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Dusaulcy R, Mavromati M, Spoerl D. [Diagnosis and etiology of primary adrenal insufficiency]. Rev Med Suisse 2024; 20:694-698. [PMID: 38568062 DOI: 10.53738/revmed.2024.20.868.694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Since its first description in 1855, our understanding of primary adrenal insufficiency has greatly evolved. However, diagnosis is often delayed, as symptoms are frequently nonspecific in the early stages of the disease. In this article, we review the classical manifestations, associated diseases, as well as the diagnostic algorithm for primary adrenal insufficiency, aiming to enable earlier diagnosis.
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Affiliation(s)
- Rodolphe Dusaulcy
- Service de médecine de laboratoire, Département diagnostique, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Maria Mavromati
- Service d'endocrinologie, diabétologie, nutrition et éducation thérapeutique du patient, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - David Spoerl
- Service de médecine de laboratoire, Département diagnostique, Hôpitaux universitaires de Genève, 1211 Genève 14
- Service d'allergologie et immunologie clinique, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
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Correia JC, Mavromati M, Pataky Z. [Weight gain during menopause: physiology and practical implications]. Rev Med Suisse 2024; 20:580-583. [PMID: 38506458 DOI: 10.53738/revmed.2024.20.866.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Fluctuations in sex hormones at different stages of reproductive life, such as the menopausal transition, have been suggested as players in weight regulation. Indeed, the transition from a predominantly estrogenic state to an androgenic state characteristic of the menopausal transition contributes to changes in body composition with accumulation of fat and simultaneous loss of lean mass. However, whether these changes contribute to the weight gain remains debatable. Other physiological and psychosocial factors come into play. It is therefore important to offer individualized support with the objective to minimize the risk of weight gain and associated complications.
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Affiliation(s)
- Jorge César Correia
- Unité d'éducation thérapeutique du patient, Centre collaborateur OMS, Service d'endocrinologie, diabétologie, nutrition et éducation thérapeutique du patient, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Maria Mavromati
- Unité d'endocrinologie, Service d'endocrinologie, diabétologie, nutrition et éducation thérapeutique du patient, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Zoltan Pataky
- Unité d'éducation thérapeutique du patient, Centre collaborateur OMS, Service d'endocrinologie, diabétologie, nutrition et éducation thérapeutique du patient, Hôpitaux universitaires de Genève, 1211 Genève 14
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Cappellacci F, Canu GL, Rossi L, De Palma A, Mavromati M, Kuczma P, Di Filippo G, Morelli E, Demarchi MS, Brazzarola P, Materazzi G, Calò PG, Medas F. Differences in surgical outcomes between cervical goiter and retrosternal goiter: an international, multicentric evaluation. Front Surg 2024; 11:1341683. [PMID: 38379818 PMCID: PMC10876881 DOI: 10.3389/fsurg.2024.1341683] [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: 11/20/2023] [Accepted: 01/25/2024] [Indexed: 02/22/2024] Open
Abstract
Introduction Goiter is a common problem in clinical practice, representing a large part of clinical evaluations for thyroid disease. It tends to grow slowly and progressively over several years, eventually occupying the thoracic inlet with its lower portion, defining the situation known as retrosternal goiter. Total thyroidectomy is a standardized procedure that represents the treatment of choice for all retrosternal goiters, but when is performed for such disease, a higher risk of postoperative morbidity is variously reported in the literature. The aims of our study were to compare the perioperative and postoperative outcomes in patients with cervical goiters and retrosternal goiters undergoing total thyroidectomy. Methods In our retrospective, multicentric evaluation we included 4,467 patients, divided into two groups based on the presence of retrosternal goiter (group A) or the presence of a classical cervical goiter (group B). Results We found statistically significant differences in terms of transient hypoparathyroidism (19.9% in group A vs. 9.4% in group B, p < 0.001) and permanent hypoparathyroidism (3.3% in group A vs. 1.6% in group B, p = 0.035). We found no differences in terms of transient RNLI between group A and group B, while the occurrence of permanent RLNI was higher in group A compared to group B (1.4% in group A vs. 0.4% in group B, p = 0.037). Moreover, no differences in terms of unilateral RLNI were found, while bilateral RLNI rate was higher in group A compared to group B (1.1% in group A vs. 0.1% in group B, p = 0.015). Discussion Wound infection rate was higher in group A compared to group B (1.4% in group A vs. 0.2% in group B, p = 0.006). Based on our data, thyroid surgery for retrosternal goiter represents a challenging procedure even for highly experienced surgeons, with an increased rate of some classical thyroid surgery complications. Referral of these patients to a high-volume center is mandatory. Also, intraoperative nerve monitoring (IONM) usage in these patients is advisable.
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Affiliation(s)
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Leonardo Rossi
- Endocrine Surgery Unit, University Hospital of Pisa, Pisa, Italy
| | - Andrea De Palma
- Endocrine Surgery Unit, University Hospital of Pisa, Pisa, Italy
| | - Maria Mavromati
- Service D'endocrinologie, Diabétologie, Nutrition et éducation du Patient, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Paulina Kuczma
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Giacomo Di Filippo
- Endocrine Surgery Unit, Department of Surgery and Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - Eleonora Morelli
- Endocrine Surgery Unit, Department of Surgery and Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - Marco Stefano Demarchi
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Paolo Brazzarola
- Endocrine Surgery Unit, Department of Surgery and Oncology, University and Hospital Trust of Verona, Verona, Italy
| | | | | | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Mavromati M, Saiji E, Demarchi MS, Lenoir V, Seipel A, Kuczma P, Jornayvaz FR, Becker M, Fernandez E, De Vito C, Triponez F, Leboulleux S. Unnecessary thyroid surgery rate for suspicious nodule in the absence of molecular testing. Eur Thyroid J 2023; 12:e230114. [PMID: 37855426 PMCID: PMC10620454 DOI: 10.1530/etj-23-0114] [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: 06/08/2023] [Accepted: 08/30/2023] [Indexed: 09/02/2023] Open
Abstract
Background Molecular tests for suspicious thyroid nodules decrease rates of unnecessary surgeries but are not widely used due to reimbursement issues. The aim of this study was to assess the rate of unnecessary surgery performed in real-life setting for Bethesda III, IV and V nodules in the absence of molecular testing. Method This is a single-center retrospective study of consecutive patients undergoing fine needle aspiration cytology (FNAC) with rapid on-site evaluation between January 2017 and December 2021. Unnecessary surgery was defined as surgery performed because of Bethesda III, IV, or V results in the absence of local compressive symptoms with final benign pathology and as second surgery for completion thyroidectomy. Results In the 862 patients (640 females, mean age: 54.2 years), 1010 nodules (median size: 24.4 mm) underwent 1189 FNAC. Nodules were EU-TIRADS 2, 3, 4, and 5 in 3%, 34%, 42%, and 22% of cases, respectively. FNAC was Bethesda I, II, III, IV, V, and VI in 8%, 48%, 17%, 17%, 3%, and 6%, respectively. Surgery was performed in 36% of Bethesda III nodules (benign on pathology: 81%), in 74% of Bethesda IV nodules (benign on pathology: 76%) and in 97% of Bethesda V nodules (benign on pathology: 21%). Surgery was considered unnecessary in 56%, 68%, and 21% of patients with Bethesda III, IV, and V nodules, respectively. Conclusion In this real data cohort surgery was unnecessary in more than half of patients with Bethesda III and IV nodules and in 21% of patients with Bethesda V nodules.
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Affiliation(s)
- Maria Mavromati
- Department of Endocrinology, Diabetology, Nutrition and Therapeutic Education, Geneva University Hospitals, Rue Gabrielle Perret Gentil, Geneva University, Geneva, Switzerland
| | - Essia Saiji
- Department of Pathology, Geneva University Hospitals, Rue Gabrielle Perret Gentil, Geneva, Switzerland
| | - Marco Stefano Demarchi
- Department of Endocrine Surgery, Geneva University Hospitals, Rue Gabrielle Perret Gentil, Geneva, Switzerland
| | - Vincent Lenoir
- Department of Radiology, Geneva University Hospitals, Rue Gabrielle Perret Gentil, Geneva, Switzerland
| | - Amanda Seipel
- Department of Pathology, Geneva University Hospitals, Rue Gabrielle Perret Gentil, Geneva, Switzerland
| | - Paulina Kuczma
- Department of Endocrine Surgery, Geneva University Hospitals, Rue Gabrielle Perret Gentil, Geneva, Switzerland
| | - François R Jornayvaz
- Department of Endocrinology, Diabetology, Nutrition and Therapeutic Education, Geneva University Hospitals, Rue Gabrielle Perret Gentil, Geneva University, Geneva, Switzerland
| | - Minerva Becker
- Department of Radiology, Geneva University Hospitals, Rue Gabrielle Perret Gentil, Geneva, Switzerland
| | - Eugenio Fernandez
- Department of Oncology, Geneva University Hospitals, Rue Gabrielle Perret Gentil, Geneva, Switzerland
| | - Claudio De Vito
- Department of Pathology, Geneva University Hospitals, Rue Gabrielle Perret Gentil, Geneva, Switzerland
| | - Frédéric Triponez
- Department of Endocrine Surgery, Geneva University Hospitals, Rue Gabrielle Perret Gentil, Geneva, Switzerland
| | - Sophie Leboulleux
- Department of Endocrinology, Diabetology, Nutrition and Therapeutic Education, Geneva University Hospitals, Rue Gabrielle Perret Gentil, Geneva University, Geneva, Switzerland
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Oung C, Tesoro R, Marti V, Mavromati M, Lahoud MJ. Hypnosis in High-Intensity Focused Ultrasound for Thyroid Nodule Ablation. Am J Case Rep 2023; 24:e941524. [PMID: 37980542 PMCID: PMC10670948 DOI: 10.12659/ajcr.941524] [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] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 10/16/2023] [Accepted: 10/05/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Current medical technologies enable physicians to treat patients outside operating rooms using minimally invasive techniques. Non-operating room anesthesia (NORA) represents a growing field of medicine, with an increasing number of cases performed over the last decade. As a result, anesthesia providers will need to enhance their understanding of the resources, medical and paramedical staff, and environment outside the operating room. Patients undergoing such procedures under light conscious sedation still experience discomfort such as pain and anxiety, thus requiring the use of pain control medication or sedative drugs. At the same time, the use of hypnosis is spreading in medical practice, particularly with minimally invasive procedures. Many studies have investigated the use of hypnosis in cases of minimally invasive procedures, showing an effective reduction of patients' discomfort and consumption of pain control medication, thus improving patient safety. CASE REPORT We describe the case of a woman in her 70s who underwent a thyroid nodule thermal ablation through high-intensity focused ultrasound (HIFU) performed under hypnosis in a NORA setting. The procedure was well endured; the patient experienced comfort and was satisfied with having avoided general anesthesia. Post-HIFU follow-up showed a 30% decrease of thyroid nodule volume. The patient was completely satisfied with the esthetic result. The operator did not encounter any difficulties with the awoken patient or movements during the procedure. CONCLUSIONS Our case confirms the effective role of hypnosis in relaxation and coping with painful procedures and highlights patient satisfaction without the use of sedative drugs in the context of NORA procedures.
