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Vogt EC, Bratland E, Berland S, Berentsen R, Lund A, Björnsdottir S, Husebye E, Øksnes M. Improving diagnostic precision in primary ovarian insufficiency using comprehensive genetic and autoantibody testing. Hum Reprod 2024; 39:177-189. [PMID: 37953503 PMCID: PMC10767963 DOI: 10.1093/humrep/dead233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 07/31/2023] [Indexed: 11/14/2023] Open
Abstract
STUDY QUESTION Is it possible to find the cause of primary ovarian insufficiency (POI) in more women by extensive screening? SUMMARY ANSWER Adding next generation sequencing techniques including a POI-associated gene panel, extended whole exome sequencing data, as well as specific autoantibody assays to the recommended diagnostic investigations increased the determination of a potential etiological diagnosis of POI from 11% to 41%. WHAT IS KNOWN ALREADY POI affects ∼1% of women. Clinical presentations and pathogenic mechanisms are heterogeneous and include genetic, autoimmune, and environmental factors, but the underlying etiology remains unknown in the majority of cases. STUDY DESIGN, SIZE, DURATION Prospective cross-sectional study of 100 women with newly diagnosed POI of unknown cause consecutively referred to Haukeland University Hospital, Bergen, Norway, January 2019 to December 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS In addition to standard recommended diagnostic investigations including screening for chromosomal anomalies and premutations in the fragile X mental retardation 1 gene (FMR1) we used whole exome sequencing, including targeted analysis of 103 ovarian-related genes, and assays of autoantibodies against steroid cell antigens. MAIN RESULTS AND THE ROLE OF CHANCE We identified chromosomal aberrations in 8%, FMR1 premutations in 3%, genetic variants related to POI in 16%, and autoimmune POI in 3%. Furthermore in 11% we identified POI associated genetic Variants of unknown signifcance (VUS). A homozygous pathogenic variant in the ZSWIM7 gene (NM_001042697.2) was found in two women, corroborating this as a novel cause of monogenic POI. No associations between phenotypes and genotypes were found. LIMITATIONS, REASONS FOR CAUTION Use of candidate genetic and autoimmune markers limit the possibility to discover new markers. To further investigate the genetic variants, family studies would have been useful. We found a relatively high proportion of genetic variants in women from Africa and lack of genetic diversity in the genomic databases can impact diagnostic accuracy. WIDER IMPLICATIONS OF THE FINDINGS Since no specific clinical or biochemical markers predicted the underlying cause of POI discussion of which tests should be part of diagnostic screening in clinical practice remains open. New technology has altered the availability and effectiveness of genetic testing, and cost-effectiveness analyses are required to aid sustainable diagnostics. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by grants and fellowships from Stiftelsen Kristian Gerhard Jebsen, the Novonordisk Foundation, the Norwegian Research Council, University of Bergen, and the Regional Health Authorities of Western Norway. The authors declare no conflict of interest. TRIAL REGISTRATION NUMBER NCT04082169.
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Affiliation(s)
- Elinor Chelsom Vogt
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Eirik Bratland
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Siren Berland
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Ragnhild Berentsen
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Agnethe Lund
- Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Sigridur Björnsdottir
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - Eystein Husebye
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Marianne Øksnes
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
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Øksnes M, Husebye ES. Approach to the Patient: Diagnosis of Primary Adrenal Insufficiency in Adults. J Clin Endocrinol Metab 2023; 109:269-278. [PMID: 37450570 PMCID: PMC10735307 DOI: 10.1210/clinem/dgad402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/28/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Marianne Øksnes
- Department of Clinical Science, University of Bergen, N-5021 Bergen, Norway
