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Haissaguerre M, Lamartina L, Caron P. Key data from the 2023 European Thyroid Association annual meeting: De-escalation strategy in diagnosis and the treatment of differentiated thyroid carcinoma: Update after the 2023 ETA congress. Ann Endocrinol (Paris) 2024; 85:155-157. [PMID: 38336563 DOI: 10.1016/j.ando.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/08/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Magalie Haissaguerre
- Service d'endocrinologie, diabétologie et nutrition, unité d'endocrinologie et oncologie endocrinienne, GH Sud - hôpital Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Livia Lamartina
- Service de cancérologie endocrinienne, institut Gustave-Roussy, Villejuif, France
| | - Philippe Caron
- Service d'endocrinologie et maladies métaboliques, hôpital Larrey, CHU de Toulouse, Toulouse, France.
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Crouzeix G, Caron P. Key data from the 2023 European Thyroid Association annual meeting: Management of thyroid nodules. Ann Endocrinol (Paris) 2024; 85:152-154. [PMID: 38311540 DOI: 10.1016/j.ando.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 01/08/2024] [Indexed: 02/06/2024]
Affiliation(s)
- Geneviève Crouzeix
- Department of Endocrinology and Metabolic Diseases, Vascular Unit, Brest University Hospital, Brest, France
| | - Philippe Caron
- Department of Endocrinology and Metabolic Diseases, CHU Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France.
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Ladsous M, Caron P. Key data from the 2023 European Thyroid Association congress: Breakthrough advances in the treatment of Graves' orbitopathy. Ann Endocrinol (Paris) 2024; 85:150-151. [PMID: 38307804 DOI: 10.1016/j.ando.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 02/04/2024]
Affiliation(s)
- Miriam Ladsous
- Department of Endocrinology, Diabetology and Metabolism, Huriez Hospital, Lille University Hospital, Lille, France
| | - Philippe Caron
- Department of Endocrinology and Metabolic diseases, Pôle Cardio-Vasculaire et Métabolique, CHU Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France.
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Caron P. The key data from the 2023 European Thyroid Association Annual Meeting: Treatment of hyperthyroidism and subclinical hypothyroidism during pregnancy. Ann Endocrinol (Paris) 2024; 85:158-160. [PMID: 38092571 DOI: 10.1016/j.ando.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/20/2023] [Indexed: 04/19/2024]
Affiliation(s)
- Philippe Caron
- Department of Endocrinology, Metabolic Diseases and Nutrition, Cardiovascular and Metabolic Unit, CHU Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France.
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Grunenwald S, Caron P. Key data from the 2023 European Thyroid Association annual meeting: Thyroid hormone resistance syndromes. Ann Endocrinol (Paris) 2024; 85:161-162. [PMID: 38365508 DOI: 10.1016/j.ando.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 02/18/2024]
Affiliation(s)
- Solange Grunenwald
- Department of Endocrinology, Metabolic Diseases and Nutrition, Cardiovascular and Metabolic Unit, CHU Larrey, Toulouse, France
| | - Philippe Caron
- Department of Endocrinology, Metabolic Diseases and Nutrition, Cardiovascular and Metabolic Unit, CHU Larrey, Toulouse, France.
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Caron P, Imbert P, Dekeister C, Grunenwald S. Concurrent pretibial myxedema and thyroid eye disease following mRNA COVID-19 vaccine in a patient with history of Graves' disease. Ann Endocrinol (Paris) 2024; 85:100-103. [PMID: 37866430 DOI: 10.1016/j.ando.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023]
Abstract
A 70-year-old female had a history of thyroid surgery for benign nodules and Graves' disease. Following mRNA COVID-19 vaccination, she presented Graves' orbitopathy and pretibial myxedema. Symptoms of thyroid eye disease and thyroid dermopathy improved after 500-mg methylprednisolone infusions.
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Affiliation(s)
- Philippe Caron
- Consultation multidisciplinaire des orbitopathies, Service d'endocrinologie et maladies métaboliques, pôle cardiovasculaire et métabolique, CHU de Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France.
| | - Philippe Imbert
- Consultation multidisciplinaire des orbitopathies, Service d'endocrinologie et maladies métaboliques, pôle cardiovasculaire et métabolique, CHU de Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France
| | - Céline Dekeister
- Consultation multidisciplinaire des orbitopathies, Service d'endocrinologie et maladies métaboliques, pôle cardiovasculaire et métabolique, CHU de Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France
| | - Solange Grunenwald
- Consultation multidisciplinaire des orbitopathies, Service d'endocrinologie et maladies métaboliques, pôle cardiovasculaire et métabolique, CHU de Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France
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Haissaguerre M, Caron P. Key data from the 2022 European Thyroid Association Congress. Role of molecular biology in aggressive thyroid cancer. Ann Endocrinol (Paris) 2023; 84:746-748. [PMID: 37277063 DOI: 10.1016/j.ando.2023.05.003] [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] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/07/2023]
Affiliation(s)
- Magalie Haissaguerre
- Department of Endocrinology and Endocrine Oncology, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
| | - Philippe Caron
- Department of Endocrinology, Metabolic Diseases and Nutrition, Cardiovascular and Metabolic Unit, CHU of Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France.
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Crouzeix G, Caron P. Key data from the 2022 European Thyroid Association congress: Clinical thyroidology. Ann Endocrinol (Paris) 2023; 84:754-755. [PMID: 37285957 DOI: 10.1016/j.ando.2023.05.006] [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] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/09/2023]
Affiliation(s)
- Geneviève Crouzeix
- Department of Endocrinology and Metabolic Diseases, Vascular Unit, Brest University Hospital, Brest, France
| | - Philippe Caron
- Department of Endocrinology and Metabolic Diseases, Cardiovascular and Metabolic Unit, CHU Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France.
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Grunenwald S, Caron P. Key data from the 2022 European Thyroid Association congress: Management of thyroid cancer with good prognosis. Ann Endocrinol (Paris) 2023; 84:749-750. [PMID: 37285955 DOI: 10.1016/j.ando.2023.05.004] [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] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/09/2023]
Affiliation(s)
- Solange Grunenwald
- Department of Endocrinology and Metabolic Diseases, Cardiovascular and Metabolic Unit, CHU Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France
| | - Philippe Caron
- Department of Endocrinology and Metabolic Diseases, Cardiovascular and Metabolic Unit, CHU Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France.
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Abeillon-du Payrat J, Caron P. The key data from the 2022 European Thyroid Association congress: Toward personalized treatment of Graves' orbitopathy. Ann Endocrinol (Paris) 2023; 84:756-757. [PMID: 37285956 DOI: 10.1016/j.ando.2023.05.007] [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] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/22/2023] [Indexed: 06/09/2023]
Affiliation(s)
| | - Philippe Caron
- Department of Endocrinology and Metabolic Diseases, Cardiovascular and Metabolic Unit, CHU Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France.
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Caron P. Key data from the 2022 European Thyroid Association congress: Treatment of primary hypothyroidism: Levothyroxine alone or a combination of levothyroxine and liothyronine? Ann Endocrinol (Paris) 2023; 84:751-753. [PMID: 37285954 DOI: 10.1016/j.ando.2023.05.005] [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] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/09/2023]
Affiliation(s)
- Philippe Caron
- Department of Endocrinology and Metabolic Diseases, Cardiovascular and Metabolic Unit, CHU Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France.
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Terzolo M, Fassnacht M, Perotti P, Libé R, Kastelan D, Lacroix A, Arlt W, Haak HR, Loli P, Decoudier B, Lasolle H, Quinkler M, Haissaguerre M, Chabre O, Caron P, Stigliano A, Giordano R, Zatelli MC, Bancos I, Fragoso MCBV, Canu L, Luconi M, Puglisi S, Basile V, Reimondo G, Kroiss M, Megerle F, Hahner S, Kimpel O, Dusek T, Nölting S, Bourdeau I, Chortis V, Ettaieb MH, Cosentini D, Grisanti S, Baudin E, Berchialla P, Bovis F, Sormani MP, Bruzzi P, Beuschlein F, Bertherat J, Berruti A. Adjuvant mitotane versus surveillance in low-grade, localised adrenocortical carcinoma (ADIUVO): an international, multicentre, open-label, randomised, phase 3 trial and observational study. Lancet Diabetes Endocrinol 2023; 11:720-730. [PMID: 37619579 PMCID: PMC10522778 DOI: 10.1016/s2213-8587(23)00193-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/31/2023] [Accepted: 06/26/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Adjuvant treatment with mitotane is commonly used after resection of adrenocortical carcinoma; however, treatment remains controversial, particularly if risk of recurrence is not high. We aimed to assess the efficacy and safety of adjuvant mitotane compared with surveillance alone following complete tumour resection in patients with adrenocortical carcinoma considered to be at low to intermediate risk of recurrence. METHODS ADIUVO was a multicentre, open-label, parallel, randomised, phase 3 trial done in 23 centres across seven countries. Patients aged 18 years or older with adrenocortical carcinoma and low to intermediate risk of recurrence (R0, stage I-III, and Ki67 ≤10%) were randomly assigned to adjuvant oral mitotane two or three times daily (the dose was adjusted by the local investigator with the target of reaching and maintaining plasma mitotane concentrations of 14-20 mg/L) for 2 years or surveillance alone. All consecutive patients at 14 study centres fulfilling the eligibility criteria of the ADIUVO trial who refused randomisation and agreed on data collection via the European Network for the Study of Adrenal Tumors adrenocortical carcinoma registry were included prospectively in the ADIUVO Observational study. The primary endpoint was recurrence-free survival, defined as the time from randomisation to the first radiological evidence of recurrence or death from any cause (whichever occurred first), assessed in all randomly assigned patients by intention to treat. Overall survival, defined as time from the date of randomisation to the date of death from any cause, was a secondary endpoint analysed by intention to treat in all randomly assigned patients. Safety was assessed in all patients who adhered to the assigned regimen, which was defined by taking at least one tablet of mitotane in the mitotane group and no mitotane at all in the surveillance group. The ADIUVO trial is registered with ClinicalTrials.gov, NCT00777244, and is now complete. FINDINGS Between Oct 23, 2008, and Dec 27, 2018, 45 patients were randomly assigned to mitotane and 46 to surveillance alone. Because the study was discontinued prematurely, 5-year recurrence-free and overall survival are reported instead of recurrence-free and overall survival as defined in the protocol. 5-year recurrence-free survival was 79% (95% CI 67-94) in the mitotane group and 75% (63-90) in the surveillance group (hazard ratio 0·74 [95% CI 0·30-1·85]). Two people in the mitotane group and five people in the surveillance group died, and 5-year overall survival was not significantly different (95% [95% CI 89-100] in the mitotane group and 86% [74-100] in the surveillance group). All 42 patients who received mitotane had adverse events, and eight (19%) discontinued treatment. There were no grade 4 adverse events or treatment-related deaths. INTERPRETATION Adjuvant mitotane might not be indicated in patients with low-grade, localised adrenocortical carcinoma considering the relatively good prognosis of these patients, and no significant improvement in recurrence-free survival and treatment-associated toxicity in the mitotane group. However, the study was discontinued prematurely due to slow recruitment and cannot rule out an efficacy of treatment. FUNDING AIFA, ENSAT Cancer Health F2-2010-259735 programme, Deutsche Forschungsgemeinschaft, Cancer Research UK, and the French Ministry of Health.
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Affiliation(s)
- Massimo Terzolo
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Martin Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany; Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - Paola Perotti
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Rossella Libé
- Rare Cancer Network COMETE Cancer, Hôpital Cochin, Paris, France
| | - Darko Kastelan
- Department of Endocrinology University Hospital Zagreb, Zagreb, Croatia
| | - André Lacroix
- Service d'Endocrinologie, Département de Médecine, Centre Hospitalier de l'Universite de Montréal, Montreal, QC, Canada
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; MRC London Institute of Medical Sciences and Faculty of Medicine, Imperial College London, London, UK
| | - Harm Reinout Haak
- Department of Internal Medicine, Maxima Medisch Centrum, Eindhoven, Netherlands; CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht University, and Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Paola Loli
- Division of Endocrinology, Niguarda Cà Granda Hospital, Milan, Italy
| | - Bénédicte Decoudier
- Centre Hospitalier Universitaire de Reims, Service d'Endocrinologie-Diabètologie-Nutrition, Reims, France
| | - Helene Lasolle
- Federation d'Endocrinologie, Hospices Civils de Lyon and University de Lyon, Lyon, France
| | | | - Magalie Haissaguerre
- Department of Endocrinology and Endocrine Oncology, Haut Leveque Hospital, University Hospital of Bordeaux, France
| | - Olivier Chabre
- University Grenoble Alpes, Service d'Endocrinologie CHU Grenoble Alpes, Unité Mixte de Recherche INSERM-CEA-UGA UMR1036 38000 Grenoble Alpes, France
| | - Philippe Caron
- Department of Endocrinology and Metabolic Diseases, Cardiovascular and Metabolic Unit, CHU Larrey, Toulouse, France
| | - Antonio Stigliano
- Endocrinology, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Roberta Giordano
- Division of Endocrinology, Diabetology and Metabolism, Department of Biological and Clinical Sciences, University of Turin, Turin, Italy
| | - Maria Chiara Zatelli
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Maria Candida Barisson Villares Fragoso
- Unidade de Suprarrenal, Disciplina de Endocrinologia e Metabologia do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Instituto do Cancer do Estado de São Paulo-ICESP, São Paulo, Brazil
| | - Letizia Canu
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Michaela Luconi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Soraya Puglisi
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy.
| | - Vittoria Basile
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Giuseppe Reimondo
- Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Matthias Kroiss
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Felix Megerle
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Stefanie Hahner
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Otilia Kimpel
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Tina Dusek
- Department of Endocrinology University Hospital Zagreb, Zagreb, Croatia
| | - Svenja Nölting
- Department of Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany; Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Isabelle Bourdeau
- Service d'Endocrinologie, Département de Médecine, Centre Hospitalier de l'Universite de Montréal, Montreal, QC, Canada
| | - Vasileios Chortis
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | | | - Deborah Cosentini
- Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health Medical, ASST-Spedali Civili, University of Brescia, Brescia, Italy
| | - Salvatore Grisanti
- Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health Medical, ASST-Spedali Civili, University of Brescia, Brescia, Italy
| | - Eric Baudin
- Endocrine Oncology Gustave Roussy, Villejuif, France
| | - Paola Berchialla
- Statistical Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Francesca Bovis
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - Paolo Bruzzi
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Felix Beuschlein
- Department of Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany; Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Jerome Bertherat
- Université Paris Cité, Institut Cochin, Inserm U1016, CNRS UMR8104, Service d'Endocrinologie, Hopital Cochin, APHP, Paris, France
| | - Alfredo Berruti
- Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health Medical, ASST-Spedali Civili, University of Brescia, Brescia, Italy
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Poirier J, Godemel S, Mourot A, Grunenwald S, Olney HJ, Le XK, Lacroix A, Caron P, Bourdeau I. Central Hypothyroidism is Frequent During Mitotane Therapy in Adrenocortical Cancer Patients: Prevalence and Timeline. J Clin Endocrinol Metab 2023; 108:2336-2342. [PMID: 36856782 DOI: 10.1210/clinem/dgad115] [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: 12/14/2022] [Revised: 02/15/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023]
Abstract
CONTEXT Central hypothyroidism was described previously in mitotane-treated patients but data on its prevalence and time of occurrence are limited. OBJECTIVE To better characterize thyroid hormone insufficiency in patients exposed to mitotane. METHODS We reviewed medical records of patients from 2 academic centers in Montreal (Canada) and Toulouse (France) with exposure to mitotane therapy for adrenocortical cancer between 1995 and 2020. We analyzed the thyroid function parameters during and after treatment. RESULTS In our cohort of 83 patients, 17 were excluded because of preexisting primary hypothyroidism or drug-induced hypothyroidism. During follow-up, 3/66 patients maintained a normal thyroid function and 63/66 developed central hypothyroidism. Among those 63 patients, 56 presented with an inappropriately normal or low TSH and 7 with a mildly elevated TSH. The onset of hypothyroidism was: <3 months in 33.3%, 3 to 6 months in 19.1%, 6 to 9 months in 14.3%, and 9 to 12 months in 9.5%. At least 14.3% of cases occurred after 12 months of exposure, and 6 patients had an undetermined time of occurrence. Over time, 27 patients stopped mitotane and partial (42.3%) or complete (23.1%) recovery from hypothyroidism was observed, mainly in the first 2 years after mitotane discontinuation. CONCLUSION Mitotane therapy is frequently associated with new onset of central hypothyroidism with a prevalence of 95.5%. Most cases occurred in the first year of treatment. Partial or full recovery of thyroid function occurs in 65.4% of cases. This study supports the importance of systematic monitoring of TSH and free T4 levels during and following discontinuation of mitotane therapy.