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Affiliation(s)
- Caroline Oung
- Division of Anesthesiology, Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Rosa Tesoro
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Valentin Marti
- Unit of Forensic Pathology, University Center of Legal Medicine Lausanne-Geneva, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Maria Mavromati
- Division of Endocrinology, Geneva University Hospitals, Geneva, Switzerland
| | - Marie-José Lahoud
- Division of Anesthesiology, Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
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Canu GL, Medas F, Cappellacci F, Rossi L, Gjeloshi B, Sessa L, Pennestrì F, Djafarrian R, Mavromati M, Kotsovolis G, Pliakos I, Di Filippo G, Lazzari G, Vaccaro C, Izzo M, Boi F, Brazzarola P, Feroci F, Demarchi MS, Papavramidis T, Materazzi G, Raffaelli M, Calò PG. Risk factors for postoperative cervical haematoma in patients undergoing thyroidectomy: a retrospective, multicenter, international analysis (REDHOT study). Front Surg 2023; 10:1278696. [PMID: 37850042 PMCID: PMC10577166 DOI: 10.3389/fsurg.2023.1278696] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/15/2023] [Indexed: 10/19/2023] Open
Abstract
Background Postoperative cervical haematoma represents an infrequent but potentially life-threatening complication of thyroidectomy. Since this complication is uncommon, the assessment of risk factors associated with its development is challenging. The main aim of this study was to identify the risk factors for its occurrence. Methods Patients undergoing thyroidectomy in seven high-volume thyroid surgery centers in Europe, between January 2020 and December 2022, were retrospectively analysed. Based on the onset of cervical haematoma, two groups were identified: Cervical Haematoma (CH) Group and No Cervical Haematoma (NoCH) Group. Univariate analysis was performed to compare these two groups. Moreover, employing multivariate analysis, all potential independent risk factors for the development of this complication were assessed. Results Eight thousand eight hundred and thirty-nine patients were enrolled: 8,561 were included in NoCH Group and 278 in CH Group. Surgical revision of haemostasis was performed in 70 (25.18%) patients. The overall incidence of postoperative cervical haematoma was 3.15% (0.79% for cervical haematomas requiring surgical revision of haemostasis, and 2.35% for those managed conservatively). The timing of onset of cervical haematomas requiring surgical revision of haemostasis was within six hours after the end of the operation in 52 (74.28%) patients. Readmission was necessary in 3 (1.08%) cases. At multivariate analysis, male sex (P < 0.001), older age (P < 0.001), higher BMI (P = 0.021), unilateral lateral neck dissection (P < 0.001), drain placement (P = 0.007), and shorter operative times (P < 0.001) were found to be independent risk factors for cervical haematoma. Conclusions Based on our findings, we believe that patients with the identified risk factors should be closely monitored in the postoperative period, particularly during the first six hours after the operation, and excluded from outpatient surgery.
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Affiliation(s)
- Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, Monserrato, Italy
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Monserrato, Italy
| | | | - Leonardo Rossi
- Endocrine Surgery Unit, University Hospital of Pisa, Pisa, Italy
| | - Benard Gjeloshi
- Endocrine Surgery Unit, University Hospital of Pisa, Pisa, Italy
| | - Luca Sessa
- UOC di Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca in Chirurgia Delle Ghiandole Endocrine e Dell’Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Pennestrì
- UOC di Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca in Chirurgia Delle Ghiandole Endocrine e Dell’Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Reza Djafarrian
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Maria Mavromati
- Service of Endocrinology, Diabetes, Nutrition and Therapeutic Patient Education, WHO Collaborating Center, Geneva University Hospital, Geneva University, Geneva, Switzerland
| | - George Kotsovolis
- First Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
- Unit of Minimally Invasive Surgery, Euromedica Kyanous Stavros, Thessaloniki, Greece
| | - Ioannis Pliakos
- First Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
- Unit of Minimally Invasive Surgery, Euromedica Kyanous Stavros, Thessaloniki, Greece
| | - Giacomo Di Filippo
- Endocrine Surgery Unit, Department of Surgery and Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - Giovanni Lazzari
- Endocrine Surgery Unit, Department of Surgery and Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - Carla Vaccaro
- SOC Chirurgia Generale, Ospedale SS Cosma e Damiano, Pescia, Italy
| | - Martina Izzo
- SOC Chirurgia Generale, Ospedale SS Cosma e Damiano, Pescia, Italy
| | - Francesco Boi
- Department of Medical Sciences, University of Cagliari, Monserrato, Italy
| | - Paolo Brazzarola
- Endocrine Surgery Unit, Department of Surgery and Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - Francesco Feroci
- SOC Chirurgia Generale, Ospedale SS Cosma e Damiano, Pescia, Italy
- Department of General and Oncologic Surgery, Santo Stefano Hospital, Prato, Italy
| | - Marco Stefano Demarchi
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Theodossios Papavramidis
- First Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
- Unit of Minimally Invasive Surgery, Euromedica Kyanous Stavros, Thessaloniki, Greece
| | | | - Marco Raffaelli
- UOC di Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca in Chirurgia Delle Ghiandole Endocrine e Dell’Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
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Mavromati M, Mavrakanas T, Jornayvaz FR, Schaller K, Fitsiori A, Vargas MI, Lobrinus JA, Merkler D, Egervari K, Philippe J, Leboulleux S, Momjian S. The impact of transsphenoidal surgery on pituitary function in patients with non-functioning macroadenomas. Endocrine 2023:10.1007/s12020-023-03400-z. [PMID: 37222882 PMCID: PMC10293445 DOI: 10.1007/s12020-023-03400-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/10/2023] [Indexed: 05/25/2023]
Abstract
PURPOSE Transsphenoidal surgery for non-functioning pituitary adenomas (NFPAs) can alter pituitary function. We assessed the rates of improvement and deterioration of pituitary function by axis and searched for predictive factors of these outcomes. METHODS We reviewed consecutive medical files from patients having had transsphenoidal surgery for NFPA between 2004 and 2018. Pituitary functions and MRI imaging were analyzed prior and after surgery. The occurrence of recovery and new deficit were documented per axis. Prognostic factors of hormonal recovery and new deficits were searched. RESULTS Among 137 patients analyzed, median tumor size of the NFPA was 24.8 mm and 58.4% of patients presented visual impairment. Before surgery, 91 patients (67%) had at least one abnormal pituitary axis (hypogonadism: 62.4%; hypothyroidism: 41%, adrenal insufficiency: 30.8%, growth hormone deficiency: 29.9%; increased prolactin: 50.8%). Following surgery, the recovery rate of pituitary deficiency of one axis or more was 46% and the rate of new pituitary deficiency was 10%. Rates of LH-FSH, TSH, ACTH and GH deficiency recovery were 35.7%, 30.4%, 15.4%, and 45.5% respectively. Rates of new LH-FSH, TSH, ACTH and GH deficiencies were 8.3%, 1.6%, 9.2% and 5.1% respectively. Altogether, 24.6% of patients had a global pituitary function improvement and only 7% had pituitary function worsening after surgery. Male patients and patients with hyperprolactinemia upon diagnosis were more likely to experience pituitary function recovery. No prognostic factors for the risk of new deficiencies were identified. CONCLUSION In a real-life cohort of patients with NFPAs, recovery of hypopituitarism after surgery is more frequent than the occurrence of new deficiencies. Hence, hypopituitarism could be considered a relative indication for surgery in patients with NFPAs.
