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Context The behavior of locally advanced pheochromocytoma (LAP) remains unknown. Objective We characterized the population with LAP and recurrence-free survival (RFS). Methods This retrospective multicentric study was run within the ENDOCAN-COMETE network and French Group of Endocrine Tumors (GTE) from 2003 to 2018, including patients from 11 French referral centers with LAP as defined by capsular invasion, vascular invasion, adipose tissue invasion, and/or positive locoregional lymph nodes at diagnosis without evidence of distant metastasis. The main outcome measure was recurrence, defined as tumor reappearance, including local site and/or distant metastasis. The primary endpoint was RFS analysis; secondary endpoints were characterization, overall survival (OS), and prognostic factors of recurrence. Results Among 950 patients, 90 (9%) exhibited LAP criteria and 55 met inclusion criteria (median age, 53 years; 61% males; 14% with germline mutation; 84% with catecholamine excess). LAP was defined by 31 (56%) capsular invasions, 27 (49%) fat invasions, 6 (11%) positive lymph nodes, and 22 (40%) vascular invasions. After median follow-up of 54 months (range, 6-180), 12 patients (22%) had recurrences and 3 (5%) died of metastatic disease. Median RFS was 115 months (range, 6-168). Recurrences were local in 2 patients, distant in 2, and both local and distant in 8 patients. Median OS of patients was not reached. Size above 6.5 cm (P = 0.019) and Ki-67 > 2% (P = 0.028) were identified as independent significant prognostic factors in multivariate analysis. Conclusion LAP represents 9% of pheochromocytoma’s population and has a metastatic behavior. This study paves the way for future pathological TNM classification.

International audience; PurposeAcromegaly is characterized by a broad range of manifestations. Early diagnosis is key to treatment success, but is often delayed as symptomatology overlaps with common disorders. We investigated sign-and-symptom associations, demographics, and clinical characteristics at acromegaly diagnosis.MethodsObservational, cross-sectional, multicenter non-interventional study conducted at 25 hospital departments in France that treat acromegaly (ClinicalTrials.gov: NCT02012127). Adults diagnosed with acromegaly

Introduction Le ganglioneurome (GN) est une tumeur neuroblastique differenciee, rare, issue du systeme nerveux sympathique peripherique. Il se developpe aux depens de la glande surrenale dans 20 a 25 % des cas. L’objectif de cette etude est de caracteriser les GN surrenaliens et d’etudier le risque de recidive apres chirurgie. Materiel/patients et methodes Etude retrospective multicentrique des cas de GN surrenaliens dans 20 centres francais appartenant au reseau COMETE et un centre belge. Resultats Parmi les 106 cas recenses, 60,4 % sont des femmes (N = 64/106), l’âge median au diagnostic est de 29 ans avec 25 cas pediatriques. 60,4 % (N = 64/106) des GN sont des incidentalomes. Les tumeurs ne secretent pas dans 90 % des cas (N = 90/100), le bilan hormonal preoperatoire est douteux pour 10 % des patients (N = 10/100). Au niveau radiologique, ce sont des tumeurs de grande taille (mediane a 50 mm) avec une densite spontanee > 10 UH dans 98 % des cas (N = 54/55) et des calcifications dans 65,3 % des cas (N = 32/49). Un hypermetabolisme en scintigraphie 123I-MIBG et en TEP 18FDG est retrouve dans respectivement 25,8 % (N = 8/31) et 41,3 % (N = 19/46) des tumeurs. 104 patients ont ete operes. Parmi les 42 patients ayant eu un suivi d’imagerie de plus de 3 mois (suivi moyen de 29,6 mois ; mediane 18 mois [4–156]), aucune recidive radiologique n’est retrouvee. Discussion Les GN surrenaliens sont des tumeurs de grande taille, classiquement non secretantes, ne possedant pas les caracteristiques radiologiques de benignite. Cependant, aucune recidive n’a ete identifiee dans notre cohorte. La revue des donnees de la litterature conforte l’absence de recidive post-operatoire.