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Affiliation(s)
- Jonathan Poirier
- Division of Endocrinology, Department of Medicine and Research Center, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, H2X 3E4, Canada
| | - Sophie Godemel
- Service d'Endocrinologie, Maladies métaboliques et Nutrition, Pôle Cardio-Vasculaire et Métabolique, Centre Hospitalo-Universitaire de Toulouse, 31059 Toulouse Cedex, France
| | - Aurélie Mourot
- Division of Endocrinology, Department of Medicine and Research Center, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, H2X 3E4, Canada
| | - Solange Grunenwald
- Service d'Endocrinologie, Maladies métaboliques et Nutrition, Pôle Cardio-Vasculaire et Métabolique, Centre Hospitalo-Universitaire de Toulouse, 31059 Toulouse Cedex, France
| | - Harold J Olney
- Oncology Division, Department of Medicine and Research Center, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, H2X 3E4, Canada
| | - Xuan Kim Le
- Division of Endocrinology, Department of Medicine and Research Center, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, H2X 3E4, Canada
| | - André Lacroix
- Division of Endocrinology, Department of Medicine and Research Center, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, H2X 3E4, Canada
| | - Philippe Caron
- Service d'Endocrinologie, Maladies métaboliques et Nutrition, Pôle Cardio-Vasculaire et Métabolique, Centre Hospitalo-Universitaire de Toulouse, 31059 Toulouse Cedex, France
| | - Isabelle Bourdeau
- Division of Endocrinology, Department of Medicine and Research Center, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, H2X 3E4, Canada
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Petyt M, Grunenwald S, Mouly C, Benoit J, Caron P. Healthy pregnancy in a woman with GH-secreting pituitary macroadenoma treated with pasireotide. Ann Endocrinol (Paris) 2023; 84:427-429. [PMID: 36736770 DOI: 10.1016/j.ando.2023.01.006] [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] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/19/2023] [Accepted: 01/22/2023] [Indexed: 02/04/2023]
Affiliation(s)
- Mahaut Petyt
- Service d'endocrinologie, maladies métaboliques et nutrition, pôle crdiovsculaire et mtabolique, CHU de Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France
| | - Solange Grunenwald
- Service d'endocrinologie, maladies métaboliques et nutrition, pôle crdiovsculaire et mtabolique, CHU de Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France
| | - Céline Mouly
- Service d'endocrinologie, maladies métaboliques et nutrition, pôle crdiovsculaire et mtabolique, CHU de Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France
| | - Julie Benoit
- Service d'endocrinologie, maladies métaboliques et nutrition, pôle crdiovsculaire et mtabolique, CHU de Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France
| | - Philippe Caron
- Service d'endocrinologie, maladies métaboliques et nutrition, pôle crdiovsculaire et mtabolique, CHU de Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France.
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Abstract
Although levothyroxine (LT4) is a widely prescribed drug, more than 30% of LT4-treated patients fail to achieve the recommended serum level of thyrotropin with a body weight-based dose of LT4. An LT4 absorption test (LT4AT) is part of the workup for confirming normal LT4 absorption or diagnosing malabsorption. We searched PubMed with the terms levothyrox*, L-T4, LT4, TT4, FT4, FT3, TT3, test, loading, uptake, absorp*, "absorb*, bioavailab*, bioequiv* malabsorb*, and pseudomalabsorb*. A total of 43 full-text publications were analyzed. The published procedures for LT4AT differ markedly in the test dose, formulation, test duration, frequency of blood collection, analyte (total thyroxine [TT4] or free thyroxine [FT4]), metric (absolute or relative peak or increment, or area under the curve) and the threshold for normal absorption. In a standardized LT4AT for routine use, the physician could advise the patient to not consume food, beverages, or medications the morning of the test; administer 1000 µg of LT4 in the patient's usual formulation as the test dose; ensure that the patient is supervised throughout the LT4AT; perform a 4-hour test, with hourly blood samples; assay FT4; and consider that normal LT4 absorption corresponds to an FT4 increment of more than 0.40 ng/dL (5.14 pmol/L) or a TT4 increment of more than 6 μg/dL (77.23 nmol/L) for a test dose of at least 300 µg, or a percentage TT4 absorption of more than 60%. If the test indicates abnormal LT4 absorption, the physician can increase the LT4 dose, change the formulation or administration route, and/or refer the patient to a gastroenterologist.
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Affiliation(s)
- Philippe Caron
- Service d'Endocrinologie, Maladies Métaboliques et Nutrition, Pôle Cardio-Vasculaire et Métabolique, Hôpital Larrey, CHU de Toulouse, Toulouse F-31059, France
| | - Xavier Declèves
- Service de Biologie du Médicament-Toxicologie, Hôpital Cochin, AP-HP, Paris F-75006, France
- INSERM UMR-S1144, Université Paris Cité, Paris F-75006, France
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16
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Abeillon-du Payrat J, Grunenwald S, Gall E, Ladsous M, Raingeard I, Caron P. Graves' orbitopathy post-SARS-CoV-2 vaccines: report on six patients. J Endocrinol Invest 2023; 46:617-627. [PMID: 36378488 PMCID: PMC9665034 DOI: 10.1007/s40618-022-01955-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 09/08/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
CONTEXT Autoimmune and inflammatory thyroid diseases (Graves' disease, subacute thyroiditis, chronic autoimmune thyroiditis) have been reported following SARS-CoV-2 vaccines but Graves' orbitopathy (GO) post-COVID-19 vaccination is uncommon. METHODS We describe six new patients seen in Endocrinology Departments with Outpatient Clinics for GO following SARS-CoV-2 vaccines in France. RESULTS After COVID-19 vaccination, GO was observed in six patients (three men, three women, mean age 53 ± 6 years) with a personal past history of Graves' disease (5/6) or orbitopathy (4/6). New-onset (n = 2) or recurrence (n = 4) of GO was observed following mRNA vaccines after the first (3/6) or second (3/6) dose, with the mean time from vaccination to GO at 23.8 ± 10.4 days. In one patient, thyrotoxicosis was confirmed by increased free T4 and low TSH concentrations while others had normal TSH levels, during chronic levothyroxine treatment in three patients. Four patients had significant anti-TSH receptor antibodies levels. According to the severity and activity of GO, the patients were treated using selenium (n = 2), intravenous glucocorticoids (n = 2), teprotumumab (n = 1), tocilizumab (n = 2) and orbital decompression (n = 1) with a significant improvement in GO signs and symptoms observed by most patients. CONCLUSION In this study, we report the main data from six new patients with GO following SARS-CoV-2 vaccines. Clinicians need to be aware of the risk of new-onset or recurrent GO in predisposed patients with autoimmune thyroid diseases after COVID-19 vaccination. This study should not raise any concerns regarding SARS-CoV-2 vaccination since the risk of COVID-19 undoubtedly outweighs the incidence of uncommon GO after SARS-CoV-2 vaccination.
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Affiliation(s)
- J Abeillon-du Payrat
- Fédération d'Endocrinologie Et Maladies Métaboliques, Hôpital Cardiovasculaire Louis-Pradel, 28, Avenue Doyen-Lépine, 69677, Bron, France
| | - S Grunenwald
- Service d'Endocrinologie Et Nutrition, Pôle Cardio-Vasculaire Et Métabolique, CHU Larrey, 24, Chemin de Pouvourville, TSA 30030, 31059, Toulouse, France
| | - E Gall
- Service d'Endocrinologie Et Diabétologie, CH Millau, Boulevard Achille Souques, 265, Millau, France
| | - M Ladsous
- Service d'Endocrinologie, Diabétologie Et Maladies Métaboliques, Hôpital Huriez, CHU Lille, Rue Michel Polonowski, 59000, Lille, France
| | - I Raingeard
- Maladies Endocriniennes, Hôpital Lapeyronie, CHRU de Montpellier, 295, Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, Montpellier, France
| | - P Caron
- Service d'Endocrinologie Et Nutrition, Pôle Cardio-Vasculaire Et Métabolique, CHU Larrey, 24, Chemin de Pouvourville, TSA 30030, 31059, Toulouse, France.
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Petyt M, Caron P, Mouly C, Benoit J, Grunenwald S. Grossesse chez une patiente acromégale traitée par une forme retard de l’analogue de la somatostatine de 2e génération (pasiréotide). Annales d'Endocrinologie 2023. [DOI: 10.1016/j.ando.2022.12.203] [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: 02/13/2023]
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18
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Grunenwald S, Lethellier G, Imbert P, Dekeister C, Caron P. Orbitopathie inflammatoire après vaccin ARN messager anti-SARS-CoV-2. Annales d'Endocrinologie 2023. [DOI: 10.1016/j.ando.2022.12.058] [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: 02/13/2023]
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19
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Maione L, Albrici C, Grunenwald S, Mouly C, Cimino V, Lecoq A, Souberbielle J, Caron P, Chanson P. À quel moment faut-il doser l’IGF-I chez les patients acromégales traités par analogues-retard de la somatostatine (SRL) ? Annales d'Endocrinologie 2023. [DOI: 10.1016/j.ando.2022.12.005] [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: 02/13/2023]
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Villemaire A, Adam G, Fayolle H, Roques M, Darcourt J, Caron P, Bonneville F. Is systematic Gadolinium injection relevant during MRI follow-up for non-functioning pituitary macroadenomas? J Neuroradiol 2023; 50:3-8. [PMID: 36055429 DOI: 10.1016/j.neurad.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To compare the performance of coronal contrast-enhanced T1-weighted (ceT1-w) and T2-weighted (T2-w) sequences for diagnosing progression during the MRI follow-up of Non-Functioning Pituitary MacroAdenomas (NFPMAs). PATIENTS AND METHODS 106 patients, who had at least two MRIs for the follow-up of NFPMA, were enrolled retrospectively. The largest adenoma diameter was measured on coronal ceT1-w sequences and separately on T2-w sequences for all follow-up MRIs. Interobserver variability was also assessed by 2 independent neuroradiologists in a sample series of 100 examinations. Progression was defined by an increase ≥ 2 mm in diameter between 2 MRIs. Progression thresholds of 3 and 4 mm were also tested. The results of ceT1-w and T2-w sequences were analysed for concordance. RESULTS 93.1% concordance was achieved between ceT1-w and T2-w coronal sequences in 580 follow-up MRIs. In the case of progression detected on at least one sequence, 64.4% concordance was documented for a 2-mm threshold, 87.7% for 3-mm and 97.1% for 4-mm. Discordance was mainly observed on the first postoperative MRI and in case of NFPMAs with multiple recurrences. Kappa was better for diagnosing progression on T2-w than on ceT1-w sequences (0.67 vs. 0.54). It should be noted that 100% agreement was observed between the 2 sequences in the 82 follow-up MRIs of patients with complete surgical resection. CONCLUSION 93.1% concordance was achieved for coronal ceT1-w and T2-w sequences during the MRI follow-up of NFPMAs, thus challenging systematic injection of gadolinium. If MRI without gadolinium injection is a first-line option, our results suggest that ceT1-w sequences should be reserved for the first postoperative MRI and for the follow-up of aggressive and recurrent NFPMAs.
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Affiliation(s)
- Axel Villemaire
- Departements of Neuroradiology, CHU Toulouse, Toulouse, France.
| | - Gilles Adam
- Departements of Neuroradiology, CHU Toulouse, Toulouse, France
| | | | - Margaux Roques
- Departements of Neuroradiology, CHU Toulouse, Toulouse, France
| | - Jean Darcourt
- Departements of Neuroradiology, CHU Toulouse, Toulouse, France
| | - Philippe Caron
- Endocrinology-Metabolic and nutrition Diseases, CHU Toulouse, Toulouse, France
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Caron P. Autoimmune and inflammatory thyroid diseases following vaccination with SARS-CoV-2 vaccines: from etiopathogenesis to clinical management. Endocrine 2022; 78:406-417. [PMID: 35763241 PMCID: PMC9243876 DOI: 10.1007/s12020-022-03118-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/14/2022] [Indexed: 01/06/2023]
Abstract
Since the Covid-19 pandemic emerged in 2019, several adenoviral-vectored, mRNA-based and inactivated whole-virus vaccines have been developed. A massive vaccination campaign has been undertaken around the world, and an increasing number of SARS-CoV-2 vaccine-induced thyroid diseases have been described in the literature. Subacute thyroiditis has been reported in 52 patients, mean age 45.5 ± 1.8 years, mainly in women (n = 39). Graves' disease is more frequent in women (n = 22) than in men (n = 10), mean age 46.2 ± 2.6 years, reported as new onset, recurrent or exacerbation of well-controlled hyperthyroidism. The mean time to symptoms onset is 9.0 ± 0.8 days in subacute thyroiditis, and 15.1 ± 2.6 days in Graves' patients. Rare patients (n = 6) present silent or painless autoimmune thyroiditis. Thyroid function and autoimmune tests, inflammatory markers, thyroid echography with colour flow Doppler, radio-activity uptake on thyroid scan, medical treatment and follow-up are described and compared in patients with SARS-CoV-2 vaccine-induced thyroid diseases. The underlying pathogenic mechanisms of vaccine-induced thyroid diseases, molecular mimicry (various SARS-CoV-2 proteins sharing a genetic homology with a large heptapeptide human protein) or autoimmune/inflammatory syndrome induced by adjuvants (ASIA) are discussed in the context of predisposition or genetic susceptibility. The benefits of SARS-CoV-2 vaccination far outweigh the potential vaccine-induced adverse effects, but clinicians should be aware of possible autoimmune and inflammatory thyroid diseases, and can advise patients to seek medical assistance when experiencing anterior neck pain, fever or palpitations following SARS-CoV-2 vaccines. Further studies are warranted to investigate the etiopathogenesis and to clarify the factors which predispose patients to SARS-CoV-2 vaccine-induced thyroid diseases.
