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Copyright of Nouveau Praticien Vétérinaire Canine & Féline is the property of EDP Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Nouveau Praticien Vétérinaire Canine & Féline is the property of EDP Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Soluble α-klotho (sαKl) is an isoform of the α-klotho protein that regulates calcium metabolism but also has anti- aging, anti-apoptotic, and tumor suppressor effects. The assumption that sαKl could inhibit the insulin-like growth factor 1 (IGF-1) signaling pathway has increased the interest of its research in acromegaly - a pathology characterized by an excess of growth hormone (GH) and IGF-1. This review aimed to identify the role of sαKl in acromegaly. Most studies have identified higher concentrations of sαKl in acromegaly versus non-GH pituitary adenomas (PAs) or healthy subjects. Also, the sαKl level was higher in active acromegaly versus controlled or cured disease. Moreover, sαKl positively correlated with GH, IGF-1, and GH-secreting PA size. The increased level of sαKl seems to be due to the autonomous secretion of GH, considering their drastic decrease after transsphenoidal surgery. The data regarding the relationship between sαKl, age, and gender in acromegaly are inconsistent. The latest research noted a correlation between sαKl and various parameters for monitoring the quality of life in acromegaly. In conclusion, sαKl could reflect the disease activity. Furthermore, sαKl would represent an alternative for monitoring acromegalic patients with discrepancies between IGF-1 and GH. [ABSTRACT FROM AUTHOR]

• Les patients atteints d'acromégalie ont une faible prévalence de fractures vertébrales. • Étude des anomalies qualitatives de la colonne vertébrale chez les patients acromégaux. • Le patient acromégalie avait une forte prévalence de déformations de la colonne vertébrale. La plupart des études retrouvent une majoration du risque de fractures vertébrales chez les patients acromégales, malgré une densité minérale osseuse normale. Nous avons étudié la prévalence des fractures vertébrales chez les patients acromégales de moins de 80 ans suivis au CHU de Nantes. Étude transversale monocentrique réalisée au CHU de Nantes de 1988 à 2018. Cinquante patients (18 femmes, 32 hommes) d'un âge médian de 52,3 ans (27 -78 ans) ont été inclus. Les fractures vertébrales étaient évaluées sur des radiographies conventionnelles des rachis lombaire et thoracique de face et de profil, selon la méthode semi-quantitative de Genant. Nous avons également étudié les déformations vertébrales autres que les fractures, en utilisant 3 critères : présence d'ostéophytes, présence de pincement discal et aspect cunéiforme des vertèbres. Nous avons analysé la densité minérale osseuse par absorptiométrie bi-photonique et le statut hormonal. Trois patients (6 %) présentaient une fracture vertébrale : une fracture de grade 1 et 2 fractures de grade 2 selon la classification de Genant, chez deux patients ostéoporotiques et un patient ostéopénique. Leurs déficits anté-hypophysaires étaient substitués. En considérant les déformations franches (ostéophyte ou pincement discal ≥ grade 2 ou aspect cunéiforme), le rachis dorsal était déformé chez 22 patients (44 %) et le rachis lombaire chez 21 patients (42 %). Les patients acromégales présentaient une faible prévalence de fractures vertébrales, mais un nombre important de déformations vertébrales. Nous supposons que cette forte prévalence de déformations franches pourrait expliquer la forte prévalence de fractures vertébrales rapportée précédemment. [ABSTRACT FROM AUTHOR]

Résumé: L'acromégalie est une maladie rare, habituellement en rapport avec une hypersécrétion d'hormone de croissance (GH) et du facteur analogue à l'insuline (IGF-1), le plus souvent par un adénome hypophysaire. Les manifestations digestives de l'acromégalie sont principalement représentées par les polypes coliques, qui peuvent dégénérer par la suite. Le but de notre travail est de décrire l'apport de la coloscopie de dépistage chez les patients suivis pour acromégalie. Il s'agit d'une série rétrospective incluant 35 patients suivis pour acromégalie et ayant bénéficié d'une coloscopie de dépistage sur une période de neuf ans (de janvier 2009 à novembre 2019). Nous avons analysé le sexe des patients, leur âge au moment de la réalisation de la coloscopie, les comorbidités associées et le résultat de la coloscopie (localisation de polypes et leur type histologique). [ABSTRACT FROM AUTHOR]