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Affiliation(s)
- Maria Mavromati
- Service of Endocrinology, Diabetes, Nutrition and Therapeutic Patient Education, WHO Collaborating Center, Geneva University Hospital, Geneva University, Geneva, Switzerland.
| | - Thomas Mavrakanas
- Division of Nephrology, McGill University Health Center, McGill University, Montreal, QC, Canada
| | - François R Jornayvaz
- Service of Endocrinology, Diabetes, Nutrition and Therapeutic Patient Education, WHO Collaborating Center, Geneva University Hospital, Geneva University, Geneva, Switzerland
| | - Karl Schaller
- Service of Neurosurgery, Geneva University Hospital, Geneva University, Geneva, Switzerland
| | - Aikaterini Fitsiori
- Service of Neurodiagnostic, Division of Neuroradiology, Geneva University Hospital, Geneva University, Geneva, Switzerland
| | - Maria I Vargas
- Service of Neurodiagnostic, Division of Neuroradiology, Geneva University Hospital, Geneva University, Geneva, Switzerland
| | - Johannes A Lobrinus
- Service of Clinical Pathology, Geneva University Hospital, Geneva, Switzerland
| | - Doron Merkler
- Service of Clinical Pathology, Geneva University Hospital, Geneva, Switzerland
| | - Kristof Egervari
- Service of Clinical Pathology, Geneva University Hospital, Geneva, Switzerland
| | | | - Sophie Leboulleux
- Service of Endocrinology, Diabetes, Nutrition and Therapeutic Patient Education, WHO Collaborating Center, Geneva University Hospital, Geneva University, Geneva, Switzerland
| | - Shahan Momjian
- Service of Neurosurgery, Geneva University Hospital, Geneva University, Geneva, Switzerland
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Kuczma P, Demarchi MS, Leboulleux S, Trésallet C, Mavromati M, Djafarrian R, Mabilia A, Triponez F. Central node dissection in papillary thyroid carcinoma in the era of near-infrared fluorescence. Front Endocrinol (Lausanne) 2023; 14:1110489. [PMID: 37124759 PMCID: PMC10140587 DOI: 10.3389/fendo.2023.1110489] [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: 11/28/2022] [Accepted: 03/24/2023] [Indexed: 05/02/2023] Open
Abstract
The most common site of lymph node metastases in papillary thyroid carcinoma is the central compartment of the neck (level VI). In many patients, nodal metastases in this area are not clinically apparent, neither on preoperative imaging nor during surgery. Prophylactic surgical clearance of the level VI in the absence of clinically suspicious lymph nodes (cN0) is still under debate. It has been suggested to reduce local recurrence and improve disease-specific survival. Moreover, it helps to accurately diagnose the lymph node involvement and provides important staging information useful for tailoring of the radioactive iodine regimen and estimating the risk of recurrence. Yet, many studies have shown no benefit to the long-term outcome. Arguments against the prophylactic central lymph node dissection (CLND) cite minimal oncologic benefit and concomitant higher operative morbidity, with hypoparathyroidism being the most common complication. Recently, near-infrared fluorescence imaging has emerged as a novel tool to identify and preserve parathyroid glands during thyroid surgery. We provide an overview of the current scientific landscape of fluorescence imaging in thyroid surgery, of the controversies around the prophylactic CLND, and of fluorescence imaging applications in CLND. To date, only three studies evaluated fluorescence imaging in patients undergoing thyroidectomy and prophylactic or therapeutic CLND for thyroid cancer. The results suggest that fluorescence imaging has the potential to minimise the risk of hypoparathyroidism associated with CLND, while allowing to exploit all its potential benefits. With further development, fluorescence imaging techniques might shift the paradigm to recommend more frequently prophylactic CLND.
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Affiliation(s)
- Paulina Kuczma
- Department of Thoracic and Endocrine Surgery, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Marco Stefano Demarchi
- Department of Thoracic and Endocrine Surgery, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Sophie Leboulleux
- Department of Endocrinology, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Christophe Trésallet
- Assistance Publique–Hôpitaux de Paris, Department of Digestive, Bariatric and Endocrine Surgery, Bobigny Avicenne Hospital, Sorbonne Paris Nord University, Bobigny, France
| | - Maria Mavromati
- Department of Endocrinology, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Reza Djafarrian
- Department of Thoracic and Endocrine Surgery, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Andrea Mabilia
- Assistance Publique–Hôpitaux de Paris, Department of Digestive, Bariatric and Endocrine Surgery, Bobigny Avicenne Hospital, Sorbonne Paris Nord University, Bobigny, France
| | - Frédéric Triponez
- Department of Thoracic and Endocrine Surgery, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
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Andrade S, Sciotto-Canel L, Mavromati M, Leboulleux S. [What's new in endocrinology]. Rev Med Suisse 2023; 19:212-216. [PMID: 36723650 DOI: 10.53738/revmed.2023.19.812.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Thyroid problems are frequent in pregnant women; recent data allow observation only in women with positive antithyroperoxidase antibodies (anti-TPO) but normal thyroïd function. New minimally invasive techniques are being developed for the management of thyroid nodules; radiofrequency ablation is effective for benign nodules. The management of Cushing's syndrome is oriented towards a more personalized approach; new treatments are available, with increased efficacy and a very good safety profile.
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Affiliation(s)
- Stéphanie Andrade
- Service d'endocrinologie, diabétologie, nutrition et éducation du patient, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Lucie Sciotto-Canel
- Service d'endocrinologie, diabétologie, nutrition et éducation du patient, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Maria Mavromati
- Service d'endocrinologie, diabétologie, nutrition et éducation du patient, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Sophie Leboulleux
- Service d'endocrinologie, diabétologie, nutrition et éducation du patient, Hôpitaux universitaires de Genève, 1211 Genève 14
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Mavromati M, Leboulleux S. [What's new in endocrinology]. Rev Med Suisse 2022; 18:26-30. [PMID: 35048575 DOI: 10.53738/revmed.2022.18.764-65.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The management of Graves' orbitopathy, an extraocular manifestation of the disease and the main contributor to morbidity, is the subject of new recommendations, published in 2021. The treatment of low risk differentiated thyroid cancer is simplified, with less surgery and less radioiodine treatment and at lower dose. The management of acromegaly is oriented towards a personalized approach; prognostic factors are more widely used, and the treatment of complications is emphasized.
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Affiliation(s)
- Maria Mavromati
- Service d'endocrinologie, diabétologie, nutrition et éducation thérapeutique, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Sophie Leboulleux
- Service d'endocrinologie, diabétologie, nutrition et éducation thérapeutique, Hôpitaux universitaires de Genève, 1211 Genève 14
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Mavromati M. [Endocrine care of gender-incongruent persons]. Rev Med Suisse 2021; 17:24-28. [PMID: 33443826] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Health care of gender-incongruent persons deserves optimization. The new World Health Organization ICD-11, introduced this year, classifies gender-incongruence to « conditions related to sexual health », and not anymore to « mental and behavioral disorders ». From an endocrine perspective, gender-affirming hormonal treatment induces physical changes consistent with gender identity, but good-quality, long follow-up studies concerning efficacy and safety are needed. Improvements in training of medical professionals as well as a specialized multidisciplinary approach are important measures to be taken.