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Affiliation(s)
- Philippe Caron
- Department of Endocrinology and Metabolic Diseases, Cardiovascular and Metabolic Unit, CHU-Larrey, Toulouse, France.
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22
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Grandgeorge N, Barchetti G, Grunenwald S, Bonneville F, Caron P. MRI follow-up of patients with acromegaly being treated with first-generation somatostatin receptor ligands after surgery. Clin Endocrinol (Oxf) 2022; 97:686-688. [PMID: 34160834 DOI: 10.1111/cen.14539] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Naia Grandgeorge
- Department of Endocrinology and Metabolic Diseases, CHU Larrey, Toulouse, France
| | | | - Solange Grunenwald
- Department of Endocrinology and Metabolic Diseases, CHU Larrey, Toulouse, France
| | | | - Philippe Caron
- Department of Endocrinology and Metabolic Diseases, CHU Larrey, Toulouse, France
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Pouliot F, Rouleau M, Neveu B, Caron P, Morin F, Toren P, Lacombe L, Turcotte V, Lévesque E, Guillemette C. 1418P Extensive alteration of androgen precursor levels after castration in prostate cancer patients and their association with active androgen level: Importance for treatment intensification. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Maione L, Albrici C, Grunenwald S, Mouly C, Cimino V, Lecoq AL, Souberbielle JC, Caron P, Chanson P. IGF-I Variability Over Repeated Measures in Patients With Acromegaly Under Long-Acting Somatostatin Receptor Ligands. J Clin Endocrinol Metab 2022; 107:e3644-e3653. [PMID: 35772775 DOI: 10.1210/clinem/dgac385] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT In patients with acromegaly on long-term treatment with long-acting somatostatin receptor ligands (SRLs), the time of blood collection for IGF-I measurement after injection is not well defined. OBJECTIVE We aimed to assess serum IGF-I dynamics and variability in SRL-treated patients compared with surgically cured patients and healthy controls. METHODS Thirty patients under SRLs considered controlled based on a normal previous IGF-I level, 10 patients cured by pituitary surgery, and 7 healthy subjects underwent 4 weekly IGF-I determinations. RESULTS In SRL-treated patients, the IGF-I SDS (mean ± SD) was higher just before injection (0.34 ± 0.66) than at Day 7 (-0.33 ± 0.61; P = 0.0041) and Day 14 (-0.23 ± 0.60; P = 0.047) after injection, but it did not significantly vary in cured patients and healthy controls. The IGF-I CV was higher in SRL-treated patients than in cured patients or healthy controls (14.4 ± 7.6% vs 7.9 ± 4.4% and 8.3 ± 3.2%, respectively; P < 0.05 for both). Among SRL-treated patients, IGF-I CV was higher in "nonoptimally controlled patients"-i.e., patients with at least one elevated IGF-I value out of 4 (n = 9) compared with "optimally controlled" patients for whom all 4 IGF-I SDS values were < 2.0 (21.3 ± 9.3 vs 11.6 ± 6.0%; P = 0.0019). The latter did not differ from surgically cured patients and healthy controls. The measurement at the farthest distance from the SRL injection was the most predictive of patients with nonoptimally controlled disease. CONCLUSION In patients treated with long-acting SRLs, IGF-I sampling at the farthest distance from SRL injection is the most informative and best predictor of optimal disease control.
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Affiliation(s)
- Luigi Maione
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, 94275 Le Kremlin-Bicêtre, France
| | - Cristina Albrici
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, 94275 Le Kremlin-Bicêtre, France
| | - Solange Grunenwald
- Service d'Endocrinologie et Maladies métaboliques, Pôle Cardio-Vasculaire et Métabolique, CHU Larrey, 31059 Toulouse Cedex, France
| | - Céline Mouly
- Service d'Endocrinologie et Maladies métaboliques, Pôle Cardio-Vasculaire et Métabolique, CHU Larrey, 31059 Toulouse Cedex, France
| | - Vincenzo Cimino
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, 94275 Le Kremlin-Bicêtre, France
| | - Anne-Lise Lecoq
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, 94275 Le Kremlin-Bicêtre, France
| | - Jean Claude Souberbielle
- Assistance Publique-Hôpitaux de Paris Hôpital Necker-Enfants Malades, Département de Physiologie, 75015 Paris, France
| | - Philippe Caron
- Service d'Endocrinologie et Maladies métaboliques, Pôle Cardio-Vasculaire et Métabolique, CHU Larrey, 31059 Toulouse Cedex, France
| | - Philippe Chanson
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, 94275 Le Kremlin-Bicêtre, France
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25
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Potorac I, Bonneville JF, Daly AF, de Herder W, Fainstein-Day P, Chanson P, Korbonits M, Cordido F, Baranski Lamback E, Abid M, Raverot V, Raverot G, Anda Apiñániz E, Caron P, Du Boullay H, Bildingmaier M, Bolanowski M, Laloi-Michelin M, Borson-Chazot F, Chabre O, Christin-Maitre S, Briet C, Diaz-Soto G, Bonneville F, Castinetti F, Gadelha MR, Oliveira Santana N, Stelmachowska-Banaś M, Gudbjartsson T, Villar-Taibo R, Zornitzki T, Tshibanda L, Petrossians P, Beckers A. Pituitary MRI Features in Acromegaly Resulting From Ectopic GHRH Secretion From a Neuroendocrine Tumor: Analysis of 30 Cases. J Clin Endocrinol Metab 2022; 107:e3313-e3320. [PMID: 35512251 DOI: 10.1210/clinem/dgac274] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Ectopic acromegaly is a consequence of rare neuroendocrine tumors (NETs) that secrete GHRH. This abnormal GHRH secretion drives GH and IGF-1 excess, with a clinical presentation similar to classical pituitary acromegaly. Identifying the underlying cause for the GH hypersecretion in the setting of ectopic GHRH excess is, however, essential for proper management both of acromegaly and the NET. Owing to the rarity of NETs, the imaging characteristics of the pituitary in ectopic acromegaly have not been analyzed in depth in a large series. OBJECTIVE Characterize pituitary magnetic resonance imaging (MRI) features at baseline and after NET treatment in patients with ectopic acromegaly. DESIGN Multicenter, international, retrospective. SETTING Tertiary referral pituitary centers. PATIENTS Thirty ectopic acromegaly patients having GHRH hypersecretion. INTERVENTION None. MAIN OUTCOME MEASURE MRI characteristics of pituitary gland, particularly T2-weighted signal. RESULTS In 30 patients with ectopic GHRH-induced acromegaly, we found that most patients had hyperplastic pituitaries. Hyperplasia was usually moderate but was occasionally subtle, with only small volume increases compared with normal ranges for age and sex. T2-weighted signal was hypointense in most patients, especially in those with hyperplastic pituitaries. After treatment of the NET, pituitary size diminished and T2-weighted signal tended to normalize. CONCLUSIONS This comprehensive study of pituitary MRI characteristics in ectopic acromegaly underlines the utility of performing T2-weighted sequences in the MRI evaluation of patients with acromegaly as an additional tool that can help to establish the correct diagnosis.
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Affiliation(s)
- Iulia Potorac
- Departments of Endocrinology, Centre Hospitalier de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, Belgium
| | - Jean-François Bonneville
- Departments of Endocrinology, Centre Hospitalier de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, Belgium
- Medical Imaging, Centre Hospitalier de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, Belgium
| | - Adrian F Daly
- Departments of Endocrinology, Centre Hospitalier de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, Belgium
| | - Wouter de Herder
- Department of Internal Medicine, Section of Endocrinology, Erasmus University Medical Center, 3015 GD, Rotterdam, The Netherlands
| | - Patricia Fainstein-Day
- Department of Endocrinology, Hospital Italiano de Buenos Aires, 1199, Buenos Aires, Argentina
| | - Philippe Chanson
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, 94270 Le Kremlin-Bicêtre, France
| | - Marta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, United Kingdom
| | - Fernando Cordido
- Department of Endocrinology, University Hospital A Coruña, 15006 A Coruña, Spain
| | - Elisa Baranski Lamback
- Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, 21941-617 Rio de Janeiro, Brazil
| | - Mohamed Abid
- Department of Endocrinology, Hedi Chaker Hospital, 3000 Sfax, Tunis
| | - Véronique Raverot
- Biochemistry Laboratory Department, Groupement Hospitalier Est, Hospices Civils de Lyon, 69002 Lyon, France
| | - Gerald Raverot
- Fédération d'Endocrinologie, Centre de Référence des Maladies Rares Hypophysaires HYPO, Groupement Hospitalier Est, Hospices Civils de Lyon, 69002 Lyon, France
| | - Emma Anda Apiñániz
- Department of Endocrinology and Nutrition, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain
| | - Philippe Caron
- Service d'Endocrinologie et Maladies Métaboliques, Centre Hospitalier Universitaire de Toulouse, 31300 Toulouse, France
| | - Helene Du Boullay
- Department of Endocrinology, General Hospital of Chambéry, 73000 Chambéry, France
| | - Martin Bildingmaier
- Department for Endocrinology, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, 80539 Munich, Germany
| | - Marek Bolanowski
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Marie Laloi-Michelin
- Department of Diabetes and Endocrinology, Lariboisière Hospital, 75010 Paris, France
| | - Francoise Borson-Chazot
- Hospices Civils de Lyon, Fédération d'Endocrinologie, Université Claude Bernard Lyon 1, 69002 Lyon, France
| | - Olivier Chabre
- Service d'Endocrinologie, Centre Hospitalier Universitaire de Grenoble, 38700 La Tronche, France
| | - Sophie Christin-Maitre
- Department of Endocrinology, Hôpital St Antoine, AP-HP, Sorbonne University, 75012 Paris, France
| | - Claire Briet
- Service d'endocrinologie, diabétologie et nutrition, CHU d'Angers, 49100 Angers, France
| | - Gonzalo Diaz-Soto
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Fabrice Bonneville
- Department of Neuroradiology, University Hospital Purpan, 31300 Toulouse, France
| | - Frederic Castinetti
- Department of Endocrinology, Aix Marseille Université, 13007 Marseille, France
| | - Mônica R Gadelha
- Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, 21941-617 Rio de Janeiro, Brazil
| | - Nathalie Oliveira Santana
- Laboratório de Endocrinologia Celular e Molecular (LIM25), Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP 05403-000, Brasil
| | | | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Faculty of Medicine, University of Iceland, 101 Reykjavik, Iceland
| | - Roció Villar-Taibo
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain
| | - Taiba Zornitzki
- Diabetes, Endocrinology and Metabolic Disease Institute, Kaplan Medical Center, Hebrew University Medical School, Rehovot 76100, Israel
| | - Luaba Tshibanda
- Medical Imaging, Centre Hospitalier de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, Belgium
| | - Patrick Petrossians
- Departments of Endocrinology, Centre Hospitalier de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, Belgium
| | - Albert Beckers
- Departments of Endocrinology, Centre Hospitalier de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, Belgium
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Grunenwald S, Lethellier G, Imbert P, Dekeister C, Caron P. Orbital inflammatory disease following mRNA SARS‐CoV‐2 vaccine. Clin Case Rep 2022; 10:e05926. [PMID: 35685829 PMCID: PMC9172587 DOI: 10.1002/ccr3.5926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/16/2022] [Indexed: 12/13/2022] Open
Abstract
A 65‐year‐old woman reported orbital symptoms two days after her first dose and presented exacerbation of signs after the second dose of BNT162b2 mRNA vaccine. The temporal relationship between the COVID‐19 vaccination and orbital symptoms suggests a probable link between SARS‐CoV‐2 mRNA vaccine and this orbital inflammatory disease.
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Affiliation(s)
- Solange Grunenwald
- Multidisciplinary Thyroid‐Eye Outpatient Clinic Department of Endocrinology and Metabolic Disease Cardio‐Vascular and Metabolic Unit CHU Larrey (University Hospital Centre) Toulouse France
| | - Gabriel Lethellier
- Department of Ophthalmology CH intercommunal Castres‐Mazamet Castres France
| | - Philippe Imbert
- Multidisciplinary Thyroid‐Eye Outpatient Clinic Department of Endocrinology and Metabolic Disease Cardio‐Vascular and Metabolic Unit CHU Larrey (University Hospital Centre) Toulouse France
- Ophthalmologist Centre de Consultations La Croix du Sud Quint‐Fonsegrives France
| | - Céline Dekeister
- Multidisciplinary Thyroid‐Eye Outpatient Clinic Department of Endocrinology and Metabolic Disease Cardio‐Vascular and Metabolic Unit CHU Larrey (University Hospital Centre) Toulouse France
- Department of Plastic and Maxillofacial Surgery Hôpital Pierre‐Paul Riquet Toulouse France
| | - Philippe Caron
- Multidisciplinary Thyroid‐Eye Outpatient Clinic Department of Endocrinology and Metabolic Disease Cardio‐Vascular and Metabolic Unit CHU Larrey (University Hospital Centre) Toulouse France
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Caron P, Grunenwald S, Persani L, Borson-Chazot F, Leroy R, Duntas L. Factors influencing the levothyroxine dose in the hormone replacement therapy of primary hypothyroidism in adults. Rev Endocr Metab Disord 2022; 23:463-483. [PMID: 34671932 PMCID: PMC8528480 DOI: 10.1007/s11154-021-09691-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 11/19/2022]
Abstract
Levothyroxine (LT4) is a safe, effective means of hormone replacement therapy for hypothyroidism. Here, we review the pharmaceutical, pathophysiological and behavioural factors influencing the absorption, distribution, metabolism and excretion of LT4. Any factor that alters the state of the epithelium in the stomach or small intestine will reduce and/or slow absorption of LT4; these include ulcerative colitis, coeliac disease, bariatric surgery, Helicobacter pylori infection, food intolerance, gastritis, mineral supplements, dietary fibre, resins, and various drugs. Once in the circulation, LT4 is almost fully bound to plasma proteins. Although free T4 (FT4) and liothyronine concentrations are extensively buffered, it is possible that drug- or disorder-induced changes in plasma proteins levels can modify free hormone levels. The data on the clinical significance of genetic variants in deiodinase genes are contradictory, and wide-scale genotyping of hypothyroid patients is not currently justified. We developed a decision tree for the physician faced with an abnormally high thyroid-stimulating hormone (TSH) level in a patient reporting adequate compliance with the recommended LT4 dose. The physician should review medications, the medical history and the serum FT4 level and check for acute adrenal insufficiency, heterophilic anti-TSH antibodies, antibodies against gastric and intestinal components (gastric parietal cells, endomysium, and tissue transglutaminase 2), and Helicobacter pylori infection. The next step is an LT4 pharmacodynamic absorption test; poor LT4 absorption should prompt a consultation with a gastroenterologist and (depending on the findings) an increase in the LT4 dose level. An in-depth etiological investigation can reveal visceral disorders and, especially, digestive tract disorders.
