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Resume Objectifs Une fonction thyroidienne optimale est necessaire pour une fertilite efficace. De nombreux auteurs ont donc suggere que la fonction thyroidienne a un impact sur les issues des FIV/ICSI. Mais la reciproque a aussi ete dite, la FIV a aussi probablement un impact sur la fonction thyroidienne. Le but de cette etude est donc d’evaluer la cinetique des hormones thyroidiennes, au cours des stimulations ovariennes pour FIV/ICSI, de l’instauration des traitements par gonadotrophines au jour du declenchement de l’ovulation et de faire une mise au point sur les connaissances et recommandations actuelles concernant la fonction thyroidienne au cours des FIV/ICSI. Methodes Il s’agit d’une etude de cohorte prospective. Cinquante patientes beneficiant d’un cycle de FIV/ICSI entre mars 2013 et aout 2013 ont ete incluses. L’exploration de l’axe thyroidien a ete realisee en pre-therapeutique, puis a chaque dosage hormonal au cours du monitorage ovarien. Resultats Des fluctuations a des temps precoces de la fonction thyroidienne ont ete observees mais sans impact sur les taux de grossesse. Nous avons pu depister un sous-groupe de femmes insuffisantes thyroidiennes potentiel et defini un continuum entre le taux de TSH et le taux de grossesse avec un seuil plus proche de 1 mIU/L que de 2,5 mIU/L recommande par l’Endocrine Society. Conclusions Le lien entre l’integrite de la fonction thyroidienne, le pronostic de conception et la grossesse est bien etabli. Mais a l’heure actuelle, il n’existe pourtant aucune recommandation sur le taux de TSH cible pour les patientes au cours d’aide medicale a la procreation.

Introduction Sellar neuroblastoma is hugely rare, only ten cases having been described in the literature. Primary intracranial neuroblastoma mainly occurs in children and arises in the supratentorial parenchyma. These tumors belong to embryonal central nervous system primitive neuroectodermal tumors (PNET). Magnetic resonance imaging (MRI) appearance is non-specific. Management is primary based on surgical resection. Diagnosis relied on histopathological examination. Through this case, it seems relevant to consider neuroblastoma face to MRI atypical aspects of pituitary adenoma. Clinical presentation We report the case of a 58-year-old-man with a 3-year old history of a rapidly growing sellar lesion diagnosed preoperatively as a pituitary non-functioning adenoma. He developed progressive bitemporal hemianopsia and visual field loss. Endocrinal investigations disclosed a functional hyperprolactinemia due to pituitary stalk effect. MRI displayed a sellar and supra-seller mass extension compressing the optic chiasm, with intra-sphenoidal sinus development, skull bone lysis and bilateral cavernous sinus invasion. He underwent near complete surgical removal through an endoscopic transseptal transsphenoidal approach. Histological and immunohistochemical studies yielded a diagnosis of neuroblastoma. Postoperatively his visual deficit improved. Neither endrocinal disturbance nor rhinorrhea occurred. He underwent fractioned radiotherapy a few weeks later. Discussion Primary sellar neuroblastoma could be easily misdiagnosed as pituitary adenoma. Unusual MRI features could lead to consider this diagnosis. The optimal management seems to be surgical resection followed by radiation therapy. Some authors suggested adjuvant chemotherapy in patients with subtotal resection or recurrence however this is no consensual.

Male infertility is present in 50% of couple infertility. Diagnosis of infertility requires methodical and rigorous approach based upon knowledge of the pathophysiology and the causes of infertility.

Although the objective of the urologist is to correct the factors of male infertility and to favour natural procreation, the strategy must consider also the couple and the female aspects of infertility. Some types of male infertility require specific treatment. In severe cases, recent advances in medical assistance to procreation have changed the prognosis of male infertility. Pregnancy can be obtained by the means of gamet manipulation and spermatozoid selection. Nevertheless, such techniques expose to genetic disorders transmission. Subsequently, genetic assessment is required during male infertility management, especially for difficult cases.

Aunque el objetivo del urologo sigue siendo corregir los factores masculinos de infertilidad y dar prioridad a una reproduccion natural, el tratamiento debe inscribirse en el enfoque terapeutico de la pareja y tener en cuenta la fertilidad femenina. Algunas infertilidades masculinas tienen un tratamiento especifico. En los demas casos, sobre todo en los mas graves, los progresos recientes de la reproduccion asistida han modificado el pronostico de las infertilidades masculinas e incluso de las mixtas. La micromanipulacion de gametos permite sustraer los espermatozoides a las condiciones naturales de seleccion y de fecundacion, asi como obtener gestaciones clinicas en las situaciones mas complejas. No obstante, estas tecnicas exponen a la descendencia a una transmision de enfermedades geneticas. Este riesgo destaca la necesidad de una valoracion genetica de las infertilidades masculinas mas graves. Dicho estudio debe guiar al urologo para realizar un tratamiento rapido de la pareja, evitando las exploraciones inutiles y los tratamientos medicos o quirurgicos ineficaces.