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Affiliation(s)
- Maria Mavromati
- Service d'endocrinologie, diabétologie, nutrition et éducation thérapeutique du patient, HUG, 1211 Genève 14
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Chatzis L, Pezoulas V, Ferro F, Donati V, Venetsanopoulou A, Zampeli E, Mavromati M, Voulgari P, Mavragani C, Fotiadis D, Skopouli F, De Vita S, Baldini C, Moutsopoulos HM, Tzioufas A, Goules A. OP0096 THE DIFFERENCES BETWEEN SJÖGREN’S SYNDROME PATIENTS WITH COMBINED SERONEGATIVITY AND ANTI-RO/SSA SEROPOSITIVITY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Sjögren’s syndrome (SS) is characterized by B cell hyperactivity reflected by hypergammaglobulinemia as well as a plethora of autoantibodies including antinuclear antibodies (ANA), anti-Ro/SSA, anti-La/SSB and rheumatoid factors (RF). Previous studies have focused on the phenotype of single positive (ANA or anti-Ro/SSA or anti-La/SSB) or double positive (anti-Ro/SSA and anti-La/SSB positive) SS patients, showing differences regarding the age of diagnosis, sicca manifestations and specific extraglandular manifestations. To our knowledge, no study has ever explored the clinical spectrum of triple seronegative (anti-Ro/SSA + anti-La/SSB + RF negative) and quadruple seronegative (ANA +anti-Ro/SSA + anti-La/SSB + RF negative) SS patients.Objectives:To study the differences in the clinical phenotype of triple and quadruple seronegative (SS) patients in a large cohort of well characterized patients, after comparison with anti-Ro/SSA positive patients.Methods:From a total cohort of 1723 consecutive SS patients who fulfill the 2016 EULAR/ACR criteria and are followed up in 4 clinical centers ([Universities of Pisa and Athens, Harokopio and Ioannina, (PAHI)], those who have been found triple or quadruple seronegative were identified and compared with matched anti-Ro/SSA positive SS patients according to age of SS onset, disease duration and gender, in 1:1 and 1:2 ratio respectively. Glandular (dry mouth, dry eyes, parotid gland enlargement) and extra-glandular manifestations (Raynaud’s phenomenon, chronic fatigue arthralgias/myalgias, arthritis, palpable purpura, liver involvement, kidney involvement, lung involvement, neurologic involvement, long standing lymphadenopathy and lymphoma) were compared between the 2 seronegative groups and the anti-Ro/SSA positive control group. Statistical analysis for categorical variables was performed by Fisher exact or chi-square tests and for continuous variables with t test or Mann-Whitney accordingly.Results:Two hundred and four SS patients (11,8%) were identified as triple negatives and 53 (3,0%) as quadruple, with a median disease duration of 6 years (range: 0-41) and 5 years (range: 0-32) respectively. The matched anti-Ro/SSA controls were 204 for the triple and 103 for the quadruple negatives. Triple negatives had lower frequency of monoclonal gammopathy (5,5% vs 12,1% p=0,04), low C4 serum levels (23% vs 36%, p=0,009) and lymphoma (3,4% vs 9,8%, OR= 3,06, 95% CI =1,27-7,85) while quadruple negatives exhibited higher prevalence of dry eyes (100% vs 90%) and lower prevalence of long standing lymphadenopathy (2,7% vs 19,5%, p=0,001) and lymphoma (0% vs 15%, p=0,001) compared to anti-Ro/SSA matched controls.Conclusion:Combined seronegativity account for more than 10% of SS population and is associated with lower prevalence of lymphoma compared to anti-Ro/SSA positive patients.Disclosure of Interests:Loukas Chatzis: None declared, Vasileios Pezoulas: None declared, Francesco Ferro: None declared, Valentina Donati: None declared, Aliki Venetsanopoulou: None declared, Evangelia Zampeli: None declared, Maria Mavromati: None declared, Paraskevi Voulgari: None declared, Clio Mavragani: None declared, Dimitris Fotiadis: None declared, Fotini Skopouli: None declared, Salvatore De Vita Consultant of: Roche, Human Genome Science, Glaxo Smith Kline and Novartis, Chiara Baldini: None declared, Haralampos M. Moutsopoulos: None declared, Athanasios Tzioufas: None declared, Andreas Goules: None declared
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Goules A, Argyropoulou O, Pezoulas V, Ferro F, Gandolfo S, Donati V, Binutti M, Callegher SZ, Chatzis L, Venetsanopoulou A, Zampeli E, Mavromati M, Voulgari P, Mavragani C, Baldini C, Skopouli F, Fotiadis D, De Vita S, Moutsopoulos HM, Tzioufas A. FRI0149 THE CLINICAL FEATURES OF SJÖGREN’S SYNDROME PATIENTS WITH EARLY AND LATE DISEASE ONSET. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Sjögren’s syndrome (SS) affects mainly individuals of the 4thor 5thdecade of life, although patients with early (≤35 years old) or late (≥65 years old) disease onset have been described in the literature. The clinical spectrum of the disease extends from mild dryness to severe systemic vasculitis and lymphoproliferative disorders. The phenotypic diversity of SS is defined by many factors, including age, since many parameters related to age may affect the clinical expression of the disease. Few studies have been conducted to study the effect of age on the clinical phenotype of SS, though with limited number of patients. Large and well-defined groups of SS are required to address such questions.Objectives:To study the clinical phenotype of SS patients with early and late disease onset and to explore the association of age with lymphoma development in a unified multicenter cohort.Methods:From a total cohort of 1997 consecutive SS patients who fulfill the 2016 EULAR/ACR criteria and are followed up in 5 clinical centers ([Universities ofUdine,Pisa andAthens,Harokopio andIoannina, (UPAHI)], those with either early (≤35 years) or late (≥65 years) disease onset were identified and matched according to gender and disease duration with middle aged controls whose disease onset was at the 4thor 5thdecade of life. Glandular manifestations, extra-glandular manifestations, serologic characteristics and histologic features were compared between the 2 age groups and the middle-aged control groups. Statistical analysis for categorical variables was performed by Fisher exact or chi-square tests and for continuous variables with t test or Mann-Whitney accordingly.Results:Three hundred seventy-nine (19%) SS patients with early and 293 (15%) with late disease onset were identified and compared with 353 and 285 middle aged SS controls respectively. The median disease duration of patients with early onset was 12 years (range:0-68) and for those with late disease onset was 5 years (range: 0-27). SS patients with early disease onset had statistically significant higher frequency of Raynaud’s phenomenon, lymphadenopathy, hypergammaglobulinemia, anti-Ro/SSA, anti-La/SSB, rheumatoid factor, salivary gland enlargement, low C4 complement levels, leukopenia and lymphoma (10,3% vs 5,7%, p= 0.03, OR= 1,91, 95% CI: 1,11-3,27) while SS patients with late disease onset had more frequently dry mouth, interstitial lung disease and lymphoma (6,8% vs 2,1%, p=0,01, OR= 3,4. 95%CI: 1,35-1,81).Conclusion:In a multicenter cohort of 1997 consecutive SS patients, those with early and late disease onset comprise more than one third of the total SS population. Patients with early disease onset, exhibit robust B cell responses with traditional risk factors for lymphoma as opposed to patients with late disease onset. Both age groups have increased lymphoma prevalence but presumably for different reasons, since late onset patients lack classical predictors of lymphoma. Therefore, these predictors deserve further study in different disease subsets.Disclosure of Interests:Andreas Goules: None declared, Ourania Argyropoulou: None declared, Vasileios Pezoulas: None declared, Francesco Ferro: None declared, Saviana Gandolfo: None declared, Valentina Donati: None declared, Marco Binutti: None declared, Sara Zandonella Callegher: None declared, Loukas Chatzis: None declared, Aliki Venetsanopoulou: None declared, Evangelia Zampeli: None declared, Maria Mavromati: None declared, Paraskevi Voulgari: None declared, Clio Mavragani: None declared, Chiara Baldini: None declared, Fotini Skopouli: None declared, Dimitris Fotiadis: None declared, Salvatore De Vita Consultant of: Roche, Human Genome Science, Glaxo Smith Kline and Novartis, Haralampos M. Moutsopoulos: None declared, Athanasios Tzioufas: None declared
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Argyropoulou O, Pezoulas V, Quartuccio L, Ferro F, Gandolfo S, Donati V, Venetsanopoulou A, Chatzis L, Zampeli E, Mavromati M, Voulgari P, Mavragani C, Baldini C, Skopouli F, Fotiadis D, Galli M, De Vita S, Moutsopoulos HM, Goules A, Tzioufas A. THU0294 THE DIFFERENCES IN THE CLINICAL SPECTRUM OF CRYOGLOBULINEMIC VASCULITIS BETWEEN SJÖGREN’S SYNDROME AND HCV HEPATITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Cryoglobulinemic vasculitis (CV) is a serious complication of Sjögren’s syndrome (SS) and is closely associated with type II IgMk cryoglobulins. CV has been well documented in HCV patients without SS, and shares common features with CV in SS. So far, few studies have described the clinical picture of CV in HCV negative SS, but the number of studied patients was rather small and CV was not well defined. To better describe the clinical spectrum of CV in SS and explore the differences compared to HCV-related CV, a large cohort of well characterized patients is required.Objectives:To study the clinical phenotype of CV in HCV-negative SS patients, in a large cohort of well characterized patients, after applying stringent classification CV criteria and in comparison with the classical CV of HCV patients.Methods:From a total cohort of 1997 consecutive SS patients who fulfill the 2016 EULAR/ACR criteria and are followed up in 5 clinical centers ([Universities ofUdine,Pisa andAthens,Harokopio andIoannina, (UPAHI)], those who fulfil the 2011 classification criteria for CV were identified and compared with matched HCV-CV patients according to age and gender. Glandular, extra-glandular manifestations and serologic features were compared between the 2 CV groups. Statistical analysis for categorical variables was performed by Fisher exact or chi-square tests and for continuous variables with t test or Mann-Whitney accordingly.Results:Among the 1083 SS patients who have been evaluated for cryoglobulins, 114 (9,8%) were found positive. Seventy-one (6,5%) SS patients met the 2011 CV criteria while 44 patients presented with type II IgMk cryoglobulinemia without CV. Sixty nine of 71 (97%) SS related CV patients were females and 2 of 71 (3%) males. Forty eight of 71 (68%) had SS disease onset >35 and <65 years old while 14/71 (19,7%) and 9/71 (12,7%) had SS disease onset <35 and >65 years old respectively. The most common clinical manifestations of CV among SS patients were purpura (90%) followed by arthralgias (70%), fatigue (59%), Raynaud’s phenomenon (48%), lymphadenopathy (31%), peripheral neuropathy (22,3%), vasculitic ulcer (11,3%) and glomerulonephritis (11,3%). Interestingly, almost 50% of SS related CV patients developed lymphoma and displayed high frequency of strong predictors including purpura, low C4 complement (88,6%) and salivary gland enlargement (SGE). Compared to HCV-CV patients, SS-CV patients had higher frequency of sicca manifestations, SGE, fatigue, arthritis, Raynaud’s phenomenon, lymphadenopathy, type II IgMk cryoglobulins and lymphoma.Conclusion:The prevalence of cryoglobulinemia and CV among SS patients is about 10% and 6-7% respectively. SS-CV patients are mainly middle-aged females with purpura as the main clinical manifestation, and up to one half of them may develop lymphoma, which is rarer in HCV-CV. Compared to HCV-CV patients, SS patients with CV have more frequently sicca symptoms, SGE and type II IgMk cryoglobulins.Disclosure of Interests:Ourania Argyropoulou: None declared, Vasileios Pezoulas: None declared, Luca Quartuccio: None declared, Francesco Ferro: None declared, Saviana Gandolfo: None declared, Valentina Donati: None declared, Aliki Venetsanopoulou: None declared, Loukas Chatzis: None declared, Evangelia Zampeli: None declared, Maria Mavromati: None declared, Paraskevi Voulgari: None declared, Clio Mavragani: None declared, Chiara Baldini: None declared, Fotini Skopouli: None declared, Dimitris Fotiadis: None declared, Massimo Galli: None declared, Salvatore De Vita Consultant of: Roche, Human Genome Science, Glaxo Smith Kline and Novartis, Haralampos M. Moutsopoulos: None declared, Andreas Goules: None declared, Athanasios Tzioufas: None declared