International audience; OC5.1Positive impact of genetic test on the management and outcome of patients with paraganglioma and/or pheochromocytomaContextParagangliomas and pheochromocytomas (PPGL) are rare neuroendocrine tumors, characterized by a strong genetic component. Indeed, up to 40% of patients carry a germline mutation in a PPGL susceptibility gene. In accordance with the international recommendations, genotyping of PPGL susceptibility genes is therefore proposed to all patients with PPGL, but it has actually never beenshown whether the identification of a germline mutation in one PPGL susceptibility gene changes the outcome of mutation-carriers.ObjectiveOur objective was to evaluate how a positive genetic test impacts the management and outcome of propositus patients with PPGL carrying a germline mutation in one of the four major PPGL susceptibility genes (SDHB, SDHD, SDHC and VHL).DesignWe performed a multicentric retrospective study on 221 propositus carrying a SDHB, SDHD, SDHC or VHL germline mutation and followed in 24 French clinical centers of the Group of Endocrine Tumors and/or the COMETE network. Patients were divided into two groups: Genetic patients, who were informed of their genetic status within the year following the first PPGL diagnosis, and Historic patients who only benefited from the genetic test several years after initial PPGL diagnosis.ResultsCompared to Historic patients, Genetic patients had a better follow-up, with a higher number of examinations and a reduced number of patients lost to follow-up (9.6% versus 72%). During follow-up, smaller (18.7 mm versus 27.6, PZ0.0128) new PPGL and metastases as well as lower metastatic spread were observed in Genetic patients. Importantly, these differences were reversed in the Historic cohort after genetic testing. Genetic patients who developed metachronous metastases had a better 5-year survival than Historic ones (PZ0.0127).ConclusionAltogether our study clearly shows the positive impact of the identification of an SDHx or VHL mutation in the management, clinical outcome and survival of patients with PPGL. It reveals, for the first time, the clinical benefits of the practice of oncogenetics for patients with a rare cancer and strongly strengthens the recommendations of the Endocrine Society to consider PPGL genetic testingin all patients affected by PPGL.DOI: 10.1530/endoabs.63.OC5.1

Introduction Le pronostic des pheochromocytomes localement avances (PLA) est inconnu. L’objectif etait de caracteriser cette population et sa survie sans recidive (SSR). Patients et methodes Etude multicentrique retrospective des PLA definis par une rupture capsulaire et/ou une invasion vasculaire et/ou une invasion du tissu adipeux et/ou une adenopathie locoregionale au diagnostic sans metastases a distance. La SSR, les facteurs pronostiques de recidive, le traitement des metastases et la survie globale ont ete evalues. Resultats Parmi 950 patients avec pheochromocytomes, 55 PLA (61 % d’hommes, 28 % predisposes genetiquement, 84 % secretant) avec statut R0 apres chirurgie ont ete inclus dans 11 centres Francais avec un suivi median de 54 mois. Les caracteristiques histologiques etaient : 31 (56 %) ruptures capsulaires, 27 (49 %) invasions graisseuses, 6 (11 %) adenopathies locoregionales et 22 (40 %) invasions vasculaires. Douze patients (22 %, taux de rechute : 4,2/100 pers/an) ont recidive (recidive locale pour 2 patients, a distance pour 3 et globale pour 7 patients) et 4 (7 %) sont decedes. La mediane de SSR etait de 115 mois. La mediane de survie globale des patients avec recidive etait de 157 mois. Le Ki67 % > 2 et la taille superieure a 6,5 cm etaient des facteurs pronostics de recidive en analyse multivariee ; les genes de predisposition du cluster 1 et la secretion predominante de normetanephrine en analyse univariee. Conclusion Les PLA representent 6 % de la population des pheochromocytomes. Ils sont de comportement malin intermediaire entre les pheochromocytomes localises et metastatiques. Cette etude ouvre la voie a une classification pTNM des pheochromocytomes.