- Department of Medicine Haukeland, University Hospital, N-5021 Bergen, Norway
| | - Eystein S Husebye
- Department of Clinical Science, University of Bergen, N-5021 Bergen, Norway
- Department of Medicine Haukeland, University Hospital, N-5021 Bergen, Norway
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Sævik ÅB, Ueland G, Åkerman AK, Methlie P, Quinkler M, Jørgensen AP, Höybye C, Debowska AWJ, Nedrebø BG, Dahle AL, Carlsen S, Tomkowicz A, Sollid ST, Nermoen I, Grønning K, Dahlqvist P, Grimnes G, Skov J, Finnes T, Valland SF, Wahlberg J, Holte SE, Kämpe O, Bensing S, Husebye ES, Øksnes M. Altered biomarkers for cardiovascular disease and inflammation in autoimmune Addison's disease - a cross-sectional study. Eur J Endocrinol 2023; 189:438-447. [PMID: 37807083 DOI: 10.1093/ejendo/lvad136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 08/01/2023] [Accepted: 09/25/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Increased prevalence of cardiovascular disease has been reported in autoimmune Addison's disease (AAD), but pathomechanisms are poorly understood. DESIGN Cross-sectional study. METHODS We compared serum levels of 177 cardiovascular and inflammatory biomarkers in 43 patients with AAD at >18-h glucocorticoid withdrawal and 43 matched controls, overall and stratified for sex. Biomarker levels were correlated with the frequency of adrenal crises and quality of life (QoL) by AddiQoL-30. Finally, we investigated changes in biomarker levels following 250 µg tetracosactide injection in patients without residual adrenocortical function (RAF) to explore glucocorticoid-independent effects of high ACTH. RESULTS Nineteen biomarkers significantly differed between patients with AAD and controls; all but 1 (ST1A1) were higher in AAD. Eight biomarkers were significantly higher in female patients compared with controls (IL6, MCP1, GAL9, SPON2, DR4, RAGE, TNFRSF9, and PGF), but none differed between male patients and controls. Levels of RAGE correlated with the frequency of adrenal crises (r = 0.415, P = .006) and AddiQoL-30 scores (r = -0.347, P = .028) but not after correction for multiple testing. PDL2 and leptin significantly declined 60 min after injection of ACTH in AAD without RAF (-0.15 normalized protein expression [NPX], P = .0001, and -0.25 NPX, P = .0003, respectively). CONCLUSIONS We show that cardiovascular and inflammatory biomarkers are altered in AAD compared with controls, particularly in women. RAGE might be a marker of disease severity in AAD, associated with more adrenal crises and reduced QoL. High ACTH reduced PDL2 and leptin levels in a glucocorticoid-independent manner but the overall effect on biomarker profiles was small.
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Affiliation(s)
- Åse Bjorvatn Sævik
- Department of Clinical Science, University of Bergen, Bergen 5021, Norway
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen 5021, Norway
| | - Grethe Ueland
- Department of Clinical Science, University of Bergen, Bergen 5021, Norway
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen 5021, Norway
- Department of Medicine, Haukeland University Hospital, Bergen 5021, Norway
| | - Anna-Karin Åkerman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm 171 77, Sweden
- Department of Medicine, Örebro University Hospital, Örebro 702 17, Sweden
| | - Paal Methlie
- Department of Clinical Science, University of Bergen, Bergen 5021, Norway
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen 5021, Norway
- Department of Medicine, Haukeland University Hospital, Bergen 5021, Norway
| | - Marcus Quinkler
- Practice for Endocrinology and Nephrology, Endocrinology in Charlottenburg, Berlin 10627, Germany
| | | | - Charlotte Höybye
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm 171 77, Sweden
- Department of Endocrinology, Karolinska University Hospital, Stockholm 171 77, Sweden
| | | | | | - Anne Lise Dahle
- Department of Internal Medicine, Haugesund Hospital, Haugesund 5528, Norway
| | - Siri Carlsen
- Department of Endocrinology, Stavanger University Hospital, Stavanger 4019, Norway
| | - Aneta Tomkowicz
- Department of Medicine, Sørlandet Hospital, Kristiansand 4604, Norway
| | - Stina Therese Sollid
- Department of Medicine, Drammen Hospital, Vestre Viken Health Trust, Drammen 3004, Norway
| | - Ingrid Nermoen
- Department of Endocrinology, Akershus University Hospital, Lørenskog 1478, Norway