Pituitary adenomas are frequent benign tumors that cause a high morbidity due to their complications. Most cases are sporadic but 5% arise in a familial setting, associated with other tumors (as is for MEN1 and MEN4, Carney Complex, McCune-Albright Syndrome) or without other associated disease as is for FIPA (Familial Isolated Pituitary Adenomas) families. AIP (Aryl-hydrocarbon Receptor Interacting Protein), a tumor suppressor gene, is mutated in approximately 30% of FIPA patients and in a much lesser percent in sporadic pituitary adenomas. Patients harboring an AIP mutation have certain characteristics: are younger and with larger pituitary adenomas, usually secreting growth hormone or prolactin and more resistant to current therapies as compared to AIP negative patients. Recently a new genotype was identified in FIPA patients with early onset gigantism - microduplications on chromosome Xq26.3 and the syndrome was called X-LAG (X-linked acrogigantism). In more than a half of FIPA patients the genetic background of the disease is still unknown and more work is needed in this direction. [ABSTRACT FROM AUTHOR]

Résumé Les hormones de croissance et leurs agonistes, les antagonistes de l’hormone de croissance et les inhibiteurs de la sécrétion de l’hormone de croissance appartiennent au secteur de l’endocrinologie. Leurs indications sont multiples et leur dispensation à l’officine nécessite un conseil éclairé de la part du pharmacien. Summary Growth hormones and their agonists, growth hormone receptor antagonists and growth hormone secretion inhibitors belong to the endocrinology sector. Their indications are multiple and the pharmacist must be able to provide clear advice when dispensing them. [ABSTRACT FROM AUTHOR]

Les adénomes somatotropes de la personne âgée sont rares, et caractérisés par un retard diagnostique, un tableau clinique peu bruyant. Leurs critères diagnostiques rejoignent ceux des patients plus jeunes. La chirurgie, si possible, reste le traitement de choix de l'acromégalie du sujet âgé. Les analogues de la somatostatine ont montré leur efficacité dans le traitement de ces patients. Le pronostic des patients acromégales est inversement corrélé à l'âge du patient, à la durée de la maladie, au dernier taux de GH sous traitement. L'âge est un déterminant majeur de la mortalité en dehors de l'évolutivité de l'acromégalie. Nous rapportons trois observations de patientes acromégales âgées respectivement de 75, 70 et 66 ans avec une revue de la littérature.

Les hypertensions artérielles (HTA) d'origine endocrine restent une cause rare d'HTA, sa prévalence globale n'excède pas 4% des hypertendus. L'intérêt de la recherche des HTA endocrines réside dans la gravité de certaines formes parfois mortelles et le caractère potentiellement curable et réversible de ces HTA. Le but du travail est de déterminer le profil clinique, para clinique, étiologique et thérapeutique des HTA secondaires d'origine endocrine chez les patients suivis au service d'endocrinologie au CHU Mohamed IV à Marrakech. Il s'agit d'une étude descriptive prospective s'étalant sur une période de 4 ans incluant 45 patients ayant une HTA endocrinienne. La moyenne d'âge est de 44,89 ans, avec une nette prédominance du sexe féminine (sexe ratio de 0,49). Les étiologies des HTA endocrines étaient dominées par le phéochromocytome (17 cas), l'hypercorticisme (11 cas) et l'acromégalie (8 cas). L'HTA était paroxystique dans 24,4%. Elle était d'emblée sevère classée grade 3 dans 40% des cas. L'HTA a été compliquée de cardiopathie dans 24% des cas et de néphropathie dans 20% des cas. Le traitement curatif a permis une guérison de l'HTA chez 60% (27 cas). Le diagnostic des HTA secondaires endocrines est parfois difficile du fait de l'absence de spécificité clinique. Il n'est pas exceptionnel que l'HTA soit l'unique manifestation de la maladie. Dans notre travail nous notons le caractère paroxystique et sévère de l'HTA. Le caractère éventuellement curable des HTA endocrines, dans plus des deux tiers des cas, fait qu'il est important de la dépister devant toute HTA sévère, résistante au traitement, ou en présence de signes cliniques, biologiques ou radiologiques évocateurs.