Among the urinary compounds measured in screening for pheochromocytomas and paragangliomas (PPGL), 3-methoxytyramine (3-MT) has a controversial place. In this study, we therefore aimed to assess the diagnostic value of an isolated elevated urinary 3-MT concentration. We collected clinical data from patients with an isolated elevated level of 3-MT/creatinine (3-MT/Cr) and from control subjects, without elevated 3-MT/Cr levels. Among 64 patients with an isolated elevation of 3-MT/Cr and 66 controls, 7 patients had PPGL compared to 8 controls. There was no difference in 3-MT/Cr values between the different types of tumor diagnosed. This study suggests that an elevated urinary 3-MT/Cr level is not specifically associated with dopamine-secreting PPGL. and may therefore have little value in PPGL screening.

International audience; OBJECTIVES: Several cases of testicular adrenal rest tumours have been reported in men with congenital adrenal hyperplasia (CAH) due to the classical form of 21-hydroxylase deficiency but the prevalence has not been established. The aims of this report were to evaluate the frequency of testicular adrenal rest tissue in this population in a retrospective multicentre study involving eight endocrinology centres, and to determine whether treatment or genetic background had an impact on the occurrence of adrenal rest tissue. MATERIAL AND METHODS: Testicular adrenal rest tissue (TART) was sought clinically and with ultrasound examination in forty-five males with CAH due to the classical form of 21-hydroxylase deficiency. When the diagnosis of testicular adrenal rest tumours was sought, good observance of treatment was judged on biological concentrations of 17-hydroxyprogesterone (17OHP), delta4-androstenedione, active renin and testosterone. The results of affected and non-affected subjects were compared. RESULTS: TART was detected in none of the 18 subjects aged 1 to 15years but was detected in 14 of the 27 subjects aged more than 15years. Five patients with an abnormal echography result had no clinical signs. Therapeutic control evaluated at diagnosis of TART seemed less effective when diagnosis was made in patients with adrenal rest tissue compared to TART-free subjects. Various genotypes were observed in patients with or without TART. CONCLUSION: Due to the high prevalence of TART in classical CAH and the delayed clinical diagnosis, testicular ultrasonography must be performed before puberty and thereafter regularly during adulthood even if the clinical examination is normal.

Purpose Acromegaly is characterized by a broad range of manifestations. Early diagnosis is key to treatment success, but is often delayed as symptomatology overlaps with common disorders. We investigated sign-and-symptom associations, demographics, and clinical characteristics at acromegaly diagnosis. Methods Observational, cross-sectional, multicenter non-interventional study conducted at 25 hospital departments in France that treat acromegaly (ClinicalTrials.gov: NCT02012127). Adults diagnosed with acromegaly

ContextMitotane is an adrenolytic and anticortisolic drug used in adrenocortical carcinoma (ACC), Cushing's disease (CD), and ectopic ACTH syndrome. Its effects on the ovaries are unknown.ObjectiveTo evaluate the ovarian and gonadotrope effects of mitotane therapy in premenopausal women.PatientsWe studied 21 premenopausal women (ACC: n=13; CD: n=8; median age 33 years, range 18–45 years) receiving mitotane at a median initial dose of 3 g/day (range 1.5–6 g/day).MethodsGynecological history was collected and ovarian ultrasound was performed. Four women also underwent ovarian CT or magnetic resonance imaging. Serum gonadotropin, estradiol (E2), androgens, sex hormone-binding globulin (SHBG), and circulating mitotane levels were determined at diagnosis and during mitotane therapy.ResultsIn the women included, ovarian macrocysts (bilateral in 51%) were detected after a median 11 months (range: 3–36) of mitotane exposure. The median number of macrocysts per woman was two (range: 1–4) and the median diameter of the largest cysts was 50 mm (range: 26–90). Menstrual irregularities and/or pelvic pain were present in 15 out of 21 women at macrocyst diagnosis. In two women, the macrocysts were revealed by complications (ovarian torsion and hemorrhagic macrocyst rupture) that required surgery. Mitotane therapy was associated with a significant decrease in androstenedione and testosterone levels and a significant increase in LH levels. Serum FSH and E2 levels were also increased, and SHBG levels rose markedly.ConclusionsMitotane therapy causes significant morphological and ovarian/gonadotrope hormonal abnormalities in premenopausal women. Follicular thecal steroid synthesis appears to be specifically altered and the subsequent increase in gonadotropins might explain the development of macrocysts. The mechanisms underlying these adverse effects, whose exact prevalence in this population still needs to be determined, are discussed.