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Chatzis L, Pezoulas V, Ferro F, Donati V, Venetsanopoulou A, Zampeli E, Mavromati M, Voulgari P, Mavragani C, Fotiadis D, Skopouli F, De Vita S, Vassilis G, Baldini C, Moutsopoulos HM, Goules A, Tzioufas A. FRI0161 PHENOTYPIC DIFFERENCES BETWEEN SJÖGREN’S SYNDROME PATIENTS WITH LOW AND HIGH-GRADE INFLAMMATION BASED ON SALIVARY GLAND FOCUS SCORE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Sjögren’s syndrome (SS) is characterized by the presence of lymphocytic infiltration around the ductal epithelium of the salivary and lachrymal glands. The periepithelial inflammatory lesions and the enclosed B cell component are responsible for the glandular and extraglandular manifestations of the disease. Previous studies have shown that the severity of inflammation observed within the salivary glands is correlated with the occurrence of extraglandular manifestations. However, in these studies either the number of patients is small or the SS criteria are not well defined. To explore the association between the degree of inflammation within the salivary glands and the phenotype of the disease, large and well characterized cohorts of SS patients is required.Objectives:To compare the phenotypic features of SS patients with low and high degree of inflammation within the minor salivary glands as reflected by the focus score (FS).Methods:From a total cohort of 1723 consecutive SS patients who fulfill the 2016 EULAR/ACR criteria and are followed up in 4 clinical centers ([Universities ofPisa,Athens,Harokopio andIoannina, (PAHI)], those who had performed a lip biopsy and the focused score was available, were classified into low grade (FS<3) or high grade (FS≥3). Glandular (dry mouth, dry eyes, parotid gland enlargement) and extra-glandular manifestations (Raynaud’s phenomenon, arthralgias/myalgias, arthritis, palpable purpura, liver involvement, kidney involvement, lung involvement, neurologic involvement, long standing lymphadenopathy and lymphoma) as well as serologic features (ANA, RF, anti-Ro/SSA, anti-La/SSB) were compared between the 2 groups. Statistical analysis for categorical variables was performed by Fisher exact or chi-square tests and for continuous variables with t test or Mann-Whitney accordingly.Results:Eight hundred and eight minor salivary gland biopsies were available and evaluated based on focus score at the initial evaluation of SS patients, of whom 753 had low grade (FS<3) and 153 high grade (≥3) inflammation. The median disease duration after SS diagnosis was not statistically significant different for the 2 groups (median: 4 years, range: 0-36 years). SS patients with high grade inflammation displayed higher prevalence of salivary gland enlargement (SGE) (40% vs 25%, p=0,0002), long standing lymphadenopathy (22% vs 14%, p=0,02), ANA (97% vs 88%, p=0,0001), anti-La/SSB (52% vs 32%, p<0,0001), RF (61,5% vs 48%, p=0,003), peripheral neuropathy (PN) (5,3% vs 1,5, p=0,01) and of lymphoma (26% vs 8%, p<0,0001, OR=4,142, 95%CI=2,65 to 6,47) compared to those with low grade inflammation.Conclusion:SS patients with FS ≥3 at the initial evaluation, display higher prevalence of lymphoma as well as higher B cell hyperactivity and certain clinical manifestations (SGE, PNS, lymphadenopathy) that constitute risk factors for lymphoma development.Disclosure of Interests:Loukas Chatzis: None declared, Vasileios Pezoulas: None declared, Francesco Ferro: None declared, Valentina Donati: None declared, Aliki Venetsanopoulou: None declared, Evangelia Zampeli: None declared, Maria Mavromati: None declared, Paraskevi Voulgari: None declared, Clio Mavragani: None declared, Dimitris Fotiadis: None declared, Fotini Skopouli: None declared, Salvatore De Vita Consultant of: Roche, Human Genome Science, Glaxo Smith Kline and Novartis, Gorgoulis Vassilis: None declared, Chiara Baldini: None declared, Haralampos M. Moutsopoulos: None declared, Andreas Goules: None declared, Athanasios Tzioufas: None declared
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Mavromati M, Fitsiori A, Janssens JP, Jornayvaz F. MON-235 Mycobacterium Fortuitum Infection Mimicking Sellar Chondrosarcoma in a Non-Immunosuppressed Patient: An Unusual Cause of Hypopituitarism and Oculomotor Nerve Palsy. J Endocr Soc 2020. [PMCID: PMC7207781 DOI: 10.1210/jendso/bvaa046.1430] [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: 11/19/2022] Open
Abstract
Abstract
A 32-year old male patient of central African origin presented with diplopia and left eyelid ptosis. He described a 2-month history of fatigue, weight loss (8 Kg), headaches, diffuse myalgia and night sweats. Clinical examination revealed cavernous sinus syndrome with left eyelid ptosis and weakness of eye adduction. Magnetic resonance imaging of the brain demonstrated a 36 mm mass centered on the left petroclival suture, infiltrating the sella and the pituitary gland, the ipsilateral orbital apex as well as the cavernous sinus bilaterally. The mass showed heterogenous enhancement after gadolinium injection, with elements of central necrosis and was associated with an extensive bone destruction. These radiologic features raised the hypothesis of chondrosarcoma. Chest computed tomography demonstrated multiple lung micro-nodules suspect of metastasis. Laboratory testing of the anterior pituitary function revealed low free-T4 (11 pmol/l, n = 12-22) with normal TSH (0.4 mUI/l, n=0.3-4.2), low total testosterone (1.5 ugr/l, n = 3.3-8.1) with normal LH and FSH and slight hyperprolactinemia (27 ugr/l, n = 4-15). IGF-1, 24-h urinary free cortisol, as well as morning serum cortisol and cortisol after 250 mcg ACTH stimulation test were normal. There was no evidence of diabetes insipidus. Levothyroxine was prescribed. Craniotomy was performed, for left optic nerve decompression and biopsy of the mass. Pathologic examination revealed granulomatous, giganto-cellular and necrotizing inflammation, but no evidence of malignancy. PCR for Mycobacterium tuberculosis complex was negative but Mycobacterium fortuitum was detected in sputum and also confirmed in cerebral biopsy latter. Other causes of granuloma were excluded (brucellosis, cat scratch disease, histoplasmosis, syphilis, coccidioidomycosis, tropical germs etc.). Different causes of immunosuppression (including HIV) were excluded. The patient was treated with amikacin, isoniazid and ciprofloxacin for several months and improved gradually. MRI performed one year later demonstrated significant decrease on the size of the sellar mass (more than 50% of its initial size). Central hypogonadism regressed spontaneously with decrease in tumor size, and normal testosterone levels were achieved at one-year follow-up (7 ugr/l, n = 3.3-8.1). Mycobacterium fortuitum infections of the sella turcica are poorly described in literature in non-immunosuppressed individuals. Although usually not pathogenic, histopathological examination, identification in the CNS lesion and the lungs and response to treatment are convincing evidence of a causal relationship. Differential diagnosis from malignant lesions is challenging and biopsy is necessary in order to establish the cause and offer adequate treatment.
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Mavromati M, Momjian S, Mavrakanas T, de Kalbermatten B, Maitre S, Philippe J. SAT-LB075 Pituitary Function after Surgery for Non-Functioning Macroadenoma: A Tertiary Single Center Retrospective Cohort. J Endocr Soc 2019. [PMCID: PMC6552329 DOI: 10.1210/js.2019-sat-lb075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: Non-functional pituitary adenomas (NFPA) represent the second most frequent cause of pituitary tumors after prolactinomas. For those patients that harbor a macroadenoma, surgery is indicated in case of visual function disturbances, risk for future optic nerve or chiasm compression, and tumor progression during follow-up. Hypopituitarism, in this context, is only a relative indication for surgery and the available data regarding postoperative hormonal outcomes are inconsistent. The aim of this study was to evaluate the impact of transphenoidal surgery on pituitary function. Methods: We retrospectively analyzed data from 350 patients having had pituitary surgery in a tertiary center, from March 2004 to January 2018, and included 137 non-functioning or gonadotroph adenomas, on the basis of histology reports. There were 40.9% males and 59.1% females, with a mean age of 60 years old at the time of surgery. For 89.9% of patients, indication for surgery was based on visual impact or risk. Mean tumor diameter was 24.8 mm. Patients were operated on with a microscopic trans-septal transsphenoidal approach, by the same experienced surgeon. Hormonal evaluation data were retrieved and patients were classified as normal or deficient, by axis. Pituitary magnetic resonance imaging, before and after surgery, was also analyzed, and the average of the three diameters was calculated. Results: In our cohort, new insufficiencies were observed in 5.1% of patients for the GH axis, 9.2% of patients for the ACTH axis, 8.3% for the FSH/LH axis, and 1.6% for the TSH axis. Among patients with hyperprolactinemia prior to surgery, 71.4% normalized prolactin values postoperatively. Recovery of preoperative insufficiencies was observed in 45.5%, 15.4%, 35.7% and 30.4% for the GH, ACTH, FSH/LH and TSH axis respectively. Logistic regression analysis showed that patients with the smallest decrease in tumor size where at higher risk for developing new insufficiencies after surgery (odds ratio: 11.37, 95% CI: 1.13-114,96) and that male sex was associated with a higher chance of postoperative hormonal recovery (odds ratio: 2.74, 95% CI: 1.11-6.78). Conclusion: Pituitary insufficiency is restored in more than one third of patients after surgery for NFPAs, whereas, new deficiencies appear in less than 10% of patients with previously normal function, with ACTH axis being the most fragile and TSH axis being the most resistant to damage. Poor postoperative results, in terms of volume decrease, are associated with higher risk of new deficiencies. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.