Pituitary adenomas are frequent benign tumors that cause a high morbidity due to their complications. Most cases are sporadic but 5% arise in a familial setting, associated with other tumors (as is for MEN1 and MEN4, Carney Complex, McCune-Albright Syndrome) or without other associated disease as is for FIPA (Familial Isolated Pituitary Adenomas) families. AIP (Aryl-hydrocarbon Receptor Interacting Protein), a tumor suppressor gene, is mutated in approximately 30% of FIPA patients and in a much lesser percent in sporadic pituitary adenomas. Patients harboring an AIP mutation have certain characteristics: are younger and with larger pituitary adenomas, usually secreting growth hormone or prolactin and more resistant to current therapies as compared to AIP negative patients. Recently a new genotype was identified in FIPA patients with early onset gigantism - microduplications on chromosome Xq26.3 and the syndrome was called X-LAG (X-linked acrogigantism). In more than a half of FIPA patients the genetic background of the disease is still unknown and more work is needed in this direction. [ABSTRACT FROM AUTHOR]

Copyright of Pan African Medical Journal is the property of Pan African Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Diabetes mellitus may occur as a complication of endocrine disorders and it's name is, according to current classification (American Diabetes Association): „other specific types of diabetes“. This particular endocrine diseases associate sustained and excessive hormonal secretion, which interferes insulin secretion or action. Over time, glucose intolerance and then diabetes occur. Generally, there are middle forms with no ketosis because of the persistence of endogenous insulin secretion. More then that, hyperglycemia is usually reversible with the treatment of the underlying endocrinopathy. Main endocrine diseases that cause diabetes are reviewed. [ABSTRACT FROM AUTHOR]

The need to evaluate patients for secondary hypertension is common in clinical practice. Suspicion of endocrine hypertension occurs when the disease starts suddenly at young age, in cases with loss of blood pressure control in a patient with previously well-controlled blood pressure or labile blood pressure cases. Careful medical history and physical examination are very important to rule out other factors responsible for these patterns of hypertension (certain medications, alcohol, lack of compliance to treatment or dietary salt restriction, panic attacks etc). Pheochromocytoma and Cushing syndrome - the major endocrine diseases associated with secondary hypertension - are rare in clinical practice. Instead, primary hyperaldosteronism is becoming more frequently identified. It can go unnoticed because of nonspecific clinical presentation and of the fact that hypokalaemia, classically described, is actually rare in practice. [ABSTRACT FROM AUTHOR]

L�acromegalie est une maladie endocrinienne rare, en rapport avec une hypersecretion d�hormone de croissance. Elle a des consequences rhumatologiques: l�arthropathie peripherique, l�atteinte rachidienne et les syndromes canalaires. L�atteinte articulaire accompagne une acromegalie active, sa survenue apres un traitement radical et une remission complete est rare. Nous presentons le cas d�une patiente de 70 ans ayant un antecedent d�acromegalie sur adenome hypophysaire il y a 25 ans, traitee chirurgicalement et declaree en remission complete, a developpe une arthropathie destructrice des deux epaules. Le but de notre observation est de mettre le point sur la possibilite d�une atteinte articulaire au cours de l�acromegalie et de son retentissement fonctionnelle.

L'acromégalie est une maladie endocrinienne rare, en rapport avec une hypersécrétion d'hormone de croissance. Elle a des conséquences rhumatologiques: l'arthropathie périphérique, l'atteinte rachidienne et les syndromes canalaires. L'atteinte articulaire accompagne une acromégalie active, sa survenue après un traitement radical et une rémission complète est rare. Nous présentons le cas d'une patiente de 70 ans ayant un antécédent d'acromégalie sur adénome hypophysaire il y a 25 ans, traitée chirurgicalement et déclarée en rémission complète, a développé une arthropathie destructrice des deux épaules. Le but de notre observation est de mettre le point sur la possibilité d'une atteinte articulaire au cours de l'acromégalie et de son retentissement fonctionnelle. [ABSTRACT FROM AUTHOR]

Copyright of IBS, Immuno-analyse & Biologie Specialisee is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of IBS, Immuno-analyse & Biologie Specialisee is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of IBS, Immuno-analyse & Biologie Specialisee is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Andrologie (11662654) is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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., (Copyright © 2021 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Acromegaly is a chronic disease due to growth hormone (GH) and insulin-like growth factor 1 (IGF-1) excess. It is associated with various systemic complications including cardiovascular disease. Arterial hypertension occurs in about 20% to 30% of patients. Its pathogenesis is mainly related to the increase in plasma volume secondary to a sodium retaining actions of GH and IGF-1 in the kidney, but abnormalities in vessel architecture and reactivity participate. Left ventricular hypertrophy and diastolic dysfunctions were frequently reported in echo-based studies and are mostly mild and without clinical consequences. Recent cardiac MRI studies described a much lower frequency of myocardial hypertrophy than echo-based assessments. Progression to systolic dysfunction with congestive heart failure is nowadays very rare. Risk of coronary heart disease and of clinically significant arrythmias does not seem to be increased. Acromegaly-related cardiac valve abnormalities may be related to fibrotic changes and seem to persist after effective treatment of acromegaly. Advances in acromegaly treatment over the last decades significantly diminished the cardiovascular burden of the disease, with the cardiovascular disease anymore being the leading cause of death., (Copyright © 2020. Published by Elsevier Masson SAS.)