| | - Kaja Grønning
- Department of Endocrinology, Akershus University Hospital, Lørenskog 1478, Norway
| | - Per Dahlqvist
- Department of Public Health and Clinical Medicine, Umeå University, Umeå 907 37, Sweden
| | - Guri Grimnes
- Division of Internal Medicine, University Hospital of North Norway, Tromsø 9019, Norway
- Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø 9019, Norway
| | - Jakob Skov
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm 171 77, Sweden
| | - Trine Finnes
- Section of Endocrinology, Innlandet Hospital Trust, Hamar 2318, Norway
| | - Susanna F Valland
- Section of Endocrinology, Innlandet Hospital Trust, Hamar 2318, Norway
| | - Jeanette Wahlberg
- Department of Endocrinology, Linköping University, Linköping 581 85, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping 581 85, Sweden
| | | | - Olle Kämpe
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen 5021, Norway
- Department of Endocrinology, Karolinska University Hospital, Stockholm 171 77, Sweden
- Department of Medicine (Solna), Karolinska University Hospital, Karolinska Institutet, Stockholm 171 77, Sweden
| | - Sophie Bensing
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm 171 77, Sweden
- Department of Endocrinology, Karolinska University Hospital, Stockholm 171 77, Sweden
| | - Eystein Sverre Husebye
- Department of Clinical Science, University of Bergen, Bergen 5021, Norway
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen 5021, Norway
- Department of Medicine, Haukeland University Hospital, Bergen 5021, Norway
- Department of Medicine (Solna), Karolinska University Hospital, Karolinska Institutet, Stockholm 171 77, Sweden
| | - Marianne Øksnes
- Department of Clinical Science, University of Bergen, Bergen 5021, Norway
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen 5021, Norway
- Department of Medicine, Haukeland University Hospital, Bergen 5021, Norway
- Department of Medicine (Solna), Karolinska University Hospital, Karolinska Institutet, Stockholm 171 77, Sweden
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Upton TJ, Zavala E, Methlie P, Kämpe O, Tsagarakis S, Øksnes M, Bensing S, Vassiliadi DA, Grytaas MA, Botusan IR, Ueland G, Berinder K, Simunkova K, Balomenaki M, Margaritopoulos D, Henne N, Crossley R, Russell G, Husebye ES, Lightman SL. High-resolution daily profiles of tissue adrenal steroids by portable automated collection. Sci Transl Med 2023; 15:eadg8464. [PMID: 37343084 DOI: 10.1126/scitranslmed.adg8464] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/26/2023] [Indexed: 06/23/2023]
Abstract
Rhythms are intrinsic to endocrine systems, and disruption of these hormone oscillations occurs at very early stages of the disease. Because adrenal hormones are secreted with both circadian and ultradian periods, conventional single-time point measurements provide limited information about rhythmicity and, crucially, do not provide information during sleep, when many hormones fluctuate from nadir to peak concentrations. If blood sampling is attempted overnight, then this necessitates admission to a clinical research unit, can be stressful, and disturbs sleep. To overcome this problem and to measure free hormones within their target tissues, we used microdialysis, an ambulatory fraction collector, and liquid chromatography-tandem mass spectrometry to obtain high-resolution profiles of tissue adrenal steroids over 24 hours in 214 healthy volunteers. For validation, we compared tissue against plasma measurements in a further seven healthy volunteers. Sample collection from subcutaneous tissue was safe, well tolerated, and allowed most normal activities to continue. In addition to cortisol, we identified daily and ultradian variation in free cortisone, corticosterone, 18-hydroxycortisol, aldosterone, tetrahydrocortisol and allo-tetrahydrocortisol, and the presence of dehydroepiandrosterone sulfate. We used mathematical and computational methods to quantify the interindividual variability of hormones at different times of the day and develop "dynamic markers" of normality in healthy individuals stratified by sex, age, and body mass index. Our results provide insight into the dynamics of adrenal steroids in tissue in real-world settings and may serve as a normative reference for biomarkers of endocrine disorders (ULTRADIAN, NCT02934399).