La infertilidad masculina se encuentra presente en mas del 50% de los casos de infertilidad de la pareja, de forma aislada o no. Su diagnostico requiere un enfoque metodico y riguroso, basado en el conocimiento de los mecanismos anatomofisiologicos y de las causas potenciales de infertilidad.

El diagnostico de la infertilidad masculina requiere un enfoque metodico, y en primer lugar clinico, con la finalidad de identificar todos los factores potenciales de infertilidad. Las pruebas de laboratorio y radiologicas permiten confirmar uno o mas diagnosticos, asi como evaluar el pronostico y las posibilidades terapeuticas del trastorno.

Optimal thyroid function is necessary for an effective fertility. Many authors have suggested that thyroid function has an impact on IVF outcome. Conversely, IVF has been suggested to induce changes in thyroid function. The aim of this study was to determine the nature and the timing of alterations in thyroid function, throughout controlled ovarian hyperstimulation, from the beginning of therapy to the day of triggering ovulation. And make a clarification of the current recommendations of the thyroid function during hormonal stimulation.Subjects were recruited from March 2013 to July 2013 at the Hospital of the University of Reims. The studied population consisted of 50 infertile patients who had undergone IVF/ICSI cycles. Thyroid axis exploration was realized before therapy and at every hormonal dosage during ovarian monitorage.Prematuary fluctuations were observed without impact on pregnancy rate. We could detect potential hypothyroid women thanks to this dosage and define a connection between pregnancy rate and TSH with a threshold closer to 1mUI/L than 2,5mUI/L defined by the endocrine society.The link between thyroid function, forecast of conception and pregnancy is well documented. Currently, there is no recommendation on the rate of TSH targets for the patients in medical assisted procreation.

The diagnosis of male infertility requires methodical approach which is primarily clinical, aimed at identifying all potential factors. Biological and radiological assessments allow diagnosis confirmation, and evaluation of both prognosis and therapeutic strategy.

Adrenocortical carcinoma (ACC) is a rare tumour with a poor prognosis. Cisplatin is the most widely tested cytotoxic agent in this disease. A total of 18 patients with advanced ACC were enrolled. Cytotoxic therapy consisted of etoposide (VP16) (100 mg m(-2) day(-1) on days 1-3) and cisplatin (100 mg m(-2) day(-1) on day 1) every 4 weeks. Mitotane treatment was maintained during chemotherapy in 14 patients. A complete response was observed in three cases and a partial response in three cases, giving an overall response rate of 33%. Tumour response was observed in three of the six patients with progressive disease during treatment with mitotane given at an effective dosage, as shown by serum levels >14 mg l(-1). Toxic effects were as expected and were non-life-threatening; no treatment interruption was required.

Resume Objectif de l'etude. — Mise au point pour optimiser l'irradiation des tumeurs cerebrales benignes, la technique de radiotherapie stereotaxique fractionnee permet l'irradiation d'un volume reduit (2, 1 cm3 ; 16 mm de diametre) avec un fractionnement standard. Les resultats d'une analyse retrospective multicentrique sont presentes. Materiel et methodes. — La radiotherapie stereotaxique fractionnee utilise les principes balistiques et dosimetriques de la radiochirurgie : reperage stereotaxique, irradiation par multifaisceaux, collimation secondaire, dosimetrie tridimensionnelle. Le fractionnement est rendu possible par l'utilisation d'un dispositif stereotaxique non invasif et repositionnable. La technique a ete utilisee pour traiter des adenomes hypophysaires (86 patients), des neurinomes de l'acoustique (32 patients), et des meningiomes du sinus caverneux (26 patients). Resultats. — Adenomes hypophysaires: les taux cumules de reponse objective tumorale (42 patients) etaient respectivement de 42 %, 69 % et 88 % a 24, 48 et 60 mois. Les taux cumules de reponse objective hormonale (32 patients) etaient respectivement de 53 %, 75 % et 85 % a 24, 48 et 60 mois. Le risque cumule d'insuffisance hypophysaire radio-induite variait de 18 % pour la GH a 42 % pour la TSH a 48 mois. Aucune autre complication n'a ete energistree. Neurinomes de l'acoustique : 33 tumeurs de diametre inferieur a 25 mm ont ete traitees chez 32 patients. Le controle tumoral a ete assure pour 29 des 33 tumeurs : 14 stabilisations, 15 regressions et trois progressions. Une audition utile a pu etre maintenue chez neuf des dix patients. Seuls trois patients (9 %) avaient une complication persistante. Meningiome du sinus caverneux: il a ete note 17 reponses cliniques sur 19, 20 stabilisations tumorales, une reponse partielle et une progression (22 patients evaluables par IRM). Une cecite unilaterale radio-induite a ete observee. Conclusion. — Pour ces tumeurs benignes, la reduction du volume irradie obtenue par radiotherapie stereotaxique fractionnee semble plus adaptee au traitement des tumeurs benignes de petit volume que la radiotherapie standard. Le fractionnement de la dose reduit le risque de lesion severe des tissus sains en comparaison avec la radiochirurgie qui delivre une dose unique elevee.