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Affiliation(s)
- Philippe Caron
- Service d'Endocrinologie, Maladies métaboliques et Nutrition, Hôpital Larrey, CHU de Toulouse, 24 chemin de Pouvourville, 31059, Toulouse Cedex, France.
| | - Solange Grunenwald
- Service d'Endocrinologie, Maladies métaboliques et Nutrition, Hôpital Larrey, CHU de Toulouse, 24 chemin de Pouvourville, 31059, Toulouse Cedex, France
| | - Luca Persani
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Françoise Borson-Chazot
- Fédération d'Endocrinologie, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | | | - Leonidas Duntas
- Unit of Endocrinology, Diabetes and Metabolism Division, Evgenideion Hospital, University of Athens, Athens, Greece
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Tabarin A, Assié G, Barat P, Bonnet F, Bonneville JF, Borson-Chazot F, Bouligand J, Boulin A, Brue T, Caron P, Castinetti F, Chabre O, Chanson P, Corcuff JB, Cortet C, Coutant R, Dohan A, Drui D, Espiard S, Gaye D, Grunenwald S, Guignat L, Hindie E, Illouz F, Kamenicky P, Lefebvre H, Linglart A, Martinerie L, North MO, Raffin-Samson ML, Raingeard I, Raverot G, Raverot V, Reznik Y, Taieb D, Vezzosi D, Young J, Bertherat J. Consensus statement by the French Society of Endocrinology (SFE) and French Society of Pediatric Endocrinology & Diabetology (SFEDP) on diagnosis of Cushing's syndrome. Ann Endocrinol (Paris) 2022; 83:119-141. [PMID: 35192845 DOI: 10.1016/j.ando.2022.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Cushing's syndrome is defined by prolonged exposure to glucocorticoids, leading to excess morbidity and mortality. Diagnosis of this rare pathology is difficult due to the low specificity of the clinical signs, the variable severity of the clinical presentation, and the difficulties of interpretation associated with the diagnostic methods. The present consensus paper by 38 experts of the French Society of Endocrinology and the French Society of Pediatric Endocrinology and Diabetology aimed firstly to detail the circumstances suggesting diagnosis and the biologic diagnosis tools and their interpretation for positive diagnosis and for etiologic diagnosis according to ACTH-independent and -dependent mechanisms. Secondly, situations making diagnosis complex (pregnancy, intense hypercortisolism, fluctuating Cushing's syndrome, pediatric forms and genetically determined forms) were detailed. Lastly, methods of surveillance and diagnosis of recurrence were dealt with in the final section.
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Affiliation(s)
- Antoine Tabarin
- Service Endocrinologie, Diabète et Nutrition, Université, Hôpital Haut-Leveque CHU de Bordeaux, 33604 Pessac, France.
| | - Guillaume Assié
- Centre de Référence Maladies Rares de la Surrénale (CRMRS), Service d'Endocrinologie, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
| | - Pascal Barat
- Unité d'Endocrinologie-Diabétologie-Gynécologie-Obésité Pédiatrique, Hôpital des Enfants CHU Bordeaux, Bordeaux, France
| | - Fidéline Bonnet
- UF d'Hormonologie Hôpital Cochin, Université de Paris, Institut Cochin Inserm U1016, CNRS UMR8104, Paris, France
| | | | - Françoise Borson-Chazot
- Fédération d'Endocrinologie, Hôpital Louis-Pradel, Hospices Civils de Lyon, INSERM U1290, Université Lyon1, 69002 Lyon, France
| | - Jérôme Bouligand
- Faculté de Médecine Paris-Saclay, Unité Inserm UMRS1185 Physiologie et Physiopathologie Endocriniennes, Paris, France
| | - Anne Boulin
- Service de Neuroradiologie, Hôpital Foch, 92151 Suresnes, France
| | - Thierry Brue
- Aix-Marseille Université, Institut National de la Recherche Scientifique (INSERM) U1251, Marseille Medical Genetics, Marseille, France; Assistance publique-Hôpitaux de Marseille, Service d'Endocrinologie, Hôpital de la Conception, Centre de Référence Maladies Rares HYPO, 13005 Marseille, France
| | - Philippe Caron
- Service d'Endocrinologie et Maladies Métaboliques, Pôle Cardiovasculaire et Métabolique, CHU Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France
| | - Frédéric Castinetti
- Aix-Marseille Université, Institut National de la Recherche Scientifique (INSERM) U1251, Marseille Medical Genetics, Marseille, France; Assistance publique-Hôpitaux de Marseille, Service d'Endocrinologie, Hôpital de la Conception, Centre de Référence Maladies Rares HYPO, 13005 Marseille, France
| | - Olivier Chabre
- Université Grenoble Alpes, UMR 1292 INSERM-CEA-UGA, Endocrinologie, CHU Grenoble Alpes, 38000 Grenoble, France
| | - Philippe Chanson
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Le Kremlin-Bicêtre, France
| | - Jean Benoit Corcuff
- Laboratoire d'Hormonologie, Service de Médecine Nucléaire, CHU Bordeaux, Laboratoire NutriNeuro, UMR 1286 INRAE, Université de Bordeaux, Bordeaux, France
| | - Christine Cortet
- Service d'Endocrinologie, Diabétologie, Métabolisme et Nutrition, CHU de Lille, Lille, France
| | - Régis Coutant
- Service d'Endocrinologie Pédiatrique, CHU Angers, Centre de Référence, Centre Constitutif des Maladies Rares de l'Hypophyse, CHU Angers, Angers, France
| | - Anthony Dohan
- Department of Radiology A, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Delphine Drui
- Service Endocrinologie-Diabétologie et Nutrition, l'institut du Thorax, CHU Nantes, 44092 Nantes cedex, France
| | - Stéphanie Espiard
- Service d'Endocrinologie, Diabétologie, Métabolisme et Nutrition, INSERM U1190, Laboratoire de Recherche Translationnelle sur le Diabète, 59000 Lille, France
| | - Delphine Gaye
- Service de Radiologie, Hôpital Haut-Lêveque, CHU de Bordeaux, 33604 Pessac, France
| | - Solenge Grunenwald
- Service d'Endocrinologie, Hôpital Larrey, CHU Toulouse, Toulouse, France
| | - Laurence Guignat
- Centre de Référence Maladies Rares de la Surrénale (CRMRS), Service d'Endocrinologie, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
| | - Elif Hindie
- Service de Médecine Nucléaire, CHU de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Frédéric Illouz
- Centre de Référence Maladies Rares de la Thyroïde et des Récepteurs Hormonaux, Service Endocrinologie-Diabétologie-Nutrition, CHU Angers, 49933 Angers cedex 9, France
| | - Peter Kamenicky
- Assistance publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
| | - Hervé Lefebvre
- Service d'Endocrinologie, Diabète et Maladies Métaboliques, CHU de Rouen, Rouen, France
| | - Agnès Linglart
- Paris-Saclay University, AP-HP, Endocrinology and Diabetes for Children, Reference Center for Rare Disorders of Calcium and Phosphate Metabolism, Filière OSCAR, and Platform of Expertise for Rare Disorders, INSERM, Physiologie et Physiopathologie Endocriniennes, Bicêtre Paris-Saclay Hospital, Le Kremlin-Bicêtre, France
| | - Laetitia Martinerie
- Service d'Endocrinologie Pédiatrique, CHU Robert-Debré, AP-HP, Paris, France; Université de Paris, Paris, France
| | - Marie Odile North
- Service de Génétique et Biologie Moléculaire, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
| | - Marie Laure Raffin-Samson
- Service d'Endocrinologie Nutrition, Hôpital Ambroise-Paré, GHU Paris-Saclay, AP-HP Boulogne, EA4340, Université de Versailles-Saint-Quentin, Paris, France
| | - Isabelle Raingeard
- Maladies Endocriniennes, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France
| | - Gérald Raverot
- Fédération d'Endocrinologie, Centre de Référence Maladies Rares Hypophysaires, "Groupement Hospitalier Est", Hospices Civils de Lyon, Lyon, France
| | - Véronique Raverot
- Hospices Civils de Lyon, LBMMS, Centre de Biologie Est, Service de Biochimie et Biologie Moléculaire, 69677 Bron cedex, France
| | - Yves Reznik
- Department of Endocrinology and Diabetology, CHU Côte-de-Nacre, 14033 Caen cedex, France; University of Caen Basse-Normandie, Medical School, 14032 Caen cedex, France
| | - David Taieb
- Aix-Marseille Université, CHU La Timone, AP-HM, Marseille, France
| | - Delphine Vezzosi
- Service d'Endocrinologie, Hôpital Larrey, CHU Toulouse, Toulouse, France
| | - Jacques Young
- Assistance publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
| | - Jérôme Bertherat
- Centre de Référence Maladies Rares de la Surrénale (CRMRS), Service d'Endocrinologie, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
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Caron P. MANAGEMENT OF THYROTOXICOSIS AND PREGNANCY: Review of the current literature and an update of the care pathway. Ann Endocrinol (Paris) 2022; 83:226-231. [PMID: 35143751 DOI: 10.1016/j.ando.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/12/2022] [Accepted: 01/20/2022] [Indexed: 10/19/2022]
Abstract
Pregnancy can be complicated by hyperthyroidism or thyrotoxicosis. Diagnosis is founded on an increase in free thyroid hormones and low TSH. The most frequent etiologies are Graves' disease, an autoimmune disease linked to stimulatory anti-TSH receptor antibodies, and non-autoimmune gestational hyperthyroidism linked to the TSH-like activity of the chorionic growth hormone (hCG). During pregnancy, thyrotoxicosis can entail maternal, obstetrical and fetal or neonatal complications. Graves' hyperthyroidism may be responsible for fetal and neonatal hyperthyroidism due to placental transfer of stimulatory anti-TSH receptor antibodies. During pregnancy, treatment of thyrotoxicosis must restore normal thyroid function in the mother without affecting fetal thyroid function. The recent reassessment of the prevalence of teratogenic effects in children of women treated with antithyroid drugs in the first weeks of gestation should orient the care pathway before and during pregnancy for women of child-bearing age with hyperthyroidism linked to Graves' disease.
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Affiliation(s)
- Philippe Caron
- Department of Endocrinology and Metabolic diseases, Cardiovascular and Metabolic Unit CHU-Larrey, Toulouse, France.
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Cruz Marino T, Villeneuve H, Leblanc J, Duranceau C, Caron P, Morin C, Milot M, Chrétien R, Gagnon MM, Mathieu J, Ellezam B, Buhas D. French-Canadian families from Saguenay-Lac-Saint-Jean: a new founder population for APECED. Endocrine 2022; 75:48-58. [PMID: 34846681 DOI: 10.1007/s12020-021-02826-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/11/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is more prevalent in some founder populations, but relatively unexplored in Canada. This study aimed at investigating the French-Canadian patients through phenotypic and genotypic characterization. METHOD Phenotype and demographic characterization were done for 12 affected individuals belonging to eight unrelated families. Samples from 11 cases were analyzed in a molecular clinical laboratory, and muscle biopsies were reviewed for two individuals with a limb-girdle muscle dystrophy. RESULTS The clinical phenotype was similar to that observed in European Caucasian populations but differed in the non-endocrine spectrum from the American-reported series of cases. Two cases exhibited a limb-girdle muscle dystrophy, and we found preliminary evidence of a mitochondrial dysfunction, since all three biopsies examined showed COX-deficient fibers in excess of what would be expected for age. Electron microscopy showed mitochondrial accumulation without abnormal cristea or inclusions. The c.1616C > T variant in the AIRE gene was responsible for 100% of APECED cases in the French-Canadian population of Saguenay-Lac-Saint-Jean in Quebec, Canada. CONCLUSIONS We report the first series of French-Canadian cases affected with APECED. The Saguenay-Lac-Saint-Jean region was uncovered as a new founder population for this condition. Muscle biopsy findings expanded the range of previously described APECED-related myopathology. Long term follow-up of our genetically homogeneous French-Canadian cases may help determine if the c.1616C > T variant increases the risk of muscle involvement. A neonatal screening program is under consideration to prevent undesired life-threatening endocrine manifestations.
