Une complication rare de l’acétate de cyprotérone chez une patiente acromégale

Papadopoulou, S.; Chambre, C.; Baudry, Camille; Bihan, H.; Reach, Gérard; Froelich, Sébastien; Fysekidis, Marinos

doi:10.1016/j.ando.2015.07.276

“…Meningioma regression after CA discontinuation was then reported by many authors 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 suggesting causal relationship between this hormonal treatment and meningioma development. The role of other progestatives in meningioma development like nomegestrol acetate (NA) and chlormadinone acetate (ChlA) is still under evaluation.…”

Section: Introductionmentioning

confidence: 77%

Preliminary report of patients with meningiomas exposed to Cyproterone Acetate, Nomegestrol Acetate and Chlormadinone Acetate – Monocentric ongoing study on progestin related meningiomas

Devalckeneer¹,

Aboukaïs²,

Bourgeois³

et al. 2021

Clinical Neurology and Neurosurgery

View full text Add to dashboard Cite

Meningioma in patients exposed to progestin drugs: results from a real-life screening program

Samoyeau

¹

,

Provost

²

,

Roux

³

et al. 2022

J Neurooncol

9

0

View full text Add to dashboard Cite

Purpose: To report the results of systematic meningioma screening program implemented by French authorities in patients exposed to progestin therapies (cyproterone (CPA), nomegestrol (NA), and chlormadinone (CMA) acetate).Methods: We conducted a prospective monocentric study on patients who, between September 2018 and April 2021, underwent standardized MRI (injection of gadolinium, then a T2 axial FLAIR and a 3D-T1 gradient-echo sequence) for meningioma screening.Results: Of the 210 included patients, 15 (7.1%) had at least one meningioma; seven (7/15, 47%) had multiple meningiomas. Meningiomas were more frequent in older patients and after exposure to CPA (13/103, 13%) compared to NA (1/22, 4%) or CMA (1/85, 1%; P=0.005). After CPA exposure, meningiomas were associated with longer treatment duration (median=20 vs 7 years, P=0.001) and higher cumulative dose (median=91 g vs. 62 g, P=0.014). Similarly, their multiplicity was associated with higher dose of CPA (median=244 g vs 61 g, P=0.027). Most meningiomas were ≤1 cm 3 (44/58, 76%) and were convexity meningiomas (36/58, 62%). At diagnosis, patients were non-symptomatic, and all were managed conservatively. Among 14 patients with meningioma who stopped progestin exposure, meningioma burden decreased in 11 (79%) cases with no case of progression during MR follow-up.Conclusion: Systematic MR screening in progestin-exposed patients uncovers small and multiple meningiomas, which can be managed conservatively, decreasing in size after progestin discontinuation. The high rate of meningiomas after CPA exposure reinforces the need for systematic screening. For NA and CMA, further studies are needed to identify patients most likely to bene t from screening.needing an invasive treatment. This risk was higher risk for CPA than CMA and NA, was dose-dependent, and a decreased after progestin discontinuation [29,30]. Recently, a meta-analysis con rmed the association between CPA and meningioma and validated the imaging-requirement before undergoing . These studies led to French recommendations of systematic MR screening in patients exposed to progestin[32]: from September 2018 for CPA, and June 2020 for CMA and NA[33].This national systematic screening as well as the information given to clinicians and patients resulted in a sudden increase of MRI examinations in asymptomatic patients. However, these screened patients were not targeted in previous studies that investigated mainly symptomatic, often surgically-treated meningiomas. Therefore, the percentage of asymptomatic meningiomas in the screened population and their type of management, as well as the possibility to detect other brain lesions (incidental or associated to progestin) is still uncertain. Hence, our aim is to report the yield of the real-life screening of meningioma in such population, in particular their prevalence, MRI characteristics and the care they received in our neurosurgical center. Methods Study design and populationWe conducted a prospective monocentric cohort study including consecutive progestin-exp...

show abstract

Meningioma in patients exposed to progestin drugs: results from a real-life screening program

Samoyeau

¹

,

Provost

²

,

Roux

³

et al. 2022

Preprint

0

View full text Add to dashboard Cite

Purpose: To report the results of systematic meningioma screening program implemented by French authorities in patients exposed to progestin therapies (cyproterone (CPA), nomegestrol (NA), and chlormadinone (CMA) acetate).Methods: We conducted a prospective monocentric study on patients who, between September 2018 and April 2021, underwent standardized MRI (injection of gadolinium, then a T2 axial FLAIR and a 3D-T1 gradient-echo sequence) for meningioma screening.Results: Of the 210 included patients, 15 (7.1%) had at least one meningioma; seven (7/15, 47%) had multiple meningiomas. Meningiomas were more frequent in older patients and after exposure to CPA (13/103, 13%) compared to NA (1/22, 4%) or CMA (1/85, 1%; P=0.005). After CPA exposure, meningiomas were associated with longer treatment duration (median=20 vs 7 years, P=0.001) and higher cumulative dose (median=91 g vs. 62 g, P=0.014). Similarly, their multiplicity was associated with higher dose of CPA (median=244 g vs 61 g, P=0.027). Most meningiomas were ≤1 cm3 (44/58, 76%) and were convexity meningiomas (36/58, 62%). At diagnosis, patients were non-symptomatic, and all were managed conservatively. Among 14 patients with meningioma who stopped progestin exposure, meningioma burden decreased in 11 (79%) cases with no case of progression during MR follow-up.Conclusion: Systematic MR screening in progestin-exposed patients uncovers small and multiple meningiomas, which can be managed conservatively, decreasing in size after progestin discontinuation. The high rate of meningiomas after CPA exposure reinforces the need for systematic screening. For NA and CMA, further studies are needed to identify patients most likely to benefit from screening.

show abstract

Une complication rare de l’acétate de cyprotérone chez une patiente acromégale

Cited by 3 publications

References 2 publications

Preliminary report of patients with meningiomas exposed to Cyproterone Acetate, Nomegestrol Acetate and Chlormadinone Acetate – Monocentric ongoing study on progestin related meningiomas

Preliminary report of patients with meningiomas exposed to Cyproterone Acetate, Nomegestrol Acetate and Chlormadinone Acetate – Monocentric ongoing study on progestin related meningiomas

Meningioma in patients exposed to progestin drugs: results from a real-life screening program

Meningioma in patients exposed to progestin drugs: results from a real-life screening program

Contact Info

Product

Resources

About