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Affiliation(s)
- Thomas J Upton
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, Translational Health Sciences, Faculty of Health Sciences, University of Bristol, Bristol BS1 3NY, UK
| | - Eder Zavala
- Centre for Systems Modelling and Quantitative Biomedicine, University of Birmingham, Edgbaston B15 2TT, UK
| | - Paal Methlie
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen N-5021, Norway
- Department of Medicine, Haukeland University Hospital, Bergen N-5021, Norway
| | - Olle Kämpe
- Department of Endocrinology, Karolinska University Hospital, 171 76 Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, 171 77 Stockholm, Sweden
| | | | - Marianne Øksnes
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen N-5021, Norway
- Department of Medicine, Haukeland University Hospital, Bergen N-5021, Norway
| | - Sophie Bensing
- Department of Endocrinology, Karolinska University Hospital, 171 76 Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77 Stockholm, Sweden
| | | | - Marianne A Grytaas
- Department of Medicine, Haukeland University Hospital, Bergen N-5021, Norway
| | - Ileana R Botusan
- Department of Endocrinology, Karolinska University Hospital, 171 76 Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Grethe Ueland
- Department of Medicine, Haukeland University Hospital, Bergen N-5021, Norway
| | - Katarina Berinder
- Department of Endocrinology, Karolinska University Hospital, 171 76 Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Katerina Simunkova
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen N-5021, Norway
| | - Maria Balomenaki
- Department of Endocrinology, Evangelismos Hospital, Athens 106 76, Greece
| | | | - Nina Henne
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen N-5021, Norway
| | | | - Georgina Russell
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, Translational Health Sciences, Faculty of Health Sciences, University of Bristol, Bristol BS1 3NY, UK
| | - Eystein S Husebye
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen N-5021, Norway
- Department of Medicine, Haukeland University Hospital, Bergen N-5021, Norway
| | - Stafford L Lightman
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, Translational Health Sciences, Faculty of Health Sciences, University of Bristol, Bristol BS1 3NY, UK
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Åkerman AK, Sævik ÅB, Thorsby PM, Methlie P, Quinkler M, Jørgensen AP, Höybye C, Debowska AJ, Nedrebø BG, Dahle AL, Carlsen S, Tomkowicz A, Sollid ST, Nermoen I, Grønning K, Dahlqvist P, Grimnes G, Skov J, Finnes T, Wahlberg J, Holte SE, Simunkova K, Kämpe O, Husebye ES, Øksnes M, Bensing S. Plasma-Metanephrines in Patients with Autoimmune Addison's Disease with and without Residual Adrenocortical Function. J Clin Med 2023; 12:jcm12103602. [PMID: 37240708 DOI: 10.3390/jcm12103602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/28/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE Residual adrenocortical function, RAF, has recently been demonstrated in one-third of patients with autoimmune Addison's disease (AAD). Here, we set out to explore any influence of RAF on the levels of plasma metanephrines and any changes following stimulation with cosyntropin. METHODS We included 50 patients with verified RAF and 20 patients without RAF who served as controls upon cosyntropin stimulation testing. The patients had abstained from glucocorticoid and fludrocortisone replacement > 18 and 24 h, respectively, prior to morning blood sampling. The samples were obtained before and 30 and 60 min after cosyntropin stimulation and analyzed for serum cortisol, plasma metanephrine (MN), and normetanephrine (NMN) by liquid-chromatography tandem-mass pectrometry (LC-MS/MS). RESULTS Among the 70 patients with AAD, MN was detectable in 33%, 25%, and 26% at baseline, 30 min, and 60 min after cosyntropin stimulation, respectively. Patients with RAF were more likely to have detectable MN at baseline (p = 0.035) and at the time of 60 min (p = 0.048) compared to patients without RAF. There was a positive correlation between detectable MN and the level of cortisol at all time points (p = 0.02, p = 0.04, p < 0.001). No difference was noted for NMN levels, which remained within the normal reference ranges. CONCLUSION Even very small amounts of endogenous cortisol production affect MN levels in patients with AAD.