Introduction Le syndrome de Netherton (SN), maladie rare (incidence 1/200 000 naissances), presente une triade (erythrodermie ichtyosiforme congenitale, trichorrhexie invaginata, atopie) ainsi qu’un retard staturo-ponderal. Autosomique, recessive, la mutation de SPINK5 (5q31–q32) codant pour « the lymphoepithelial Kazal-type-related inhibitor » (LEKTI) entraine une augmentation d’hormone de croissance (hGH) inactive. Ce retard statural n’est pas un deficit mais une inactivation hormonale. Objectif Faire une description phenotypique hypophysaire clinique et biologique du SN et proposer une prise en charge. Materiels et methodes Dans les centres hospitaliers universitaires de Brest, Nantes, Poitiers, Tours et Toulouse, les SN ayant beneficie d’une exploration endocrinologique (entre 1990 et 2015) ont ete collecte avec des donnees demographiques, anamnestiques, cliniques, paracliniques, genetiques et un test dynamique de l’axe somatotrope. Resultats Nous avons 7 cas (1 femme, 6 hommes) de 2 a 72 ans. La taille finale est a la moyenne et proche de la taille cible. Pour les patients en croissance, corrigee a l’âge osseux la taille est entre −1,2 et +0,2 DS versus −4DS et −4,6DS en realite. Les hypophysiogrammes revelent une hypothyroidie centrale, deux retards pubertaires a fonction sertolienne normale, trois insuffisances corticotropes sous dermocorticoides. Les tests de stimulation de la GH sont majoritairement normaux avec des IGF1 basses. Il existerait un lien genotype–phenotype. Les patients les moins severes sur le plan endocrinologique (taille finale normale et puberte spontanee) presentent moins d’elements pathognomoniques. Conclusion Nous preconisons donc cinq axes de soins : dermatologique, endocrinologique (surveillance thyroidienne, supplementation en hGH a 0,030 mg/kg/j, induction pubertaire), allergologique, genetique et biologique.

ObjectiveThe calcium-sensing receptor (CASR) has an important role in calcium homoeostasis by controlling PTH secretion and renal calcium handling. Inactivating mutations in the CASR gene (HGNC ID: 1514) cause familial hypocalciuric hypercalcaemia (FHH). We present a case of FHH patient to describe a novel mutation in the CASR.Subjects and methodsA 34-year-old patient was referred because of recurrent hypercalcaemia after resection of two hyperplastic parathyroids. Extensive evaluation found elevated PTH and low calcium/creatinine clearance ratio. One of her three children had high serum calcium concentrations. Genetic studies were performed by PCR amplification of CASR coding exons and direct sequencing of PCR products. Transient transfection of the wild-type (WT) CASR and the mutant CASR into COS-7 was performed to assess functional impact of the mutation and the capacity of either protein to mediate increases in cellular levels of inositol phosphates (IPs).ResultsCASR sequencing found a previously undescribed heterozygous base substitution, determining a change of threonine to isoleucine at codon 550 (p.T550I) in the sixth exon. In contrast to those transfected with WT CASR, which showed a five- to eightfold increase in total IPs at high levels of calcium, COS-7 cells transfected with the (p.T550I) mutant showed no increase confirming to the inactivating nature of the mutation. COS-7 cells co-transfected with the WT and the (p.T550I) mutant showed an intermediate response suggesting a possible dominant negative effect.ConclusionThis case report presents a not-yet-described mutation in the cysteine-rich region of the CASR extracellular domain, a mutation with a possible dominant negative effect.