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Affiliation(s)
- Tania Cruz Marino
- Department of Laboratory Medicine, CIUSSS Saguenay-Lac-St-Jean, Saguenay, QC, Canada.
| | - Hélène Villeneuve
- Department of Endocrinology, CIUSSS Saguenay-Lac-St-Jean, Saguenay, QC, Canada
| | - Josianne Leblanc
- Department of Laboratory Medicine, CIUSSS Saguenay-Lac-St-Jean, Saguenay, QC, Canada
| | - Caroline Duranceau
- Department of Endocrinology, CIUSSS Saguenay-Lac-St-Jean, Saguenay, QC, Canada
| | - Philippe Caron
- Department of Endocrinology, CIUSSS Saguenay-Lac-St-Jean, Saguenay, QC, Canada
| | - Charles Morin
- Department of Pediatrics, CIUSSS Saguenay-Lac-St-Jean, Saguenay, QC, Canada
| | - Marcel Milot
- Department of Pediatrics, CIUSSS Saguenay-Lac-St-Jean, Saguenay, QC, Canada
| | - Raphaëlle Chrétien
- Department of Pediatrics, CIUSSS Saguenay-Lac-St-Jean, Saguenay, QC, Canada
| | - Maude-Marie Gagnon
- Clinique des Maladies Neuromusculaires, CIUSSS Saguenay-Lac-St-Jean, Saguenay, QC, Canada
| | - Jean Mathieu
- Department of Neurology, Université de Sherbrooke, QC, Sherbrooke, Canada
| | - Benjamin Ellezam
- Department of Pathology, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Daniela Buhas
- Division of Medical Genetics, Department of Specialized Medicine; Department of Human Genetics, McGill University, Montreal, QC, Canada
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Tanguy F, Hamdi S, Chikh K, Glinoer D, Caron P. Central hypothyroidism during pregnancy in a woman with Graves' disease. Clin Endocrinol (Oxf) 2022; 96:89-91. [PMID: 34658049 DOI: 10.1111/cen.14600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Faustine Tanguy
- Department of Endocrinology and Metabolic Diseases, Cardiovascular and Metabolic Unit, CHU Larrey, Toulouse, France
| | - Safouane Hamdi
- Laboratoire de Biochimie et d'Hormonologie, Institut Fédératif de Biologie, Hôital Purpan, CHU Toulouse, Toulouse, France
| | - Karim Chikh
- Laboratoire de Biochimie et Biologie Moléculaire-Centre Hospitalier Lyon Sud. ISPB, Faculté de Pharmacie de Lyon-UCBL1. Laboratoire CARMEN INSERM U1060, INRA U1397, Université Lyon 1, INSA Lyon, Lyon, France
| | - Daniel Glinoer
- Division of Endocrinology, Hospital Saint Pierre, University of Brussels, Brussels, Belgium
| | - Philippe Caron
- Department of Endocrinology and Metabolic Diseases, Cardiovascular and Metabolic Unit, CHU Larrey, Toulouse, France
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Geslot A, Chanson P, Caron P. Covid-19, the thyroid and the pituitary - the real state of play. Annales d'Endocrinologie 2022; 83:103-108. [PMID: 35065920 PMCID: PMC8772063 DOI: 10.1016/j.ando.2021.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/24/2021] [Indexed: 01/08/2023]
Abstract
Thyroid and pituitary disorders linked to the coronavirus SARS-CoV-2, responsible for the COVID-19 epidemic, are mainly due to direct infection of the endocrine glands by the virus and to cell damage induced by the immune response. The two most frequent thyroid complications of COVID-19 are low T3 syndrome, or “non-thyroidal illness syndrome” (NTIS), and thyroiditis. Studies among in-patients with COVID-19 have shown that between one out of six and half of them have a low TSH level, related to NTIS and thyroiditis, respectively, sometimes found in the same patient. In NTIS, the decrease in free T3 concentration correlates with the severity of the infection and with a poor prognosis. Assessment of thyroid function in patients after a COVID-19 infection, shows normalization of thyroid function tests. Thyroiditis linked to COVID-19 can be divided into two groups, which probably differ in their pathophysiology. One is “destructive” thyroiditis occurring early in infection with SARS-CoV-2, with a severe form of COVID-19, usually observed in men. It is often asymptomatic and associated with lymphopenia. The other is subacute thyroiditis occurring, on average, one month after the COVID-19 episode, usually in clinically symptomatic women and associated with moderate hyperleukocytosis. Post-infection, one quarter to one third of patients remain hypothyroid. An Italian study demonstrated that low TSH in patients hospitalized for COVID-19 was associated with prolonged hospitalization and a higher mortality risk. Pituitary diseases associated with SARS-CoV-2 infection are much rarer and the causal relationship more difficult to ascertain. Several cases of pituitary apoplexy and diabetes insipidus during COVID-19 infection have been reported. Hyponatremia occurs in 20–50% of patients admitted to hospital for COVID-19. The prevalence of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) amongst these hyponatremic cases is difficult to determine. These endocrine complications may influence the prognosis of infection with SARS-CoV-2. Although they rarely require specific treatment, it is important that endocrinologists recognize them to ensure appropriate management, particularly in the acute phase.
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Affiliation(s)
- Aurore Geslot
- Service d'endocrinologie, maladies métaboliques et nutrition, pôle cardio-vasculaire et métabolique, CHU Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France.
| | - Philippe Chanson
- Université Paris-Saclay, Inserm, physiologie et physiopathologie endocriniennes, Assistance publique-Hôpitaux de Paris, hôpital Bicêtre, service d'endocrinologie et des maladies de la reproduction, centre de référence des maladies rares de l'hypophyse HYPO, Le Kremlin-Bicêtre, France
| | - Philippe Caron
- Service d'endocrinologie, maladies métaboliques et nutrition, pôle cardio-vasculaire et métabolique, CHU Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France
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Castinetti F, Caron P, Raingeard I, Amodru V, Albarel F, Morange I, Chanson P, Calvo J, Graillon T, Baumstarck K, Dufour H, Regis J, Brue T. Lack of delayed neurocognitive side effects of Gamma Knife radiosurgery in acromegaly: the Later-Ac study. Eur J Endocrinol 2021; 186:37-44. [PMID: 34714763 DOI: 10.1530/eje-21-0826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/28/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Persistent growth hormone hypersecretion can be observed in roughly 50% of patients operated for somatotroph adenomas, requiring additional treatments. Despite its proven antisecretory efficacy, the use of Gamma Knife radiosurgery (GK) is limited probably due to the lack of data on long-term side effects, including potential cognitive consequences. METHODS The LATe Effects of Radiosurgery in Acromegaly study was a cross-sectional exposed/unexposed non-randomized study. The primary objective was to determine the long-term neurocognitive effects of GK focusing on memory, executive functions, and calculation ability. Exposed patients had been treated by GK for acromegaly at least 5 years before inclusion. Unexposed patients (paired for age) had to be cured or controlled at last follow-up without any radiation technique. Patients of both groups were cured or controlled at the last follow-up. RESULTS Sixty-four patients were evaluated (27 exposed and 37 unexposed). Mean follow-up after GK was 13 ± 6 years (including 24 patients followed for at least 10 years). While up to 23.8% of the patients of the whole cohort presented at least one abnormal cognitive test, we did not observe any significant difference in neurocognitive function between both groups. During the follow-up, 11 patients presented at least one new pituitary deficiency (P = 0.009 for thyroid-stimulating hormone deficiency with a higher rate in exposed patients), two presented a stroke (1 in each group), and one presented a meningioma (12 years after GK). CONCLUSIONS While GK exposes patients to a well-known risk of pituitary deficiency, it does not seem to induce long-term cognitive consequences in patients treated for acromegaly.
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Affiliation(s)
- Frederic Castinetti
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Department of Endocrinology, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | - Philippe Caron
- Service d'Endocrinologie, Hôpital Larrey, Toulouse, France
| | | | - Vincent Amodru
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Department of Endocrinology, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | - Frederique Albarel
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Department of Endocrinology, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | - Isabelle Morange
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Department of Endocrinology, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse and Université Paris-Saclay, Univ. Paris-Sud, Inserm, Signalisation Hormonale, Physiopathologie Endocrinienne et Métabolique, Le Kremlin-Bicêtre, France
| | - Julie Calvo
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Department of Endocrinology, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | - Thomas Graillon
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Department of Neurosurgery, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital de la Timone, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | | | - Henry Dufour
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Department of Neurosurgery, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital de la Timone, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | - Jean Regis
- Department of Functional Neurosurgery, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital de la Timone, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
| | - Thierry Brue
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Marseille, France
- Department of Endocrinology, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, Marseille, France
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Le Bras M, Leclerc H, Rousseau O, Goudet P, Cuny T, Castinetti F, Bauters C, Chanson P, Tabarin A, Gaujoux S, Christin-Maitre S, Ruszniewski P, Borson-Chazot F, Guilhem I, Caron P, Goichot B, Beckers A, Delemer B, Raingeard I, Vergès B, Smati S, Wargny M, Cariou B, Hadjadj S. Pituitary adenoma in patients with multiple endocrine neoplasia type 1: a cohort study. Eur J Endocrinol 2021; 185:863-873. [PMID: 34636744 DOI: 10.1530/eje-21-0630] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/07/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Pituitary adenoma (PA) is one of the three major components of multiple endocrine neoplasia type 1 (MEN1). Recent studies have suggested that MEN1-associated PAs are less aggressive than initially estimated. We propose an analysis of the outcome of PAs with a standard of care treatment in a nationwide cohort of MEN1 patients. DESIGN Retrospective observational nationwide cohort study using the MEN1 patient registry from the French Group of Endocrine Tumours (GTE). METHODS The GTE database population consists of 1435 patients with MEN1. This analysis focused on 551 patients recruited after 2000 with at least 3 years of follow-up. The study outcome was tumour progression of PA defined by an increase in Hardy classification (HC) during follow-up according to referring physician regular reports. RESULTS Among 551 MEN1 patients (index and related), 202 (36.7%) had PA, with 114 (56.4%) diagnosed by MEN1-related screening. PAs were defined according to HC as microadenoma (grade I) in 117 cases (57.9%), macroadenoma in 59 (29.2%) with 20 HC grade II and 39 HC grades III-IV and unspecified in 26 (12.8%). They were prolactinomas in 92 cases (45.5%) and non-secreting in 73 (36.1%). After a median follow-up of 3 years among the 137 patients with HC grades I-II, 4 patients (2.9%) presented tumour progression. CONCLUSION PAs in patients with MEN1 are less aggressive than previously thought. Tumour progression is rare with a standard of care monitoring and treatment, especially in related patients who mostly present non-secreting microadenoma. MRI monitoring for asymptomatic MEN1 patients should be reduced accordingly.
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Affiliation(s)
- Maelle Le Bras
- CHU de Nantes PHU2 Institut du Thorax et du Système Nerveux, Service d'Endocrinologie, Diabétologie et Nutrition, Nantes, France
| | - Hélène Leclerc
- Centre Hospitalier de La Roche sur Yon, Department of Endocrinology and Diabetology, La Roche sur Yon, France
| | - Olivia Rousseau
- INSERM CIC 1413, Clinique des Données, CHU de Nantes, Nantes, France
| | - Pierre Goudet
- University Hospital Dijon, Endocrine Surgery, Hôpital du Bocage, Dijon, France
| | - Thomas Cuny
- Department of Endocrinology, Hopital de la Conception, Marseille, France
| | - Frederic Castinetti
- Aix-Marseille Université, Assistance-Publique-Hôpitaux de Marseille, Centre de Référence des Maladies Rares d'Origine Hypophysaire, Department of endocrinology, Marseille, France
| | | | - Philippe Chanson
- Assistance Publique-Hôpitaux de Paris, Endocrinology, Le Kremlin-Bicêtre, Île-de-France, France
| | - Antoine Tabarin
- Department of Endocrinology, Hôpital Haut Lévêque-CHU de Bordeaux, Pessac, France
| | | | | | - Philippe Ruszniewski
- Department of Gastroenterology and Pancreatology, Université Paris Diderot, Sorbonne Paris Cité, Beaujon Hospital, Paris Clichy, France
| | - Francoise Borson-Chazot
- Hospices Civils de Lyon, Fédération d'Endocrinologie Groupement Hospitalier Est, Lyon, France
| | - Isabelle Guilhem
- Centre Hospitalier Universitaire de Rennes, Hôpital Sud, Service d'Endocrinologie-Diabétologie-Nutrition, Rennes, France
| | - Philippe Caron
- CHU Toulouse, Endocrinology and Metabolic diseases, Service d'Endocrinologie, Toulouse, France
| | - Bernard Goichot
- Hôpital de Hautepierre, Service de Medecine Interne et Nutrition, Strasbourg Cedex, France
| | - Albert Beckers
- CHU de Liège, Service d'Endocrinologie, Domaine Univeritaire du Sart-Tilman, Liège, Belgium
| | - Brigitte Delemer
- Hôpital Robert-Debré, CHU de Reims, Service Endocrinologie, Reims, France
| | | | - Bruno Vergès
- CHU Dijon, Hôpital du Bocage, Endocrinologie, Diabétologie, Dijon, France
| | - Sarra Smati
- CHU de Nantes PHU2 Institut du Thorax et du Système Nerveux, Service d'Endocrinologie, Diabétologie et Nutrition, Nantes, France
- UNIV Nantes, CNRS, INSERM, CHU Nantes, l'Institut du Thorax, Nantes, France
| | - Matthieu Wargny
- CHU de Nantes PHU2 Institut du Thorax et du Système Nerveux, Service d'Endocrinologie, Diabétologie et Nutrition, Nantes, France
- UNIV Nantes, CNRS, INSERM, CHU Nantes, l'Institut du Thorax, Nantes, France
| | - Bertrand Cariou
- CHU de Nantes PHU2 Institut du Thorax et du Système Nerveux, Service d'Endocrinologie, Diabétologie et Nutrition, Nantes, France
- UNIV Nantes, CNRS, INSERM, CHU Nantes, l'Institut du Thorax, Nantes, France
| | - Samy Hadjadj
- CHU de Nantes PHU2 Institut du Thorax et du Système Nerveux, Service d'Endocrinologie, Diabétologie et Nutrition, Nantes, France
- UNIV Nantes, CNRS, INSERM, CHU Nantes, l'Institut du Thorax, Nantes, France
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Geslot A, Savagner F, Caron P. Inherited Selenocysteine Transfer RNA Mutation: Clinical and Hormonal Evaluation of 2 Patients. Eur Thyroid J 2021; 10:542-547. [PMID: 34956927 PMCID: PMC8647050 DOI: 10.1159/000518275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 06/29/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Iodothyronine deiodinases are selenoproteins with the amino acid selenocysteine (Sec) introduced into the position of a TGA stop codon by a complex machinery involving tRNA[Ser]Sec when a cis-acting Sec-insertion sequence element is present in the 3' end of the mRNA. Recently, a variant in the TRU-TCA1-1 gene encoding for tRNA[Ser]Sec was reported, which resulted in reduced expression of stress-related selenoproteins. The proband presented with multisystem symptoms, euthyroid hyperthyroxinemia, and selenium deficiency. Here, we describe 2 new members of a family harboring the same tRNA[Ser]Sec variant. CASE PRESENTATION A 13-year-old patient was seen for Hashimoto's disease with high FT3 (4.6 pg/mL, normal range 2-4.2 pg/mL) and normal FT4 and TSH concentrations. He had no clinical complaints. During a 6-year clinical and hormonal follow-up, the index patient was not treated, FT3 decreased, FT4 increased, and serum TSH stayed in the normal range resulting in a euthyroid hyperthyroxinemia. Reverse T3 concentration was significantly increased at the last visit (19 years and 4 months). At the last evaluation, the total selenium level was low (91 μg/L, normal range 95-125). DNA sequencing identified a germinal homozygous variant (C65G) in the TRU-TCA1-1 gene. During follow-up, no additional clinical symptom was observed in the absence of any treatment. The same germinal tRNA[Ser]Sec variant was identified at heterozygous state in his father, who had normal thyroid function tests except a moderately increased reverse T3 concentration, with increased total selenium (143 μg/L) level. In both patients, the expression of stress-related selenoprotein GPX3 was in the low-normal range (168 and 180 IU/L, respectively, normal range: 150-558 IU/L). We did not find any significant biological abnormalities evocative of other selenoprotein deficiencies. DISCUSSION/CONCLUSION We report on 2 members of a family with a variant in the TRU-TCA1-1 gene encoding for tRNA[Ser]Sec. Our study suggests that this tRNA[Ser]Sec variant is not exclusively causative of disruption in selenoprotein synthesis.
