[Prognostic factors for surgical cure in acromegaly]

Surgery is the treatment of choice in acromegaly. To determine the prognostic factors for surgical cure in growth hormone secreting pituitary adenomas, we studied 35 patients who underwent surgery between 1986 and 2005. We compared the clinical, biological and tumoral characteristics of the cured group [n=19] and those of the non cured group [n=16]. A young age and in invasive adenoma were factors for a poor surgical prognosis. Other factors for bad surgical prognosis are reported in the literature such as a preoperative GH level higher than 50 ng/ml, a monohormonal finding at immunohistochemistry and no GH suppression after surgery

non functioning pituitary adenomas: about 24 case]

We present a retrospective study of 24 cases of non functioning pituitary adenomas which represent 10% of all our cases of pituitary adenomas. Macroadenomas were present in 76% of these patients and in 50% the diagnosis was made because of visual abnormalities that were isolated or associated to headache. The main endocrine symptoms were menstrual disturbances [46%] or sexual impotence [36%]. The first choice treatment was surgery in 46% of the cases

Adrenal incidentalomas

The increased use of morphological explorations more and more frequently involoves the fortuitous discovery of the adrenal tumours. Adrenal incidentalomas have become a common clinical and therapeutic problem. The aim of this study is to determine their frequency, the prevalence of the secreting and non secreting tumours, to establish the role of morphological and hormonal data in the therapeutic decision and to show the action to be taken recommended by our department. Our study reports 24 patients presenting with an adrenal incidentaloma. Our patients profited from a meticulous clinical examination, hormonal and morphological evaluation. The therapeutic decision rested on solid arguments. A clinical, endocrinological and morphological monitoring was recommended among all our patients. On 300 patients with adrenal tumours, we reported 24 cases of incidentalomas, that is to say a prevalence of 8%. The average age is 42 years with a clear female prevalence [17 women- 7 men]. The discovery of the mass was made primarily by abdominal ultrasound [18 cases]; these masses unilateral was 17 cases and bilateral in seven cases. Hormonal exploration discovered eight secreting tumours [six are pheochromocytomas, one is an adrenocortical adenoma and the other is an adrenocortical carcinoma]. Abdominal CT scan was practiced among all our patients, it evalueted the parameters with malignant tumours [large mass, irregular contours, necrosis...] in nine cases. All the patients with secreting and suspected tumours were operated. The not operated seven patients were re-examined periodically for 36 months [12-72 month]. The adrenal mass was disappeared in two cases, regressed in one case and remained stable among four patients three of then profited from cyto puncturo with results, returned negative. Within sight of this work, it appears to propose a systematic adrenalectomy in the event of hypersecreting tumour or suspect of malignaney than to operate all the incidentalomas