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Affiliation(s)
| | - Shahan Momjian
- Hopitaux Universitaires de Geneve, Geneva, , Switzerland
| | | | | | - Sophie Maitre
- Hopitaux Universitaires de Geneve, Geneva, , Switzerland
| | - Jacques Philippe
- Div of Endo, Diabetes and Nutrition, Hopitaux Universitaires de Geneve, Geneva, , Switzerland
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Mavromati M. [News in endocrinology : contemporary treatment of hypothyroidism]. Rev Med Suisse 2019; 15:42-45. [PMID: 30629367] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Hypothyroidism is the most common hormonal disorder, especially in the female population. Advances in clinical research have allowed more precision in the management of this entity, particularly its subclinical form in the elderly and pregnant women.
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Affiliation(s)
- Maria Mavromati
- Service d'endocrinologie, diabétologie, nutrition et hypertension, Département des spécialités de médecine, HUG, 1211 Genève 14
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Jaafar J, Mavromati M, Philippe J. [Endocrinopathies induced by immune checkpoint inhibitors]. Rev Med Suisse 2018; 14:34-38. [PMID: 29337446] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Immune checkpoint Inhibitors are new immunomodulatory treatments that have proven their anti-tumor efficacy in several advanced cancers. Nevertheless, their use has paved the way for multiple immunological adverse effects that affect many systems and organs including endocrine glands such as the pituitary, thyroid, adrenal and pancreas. Hypophysitis is the most common complication of anti-CTLA-4 monoclonal antibodies, while anti-PD-1 and anti-PD-L1 antibodies cause more thyroid complications. Adrenal insufficiency and type 1 diabetes are relatively less common. Endocrinologists and primary care physicians as well as oncologists are likely to deal with these complications and as such, knowledge of these drugs and their side effects is essential for good practice.
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Affiliation(s)
- Jaafar Jaafar
- Service d'endocrinologie, diabétologie, hypertension et nutrition, HUG, 1211 Genève 14
| | - Maria Mavromati
- Service d'endocrinologie, diabétologie, hypertension et nutrition, HUG, 1211 Genève 14
| | - Jacques Philippe
- Service d'endocrinologie, diabétologie, hypertension et nutrition, HUG, 1211 Genève 14
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Mavromati M, Kuhn E, Agostini H, Brailly-Tabard S, Massart C, Piketty ML, Arnoux A, Young J, Souberbielle JC, Chanson P. Classification of Patients With GH Disorders May Vary According to the IGF-I Assay. J Clin Endocrinol Metab 2017; 102:2844-2852. [PMID: 28505364 DOI: 10.1210/jc.2017-00202] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 05/08/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT Insulinlike growth factor I (IGF-I) measurement is essential for the diagnosis and management of growth hormone (GH) disorders. However, patient classification may vary substantially according to the assay technique. OBJECTIVE We compared individual patient data and classifications obtained with six different IGF-I assay kits in a group of patients with various GH disorders. DESIGN In this cross-sectional study, we measured IGF-I with six immunoassays in 102 patients with active or treated acromegaly or GH deficiency. IGF-I normative data previously established for the same six assay kits were used to classify the patients (high, low, or normal IGF-I levels), using both raw data and standard deviation scores (SDSs). Pairwise concordance between assays was assessed with Bland-Altman plots and with the percentage of observed agreement and the weighted κ coefficient for categorized IGF-I SDS. RESULTS We observed marked variability both across each individual's IGF-I raw data and across IGF-I SDS values obtained with each of the six immunoassays. Pairwise concordance between assay values, as assessed with the weighted κ coefficient, ranged from 0.50 (moderate) to 0.81 (excellent). CONCLUSION Even when using normative data obtained in the same large population of healthy subjects and when using calculated IGF-I SDSs, agreement among IGF-I assay methods is only moderate to good. Differences in assay performance must be taken into account when evaluating and monitoring patients with GH disorders. This argues for the use of the same IGF-I assay for a given patient throughout follow-up.
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Affiliation(s)
- Maria Mavromati
- Service d'Endocrinologie et des Maladies de la Reproduction and Centre de Référence des Maladies Rares de l'Hypophyse, F94275 Le Kremlin-Bicêtre, France
| | - Emmanuelle Kuhn
- Service d'Endocrinologie et des Maladies de la Reproduction and Centre de Référence des Maladies Rares de l'Hypophyse, F94275 Le Kremlin-Bicêtre, France
- Inserm 1185, Fac Med Paris Sud, Université Paris-Saclay, F94276 Le Kremlin-Bicêtre, France
| | - Hélène Agostini
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Unité de Recherche Clinique, F94275 Le Kremlin-Bicêtre, France
| | - Sylvie Brailly-Tabard
- Inserm 1185, Fac Med Paris Sud, Université Paris-Saclay, F94276 Le Kremlin-Bicêtre, France
- Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, F94275 Le Kremlin-Bicêtre, France
| | - Catherine Massart
- Laboratoire d'Hormonologie, Centre Hospitalier Universitaire de Rennes, Centre d'Investigation Clinique Plurithématique, Inserm 1414, Hôpital Pontchaillou, F29000 Rennes, France
| | - Marie-Liesse Piketty
- Service des Explorations Fonctionnelles, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, F75015 Paris, France
| | - Armelle Arnoux
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Unité de Recherche Clinique, F94275 Le Kremlin-Bicêtre, France
| | - Jacques Young
- Service d'Endocrinologie et des Maladies de la Reproduction and Centre de Référence des Maladies Rares de l'Hypophyse, F94275 Le Kremlin-Bicêtre, France
- Inserm 1185, Fac Med Paris Sud, Université Paris-Saclay, F94276 Le Kremlin-Bicêtre, France
| | - Jean-Claude Souberbielle
- Service des Explorations Fonctionnelles, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, F75015 Paris, France
| | - Philippe Chanson
- Service d'Endocrinologie et des Maladies de la Reproduction and Centre de Référence des Maladies Rares de l'Hypophyse, F94275 Le Kremlin-Bicêtre, France
- Inserm 1185, Fac Med Paris Sud, Université Paris-Saclay, F94276 Le Kremlin-Bicêtre, France
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Mavromati M, Philippe J. [Endocrinology, what's new in 2016]. Rev Med Suisse 2017; 13:45-48. [PMID: 28703535] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The European Society of Endocrinology has published this year a series of guidelines for hypoparathyroidism, the management of adrenal incidentalomas as well as for the long-term follow-up of patients operated on for a phaeochromocytoma/paraganglioma (PPGL). For hypoparathyroidism, guidelines insist on screening for chronic complications and monitoring treatment with calcium and vitamin D; the use of recombinant PTH may provide new opportunities for the future. Concerning adrenal incidentalomas, the panel of the guidelines primarily recommends non contrast CT for the evaluation of the risk of malignancy. Patients operated on for a PPGL, should be offered an individualized follow-up plan based on assessment of their risk of tumor recurrence.
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Affiliation(s)
- Maria Mavromati
- Service d'endocrinologie, diabétologie, nutrition et hypertension, Département des spécialités de médecine, HUG, 1211 Genève 14
| | - Jacques Philippe
- Service d'endocrinologie, diabétologie, nutrition et hypertension, Département des spécialités de médecine, HUG, 1211 Genève 14
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Chanson P, Arnoux A, Mavromati M, Brailly-Tabard S, Massart C, Young J, Piketty ML, Souberbielle JC. Reference Values for IGF-I Serum Concentrations: Comparison of Six Immunoassays. J Clin Endocrinol Metab 2016; 101:3450-8. [PMID: 27167056 PMCID: PMC5054194 DOI: 10.1210/jc.2016-1257] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT Measurement of IGF-I is essential for diagnosis and management of patients with disorders affecting the somatotropic axis. However, even when IGF-I kit manufacturers follow recent consensus guidelines, different kits can give very different results for a given sample. OBJECTIVES We sought to establish normative data for six IGF-I assay kits based on a large random sample of the French general adult population. SUBJECTS AND METHODS In a cross-sectional multicenter cohort study, we measured IGF-I in 911 healthy adults (18-90 years) with six immunoassays (iSYS, LIAISON XL, IMMULITE, IGFI RIACT, Mediagnost ELISA, and Mediagnost RIA). Pairwise concordance between assays was assessed with Bland-Altman plots for both IGF-1 raw data and standard deviation scores (SDS), as well as with the percentage of observed agreement and the weighted Kappa coefficient for categorized IGF-I SDS. RESULTS Normative data included the range of values (2.5-97.5 percentiles) given by the six IGF-I assays according to age group and sex. A formula for SDS calculation is provided. Although the lower limits of the reference intervals of the six assays were similar, the upper limits varied markedly. Pairwise concordances were moderate to good (0.38-0.70). CONCLUSION Despite being obtained in the same healthy population, the reference intervals of the six commercial IGF-1 assay kits showed noteworthy differences. Agreement between methods was moderate to good.