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Affiliation(s)
- Aurore Geslot
- Department of Endocrinology and metabolic diseases, CHU Larrey, Toulouse, France
| | | | - Philippe Caron
- Department of Endocrinology and metabolic diseases, CHU Larrey, Toulouse, France
- *Philippe Caron,
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Barraud S, Caron P, Raingeard I, Lefebvre H, Raverot G, Cortet-Rudelli C, Desailloud R, Henocque R, Brault Y, Brue T, Chanson P, Delemer B. Pegvisomant treatment in acromegaly in clinical practice: Final results of the French ACROSTUDY (312 patients). Ann Endocrinol (Paris) 2021; 82:582-589. [PMID: 34256010 DOI: 10.1016/j.ando.2021.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/19/2021] [Accepted: 05/21/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We report the final analysis of the French ACROSTUDY, using data revised and enriched since the 2013 interim analysis. Our objective was to validate the use of pegvisomant (PEGV) in the treatment of acromegaly and to determine efficacy and safety. PATIENTS AND METHODS Patients with acromegaly treated with PEGV and followed up for at least 5 years were included. Eighty-eight investigators from 62 clinical centers in France included patients from April 2007 to April 2014. PEGV dose and administration frequency were determined by the physicians, based on their clinical evaluation and local habits. No additional examinations beyond those performed in normal follow-up were required. Minimum recommended follow-up included check-ups at treatment initiation, 6 months, 12 months and then annually. RESULTS In total, 312 patients were enrolled. Mean age was 46.1±14.3 years at introduction of PEGV. Median PEGV treatment duration was 6.3 years and median follow-up was 5.6 years. Median dose at initiation was 10mg/day. The percentages of patients with IGF-1 ≤ ULN (upper limit of normal) were 10% (n=300) at baseline, 54% at 6 months (n=278), and 61.7% (n=253) at 2 years, then stabilizing at 64.4% (n=180) at 5 years. Mean PEGV dose was 17.4±11.7mg in patients with controlled disease versus 21.1±17.3mg in those without control at 5 years. At 5 years, 21.8% of patients (54/248) were receiving >30mg PEGV per day. In patients with at least one pituitary imaging procedure during the 5-year follow-up (n=292), the most recent image showed stable tumor volume in 212 subjects (72.6%), increased volume in 13 (4.5%), and decreased volume in 30 (10.3%). No PEGV treatments were permanently discontinued due to transaminase elevation. There were no cases of liver failure. CONCLUSION The French ACROSTUDY showed normalization of IGF-1 levels in 64.4% of a real-life cohort of patients, mostly with uncontrolled disease despite multiple prior therapies. Long-term follow-up showed a sustained effectiveness and good long-term safety.
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Affiliation(s)
- Sara Barraud
- CRESTIC EA 3804, université de Reims Champagne Ardenne, UFR Sciences Exactes et Naturelles, Moulin de la Housse, BP 1039, 51687 Reims cedex 2, France; Service d'Endocrinologie-Diabète-Nutrition, CHU de Reims, hôpital Robert Debré, avenue du Général Koenig, 51092 Reims cedex, France.
| | - Philippe Caron
- Service d'endocrinologie et maladies métaboliques, pôle cardio-vasculaire et métabolique, hôpital Larrey, CHU de Toulouse, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex 9, France.
| | - Isabelle Raingeard
- Maladies endocriniennes, hôpital Lapeyronie, CHRU de Montpellier, 295, avenue du Doyen Gaston Giraud, 34295 Montpellier cedex 5, France.
| | - Hervé Lefebvre
- CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
| | - Gérald Raverot
- Hospices civils de Lyon, hôpital Louis-Pradel, 59, boulevard Pinel, 69677 Bron cedex, France.
| | | | - Rachel Desailloud
- CHU d'Amiens, hôpital Nord, place Victor Pauchet, 80054 Amiens cedex 1, France.
| | - Robin Henocque
- Pfizer France, 23-25, avenue du Docteur Lannelongue, 75668 Paris cedex 14, France.
| | - Yves Brault
- Pfizer France, 23-25, avenue du Docteur Lannelongue, 75668 Paris cedex 14, France.
| | - Thierry Brue
- Department of Endocrinology, Centre de référence des maladies rares de l'hypophyse HYPO, hôpital de la Conception, AP-HM, 13005 Marseille, France; INSERM, U1251, Marseille Medical Genetics (MMG), Institut Marseille Maladies Rares (MarMaRa), Aix-Marseille université, Marseille, France.
| | - Philippe Chanson
- Centre de référence des maladies rares de l'hypophyse HYPO, AP-HP, Hôpital Bicêtre, 94275 Le Kremlin-Bicêtre, France; Signalisation Hormonale, Physiopathologie Endocrinienne et Métabolique, Université Paris-Saclay, university Paris-Sud, Inserm, Le Kremlin-Bicêtre, France.
| | - Brigitte Delemer
- CRESTIC EA 3804, université de Reims Champagne Ardenne, UFR Sciences Exactes et Naturelles, Moulin de la Housse, BP 1039, 51687 Reims cedex 2, France; Service d'Endocrinologie-Diabète-Nutrition, CHU de Reims, hôpital Robert Debré, avenue du Général Koenig, 51092 Reims cedex, France.
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Abstract
The world is dealing with the Covid-19 pandemic due to the coronavirus SARS-CoV-2. Amongst the extra-pulmonary manifestations presented by Covid-19 patients, thyroiditis form part of the spectrum of visceral involvement linked to SARS-CoV-2. In this review, we will describe the various documented clinical forms of thyroiditis (inflammatory thyroiditis, subacute or de Quervain's thyroiditis, chronic lymphocytic thyroiditis or Hashimoto's disease, painless (silent) postpartum thyroiditis) to facilitate their diagnosis in more or less symptomatic Covid-19 patients and to provide guidance for patient treatment.
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Affiliation(s)
- Philippe Caron
- Department of Endocrinology and Metabolic diseases, Cardiovascular and Metabolic Unit CHU-Larrey, Toulouse, France.
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Geslot A, Vialon M, Caron P, Grunenwald S, Vezzosi D. New therapies for patients with multiple endocrine neoplasia type 1. Ann Endocrinol (Paris) 2021; 82:112-120. [PMID: 33839123 DOI: 10.1016/j.ando.2021.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/18/2021] [Accepted: 03/26/2021] [Indexed: 02/06/2023]
Abstract
In 1953, for the first time, Paul Wermer described a family presenting endocrine gland neoplasms over several generations. The transmission was autosomal dominant and the penetrance was high. Forty years later in 1997, the multiple endocrine neoplasia type 1 (MEN1) gene was sequenced, thus enabling diagnosis and early optimal treatment. Patients carrying the MEN1 gene present endocrine but also non-endocrine tumors. Parathyroid, pancreatic and pituitary impairment are the three main types of endocrine involvement. The present article details therapeutic management of hyperparathyroidism, neuroendocrine pancreatic tumors and pituitary adenomas in patients carrying the MEN1 gene. Significant therapeutic progress has in fact been made in the last few years. As concerns the parathyroid glands, screening of family members and regular monitoring of affected subjects now raise the question of early management of parathyroid lesions and optimal timing of parathyroid surgery. As concerns the duodenum-pancreas, proton-pump inhibitors are able to control gastrin-secreting syndrome, reducing mortality in MEN1 patients. Mortality in MEN1 patients is no longer mainly secondary to uncontrolled hormonal secretion but to metastatic (mainly pancreatic) disease progression. Tumor risk requires regular monitoring of morphological assessment, leading to iterative pancreatic surgery in a large number of patients. Finally, pituitary adenomas in MEN1 patients are traditionally described as aggressive, invasive and resistant to medical treatment. However, regular pituitary screening showed them to be in fact infra-centimetric and non-secreting in the majority of patients. Consequently, it is necessary to regularly monitor MEN1 patients, with regular clinical, biological and morphological work-up. Several studies showed that this regular monitoring impairs quality of life. Building a relationship of trust between patients and care provider is therefore essential. It enables the patient to be referred for psychological or psychiatric care in difficult times, providing long-term support and preventing any breakdown in continuity of care.
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Affiliation(s)
- Aurore Geslot
- Service d'endocrinologie, hôpital Larrey, 24, chemin de Pouvourville, 31029 Toulouse cedex 9, France
| | - Magaly Vialon
- Service d'endocrinologie, hôpital Larrey, 24, chemin de Pouvourville, 31029 Toulouse cedex 9, France
| | - Philippe Caron
- Service d'endocrinologie, hôpital Larrey, 24, chemin de Pouvourville, 31029 Toulouse cedex 9, France
| | - Solange Grunenwald
- Service d'endocrinologie, hôpital Larrey, 24, chemin de Pouvourville, 31029 Toulouse cedex 9, France
| | - Delphine Vezzosi
- Institut CardioMet, Toulouse, France; Service d'endocrinologie, hôpital Larrey, 24, chemin de Pouvourville, 31029 Toulouse cedex 9, France.
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Metsu D, Aquilina C, Delobel P, Gandia P, Savagner F, Raymond S, Caron P, Martin-Blondel G. Maraviroc exposure is influenced by exogenous thyrotoxicosis. AIDS 2021; 35:701-703. [PMID: 33620876 DOI: 10.1097/qad.0000000000002754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- David Metsu
- Laboratory of Pharmacokinetics and Toxicology, Purpan Hospital, University Hospital of Toulouse
- INTHERES UMR1436 INRA-ENVT
| | | | - Pierre Delobel
- Department of Infectious Diseases, University Hospital of Toulouse
- Inserm U1043 - CNRS UMR 5282, Toulouse-Purpan Pathophysiology Center
| | - Peggy Gandia
- Laboratory of Pharmacokinetics and Toxicology, Purpan Hospital, University Hospital of Toulouse
- INTHERES UMR1436 INRA-ENVT
| | - Frédérique Savagner
- Biochemistry and Genetic Laboratory, Federative Institute of Biology, CHU Toulouse
- Team 6, Inserm UMR 1048, Institute of Metabolic and Cardiovascular Diseases (I2MC), CHU Rangueil
| | - Stéphanie Raymond
- Inserm U1043 - CNRS UMR 5282, Toulouse-Purpan Pathophysiology Center
- Department of Virology, CHU Purpan
| | - Philippe Caron
- Team 6, Inserm UMR 1048, Institute of Metabolic and Cardiovascular Diseases (I2MC), CHU Rangueil
- Department of Endocrinology and Metabolic Diseases, Pôle Cardiovascular and Metabolic, Larrey University Hospital, Toulouse, France
| | - Guillaume Martin-Blondel
- Department of Infectious Diseases, University Hospital of Toulouse
- Inserm U1043 - CNRS UMR 5282, Toulouse-Purpan Pathophysiology Center
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Bouzehouane N, Borson-Chazot F, Abeillon J, Caron P. Treatment of moderate to severe orbitopathy: Current modalities and perspectives. Ann Endocrinol (Paris) 2021; 82:92-98. [PMID: 33676921 DOI: 10.1016/j.ando.2021.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 02/24/2021] [Indexed: 11/18/2022]
Abstract
Graves' orbitopathy (GO) is the primary cause of exophthalmos in adults. It appears in 30 to 50% of patients with Graves' disease. About 5% are moderate-to-severe cases that might be see-threatening or lead to long term disabling sequelae. Recommendations have been established in 2016 by the European thyroid association (ETA) and the European group on Grave's orbitopathy (EUGOGO), suggesting a wide use of corticosteroids in moderate to severe forms. However, disappointing results have been reported in 20 to 30% of cases. Improved understanding of pathophysiological mechanisms has allowed the use of non-specific immunomodulatory agents, currently under evaluation, and which place in the therapeutic strategy remains to be determined. Very recently, new promising therapeutic advances have emerged with the identification of new therapeutic targets, such as the TSH receptor and IGF-1 receptor complex.
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Affiliation(s)
- Nadia Bouzehouane
- Fédération d'endocrinologie et maladies métaboliques, hôpital cardiovasculaire Louis-Pradel, 28, avenue Doyen-Lépine, 69677 Bron, France.
| | - Françoise Borson-Chazot
- Fédération d'endocrinologie et maladies métaboliques, hôpital cardiovasculaire Louis-Pradel, 28, avenue Doyen-Lépine, 69677 Bron, France
| | - Juliette Abeillon
- Fédération d'endocrinologie et maladies métaboliques, hôpital cardiovasculaire Louis-Pradel, 28, avenue Doyen-Lépine, 69677 Bron, France
| | - Philippe Caron
- Service d'endocrinologie et maladies métaboliques, pôle cardiovasculaire et métabolique, CHU Larrey, 24, chemin de Pouvourville, 31400 Toulouse, France
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Kuhn E, Caron P, Delemer B, Raingeard I, Lefebvre H, Raverot G, Cortet-Rudelli C, Desailloud R, Geffroy C, Henocque R, Brault Y, Brue T, Chanson P. Pegvisomant in combination or pegvisomant alone after failure of somatostatin analogs in acromegaly patients: an observational French ACROSTUDY cohort study. Endocrine 2021; 71:158-167. [PMID: 32986202 PMCID: PMC7835180 DOI: 10.1007/s12020-020-02501-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/14/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE After surgery, when somatostatin analogs (SAs) do not normalise IGF-I, pegvisomant (PEG) is indicated. Our aim was to define the medical reasons for the treatment of patients with PEG as monotherapy (M) or combined with SA, either as primary bitherapy, PB (PEG is secondarily introduced after SA) or as secondary bitherapy, SB (SAs secondarily introduced after PEG). METHODS We retrospectively analysed French data from ACROSTUDY. RESULTS 167, 88 and 57 patients were treated with M, PB or SB, respectively, during a median time of 80, 42 and 70 months. The median PEG dose was respectively 15, 10 and 20 mg. Before PEG, the mean IGF-I level did not differ between M and PB but the proportion of patients with suprasellar tumour extension was higher in PB group (67.5% vs. 44.4%, P = 0.022). SB regimen was used preferentially in patients with tumour increase and IGF-I level difficult to normalise under PEG. In both secondary regimens, the decrease of the frequency of PEG's injections, compared to monotherapy was confirmed. However, the mean weekly dose of PEG between M and PB remained the same. CONCLUSIONS The medical rationale for continuing SAs rather than switching to PEG alone in patients who do not normalise IGF-I under SAs was a tumour concern with suprasellar extension and tumour shrinkage under SA. A potential explanation for introducing SA in association with PEG appears to be a tumour enlargement and difficulties to normalise IGF-I levels under PEG given alone. In both regimens, the prospect of lowering PEG injection frequency favoured the choice.