Background: In acromegaly, chronic growth hormone (GH) and insulin-like growth factor-1 (IGF-1) exacerbate comorbidities in multiple organs. Differentiated thyroid carcinoma (DTC) has been reported as being a comorbid condition in acromegaly. Acromegaly is usuallysporadic, but 5% of cases may be genetic. The most frequent inheritable form of acromegaly is related to germline mutations in the aryl hydrocarbon receptor interacting protein (AIP) gene. Epidemiological data on the relationship between active acromegaly, its familial forms and DTC are sparse. We present the investigation of a FIPA family (familial isolated pituitary adenoma) with homogeneous acromegaly and 6 sporadic acromegaly patients with DTC., Patients and Methods: A study of 59 acromegaly patients assessed thyroid nodules on ultrasound and fine-needle aspiration biopsy following the ATA 2015 criteria. We diagnosed 7 differentiated thyroid carcinomas. Resected thyroid carcinoma tissues were stained using an anti-AIP antibody. Analysis of germline and tumor-derived DNA for variants in the AIP and MEN1 genes were performed in the FIPA kindred., Results: We describe one FIPA patient and 6 sporadic acromegaly cases with DTC. The FIPA family (AIP mutation negative) consisted of two sisters, one of whom had a DTC with intermediate risk and incomplete structural response to therapy. In our study, DTC in sporadic acromegaly had a low recurrence rate (6/6), and excellent response to therapy (6/6). Immunohistochemistry for AIP showed similar or increased staining intensity in DTC versus normal thyroid tissue., Conclusion: In our cohort of sporadic and familial forms of acromegaly with DTC, AIP did not appear to influence thyroid cancer progression., (Copyright © 2020. Published by Elsevier Masson SAS.)