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Affiliation(s)
- Anna-Karin Åkerman
- Department of Medicine, Örebro University Hospital, 701 85 Örebro, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Åse Bjorvatn Sævik
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, 7804 Bergen, Norway
| | - Per Medbøe Thorsby
- Hormone Laboratory, Department of Medical Biochemistry and Biochemical Endocrinology and Metabolism Research Group, Oslo University Hospital, 0372 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway
| | - Paal Methlie
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, 7804 Bergen, Norway
- Department of Medicine, Haukeland University Hospital, 5009 Bergen, Norway
| | | | | | - Charlotte Höybye
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76 Stockholm, Sweden
- Department of Endocrinology, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | | | - Bjørn Gunnar Nedrebø
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
- Department of Internal Medicine, Haugesund Hospital, 5528 Haugesund, Norway
| | - Anne Lise Dahle
- Department of Internal Medicine, Haugesund Hospital, 5528 Haugesund, Norway
| | - Siri Carlsen
- Department of Endocrinology, Stavanger University Hospital, 4068 Stavanger, Norway
| | - Aneta Tomkowicz
- Department of Medicine, Sørlandet Hospital, 4604 Kristiansand, Norway
| | - Stina Therese Sollid
- Department of Medicine, Drammen Hospital, Vestre Viken Health Trust, 3004 Drammen, Norway
| | - Ingrid Nermoen
- Department of Endocrinology, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Kaja Grønning
- Department of Endocrinology, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Per Dahlqvist
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden
| | - Guri Grimnes
- Division of Internal Medicine, University Hospital of North Norway, 9038 Tromsø, Norway
- Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, 9037 Tromsø, Norway
| | - Jakob Skov
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Trine Finnes
- Section of Endocrinology, Innlandet Hospital Trust, 2381 Hamar, Norway
| | - Jeanette Wahlberg
- Department of Medicine, Örebro University Hospital, 701 85 Örebro, Sweden
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, 702 81 Örebro, Sweden
| | | | - Katerina Simunkova
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
| | - Olle Kämpe
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76 Stockholm, Sweden
- Department of Endocrinology, Karolinska University Hospital, 171 76 Stockholm, Sweden
- Department of Medicine (Solna), Karolinska University Hospital, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Eystein Sverre Husebye
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, 7804 Bergen, Norway
- Department of Medicine, Haukeland University Hospital, 5009 Bergen, Norway
- Department of Medicine (Solna), Karolinska University Hospital, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Marianne Øksnes
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, 7804 Bergen, Norway
- Department of Medicine, Haukeland University Hospital, 5009 Bergen, Norway
- Department of Medicine (Solna), Karolinska University Hospital, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Sophie Bensing
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76 Stockholm, Sweden
- Department of Endocrinology, Karolinska University Hospital, 171 76 Stockholm, Sweden
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Vogt EC, Russell HNB, Øksnes M, Lund A. Premature ovarian insufficiency. Tidsskr Nor Laegeforen 2022; 142:21-0675. [PMID: 35997198 DOI: 10.4045/tidsskr.21.0675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Premature ovarian insufficiency is a complex condition with a heterogenous aetiology, and is defined as loss of ovarian function before the age of 40. Early diagnosis and initiation of hormone replacement therapy is essential to alleviate symptoms and prevent later complications as a result of premature oestrogen deficiency. In this clinical review article we present an update on the diagnostics and treatment of the condition.
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Affiliation(s)
- Elinor Chelsom Vogt
- Medisinsk klinikk, Haukeland universitetssjukehus, og, Universitetet i Bergen
| | | | - Marianne Øksnes
- Medisinsk klinikk, Haukeland universitetssjukehus, og, Universitetet i Bergen
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Vogt EC, Real FG, Husebye ES, Björnsdottir S, Benediktsdottir B, Bertelsen RJ, Demoly P, Franklin KA, de Aja Gallastegui LS, González FJC, Heinrich J, Holm M, Jogi NO, Leynaert B, Lindberg E, Malinovschi A, Martínez-Moratalla J, Mayoral RG, Oudin A, Pereira-Vega A, Semjen CR, Schlünssen V, Triebner K, Øksnes M. Premature menopause and autoimmune primary ovarian insufficiency in two international multi-center cohorts. Endocr Connect 2022; 11:e220024. [PMID: 35521804 PMCID: PMC9175594 DOI: 10.1530/ec-22-0024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/22/2022] [Indexed: 11/08/2022]
Abstract
Objective To investigate markers of premature menopause (<40 years) and specifically the prevalence of autoimmune primary ovarian insufficiency (POI) in European women. Design Postmenopausal women were categorized according to age at menopause and self-reported reason for menopause in a cross-sectional analysis of 6870 women. Methods Variables associated with the timing of menopause and hormone measurements of 17β-estradiol and follicle-stimulating hormone were explored using multivariable logistic regression analysis. Specific immunoprecipitating assays of steroidogenic autoantibodies against 21-hydroxylase (21-OH), side-chain cleavage enzyme (anti-SCC) and 17alpha-hydroxylase (17 OH), as well as NACHT leucine-rich-repeat protein 5 were used to identify women with likely autoimmune POI. Results Premature menopause was identified in 2.8% of women, and these women had higher frequencies of nulliparity (37.4% vs 19.7%), obesity (28.7% vs 21.4%), osteoporosis (17.1% vs 11.6%), hormone replacement therapy (59.1% vs 36.9%) and never smokers (60.1% vs 50.9%) (P < 0.05), compared to women with menopause ≥40 years. Iatrogenic causes were found in 91 (47%) and non-ovarian causes in 27 (14%) women, while 77 (39%) women were classified as POI of unknown cause, resulting in a 1.1% prevalence of idiopathic POI. After adjustments nulliparity was the only variable significantly associated with POI (odds ratio 2.46; 95% CI 1.63-3.42). Based on the presence of autoantibodies against 21 OH and SCC, 4.5% of POI cases were of likely autoimmune origin. Conclusion Idiopathic POI affects 1.1% of all women and almost half of the women with premature menopause. Autoimmunity explains 4.5% of these cases judged by positive steroidogenic autoantibodies.