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Affiliation(s)
- Emmanuelle Kuhn
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, 94275, Le Kremlin-Bicêtre, France
- Université Paris-Saclay (Université Paris-Sud), Inserm, Signalisation Hormonale, Physiopathologie Endocrinienne et Métabolique, Le Kremlin-Bicêtre, France
| | - Philippe Caron
- CHU de Toulouse, Hôpital Larrey, 24 Chemin de Pouvourville, TSA 30030, 31059, Toulouse Cedex 9, France
| | - Brigitte Delemer
- CHU de Reims-Hôpital Robert Debré, Avenue du Général Koenig, 51092, Reims Cedex, France
| | - Isabelle Raingeard
- CHRU de Montpellier, Maladies Endocriniennes, Hopital Lapeyronie, 295 Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Hervé Lefebvre
- CHU de Rouen, 1 Rue de Germont, 76031, Rouen Cedex, France
| | - Gérald Raverot
- Hospices civils de Lyon, Hôpital Louis Pradel, 59 Boulevard Pinel, 69677, Bron Cedex, France
| | | | - Rachel Desailloud
- CHU d'Amiens, Hôpital Nord, Place Victor Pauchet, 80054, Amiens Cedex 1, France
| | - Clementine Geffroy
- Pfizer France, 23-25 Avenue du Docteur Lannelongue, 75668, Paris Cedex 14, France
| | - Robin Henocque
- Pfizer France, 23-25 Avenue du Docteur Lannelongue, 75668, Paris Cedex 14, France
| | - Yves Brault
- Pfizer France, 23-25 Avenue du Docteur Lannelongue, 75668, Paris Cedex 14, France
| | - Thierry Brue
- CHU de Marseille, Hôpital de la Conception, 147 boulevard Baille, 13385, Marseille Cedex 5, France
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, 94275, Le Kremlin-Bicêtre, France.
- Université Paris-Saclay (Université Paris-Sud), Inserm, Signalisation Hormonale, Physiopathologie Endocrinienne et Métabolique, Le Kremlin-Bicêtre, France.
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den Boer ACL, Kok KPW, Gill M, Breda J, Cahill J, Callenius C, Caron P, Damianova Z, Gurinovic M, Lähteenmäki L, Lang T, Sonnino R, Verburg G, Westhoek H, Cesuroglu T, Regeer BJ, Broerse JEW. Research and innovation as a catalyst for food system transformation. Trends Food Sci Technol 2021; 107:150-156. [PMID: 32994668 PMCID: PMC7511170 DOI: 10.1016/j.tifs.2020.09.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/03/2020] [Accepted: 09/19/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Food systems are associated with severe and persistent problems worldwide. Governance approaches aiming to foster sustainable transformation of food systems face several challenges due to the complex nature of food systems. SCOPE AND APPROACH In this commentary we argue that addressing these governance challenges requires the development and adoption of novel research and innovation (R&I) approaches that will provide evidence to inform food system transformation and will serve as catalysts for change. We first elaborate on the complexity of food systems (transformation) and stress the need to move beyond traditional linear R&I approaches to be able to respond to persistent problems that affect food systems. Though integrated transdisciplinary approaches are promising, current R&I systems do not sufficiently support such endeavors. As such, we argue, we need strategies that trigger a double transformation - of food systems and of their R&I systems. KEY FINDINGS AND CONCLUSIONS Seizing the opportunities to transform R&I systems has implications for how research is done - pointing to the need for competence development among researchers, policy makers and society in general - and requires specific governance interventions that stimulate a systemic approach. Such interventions should foster transdisciplinary and transformative research agendas that stimulate portfolios of projects that will reinforce one another, and stimulate innovative experiments to shape conditions for systemic change. In short, a thorough rethinking of the role of R&I as well as how it is funded is a crucial step towards the development of the integrative policies that are necessary to engender systemic change - in the food system and beyond.
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Affiliation(s)
- A C L den Boer
- Athena Institute, Faculty of Science, Vrije Universiteit (VU) Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, the Netherlands
| | - K P W Kok
- Athena Institute, Faculty of Science, Vrije Universiteit (VU) Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, the Netherlands
| | - M Gill
- The School of Biological Science, Aberdeen University, Tillydrone Ave, AB24 2TZ, United Kingdom
| | - J Breda
- World Health Organization, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100, Copenhagen, Denmark
| | - J Cahill
- Technological University (TU) Dublin, City Centre, Park House Grangegorman, 191 North Circular Road, D07 EWV4, Ireland
| | - C Callenius
- Research Center for Global Food Security and Ecosystems, University of Hohenheim, Schloss Hohenheim 1, 70599, Stuttgart, Germany
| | - P Caron
- ART-DEV, University of Montpellier, CIRAD, 34090, Montpellier, France
| | - Z Damianova
- Applied Research and Communications Fund (ARC Fund), Alexander Zhendov St. 5, 1113, Sofia, Bulgaria
| | - M Gurinovic
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, Tadeuša Košćuška 1, PAK 104 201, 11 158, Belgrade, Serbia
| | - L Lähteenmäki
- Department of Management, Aarhus University, Fuglesangs Allé 4, DK-8210, Aarhus V, Denmark
| | - T Lang
- Centre for Food Policy, City, University of London, Northampton Square, EC1V 0HB, London, United Kingdom
| | - R Sonnino
- School of Geography and Planning, Cardiff University, CF10 3AT, Cardiff, Wales, United Kingdom
| | - G Verburg
- Assistant Secretary-General of the United Nations (UN), Coordinator of the Scaling Up Nutrition (SUN) Movement, Avenue de La Paix 8-14, 1202, Geneva, Switzerland
| | - H Westhoek
- PBL Netherlands Environmental Assessment Agency, Bezuidenhoutseweg 30, 2594 AV, The Hague, the Netherlands
| | - T Cesuroglu
- Athena Institute, Faculty of Science, Vrije Universiteit (VU) Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, the Netherlands
| | - B J Regeer
- Athena Institute, Faculty of Science, Vrije Universiteit (VU) Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, the Netherlands
| | - J E W Broerse
- Athena Institute, Faculty of Science, Vrije Universiteit (VU) Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, the Netherlands
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Kuhn E, Caron P, Delemer B, Raingeard I, Lefebvre H, Raverot G, Cortet-Rudelli C, Desailloud R, Geffroy C, Henocque R, Brault Y, Brue T, Chanson P. Correction to: Pegvisomant in combination or pegvisomant alone after failure of somatostatin analogs in acromegaly patients: an observational French ACROSTUDY cohort study. Endocrine 2021; 71:265. [PMID: 33156493 PMCID: PMC7835287 DOI: 10.1007/s12020-020-02532-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Affiliation(s)
- Emmanuelle Kuhn
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, 94275, Le Kremlin-Bicêtre, France
- Université Paris-Saclay (Université Paris-Sud), Inserm, Signalisation Hormonale, Physiopathologie Endocrinienne et Métabolique, Le Kremlin-Bicêtre, France
| | - Philippe Caron
- CHU de Toulouse, Hôpital Larrey, 24 Chemin de Pouvourville, TSA 30030, 31059, Toulouse Cedex 9, France
| | - Brigitte Delemer
- CHU de Reims-Hôpital Robert Debré, Avenue du Général Koenig, 51092, Reims Cedex, France
| | - Isabelle Raingeard
- CHRU de Montpellier, Maladies Endocriniennes, Hopital Lapeyronie, 295 Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Hervé Lefebvre
- CHU de Rouen, 1 Rue de Germont, 76031, Rouen Cedex, France
| | - Gérald Raverot
- Hospices civils de Lyon, Hôpital Louis Pradel, 59 Boulevard Pinel, 69677, Bron Cedex, France
| | | | - Rachel Desailloud
- CHU d'Amiens, Hôpital Nord, Place Victor Pauchet, 80054, Amiens Cedex 1, France
| | - Clementine Geffroy
- Pfizer France, 23-25 Avenue du Docteur Lannelongue, 75668, Paris Cedex 14, France
| | - Robin Henocque
- Pfizer France, 23-25 Avenue du Docteur Lannelongue, 75668, Paris Cedex 14, France
| | - Yves Brault
- Pfizer France, 23-25 Avenue du Docteur Lannelongue, 75668, Paris Cedex 14, France
| | - Thierry Brue
- CHU de Marseille, Hôpital de la Conception, 147 boulevard Baille, 13385, Marseille Cedex 5, France
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, 94275, Le Kremlin-Bicêtre, France.
- Université Paris-Saclay (Université Paris-Sud), Inserm, Signalisation Hormonale, Physiopathologie Endocrinienne et Métabolique, Le Kremlin-Bicêtre, France.
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Vialon M, Grunenwald S, Mouly C, Vezzosi D, Bennet A, Caron P. First-generation somatostatin receptor ligands and pregnancy: lesson from women with acromegaly. Endocrine 2020; 70:396-403. [PMID: 32734551 DOI: 10.1007/s12020-020-02430-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/18/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Few data are available on the risks of first-generation somatostatin receptor ligands (SRLs) during pregnancy in women treated for acromegaly. Current recommendations suggest the withdrawal of treatment at diagnosis of pregnancy. The aims of this literature review were to evaluate the teratogenic effects and the potential impact of SRLs on maternal and fetal outcomes by comparing acromegalic patients treated or not during pregnancy. PATIENTS AND METHODS This study concerns 141 pregnancies in 127 women with acromegaly: 67 pregnancies in 62 women treated with SRLs during pregnancy and 74 pregnancies in 65 women not medically treated during pregnancy. A second analysis was then realized comparing women treated during 1st trimester only (36 pregnancies) and women treated longer (20 pregnancies). RESULTS One malformation (ureteral stenosis) was reported in a newborn of a woman treated with SRL during pregnancy. No difference was found concerning maternal outcomes (gestational diabetes, hypertension, headaches, and delivery mode) and fetal outcomes (birth term, height, and weight). These results were also confirmed for the second analysis. CONCLUSIONS This review of the literature did report one malformation without being able to prove a specific link with the first-generation SRL treatment. No significant impact on maternal and fetal outcomes is related to first-generation SRL treatment in women with acromegaly. The number of pregnancies is still low and more data are necessary to conclude on the total safety of this treatment during gestation. In the meantime, based on the nonthreatening data from this review of literature, SRL treatment can be continued and/or reintroduced during pregnancy if necessary (mainly for persistent headaches) in women with acromegaly.
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Affiliation(s)
- Magaly Vialon
- Department of Endocrinology and Metabolic Diseases, CHU Larrey, 24 chemin de Pouvourville, TSA 30030, 31059, Toulouse Cedex, France
| | - Solange Grunenwald
- Department of Endocrinology and Metabolic Diseases, CHU Larrey, 24 chemin de Pouvourville, TSA 30030, 31059, Toulouse Cedex, France
| | - Céline Mouly
- Department of Endocrinology and Metabolic Diseases, CHU Larrey, 24 chemin de Pouvourville, TSA 30030, 31059, Toulouse Cedex, France
| | - Delphine Vezzosi
- Department of Endocrinology and Metabolic Diseases, CHU Larrey, 24 chemin de Pouvourville, TSA 30030, 31059, Toulouse Cedex, France
| | - Antoine Bennet
- Department of Endocrinology and Metabolic Diseases, CHU Larrey, 24 chemin de Pouvourville, TSA 30030, 31059, Toulouse Cedex, France
| | - Philippe Caron
- Department of Endocrinology and Metabolic Diseases, CHU Larrey, 24 chemin de Pouvourville, TSA 30030, 31059, Toulouse Cedex, France.
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Prevost A, Dekeister C, Caron P, Imbert P, Cavallier Z, Lauwers F, Boutault F. Outcomes of orbital decompression using surgical navigation in thyroid-associated ophthalmopathy. Int J Oral Maxillofac Surg 2020; 49:1279-1285. [DOI: 10.1016/j.ijom.2020.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/25/2019] [Accepted: 02/13/2020] [Indexed: 11/30/2022]
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Grandgeorge N, Aussibal M, Saintherant C, Geslot A, Caron P, Bennet A, Grunenwald S, Vezzosi D. Insuffisance surrénalienne chronique et infection par le COVID-19. Annales d'Endocrinologie 2020. [PMCID: PMC7524667 DOI: 10.1016/j.ando.2020.07.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Contexte Objectif Patients et méthodes Résultats Conclusion
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Caron P, Broussaud S, Galano-Frutos JJ, Sancho J, Savagner F. New variant (Val597Ile) in transmembrane region of the TSH receptor with human chorionic gonadotropin hypersensitivity in familial gestational hyperthyroidism. Clin Endocrinol (Oxf) 2020; 93:339-345. [PMID: 32437589 DOI: 10.1111/cen.14215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Only two mutations at the lysine 183 amino acid in the extracellular N-terminal domain of human TSH receptor (hTSHR) have been associated with hypersensitivity to hCG and familial gestational hyperthyroidism. DESIGN Describe a new variant of the TSHR gene with hCG hypersensitivity found in two women of the same family diagnosed with gestational hyperthyroidism. PATIENTS A 38-year-old woman was seen during the first trimester of her second pregnancy for thyrotoxicosis with increased fT3 and fT4 concentrations and low TSH levels without anti-TSH receptor antibody. Thyrotoxicosis improved spontaneously during the 2nd trimester and persisted at the 3rd trimester. Similar clinical symptoms (weight loss, nausea, vomiting) were also reported during the first trimester of her first pregnancy and the first pregnancy of her mother. RESULTS DNA sequencing of the hTSHR gene of this woman and her mother identifies a heterozygous variant changing valine to isoleucine residue at codon 597 in the transmembrane domain (TMD) of this receptor. In vitro functional studies of this variant showed increased constitutive activity in regard to the basal level of cAMP and IP3 production and to the low cell-surface expression, while response to TSH was reduced compared to that of the wild-type receptor. The Val597Ile variant presented a dose-dependent increase in cAMP response to hGC and human luteinizing hormone (hLH). Simulation of the protein dynamics showed a high structural impact of the Val597Ile variant on helices 3 (TMH3) and 5 (TMH5) of the transmembrane domain participating to constitutive activity and hCG sensitivity. CONCLUSION We describe a new variant in the transmembrane region of the hTSHR gene with increased constitutive activity and hCG hypersensitivity in familial gestational hyperthyroidism.