Objective: The aim of this study was to describe endocrinological outcome in patients operated on for acromegaly., Methods: A retrospective study included 167 patients. Patients were assessed in the early postoperative period (EPP), at 3 months (M3), at 1 year (Y1), and then annually. They were classified as grade I (IGF-1 level normal-for-age and positive GH response on oral glucose tolerance test [nadir <0.4ng/L]); grade II (discordant); or grade III or IV (acromegaly, controlled or uncontrolled under medical therapy, respectively)., Results: Taking all patients with all grades, 35% changed grades between EPP and M3, 26% between M3 and Y1 and 9% after Y1. In grade I, respectively 22%, 15% and 2% of patients changed grades between EPP and M3, between M3 and Y1, and after Y1, compared to 31%, 6% and 6% in grade IV. Respectively 57%, 67%, and 47% of grade II patients changed grades between EPP and M3, between M3 and Y1, and after Y1; between EPP or M3 and last follow-up (>1 year), respectively 74% and 75% of grade II patients changed grades. Knosp category, resection quality and abnormal GH response (vs. abnormal IGF-1) significantly impacted grade II patients' outcome., Conclusions: Whereas outcome in grades I and III-IV seems to be determined by 1 year, grade II discordant patients' outcome remains uncertain even after 1 year., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Purpose: Acromegaly causes multiple comorbidities, including gastrointestinal disorders. The present study evaluated the frequency of hiatal hernia and other upper gastrointestinal pathologies in patients with acromegaly, given that visceromegaly and reduced nitric oxide levels in acromegaly may impact diaphragm and lower esophageal sphincter function and thus possibly the development of hiatal hernia., Methods: Thirty-nine acromegaly patients followed our center for the previous 6months were recruited. Upper gastrointestinal endoscopy was performed once in all patients to evaluate hiatal hernia, esophagitis, gastroduodenitis and ulcer., Results: Twenty-three patients were male and 16 female. Upper gastrointestinal endoscopy found hiatal hernia, esophagitis and gastroduodenitis or gastric ulcer in 3 (7.6%), 2 (1.7%) and 31 (79.4%) patients, respectively. Pathologic examination of gastric antrum biopsy found intestinal metaplasia in 12 (30.7%) patients, and Helicobacter pylori was positive in 13 (33.3%). There were no significant correlations between age, gender, disease duration or preoperative adenoma size on the one hand and hiatal hernia or other endoscopic findings on the other. Similarly, neither surgical success nor recurrence was associated with endoscopic findings., Conclusions: The study showed that prevalence of gastritis, duodenitis, peptic ulcer and intestinal metaplasia is higher and prevalence of hiatal hernia lower in acromegaly patients than in the healthy population. Various unknown disease-related pathophysiological conditions may play a role; there is a need for further studies., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Acromegaly is characterized by increased release of growth hormone (GH) and, consequently, Insulin-Like Growth Factor I (IGF-I), most often by a pituitary adenoma. Prolonged exposure to excess hormone leads to progressive somatic disfigurement and a wide range of systemic manifestations that are associated with increased mortality. Transsphenoidal adenomectomy is the treatment of choice of GH-secreting pituitary tumors but surgical cure is not achieved in around 50% of patients, then adjuvant treatment is necessary. Mortality in acromegaly is normalized with biochemical control and has decreased in the last decade with the increased use of adjuvant therapy. Both GH and IGF-I are currently biomarkers for assessing disease activity in patients with acromegaly. However, discordance between GH and IGF-I results is encountered in a quarter of treated patients. The impacts of such a discrepancy over mortality and morbidity and the risk of biochemical and/or clinical recurrence are unclear. Moreover, despite a good biochemical control, some symptoms persist, leading to a decreased quality of life. Back pain due to vertebral fractures seem to be frequent in these patients and underdiagnosed. In patients with acromegaly, bone mineral density is not a reliable predictor of fracture risk. A more accurate evaluation of bone microstructural alterations associated with GH hypersecretion and vertebral fractures may be provided by new radiological devices analyzing alteration of trabecular microarchitecture, leading to a better prevention. © 2019 Published by Elsevier Masson SAS. All rights reserved. Cet article fait partie du numéro supplément Les Must de l'Endocrinologie 2019 réalisé avec le soutien institutionnel de Ipsen-Pharma., (© 2019 Elsevier Masson SAS. Tous droits réservés.)

Acromegaly can impair quality of life, but impact on patients' daily life, needs and expectations have been poorly explored., Objectives: To better understand the impact of acromegaly on patients' daily life, and evaluate their needs and expectations., Patients and Methods: An on-line questionnaire survey of acromegaly patient and relative community members was conducted on the Carenity website., Results: Twenty-five patients and 3 relatives, with a mean age of 48.9 years, responded. Diagnosis of acromegaly was recent (60% within 10 years). Signs at diagnosis were mainly clinical (fatigue, headache) and physical changes (acral enlargement). Reported complications comprised morphological changes (93%), bone and joint symptoms (75%) and metabolic disorders (75%). Pain and fatigue impacted the daily life of 61% and 54% patients, respectively. Acromegaly had strong impact on mood (79%), leisure (75%) and social life (71%). Patients mostly got information from specialized websites (71%), their endocrinologist (61%) and patient associations (54%). The information sought was patient testimony (82%), practical advice (64%), and information on clinical trials (61%) and treatments (50%). Patients wished to have patient-physician discussion groups (25%), and better knowledge of acromegaly on the part of those they were in contact with (25%)., Conclusion: Acromegaly has a major impact on patients' daily life and mood. Patients wished their disease to be better known, and advocated setting up discussion groups. This study should encourage acromegaly education programs to adapt the services and information that are needed by acromegalic patients., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Acromegaly and Cushing's disease lead to common and distinct comorbidities. Currently available treatments lead to the control of hyper secretion in the majority of cases. However, the prevalence of the comorbidities does not always go back to the one of the normal population after remission. For instance, about 1/3 of acromegalic patients with diabetes and half of patients with Cushing's disease and diabetes will have normal blood glucose values after remission. In contrast, high blood pressure frequently recovers after remission in both diseases. In contrast, while patients with acromegaly improve their lipid profile, patients with Cushing's disease frequently remain hypertriglyceridemic. Many other comorbidities (cardiovascular disease, bone alterations, altered quality of life) may persist after the control of hyper secretion. The aim of this review is to focus on the outcome of patients with acromegaly and Cuhing's disease, and to suggest the optimal follow-up of such patients in a multidisciplinary approach. These points have been discussed during the 2016 European Congress of Endocrinology, notably by J.Romijn and E.Valassi., (© 2016 Elsevier Masson SAS. Tous droits réservés.)