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Affiliation(s)
- Philippe Chanson
- Service d'Endocrinologie et des Maladies de la Reproduction and Centre de Référence des Maladies Endocriniennes Rares de la Croissance (P.C., M.M., J.Y.), Unité de Recherche Clinique (A.A.), and Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie (S.B.T.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, F94275, France; Inserm 1185 (P.C., S.B.T., J.Y.), Fac Med Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, F-94276, France; and Laboratoire d'Hormonologie (C.M.), Centre Hospitalier Universitaire de Rennes, Centre d'Investigation Clinique Plurithématique, Inserm 1414, Hôpital Pontchaillou, Rennes, F29000, France; Service des Explorations Fonctionnelles (M-L.P., J.-C.S.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, F75015, France
| | - Armelle Arnoux
- Service d'Endocrinologie et des Maladies de la Reproduction and Centre de Référence des Maladies Endocriniennes Rares de la Croissance (P.C., M.M., J.Y.), Unité de Recherche Clinique (A.A.), and Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie (S.B.T.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, F94275, France; Inserm 1185 (P.C., S.B.T., J.Y.), Fac Med Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, F-94276, France; and Laboratoire d'Hormonologie (C.M.), Centre Hospitalier Universitaire de Rennes, Centre d'Investigation Clinique Plurithématique, Inserm 1414, Hôpital Pontchaillou, Rennes, F29000, France; Service des Explorations Fonctionnelles (M-L.P., J.-C.S.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, F75015, France
| | - Maria Mavromati
- Service d'Endocrinologie et des Maladies de la Reproduction and Centre de Référence des Maladies Endocriniennes Rares de la Croissance (P.C., M.M., J.Y.), Unité de Recherche Clinique (A.A.), and Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie (S.B.T.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, F94275, France; Inserm 1185 (P.C., S.B.T., J.Y.), Fac Med Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, F-94276, France; and Laboratoire d'Hormonologie (C.M.), Centre Hospitalier Universitaire de Rennes, Centre d'Investigation Clinique Plurithématique, Inserm 1414, Hôpital Pontchaillou, Rennes, F29000, France; Service des Explorations Fonctionnelles (M-L.P., J.-C.S.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, F75015, France
| | - Sylvie Brailly-Tabard
- Service d'Endocrinologie et des Maladies de la Reproduction and Centre de Référence des Maladies Endocriniennes Rares de la Croissance (P.C., M.M., J.Y.), Unité de Recherche Clinique (A.A.), and Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie (S.B.T.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, F94275, France; Inserm 1185 (P.C., S.B.T., J.Y.), Fac Med Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, F-94276, France; and Laboratoire d'Hormonologie (C.M.), Centre Hospitalier Universitaire de Rennes, Centre d'Investigation Clinique Plurithématique, Inserm 1414, Hôpital Pontchaillou, Rennes, F29000, France; Service des Explorations Fonctionnelles (M-L.P., J.-C.S.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, F75015, France
| | - Catherine Massart
- Service d'Endocrinologie et des Maladies de la Reproduction and Centre de Référence des Maladies Endocriniennes Rares de la Croissance (P.C., M.M., J.Y.), Unité de Recherche Clinique (A.A.), and Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie (S.B.T.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, F94275, France; Inserm 1185 (P.C., S.B.T., J.Y.), Fac Med Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, F-94276, France; and Laboratoire d'Hormonologie (C.M.), Centre Hospitalier Universitaire de Rennes, Centre d'Investigation Clinique Plurithématique, Inserm 1414, Hôpital Pontchaillou, Rennes, F29000, France; Service des Explorations Fonctionnelles (M-L.P., J.-C.S.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, F75015, France
| | - Jacques Young
- Service d'Endocrinologie et des Maladies de la Reproduction and Centre de Référence des Maladies Endocriniennes Rares de la Croissance (P.C., M.M., J.Y.), Unité de Recherche Clinique (A.A.), and Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie (S.B.T.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, F94275, France; Inserm 1185 (P.C., S.B.T., J.Y.), Fac Med Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, F-94276, France; and Laboratoire d'Hormonologie (C.M.), Centre Hospitalier Universitaire de Rennes, Centre d'Investigation Clinique Plurithématique, Inserm 1414, Hôpital Pontchaillou, Rennes, F29000, France; Service des Explorations Fonctionnelles (M-L.P., J.-C.S.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, F75015, France
| | - Marie-Liesse Piketty
- Service d'Endocrinologie et des Maladies de la Reproduction and Centre de Référence des Maladies Endocriniennes Rares de la Croissance (P.C., M.M., J.Y.), Unité de Recherche Clinique (A.A.), and Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie (S.B.T.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, F94275, France; Inserm 1185 (P.C., S.B.T., J.Y.), Fac Med Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, F-94276, France; and Laboratoire d'Hormonologie (C.M.), Centre Hospitalier Universitaire de Rennes, Centre d'Investigation Clinique Plurithématique, Inserm 1414, Hôpital Pontchaillou, Rennes, F29000, France; Service des Explorations Fonctionnelles (M-L.P., J.-C.S.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, F75015, France
| | - Jean-Claude Souberbielle
- Service d'Endocrinologie et des Maladies de la Reproduction and Centre de Référence des Maladies Endocriniennes Rares de la Croissance (P.C., M.M., J.Y.), Unité de Recherche Clinique (A.A.), and Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie (S.B.T.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, F94275, France; Inserm 1185 (P.C., S.B.T., J.Y.), Fac Med Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, F-94276, France; and Laboratoire d'Hormonologie (C.M.), Centre Hospitalier Universitaire de Rennes, Centre d'Investigation Clinique Plurithématique, Inserm 1414, Hôpital Pontchaillou, Rennes, F29000, France; Service des Explorations Fonctionnelles (M-L.P., J.-C.S.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, F75015, France
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Mavromati M, Amsallem M, Jublanc C, Bruckert E, Leenhardt L, Girerd X. Questioning the pathogenic role of the pTyr791Phe mutation of the RET proto-oncogene: Insight from a case report. Ann Endocrinol (Paris) 2015; 76:690-694. [PMID: 26639185 DOI: 10.1016/j.ando.2015.10.007] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
UNLABELLED The pTyr791Phe mutation of the RET proto-oncogene is associated with a low penetrance of medullar thyroid carcinoma (MTC). Thus, there is a lack in guidelines on management of these patients presenting without a thyroid disease. CLINICAL CASE A 27-year-old woman presented with a history of severe hypertension, paroxysmal tachycardia, diaphoresis and headaches. Twenty-four-hour urinary norepinephrine and normetanephrine levels were exclusively up to 20 times the normal limit. CT-scan and MRI found a 35-mm diameter right adrenal tumor, highly intense in T2- and hypo-intense in T1-weighted image, enhanced after gadolinium injection. After alpha-adrenergic blocker treatment, a surgical resection of the tumor was performed; this latter proved to be a pheochromocytoma. Genetic screening only revealed a germline pTyr791Phe mutation of the RET proto-oncogene. However, the patient showed no evidence of MEN2: basal calcitonin was normal and calcium infusion test was negative. Thyroid ultrasound revealed a TIRADS 3 nodule with benign cytology. Total thyroidectomy was suggested but withheld due to the patient's refusal and a close follow-up was decided. CONCLUSION This rare case of pTyr791Phe mutation-related pheochromocytoma without evidence of MTC questions the indication for prophylactic thyroidectomy in mutation carriers, as recent data challenges its pathogenicity.
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Affiliation(s)
- Maria Mavromati
- Department of Endocrinology and Metabolic Diseases, La Pitié-Salpêtrière Hospital, boulevard de l'Hôpital, 75013 Paris, France; Department of Endocrinology and Diabetes, University Hospital of Geneva, Geneva, Switzerland
| | - Myriam Amsallem
- Department of Endocrinology and Metabolic Diseases, La Pitié-Salpêtrière Hospital, boulevard de l'Hôpital, 75013 Paris, France.
| | - Christel Jublanc
- Department of Endocrinology and Metabolic Diseases, La Pitié-Salpêtrière Hospital, boulevard de l'Hôpital, 75013 Paris, France
| | - Eric Bruckert
- Department of Endocrinology and Metabolic Diseases, La Pitié-Salpêtrière Hospital, boulevard de l'Hôpital, 75013 Paris, France
| | - Laurence Leenhardt
- Department of Nuclear Medicine, La Pitié-Salpêtrière Hospital, boulevard de l'Hôpital, 75013 Paris, France
| | - Xavier Girerd
- Department of Endocrinology and Metabolic Diseases, La Pitié-Salpêtrière Hospital, boulevard de l'Hôpital, 75013 Paris, France
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Lidsky D, Malacarne S, Mavromati M, Köhler Ballan B, Philippe J. [News in endocrinology in 2013]. Rev Med Suisse 2014; 10:36-40. [PMID: 24558895] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Transsphenoidal surgery is the treatment of choice for acromegaly due to pituitary adenoma but it is not always possible to reduce or control tumor growth, inhibit GH hypersecretion and normalize IGF-I. The first-line drug treatment in 2013 remains the somatostatin analogues. In 2012 and 2013 have been published several publications presenting the prognosis of well-differentiated thyroid cancers of intermediate risk. Indeed, the dose of radioactive iodine administered to patients with "favorable" histology in this risk category should be reduced without change in prognosis. Elastograhy could, in combination with conventional ultrasound features, allow a better selection of thyroid nodules that need a cytology, with, however, still limitations in the detection of follicular carcinomas.
