Biological and radiological exploration and management of non-functioning pituitary adenoma

AbstractNon-functioning pituitary adenoma may be totally asymptomatic and discovered “incidentally” during radiological examination for some other indication, or else induce tumoral signs with compression of the optic chiasm and pituitary dysfunction. Non-functioning adenomas are mainly gonadotroph, but may also be “silent”. Treatment strategy depends on initial clinical, biological, ophthalmological and radiological findings. The present French Society of Endocrinology Consensus work-group sought to update the pitfalls associated with hormone assay and outline a hormonal exploration strategy for diagnosis and follow-up, without overlooking the particularities of silent adenoma. We also drew up basic rules for initial exploration and radiological follow-up of both operated and non-operated pituitary adenomas

Récidive de la maladie de Basedow (quelle place pour la médecine générale dans la réduction de l'incidence ?)

Le traitement par antithyroidiens de synthèse (ATS) est la stratégie thérapeutique de premier choix de l'hyperthyroidie par maladie de Basedow en Europe et au Japon, mais elle est également la plus pourvoyeuse de récidives. Notre étude portant sur 169 basedowiens traités par ATS et suivis entre 1990 et 2010 à l'hôpital de Saint Pierre, a cherché à savoir ciomment le médecin généraliste pouvait intervenir pour améliorer le pronostic de cette maladie lors d'un traitement médical. Pour cela, nous avons étudié les modalités de prise en charge, les paramètres précoces ou évolutifs de la maladie, ainsi que des facteurs pronostiques déjà cités dans la littérature. Il en ressort des éléments nouveaux, jamais retrouvés dans les études antérieures ; la mauvaise observance (p = 0,0091), le taux d'ATPO lors du diagnostic (p = 0,0115) et le retard thérapeutique (p = 0,0009) lui même lié à une prise en charge médicale triop tardive, sembleraient liés à la récidive. Ces résultats soulignent notamment l'importance d'un dépistage précoce de l'hyperthyroidie et de l'éducation du patient pour une meilleure observance et une réduction des facteurs de risque de récidive tels que le tabagisme actif. Par ailleurs, notre enquête auprès des généralistes laisse suggérer qu'une collaboration plus efficace entre généralistes et endocrinologues pourrait réduire l'incidence des récidives. Néanmoins, des études prospectives sont nécessaires afin de confirmer ces résultats, notamment la valeur pronostique de ce retard de prise en charge thérapeutique.Antithyroid drug therapy is the first line treatment of choice of hyperthyroidism due to Grave's disease in Europe and Japan but it is also the most provider of recurrence. Our study was about 169 Grave's disease patients with antithyroid drug therapy, with a follow-up from 1990 to 2010 in the hospital of Saint Pierre ; the aim was to know how general practitioners could involve themselves to improve the prognosis of this disease during medical treatment. That is why we studied the different ways to take care of these patients, early indicators or evolution of their disease, and also prognostic factors already mentioned in the literature. It brought to light new elements never described in the past studies ; bad compliance (p = 0,0091), TPOAb level at diagnosis (p = 0,0115) and delay of treatment (p = 0,0009) itself bound to a later medical take care, would seem to be in relation with recurrence. These results show the importance of an early screening for hyperthyroidism and of patient's education to get a better compliance and to reduce recurrence risk factors as smoking. Furthermore, our investigation in general practitioners group suggests that a more efficient collaboration between general physicians and endocrinologist could reduce the incidence of recurrences. Nevertheless some prospective studies are needed to confirm our results, especially the prognostic value of this delay of treatment.BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Etude des patients perdus de vue présentant une pathologie hypophysaire suivis au CHR de Saint-Pierre de la Réunion entre 2000 et 2010

BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Incidence des cancers thyroïdiens à l'ile de la Réunion (analyse à partir des données du registre des cancers)