Acromegaly is a rare hormonal disease related to excessive growth hormone secretion. It can result in a range of complications, including cardiovascular, respiratory, metabolic, articular and neoplastic disorders. Among patients with the condition, obstructive sleep apnea syndrome occurs frequently and the effect of treatment is inconstant: improvement, statu quo or deterioration can be observed. We here report three clinical cases, which illustrate the unpredictable evolution of this condition., (Copyright © 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Objective: To monitor long-term pegvisomant treatment of patients with acromegaly in routine clinical practice., Patients and Methods: The French ACROSTUDY is part of the global ACROSTUDY, an observational post-authorization safety surveillance study of acromegaly treatment with pegvisomant., Results: The median duration of follow-up of the 292 included patients was 5.2 years. Overall 272 (93%) patients received somatostatin analogues before initiation of pegvisomant. The most prescribed initial dose of pegvisomant (after possible administration of a loading dose) was 10mg/day and, starting from the 2nd year, the median dose was 20mg/day. Serum IGF-1 concentration decreased as soon as pegvisomant was started and after 5 years there was a 62% mean decrease in serum IGF-1 concentration. The percentage of patients with serum IGF-1 concentration within normal ranges (for age and sex) of the local laboratory shifted from 11% at start of pegvisomant to 43% at 6 months and 63% after 5 years. The last available imaging (242 patients) showed an increased or decreased tumor size in 4 and 10% of patients, respectively. Mean weight increased by 3 kg over the 5-year period (P<10(-3)). Mean fasting blood glucose significantly decreased over time (P<0.05), while HbA1c level remained unchanged. Tolerance profile was generally good and similar to that described in clinical studies., Conclusion: This analysis showed a significant decrease in IGF-1 levels throughout the follow-up period, and confirmed that pegvisomant treatment is safe in acromegaly. The results of this interim analysis remain to be confirmed by the final analysis., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Pituitary adenomas (PA) represent in the majority of cases, benign tumors whose treatment currently associate surgery, medical therapies and radiotherapy in a multidisciplinary approach. While trans-sphenoidal surgery remains, except for prolactin-secreting adenomas, the first-line treatment of PA, it can considerably be hampered by the existence of an invasive and/or aggressive tumor for which medical therapies are often requested. In this review, we extensively discuss, both at molecular and clinical levels, the medical therapies currently used and in development in the different phenotypes of pituitary adenomas., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Introduction: Pregnancies in acromegalic women are rare. Data from the literature indicate absence of congenital malformation in newborns, an increase of pituitary adenoma volume rarely clinically symptomatic, an increased risk of gestational diabetes and gravid hypertension in women with non-controlled GH/IGF-1 hypersecretion before gestation. The changes of somatotroph function are rarely described., Aim of the Study: Report of six new pregnancies in five women with acromegaly., Patients and Methods: Before pregnancy three women had incomplete surgical resection of GH-secreting pituitary adenoma, all were treated with somatostatin analogues, and the medical treatment was withdrawal at the diagnosis of gestation. We studied clinical (blood pressure, headaches, visual field), biological (blood glucose concentration) signs, GH and IGF-1 levels were measured during each trimester of pregnancy as well as in post-partum and were compared with pregestational values, MRI of the pituitary performed during the second trimester and in the post-partum were compared with MRI examen before pregnancy., Results: All those pregnancies were normal without gestational diabetes, gravid hypertension and pituitary tumor syndrome. Clinical signs of acromegaly improved in 50 % of the patients, and IGF-1 decreased (22 %) in comparison of pregestational value without significant change in GH levels. No newborn had congenital malformation., Conclusion: Pregnancies in those women with acromegaly are uneventful without obstetrical or foetal complication, but a maternal follow-up is necessary in order to diagnose gravid hypertension and gestational diabetes. On the other hand, a clinical monitoring of pituitary tumor syndrome is necessary in women with non-operated GH-secreting macroadenoma before pregnancy. During the first trimester of gestation, an improvement of acromegalic signs can be due to a decrease of IGF-1 levels related to hepatic GH-resistance state secondary to physiological secretion of estrogens during gestation., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)