With an incidence of 5% in the female population, genital malformations are a frequent clinical occurrence presented by Oppelt et al. (2007) [1]. First, we have to diagnostic them and search for extra genital malformation when it is necessary. Think about maturity-onset-diabetes-of-the young 5 (MODY-5) when there's a personnel or family story of diabetes. This is often within the competence of the diabetologist and our speciality can be put in contribution in the research for the associated genital malformation. We report on the case of a young woman age of 19 with diabetes diagnosed during her adolescence, a nephropathy with polycystic kidneys, biological cytolysis, a bicornuate unicervical uterus while this may be a clinical diabetes MODY-5 confirmed by the discovery of the complete deletion of the gene coding for HNF-1 beta in the heterozygous state.

Male infertility is present in 50% of couple infertility. Diagnosis of infertility requires methodical and rigorous approach based upon knowledge of the pathophysiology and the causes of infertility.

Although the objective of the urologist is to correct the factors of male infertility and to favour natural procreation, the strategy must consider also the couple and the female aspects of infertility. Some types of male infertility require specific treatment. In severe cases, recent advances in medical assistance to procreation have changed the prognosis of male infertility. Pregnancy can be obtained by the means of gamet manipulation and spermatozoid selection. Nevertheless, such techniques expose to genetic disorders transmission. Subsequently, genetic assessment is required during male infertility management, especially for difficult cases.

The diagnosis of male infertility requires methodical approach which is primarily clinical, aimed at identifying all potential factors. Biological and radiological assessments allow diagnosis confirmation, and evaluation of both prognosis and therapeutic strategy.

To optimize and reduce the toxicity of pituitary adenoma irradiation, we evaluated the feasibility and effectiveness of fractionated stereotactic radiotherapy (FSR) in 51 patients with functional adenoma; 12 of them had Cushing's disease.Eleven females and one male, median age: 49 years, 8 of them relapsed and 4 had persistent hormonal secretion after surgery. The delivered dose was 50 grays (Gy) (5 x 1.8 Gy/week) using 5 convergent micro-beams scanning in arc therapy mode. The median planned target volume (PTV) receiving 90 to 100% of the total dose was 2,1 cm(3). We used relocatable non-invasive stereotactic device Brain Lab, and adapted Linac for stereotactic radiotherapy.Nine out of twelve patients (75%) presented with complete remission after a median time of 29 months, 3/12 patients with partial remission. Actuarial probability to have hormonal persistent secretion was 88% at on year, 44% from 3 to 5 years, 22% at 7 years, and 11% to 0% after 7 years. The 12-corticotroph adenomas were significantly (p=0.007) more radiosensitive than 39 non-corticotroph adenomas. Toxicity was significantly lower for corticotrope adenoma, with no radio-induced pituitary deficiency and no neurological or optic injury.Combined surgery and FSR appears to be safe and effective for treatment of pituitary adenomas. However, long-term follow-up is required to determine the impact in terms of tumor response and hormone deficiency. The focused treated volume obtained by FSR seems more suitable for these benign tumours than standard radiotherapy. In addition to this conformal approach, the use of standard fractionation reduced the risk of severe damage to the optic chiasma, which is sometimes observed after radiosurgery and is inherent in single fraction radiotherapy.

In order to optimize cerebral benign tumor irradiation, fractionated stereotactic radiotherapy allows a focused-volume irradiation (2.1 cm3, 16 mm diameter) under standard fractionation conditions. Results of a retrospective and multicentric analysis are presented.Fractionated stereotactic radiotherapy uses the ballistic principles of the radiosurgery: stereotactic localization, multi-beam irradiation, secondary collimation, three-dimensional dosimetry. Standard fractionation is possible with a re-locatable non-invasive stereotactic device. The technique has been used for treating pituitary adenomas (86 patients), acoustic neuromas (32 patients) and cavernous meningiomas (26 patients).1) pituitary adenomas: cumulative tumoral objective-response rates (42 patients) were respectively 42%, 69% and 88% at 24, 48 and 60 months. The cumulative endocrinologic objective-response rates (32 patients) were respectively 53%, 75% and 85% at 24, 48 and 60 months. The cumulative risk of radio-induced hormonal deficiency varied from 18% (growth hormone [GH]) to 42% for TSH (thyroid stimulating hormone) at 48 months. No other complication was observed; 2) acoustic neuromas: 33 tumors,25 mm in diameter, were treated in 32 patients. Tumor control was observed in 29/33 tumors: 14 were stable, 15 decreased and three progressed. Useful hearing was maintained in 9/10 patients. Only three patients (9%) presented persistent complications; 3) cavernous meningioma: 17/19 clinical responses were noted, 20 tumoral stabilisations, one partial response and one progression (22 magnetic resonance imaging [MRI] evaluable patients). One unilateral radio-induced blindness was observed.For these benign tumors, the focused target volume obtained by the fractionated stereotactic radiotherapy seems to be better adapted to the treatment of limited benign tumors than standard radiotherapy. The use of standard fractionation reduces the risk of severe normal tissue damage, sometimes observed for radiosurgery and inherent in the use of single fraction.