L'incidence des cancers de la thyroïde augmente en France en particulier et dans les pays développés en général. Cette augmentation est le fait de pratiques diagnostiques plus performantes, essentiellement par l'échographie et la cytoponction à l'aiguille fine, mais également basée sur des registres plus rigoureux dans le recueil des données. L'île de La Réunion dispose depuis quelques années d'un tel registre. Son analyse permet de constater également une augmentation de l'incidence des cancers thyroïdiens comparable à celle de Métropole.Nous nous sommes intéressés à l'année 2002 (dernière année dont le registre a validé les données) pour faire un état des lieux sur le profil des patients concernés et de leur pathologie.ORLEANS-ISTO (452342307) / SudocTOULOUSE3-BU Santé-Centrale (315552105) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Familial partial lipodystrophy type 2 and obesity, two adipose tissue pathologies with different inflammatory profiles

International audienceThe transition to metabolically unhealthy obesity (MUO) is driven by the limited expandability of adipose tissue (AT). Familial Partial Lipodystrophy type 2 (FPLD2) is an alternative model for AT dysfunction that is suitable for comparison with obesity. While MUO is associated with low-grade systemic inflammation, studies of inflammation in FPLD2 have yielded inconsistent results. Consequently, comparison of inflammation markers between FPLD2 and obesity is of great interest to better understand the pathophysiological defects of FPLD2. Objective: To compare the levels of inflammatory biomarkers between a population of patients with FPLD2 due to the same ‘Reunionese’ LMNA variant and a population of patients with obesity (OB group). Methods: Adiponectin, leptin, IL-6, TNF-α and MCP-1 plasma levels were measured by enzyme-linked immuno assays for 60 subjects with FPLD2 and for 60 subjects with obesity. The populations were closely matched for age, sex, and diabetic status. Results: Metabolic outcomes were similar between the two populations. Adiponectinemia and leptinemia were lower in the FPLD2 group than in the OB group (p < 0.01 for both), while MCP-1 levels were higher in the FPLD2 than in the OB group (p < 0.01). Levels of other inflammatory markers were not significantly different. Conclusions: Insulin-resistant patients with FPLD2 and obesity share common complications related to AT dysfunction. Inflammatory biomarker analyses demonstrated that MCP-1 levels and adiponectin levels differ between patients with FPLD2 and patients with obesity. These two AT pathologies thus appear to have different inflammatory profiles

Usefulness of Home Screening for Promoting Awareness of Impaired Glycemic Status and Utilization of Primary Care in a Low Socio-Economic Setting: A Follow-Up Study in Reunion Island

International audienceBackground: Low socioeconomic settings are characterized by high prevalence of diabetes and difficulty in accessing healthcare. In these contexts, proximity health services could improve healthcare access for diabetes prevention. Our primary objective was to evaluate the usefulness of home screening for promoting awareness of impaired glycemic status and utilization of primary care among adults aged 18-79 in a low socioeconomic setting. Methods: This follow-up study was conducted in 2015-2016 in Reunion Island, a French overseas department in the Indian Ocean. Enrollment and screening occurred on the same day at the home of participants (N = 907). Impaired glycemic status was defined as [glycated hemoglobin (HbA1c) ≥5.7%] OR [fasting capillary blood glucose (FCBG) ≥1.10 g/L] OR [HbA1c = 5.5-5.6% and FCBG = 1.00-1.09 g/L]. Medical, socio-cultural, and socioeconomic characteristics were collected via a face-to-face questionnaire. A one-month telephone follow-up survey was conducted to determine whether participants had consulted a general practitioner (GP) for confirmation of screening results. A multinomial polytomous logistic regression model was used to identify factors independently associated with non-use of GP consultation for confirmation of screening results and nonresponse to the telephone follow-up survey. Results: Prevalence of glycemic abnormalities was 46.0% (95% CI = 42.7-49.2%). Among participants with impaired glycemic status (N = 417), 77.7% (95% CI = 73.7-81.7%) consulted a GP for confirmation of screening results, 12.5% (95% CI = 9.3-15.6%) did not, and 9.8% failed to respond to the follow-up survey. Factors independently associated with nonuse of GP consultation for confirmation of screening results were self-reported unwillingness to consult a GP (adjusted odds ratio [OR]: 4.86, 95% CI = 1.70-13.84), usual GP consultation frequency of less than once a year (adjusted OR: 4.13, 95% CI = 1.56-10.97), and age 18-39 years (adjusted OR: 3.09, 95% CI = 1.46-6.57). Conclusion: Home screening for glycemic abnormalities is a useful proximity health service for diabetes prevention in low socioeconomic settings. Further efforts, including health literacy interventions, are needed to increase utilization of primary care