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Affiliation(s)
- Elinor Chelsom Vogt
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Francisco Gómez Real
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Eystein Sverre Husebye
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Sigridur Björnsdottir
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - Bryndis Benediktsdottir
- Medical Faculty, University of Iceland, Reykjavik, Iceland
- Department of Sleep, Landspitali University Hospital Reykjavík, Reykjavik, Iceland
| | | | - Pascal Demoly
- University Hospital of Montpellier, IDESP, Univ Montpellier-Inserm, Montpellier, France
| | - Karl Anders Franklin
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | | | | | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mathias Holm
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nils Oscar Jogi
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Benedicte Leynaert
- Université Paris-Saclay, Inserm U1018, Center for Epidemiology and Population Health, Integrative Respiratory Epidemiology Team, Villejuif, France
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Medicine, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Jesús Martínez-Moratalla
- Pneumology Service of the General University Hospital of Albacete, Albacete, Spain
- Albacete Faculty of Medicine, Castilla-La Mancha University, Albacete, Spain
| | - Raúl Godoy Mayoral
- Department of Respiratory Medicine, Albacete University Hospital, Albacete, Spain
| | - Anna Oudin
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | | | - Vivi Schlünssen
- Department of Public Health, Environment, Work and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
- The National Research Center for the Working Environment, Copenhagen, Denmark
| | - Kai Triebner
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Marianne Øksnes
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
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8
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Vogt EC, Breivik L, Røyrvik EC, Grytaas M, Husebye ES, Øksnes M. Primary Ovarian Insufficiency in Women With Addison's Disease. J Clin Endocrinol Metab 2021; 106:e2656-e2663. [PMID: 33686417 PMCID: PMC8208662 DOI: 10.1210/clinem/dgab140] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/22/2021] [Indexed: 02/07/2023]
Abstract
CONTEXT Primary ovarian insufficiency (POI) is defined by menopause before 40 years of age. POI prevalence is higher among women with autoimmune Addison's disease (AAD) than in the general population, but their clinical characteristics are insufficiently studied. OBJECTIVE To assess the prevalence of POI in a large cohort of women with AAD and describe clinical, immunological, and genetic characteristics. METHODS An observational population-based cohort study of the Norwegian National Addison Registry. The Norwegian Prescription Database was used to assess prescription of menopausal hormone replacement therapy (HRT). A total of 461 women with AAD were studied. The primary outcome measure was prevalence of POI. Secondary outcomes were clinical characteristics, autoantibodies, and genome-wide single nucleotide polymorphism variation. RESULTS The prevalence of POI was 10.2% (47/461) and one-third developed POI before 30 years of age. POI preceded or coincided with AAD diagnosis in more than half of the women. The prevalence of concomitant autoimmune diseases was 72%, and AAD women with POI had more autoantibodies than AAD women without (≥2 autoantibodies in 78% vs 25%). Autoantibodies against side-chain cleavage enzyme (SCC) had the highest accuracy with a negative predictive value for POI of 96%. HRT use was high compared to the age adjusted normal population (11.3 % vs 0.7%). CONCLUSION One in 10 women with AAD have POI. Autoantibodies against SCC are the most specific marker for autoimmune POI. We recommend testing women with AAD <40 years with menstrual disturbances or fertility concerns for autoantibodies against SCC.