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Affiliation(s)
- Philippe Caron
- Department of Endocrinology and Metabolic Diseases, Cardiovascular and Metabolic Unit, CHU Larrey, Toulouse, France
| | | | - Juan José Galano-Frutos
- Biocomputation and Complex Systems Physics Institute (BIFI)-Joint Units: BIFI-IQFR (CSIC) and GBsC-CSIC, Universidad de Zaragoza, Zaragoza, Spain
- Departamento de Bioquímica y Biología Molecular y Celular, Facultad de Ciencias, Universidad de Zaragoza, Zaragoza, Spain
| | - Javier Sancho
- Biocomputation and Complex Systems Physics Institute (BIFI)-Joint Units: BIFI-IQFR (CSIC) and GBsC-CSIC, Universidad de Zaragoza, Zaragoza, Spain
- Departamento de Bioquímica y Biología Molecular y Celular, Facultad de Ciencias, Universidad de Zaragoza, Zaragoza, Spain
- Aragon Health Research Institute (IIS Aragón), Universidad de Zaragoza, Zaragoza, Spain
| | - Frédérique Savagner
- Biochemistry and Genetic Laboratory, Federative Institute of Biology, CHU Toulouse, Toulouse, France
- Team 6, Inserm UMR 1048, Institute of Metabolic and Cardiovascular Diseases (I2MC), CHU Rangueil, Toulouse, France
- Institut Cardiomet, Toulouse, France
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Mouly C, Vargas-Poussou R, Lienhardt A, Silve C, Hureaux M, Magdelaine C, Buffet A, Grunenwald S, Kuhn JM, Brue T, Reznik Y, Tabarin A, Martin-Coignard D, Haymann JP, Tack I, Bennet A, Caron P, Linglart A, Vezzosi D. Clinical characteristics of familial hypocalciuric hypercalcaemia type 1: A multicentre study of 77 adult patients. Clin Endocrinol (Oxf) 2020; 93:248-260. [PMID: 32347971 DOI: 10.1111/cen.14211] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 12/16/2019] [Revised: 03/17/2020] [Accepted: 03/31/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Familial hypocalciuric hypercalcaemia type 1 (FHH1), related to heterozygous loss-of-function mutations of the calcium-sensing receptor gene, is the main differential diagnosis for primary hyperparathyroidism. The aim of our study was to describe clinical characteristics of adult patients living in France with a genetically confirmed FHH1. DESIGN AND PATIENTS This observational, retrospective, multicentre study included 77 adults, followed up in 32 clinical departments in France, with a genetic FHH1 diagnosis between 2001 and 2012. RESULTS Hypercalcaemia was diagnosed at a median age of 53 years [IQR: 38-61]. The diagnosis was made after clinical manifestations, routine analysis or familial screening in 56, 34 and 10% of cases, respectively, (n = 58; data not available for 19 patients). Chondrocalcinosis was present in 11/51 patients (22%), bone fractures in 8/56 (14%) and renal colic in 6/55 (11%). The median serum calcium was 2.74 mmol/L [IQR: 2.63-2.86 mmol/L], the median plasma parathyroid hormone level was 4.9 pmol/L [3.1-7.1], and the median 24-hour urinary calcium excretion was 2.8 mmol/24 hours [IQR: 1.9-4.0]. Osteoporosis (dual X-ray absorptiometry) or kidney stones (renal ultrasonography) were found in 6/38 patients (16%) and 9/32 patients (28%), respectively. Fourteen patients (18%) underwent parathyroid surgery; parathyroid adenoma was found in three patients (21%) and parathyroid hyperplasia in nine patients (64%). No correlation between genotype and phenotype was established. CONCLUSION This large cohort study demonstrates that FHH1 clinical characteristics can be atypical in 33 patients (43%). Clinicians should be aware of this rare differential diagnosis in order to adopt an appropriate treatment strategy.
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Affiliation(s)
- Céline Mouly
- Department of Endocrinology, Larrey Hospital, CardioMet Institute, University Hospital Centre of Toulouse, Toulouse, France
| | | | - Anne Lienhardt
- Department of Medical Paediatrics, University Hospital Centre of Limoges, Limoges, France
| | - Caroline Silve
- Department of Molecular Biochemistry and Genetics, Cochin Hospital, Paris, France
| | - Marguerite Hureaux
- Department of Genetics, European Hospital Georges Pompidou, Paris, France
| | - Corinne Magdelaine
- Department of Molecular Genetic Biochemistry, University Hospital Centre of Limoges, Limoges, France
| | - Alexandre Buffet
- Department of Endocrinology, Larrey Hospital, CardioMet Institute, University Hospital Centre of Toulouse, Toulouse, France
| | - Solange Grunenwald
- Department of Endocrinology, Larrey Hospital, CardioMet Institute, University Hospital Centre of Toulouse, Toulouse, France
| | - Jean-Marc Kuhn
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Hospital Centre of Rouen, Rouen, France
| | - Thierry Brue
- Department of Endocrinology, Diabetes and Metabolic Disorders, University Hospital Centre of Marseille, Marseille, France
| | - Yves Reznik
- Department of Endocrinology-Diabetology, University Hospital Centre of Caen, Caen, France
| | - Antoine Tabarin
- Department of Endocrinology, Diabetology, Metabolic Diseases and Nutrition, University Hospital Centre of Bordeaux, Bordeaux, France
| | | | | | - Ivan Tack
- Department of Physiological Function Tests, University Hospital Centre of Toulouse, Toulouse, France
| | - Antoine Bennet
- Department of Endocrinology, Larrey Hospital, CardioMet Institute, University Hospital Centre of Toulouse, Toulouse, France
| | - Philippe Caron
- Department of Endocrinology, Larrey Hospital, CardioMet Institute, University Hospital Centre of Toulouse, Toulouse, France
| | - Agnès Linglart
- Department of Paediatric Endocrinology, Diabetology and Severe Obesity, Bicêtre Hospital, Paris, France
| | - Delphine Vezzosi
- Department of Endocrinology, Larrey Hospital, CardioMet Institute, University Hospital Centre of Toulouse, Toulouse, France
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Roumeau S, Thevenon J, Ouchchane L, Maqdasy S, Batisse-Lignier M, Duale C, Pham Dang N, Caron P, Tauveron I, Devoize L. Assessment of oro-dental manifestations in a series of acromegalic patients, the AcroDent study. Endocr Connect 2020; 9:824-833. [PMID: 32738132 PMCID: PMC7487182 DOI: 10.1530/ec-20-0176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 07/30/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The dental and periodontal impact of GH/IGF-1 hypersecretion has been poorly investigated until now. Our aim is to precisely describe the oro-dental state of acromegalic patients and to study the impact of GH/IGF-1 hypersecretion on patients' reported oral health-related quality of life (OHRQoL). METHODS After collecting characteristics of their disease, acromegalic patients answered the GOHAI questionnaire assessing their OHRQoL, the AcroQoL questionnaire and then benefited from a complete stomatological and radiological examination (orthopantomogram systematically, retro-alveolar radiography or Cone Beam CT if necessary). RESULTS In total, 29 patients aged 59.1 ± 16.0 years were included. The average DMFT index (sum of Decayed, Missing and Filled Teeth per patient) was 19.0 ± 7.8. 16/29 patients had a gingivitis and 18/29 a mild to moderate chronic periodontitis, but no case of severe chronic periodontitis was found, probably because the frequency of a protective thick gingival biotype was increased (9/29). No case of generalized gingival hypertrophy or diffuse hypercementosis was observed. According to the Add-GOHAI score, only 8/26 patients had a satisfactory OHRQoL. This parameter was correlated to the acromegaly-specific quality of life according to the AcroQoL score. Interestingly, 11/29 patients had bulky oral bony outgrowths (OBO), such as large maxillary or mandibular tori and multiple vestibular exostosis. CONCLUSIONS The unsatisfactory OHRQoL reported by acromegalic patients contrasts with a rather good objective oro-dental state and annual oral examination seems relevant in this population. Finally, we report that huge OBO could be helpful signposts for the diagnosis of acromegaly.
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Affiliation(s)
- Sylvain Roumeau
- CHU de Clermont-Ferrand, Service d’Endocrinologie, Diabétologie et Maladies Métaboliques, Clermont-Ferrand, France
- Université Clermont Auvergne, Faculté de Médecine, Clermont-Ferrand, France
- Correspondence should be addressed to S Roumeau:
| | - Joannice Thevenon
- CHU Clermont-Ferrand, Service d’Odontologie, Clermont-Ferrand, France
| | - Lemlih Ouchchane
- Université Clermont Auvergne, CNRS, ISIT, Clermont-Ferrand, France
- CHU Clermont-Ferrand, Service de Biostatistiques, Clermont-Ferrand, France
| | - Salwan Maqdasy
- Université Clermont Auvergne, Faculté de Médecine, Clermont-Ferrand, France
- CHU de Clermont-Ferrand, Service d’Endocrinologie, Diabétologie et Maladies Métaboliques, Clermont-Ferrand, France
- Laboratoire GReD: UMR Université Clermont Auvergne-CNRS 6293, INSERM U1103, Clermont-Ferrand, France
| | - Marie Batisse-Lignier
- CHU de Clermont-Ferrand, Service d’Endocrinologie, Diabétologie et Maladies Métaboliques, Clermont-Ferrand, France
- Laboratoire GReD: UMR Université Clermont Auvergne-CNRS 6293, INSERM U1103, Clermont-Ferrand, France
| | - Christian Duale
- Université Clermont Auvergne, Inserm, Neuro-Dol, Clermont-Ferrand, France
- CHU Clermont-Ferrand, Inserm CIC 1405, Clermont-Ferrand, France
| | - Nathalie Pham Dang
- Université Clermont Auvergne, Faculté de Médecine, Clermont-Ferrand, France
- Université Clermont Auvergne, Inserm, Neuro-Dol, Clermont-Ferrand, France
- CHU de Clermont-Ferrand, Service de chirurgie maxillo-faciale, Clermont-Ferrand, France
| | - Philippe Caron
- CHU Larrey-Rangueil, Service Endocrinologie et Maladies Métaboliques, Pôle Cardio-Vasculaire et Métabolique, Toulouse, France
| | - Igor Tauveron
- CHU de Clermont-Ferrand, Service d’Endocrinologie, Diabétologie et Maladies Métaboliques, Clermont-Ferrand, France
- Université Clermont Auvergne, Faculté de Médecine, Clermont-Ferrand, France
- Laboratoire GReD: UMR Université Clermont Auvergne-CNRS 6293, INSERM U1103, Clermont-Ferrand, France
| | - Laurent Devoize
- CHU Clermont-Ferrand, Service d’Odontologie, Clermont-Ferrand, France
- Université Clermont Auvergne, Inserm, Neuro-Dol, Clermont-Ferrand, France
- Université Clermont Auvergne, Faculté de Chirurgie Dentaire, Clermont-Ferrand, France
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Timila Touhouche A, Chaput B, Marie Rouquet R, Montastier E, Caron P, Gall Y, Aquilina C, Boulinguez S, Claude Marguery M, Giordano-Labadie F, Mazereeuw J, Paul C, Polina Konstantinou M. Integrated multidisciplinary approach to hidradenitis suppurativa in clinical practice,. Int J Womens Dermatol 2020; 6:164-168. [PMID: 32637537 PMCID: PMC7330447 DOI: 10.1016/j.ijwd.2020.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/14/2020] [Accepted: 02/16/2020] [Indexed: 11/29/2022] Open
Abstract
Background The European hidradenitis suppurativa (HS) guidelines recommend a multidisciplinary approach for patients with HS and management of comorbidities. Objective We aimed to describe the organization of a multidisciplinary HS program and characterize the patient population. Methods We conducted a retrospective study of patients with HS undergoing prospectively defined multidisciplinary work-up including examinations by a dermatologist, plastic surgeon, smoking specialist, and nutritionist in our outpatient unit between October 2015 and January 2017. Results The study included 49 patients with a sex ratio of 1:1. A total of 73.4% of patients were smokers, 20.4% were overweight, 48.9% were obese, and 30.6% had symptoms of depression. The mean Sartorius score was 30.4 (±17.6). The outcome of plastic surgery consultation was as follows: 16 patients had operations, 5 were excluded based on medical history, 9 refused surgery, and 16 remained undecided. The refusal rates for consulting with the smoking cessation and nutrition specialists were 55.8% and 69.5%, respectively. Twelve patients received antibiotics, 9 received biologics, 9 underwent medico-surgical treatment, 9 underwent surgery, and 10 were lost to follow-up. The mean visual analogue scale score for satisfaction was 8.3 (±1.6; n = 28). Conclusion An integrated multidisciplinary care model for HS is associated with high patient satisfaction. Adherence to the proposed comorbidity management was higher in female patients and related to empathetic interactions with physicians.
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Affiliation(s)
- Assia Timila Touhouche
- Department of Dermatology, Paul Sabatier University and Larrey Hospital, Toulouse, France
| | - Benoit Chaput
- Department of Plastic and Reconstructive Surgery, Rangueil University Hospital, Toulouse, France
| | | | - Emilie Montastier
- Department of Nutrition, Rangueil, University Hospital, Toulouse, France
| | - Philippe Caron
- Department of Endocrinology, Larrey, University Hospital, Toulouse, France
| | - Yvon Gall
- Department of Dermatology, Paul Sabatier University and Larrey Hospital, Toulouse, France
| | - Christian Aquilina
- Department of Dermatology, Paul Sabatier University and Larrey Hospital, Toulouse, France
| | - Serge Boulinguez
- Department of Dermatology, Paul Sabatier University and Larrey Hospital, Toulouse, France
| | - Marie Claude Marguery
- Department of Dermatology, Paul Sabatier University and Larrey Hospital, Toulouse, France
| | | | - Juliette Mazereeuw
- Department of Dermatology, Paul Sabatier University and Larrey Hospital, Toulouse, France
| | - Carle Paul
- Department of Dermatology, Paul Sabatier University and Larrey Hospital, Toulouse, France
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