Genetic analysis in young patients with sporadic pituitary macroadenomas:Beside AIP don't forget MEN1 genetic analysis.

CONTEXT: germline mutations in the AIP gene have been identified in young patients (age </= 30 years old) with sporadic pituitary macroadenomas. Otherwise, there are few data concerning the prevalence of MEN1 mutations in such population. OBJECTIVE: We assessed the prevalence of both AIP and MEN1 genetic abnormalities (mutations and large gene deletions) in young patients (age </= 30 years old) diagnosed with sporadic and isolated macroadenoma, without hypercalcemia and/or MEN1-associated lesions. DESIGN: The entire coding sequences of AIP and MEN1 were screened for mutations. In cases of negative sequencing screening, multiplex ligation-dependent probe amplification was performed for the detection of large genetic deletions. PATIENTS AND SETTINGS: 174 patients from Endocrinology Departments of 15 French University Hospital Centers were eligible for this study. RESULTS: 21/174(12%) patients had AIP (n=15, 8.6%) or MEN1 (n=6, 3.4%) mutations. In pediatric patients (age </= 18 years old), AIP/MEN1 mutation frequency reached nearly 22% (n=10/46). AIPmut and MEN1mut were respectively identified in 8/79 (10.1%) and 1/79 (1.2%) somatotropinoma patients; they each accounted for 4/74 (5.4%) prolactinoma patients with mutations. Half of patients (n=3/6) with gigantism displayed mutations in AIP. Interestingly, 4/12 (33%) patients with non-secreting adenomas bore either AIP or MEN1 mutations, whereas none of the 8 corticotroph-adenomas and a single thyrotropinoma case had mutations. No large gene deletions were observed in sequencing-negative patients. CONCLUSION: mutations in MEN1 can be of significance in young patients with sporadic isolated pituitary macroadenomas, particularly prolactinomas, and together with AIP, we suggest genetic analysis of MEN1 in such population

The clinical and therapeutic profiles of prolactinomas associated with germline pathogenic variants in the aryl hydrocarbon receptor interacting protein gene

peer reviewedIntroduction: Prolactinomas are the most frequent type of pituitary adenoma encountered in clinical practice. Dopamine agonists (DA) like cabergoline typically provide sign/ symptom control, normalize prolactin levels and decrease tumor size in most patients. DA-resistant prolactinomas are infrequent and can occur in association with some genetic causes like MEN1 and pathogenic germline variants in the AIP gene (AIPvar). Methods: We compared the clinical, radiological, and therapeutic characteristics of AIPvar-related prolactinomas (n=13) with unselected hospital-treated prolactinomas (“unselected”, n=41) and genetically-negative, DA-resistant prolactinomas (DA-resistant, n=39). Results: AIPvar-related prolactinomas occurred at a significantly younger age than the unselected or DA-resistant prolactinomas (p50%) occurred in 58.3% in the AIPvar group versus 4.2% in the DA-resistant group (p<0.01). Surgery was more frequent in the AIPvar and DA- resistant groups (43.8% and 61.5%, respectively) versus unselected (19.5%: p<0.01). Radiotherapy was used only in AIPvar (18.8%) and DA-resistant (25.6%) groups. Discussion: AIPvar confer an aggressive phenotype in prolactinomas, with invasive tumors occurring at a younger age. These characteristics can help differentiate rare AIPvar related prolactinomas from DA-resistant, genetically-negative tumors