreover, no functional impact was observed. Overall, in contrast with the initial report, our results exclude NR5A1 mutations as a major genetic cause of POI.
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Affiliation(s)
- Adela Voican
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche S693, Université Paris Sud, Faculté de Médecine Paris Sud, F-94276 Le Kremlin-Bicêtre, Paris, France
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16
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Bidet M, Bachelot A, Bissauge E, Golmard JL, Gricourt S, Dulon J, Coussieu C, Badachi Y, Touraine P. Resumption of ovarian function and pregnancies in 358 patients with premature ovarian failure. J Clin Endocrinol Metab 2011; 96:3864-72. [PMID: 21994953 DOI: 10.1210/jc.2011-1038] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Resumption of ovarian activity and spontaneous pregnancies are described in patients with premature ovarian failure (POF), but there is a lack of data concerning the prevalence of and predictive factors for these phenomena. OBJECTIVE The aim of the study was to determine both the prevalence of and predictive factors for spontaneous resumption of ovarian function in POF patients. DESIGN AND SETTING A mixed retrospective and prospective study was performed at a referral center for reproductive endocrinology. PATIENTS A total of 358 consecutive POF patients were followed from 1997 to 2010 in our center. MAIN OUTCOMES MEASURES The cumulative incidence of resumption of ovarian function was determined, and predictive factors were identified by univariate and multivariate analysis. RESULTS Of 358 patients with idiopathic POF, 86 (24%) patients presented features indicating resumption of ovarian function, and in 77 cases (88%) within 1 yr of diagnosis. Twenty-one spontaneous pregnancies (16 births, five miscarriages) occurred in 15 (4.4%) patients. Multivariate analysis (Cox model) showed that a familial history of POF, secondary amenorrhea, presence of follicles at ultrasound, and inhibin B and estradiol levels were significantly predictive of resumption of ovarian function (P < 0.01), whereas association with an autoimmune disease, anti-mullerian hormone level, the presence of follicles on biopsy, and/or genetic abnormalities did not appear predictive. We created a predictive score for resumption of ovarian function comprising age at diagnosis, presence of follicles at ultrasound, and inhibin B level. CONCLUSION Intermittent ovarian activity in patients with POF is not a rare phenomenon. The predictive score described in this study may help us to identify POF patients most likely to recover intermittent ovarian function.
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Affiliation(s)
- Maud Bidet
- Department of Endocrinology and Reproductive Medicine, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France
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17
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Chakhtoura Z, Bachelot A, Samara-Boustani D, Ruiz JC, Donadille B, Dulon J, Christin-Maître S, Bouvattier C, Raux-Demay MC, Bouchard P, Carel JC, Leger J, Kuttenn F, Polak M, Touraine P. Impact of total cumulative glucocorticoid dose on bone mineral density in patients with 21-hydroxylase deficiency. Eur J Endocrinol 2008; 158:879-87. [PMID: 18390993 DOI: 10.1530/eje-07-0887] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE It remains controversial whether long-term glucocorticoids are charged of bone demineralization in patients with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency. The aim of this study was to know whether cumulative glucocorticoid dose from the diagnosis in childhood to adulthood in patients with CAH had a negative impact on bone mineral density (BMD). DESIGN This was a retrospective study. METHODS Thirty-eight adult patients with classical and non-classical CAH were included. BMD was measured in the lumbar spine and femoral neck. Total cumulative glucocorticoid (TCG) and total average glucocorticoid (TAG) doses were calculated from pediatric and adult files. RESULTS We showed a difference between final and target heights (-0.82+/-0.92 s.d. for women and -1.31+/-0.84 s.d. for men; P<0.001). Seventeen patients (44.7%) had bone demineralization (35.7% of women and 70% of men). The 28 women had higher BMD than the 10 men for lumbar (-0.26+/-1.20 vs -1.25+/-1.33 s.d.; P=0.02) and femoral T-scores (0.21+/-1.30 s.d. versus -1.08+/-1.10 s.d.; P=0.007). In the salt-wasting group, women were almost significantly endowed with a better BMD than men (P=0.053). We found negative effects of TCG, TAG on lumbar (P<0.001, P=0.002) and femoral T-scores (P=0.006, P<0.001), predominantly during puberty. BMI was protective on BMD (P=0.006). CONCLUSION The TCG is an important factor especially during puberty for a bone demineralization in patients with 21-hydroxylase deficiency. The glucocorticoid treatment should be adapted particularly at this life period and preventive measures should be discussed in order to limit this effect.
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Affiliation(s)
- Zeina Chakhtoura
- AP-HP, Department of Endocrinology and Reproductive Medicine, Groupe Hospitalier Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75651 Paris Cedex 13, France
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Bachelot A, Chakhtoura Z, Rouxel A, Dulon J, Touraine P. Hormonal treatment of congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Annales d'Endocrinologie 2007; 68:274-80. [PMID: 17689481 DOI: 10.1016/j.ando.2007.06.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
During childhood, the main aims of the medical treatment of congenital adrenal hyperplasia (CAH) secondary to 21-hydroxylase deficiency, are to prevent salt loss and virilization and to achieve normal stature and normal puberty. As such, there is a narrow therapeutic window through which the intended results can be achieved. In adulthood, the clinical management has received little attention, but recent studies have shown the relevance of long-term follow-up of these patients. Indeed, long-term evaluation of adult CAH patients enables the identification of multiple clinical, hormonal and metabolic abnormalities as bone mineral density alteration, overweight and disturbed reproductive functions. In women with classic CAH, low fertility rate is reported, and is probably the consequence of multiple factors, including neuroendocrine and hormonal factors, feminizing surgery, and psychological factors. Men with CAH may present hypogonadism either through the effect of adrenal rests or from suppression of gonadotropins resulting in infertility. These patients should therefore be carefully followed-up, from childhood through to adulthood, to avoid these complications and to ensure treatment compliance and tight control of the adrenal androgens, by multidisciplinary teams who have knowledge of CAH.
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Affiliation(s)
- A Bachelot
- Department of endocrinology and reproductive medicine (Centre de référence des maladies endocriniennes rares de la croissance), groupe hospitalier Pitié-Salpêtrière, 75013 Paris, France
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