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Affiliation(s)
- Deborah Lidsky
- Service de Médecine Interne Générale, Département de Médicine Interne Générale, Réhabilitation et Gériatrie
| | - Sarah Malacarne
- Service D'endocrinologie, Diabétologie, Nutrition et Hypertension, Département des Spécialités de Médicine, HUG, Genève
| | - Maria Mavromati
- Service D'endocrinologie, Diabétologie, Nutrition et Hypertension, Département des Spécialités de Médicine, HUG, Genève
| | - Bettina Köhler Ballan
- Service D'endocrinologie, Diabétologie, Nutrition et Hypertension, Département des Spécialités de Médicine, HUG, Genève
| | - Jacques Philippe
- Service D'endocrinologie, Diabétologie, Nutrition et Hypertension, Département des Spécialités de Médicine, HUG, Genève
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Tsaoussoglou M, Lianou L, Maragozidis P, Hatzinikolaou S, Mavromati M, Orologas N, Panaghiotopoulou-Gartagani P, Rassidakis G, Balatsos NAA, Chrousos G, Kaditis AG. Cysteinyl leukotriene receptors in tonsillar B- and T-lymphocytes from children with obstructive sleep apnea. Sleep Med 2012; 13:879-85. [PMID: 22647498 DOI: 10.1016/j.sleep.2012.03.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 03/05/2012] [Accepted: 03/12/2012] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Cysteinyl leukotrienes have been implicated in the pathogenesis of adenotonsillar hypertrophy in children with obstructive sleep apnea (OSA). This study aimed to quantify the expression of cysteinyl leukotriene receptors (CysLT(1), CysLT(2)) by tonsillar lymphocyte subpopulations from children with OSA and to make comparisons to lymphocyte subpopulations from control subjects with recurrent tonsillitis (RT). METHODS Tonsillar tissue from children with OSA or RT was studied for CysLT(1) and CysLT(2) expression by RT-PCR, flow cytometry (FC), and immunofluorescence. RESULTS Ten children with OSA and 10 control subjects were recruited. In OSA participants, CysLT(1)+ fraction of small-size CD19+ B-lymphocytes was similar to the CysLT(1)+ CD3+ T-lymphocytes fraction (FC: 36.5 [16.5-55.4] vs. 14 [2.8-22.1]) (p>0.05) and higher than the CysLT(1)+ moderate/large-size CD19+ B-lymphocytes fraction (6.6 [1.5-14.4]) (p<0.01). Similar trends were recognized for CysLT(2). CysLT(1) and CysLT(2) immunoreactivity was detected by immunofluorescence in the tonsillar mantle zones (small B-lymphocytes) and the extrafollicular areas (T-lymphocytes). Compared to subjects with RT, children with OSA had significantly higher expression of CysLT(1) in small-size CD19+ B-lymphocytes (FC) and in CD3+ T-lymphocytes (RT-PCR and FC) (p<0.05). CONCLUSIONS Increased expression of leukotriene receptors by immunologically active tonsillar areas in children with OSA is a potential therapeutic target for pediatric sleep apnea.
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Affiliation(s)
- Marina Tsaoussoglou
- Pediatric Pulmonology Unit, Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens 115.27, Greece
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Fakas S, Makri A, Mavromati M, Tselepi M, Aggelis G. Fatty acid composition in lipid fractions lengthwise the mycelium of Mortierella isabellina and lipid production by solid state fermentation. Bioresour Technol 2009; 100:6118-6120. [PMID: 19574039 DOI: 10.1016/j.biortech.2009.06.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 06/02/2009] [Accepted: 06/04/2009] [Indexed: 05/28/2023]
Abstract
This paper investigates the correlation between mycelial age and fatty acid biosynthesis. The correlation was investigated by analyzing the lipid composition lengthwise the mycelium of the oleaginous fungus Mortierella isabellina, a potential producer of gamma-linolenic acid (GLA). Young mycelia were rich in polar lipids (glycolipids plus sphingolipids and phospholipids), while neutral lipid content increased in aged mycelia. In young mycelia, each polar lipid fraction contained almost 40% (w/w) polyunsaturated fatty acids (PUFAs), but this content decreased to less than 30% (w/w) in aged mycelia. On the other hand, PUFA content in neutral lipids fluctuated slightly with age. These results indicate that PUFA biosynthesis is favored in young, fast growing mycelia, while it decreases significantly in aged mycelia. This trend was also observed when we grew M. isabellina on pear pomace, an agro-industrial waste. Pear pomace cultures yielded significant amounts of lipid, which reached 12% (w/w) in dry fermented mass. The produced lipid was rich in GLA and the maximum GLA content in dry fermented mass was 2.9 mg/g.
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Affiliation(s)
- Stylianos Fakas
- Unit of Microbiology, Division of Genetics, Cell and Development Biology, Department of Biology, University of Patras, Patras, 265 04-GR, Greece
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Ferreiro-Neira I, Calaza M, Alonso-Perez E, Marchini M, Scorza R, Sebastiani GD, Blanco FJ, Rego I, Pullmann R, Pullmann R, Kallenberg CG, Bijl M, Skopouli FN, Mavromati M, Migliaresi S, Barizzone N, Ruzickova S, Dostal C, Schmidt RE, Witte T, Papasteriades C, Kappou-Rigatou I, Endreffy E, Kovacs A, Ordi-Ros J, Balada E, Carreira P, Gomez-Reino JJ, Gonzalez A. Opposed independent effects and epistasis in the complex association of IRF5 to SLE. Genes Immun 2007; 8:429-38. [PMID: 17568788 DOI: 10.1038/sj.gene.6364407] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [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: 01/25/2023]
Abstract
Genetic variation in the interferon regulatory factor 5 (IRF5) gene affects systemic lupus erythematosus (SLE) susceptibility. However, association is complex and incompletely defined. We obtained fourteen European sample collections with a total of 1383 SLE patients and 1614 controls to better define the role of the different IRF5 variants. Eleven polymorphisms were studied, including nine tag single nucleotide polymorphisms (SNPs) and two extra functional polymorphisms. Two tag SNPs showed independent and opposed associations: susceptibility (rs10488631, P<10(-17)) and protection (rs729302, P<10(-6)). Haplotype analyses showed that the susceptibility haplotype, identified by the minor allele of rs10488631, can be due to epistasis between three IRF5 functional polymorphisms. These polymorphisms determine increased mRNA expression, a splice variant with a different exon 1 and a longer proline-rich region in exon 6. This result is striking as none of the three polymorphisms had an independent effect on their own. Protection was independent of these polymorphisms and seemed to reside in the 5' side of the gene. In conclusion, our results help to understand the role of the IRF5 locus in SLE susceptibility by clearly separating protection from susceptibility as caused by independent polymorphisms. In addition, we have found evidence for epistasis between known functional polymorphisms for the susceptibility effect.
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Affiliation(s)
- I Ferreiro-Neira
- Laboratorio Investigacion 2 and Rheumatology Unit, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain
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Ferreiros-Vidal I, D'Alfonso S, Papasteriades C, Skopouli FN, Marchini M, Scorza R, Migliaresi S, Sebastiani GD, Endreffy E, Mavromati M, Kappou-Rigatou I, Ruzickova S, Dostal C, Schmidt RE, Witte T, Gomez-Reino JJ, Gonzalez A. Bias in association studies of systemic lupus erythematosus susceptibility due to geographical variation in the frequency of a programmed cell death 1 polymorphism across Europe. Genes Immun 2007; 8:138-46. [PMID: 17230193 DOI: 10.1038/sj.gene.6364370] [Citation(s) in RCA: 29] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We obtained eight collections of DNA samples from ethnically matched systemic lupus erythematosus (SLE) patients and controls from five European countries totaling 783 patients and 1210 controls. A highly significant cline in the frequency of the PD1.3 A allele was found among controls but not among SLE patients. The frequency of the PD1.3 A allele increased from the Northeast to the Southwest of Europe. The cline was clearly apparent (P=1.2 x 10(-6)) when data from controls of other five SLE susceptibility studies were included in the analysis. This variation has severely biased SLE association studies owing to the lack of parallel changes in SLE patients. As a consequence, the PD1.3 A allele was more common in SLE patients than in controls in the Northeast and Center of Europe, similar to controls in Southeast Europe, and less frequent than in the controls in the Southwest of the Continent. This dissociation in allele frequencies between SLE patients and controls in different subpopulations indicated that programmed cell death 1 variation and disease susceptibility are not independent but the type of relationship is currently unclear. As allele frequency clines are common in other polymorphisms their impact in genetic epidemiology studies should be carefully considered.
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Affiliation(s)
- I Ferreiros-Vidal
- Laboratorio de Investigacion 2, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain
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