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Affiliation(s)
- Elinor C Vogt
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Lars Breivik
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway
| | - Ellen C Røyrvik
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway
| | - Marianne Grytaas
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Eystein S Husebye
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
- Correspondence: Eystein Husebye, Department of Clinical Science, University of Bergen, N-5021 Bergen.
| | - Marianne Øksnes
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
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9
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Sævik ÅB, Wolff A, Björnsdottir S, Simunkova K, Hynne MS, Dolan D, Bratland E, Knappskog P, Methlie P, Carlsen S, Isaksson M, Bensing S, Kämpe O, Husebye ES, Løvås K, Øksnes M. Gene Expression to Guide Glucocorticoid Replacement in Autoimmune Addison’s Disease. J Endocr Soc 2021. [DOI: 10.1210/jendso/bvab048.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Objective: Deciding the optimal doses of glucocorticoid (GC) replacement treatment in autoimmune Addison’s disease (AAD) is impeded by the lack of reliable biomarkers. This frequently results in over-treatment, with alarming and persistent side-effects, or under-replacement, which could be fatal. There is a need to think new in the quest for robust biomarkers to optimize GC replacement in AAD at an individual level.
Aim: We aimed to identify genes that are consistently up- or down-regulated in patients with AAD in response to different GC replacement doses. This information can be used to establish novel biomarkers to guide GC treatment in AAD.
Methods: Step 1: Global microarray expression analysis on RNA from whole blood before and after intravenous infusion of 100 mg hydrocortisone (HC) in 10 patients with AAD. To verify the results, we performed real-time PCR to compare gene expression levels of three of the highly differentially expressed genes (FKBP5, MMP9, and DSIPI) to compare gene expression levels before and two, four, and six hours after the HC infusion. Step 2: Rt-PCR to compare expression levels of 93 GC-regulated genes in normal versus very low morning cortisol levels in 27 patients with AAD.
Results: Step 1: Two hours after infusion of 100 mg HC, there was a marked increase in FKBP5, MMP9, and DSIPI expression levels. MMP9 and DSIPI expression levels correlated with serum cortisol. Step 2: Expression levels of CEBPB, DDIT4, FKBP5, DSIPI, and VDR were increased and ADARB1, ARIDB5, and POU2F1 decreased in normal versus very low morning cortisol. Normal serum cortisol levels positively correlated with DSIPI, DDIT4, and FKBP5 expression.
Conclusions: We introduce gene expression as a novel approach to guide GC replacement in AAD. We suggest that gene expression of DSIPI, DDIT4, and FKBP5 are particularly promising candidate biomarkers of GC replacement, followed by MMP9, CEBPB, VDR, ADARB1, ARID5B, and POU2F1.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Siri Carlsen
- Stavanger University Hospital, Stavanger, Norway
| | | | | | - Olle Kämpe
- Karolinska Institutet, Stockholm, Sweden
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10
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Sævik ÅB, Wolff AB, Björnsdottir S, Simunkova K, Hynne MS, Dolan DWP, Bratland E, Knappskog PM, Methlie P, Carlsen S, Isaksson M, Bensing S, Kämpe O, Husebye ES, Løvås K, Øksnes M. Potential Transcriptional Biomarkers to Guide Glucocorticoid Replacement in Autoimmune Addison's Disease. J Endocr Soc 2021; 5:bvaa202. [PMID: 33553982 PMCID: PMC7853175 DOI: 10.1210/jendso/bvaa202] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Indexed: 12/11/2022] Open
Abstract
Background No reliable biomarkers exist to guide glucocorticoid (GC) replacement treatment in autoimmune Addison's disease (AAD), leading to overtreatment with alarming and persistent side effects or undertreatment, which could be fatal. Objective To explore changes in gene expression following different GC replacement doses as a means of identifying candidate transcriptional biomarkers to guide GC replacement in AAD. Methods Step 1: Global microarray expression analysis on RNA from whole blood before and after intravenous infusion of 100 mg hydrocortisone (HC) in 10 patients with AAD. In 3 of the most highly upregulated genes, we performed real-time PCR (rt-PCR) to compare gene expression levels before and 3, 4, and 6 hours after the HC infusion. Step 2: Rt-PCR to compare expression levels of 93 GC-regulated genes in normal versus very low morning cortisol levels in 27 patients with AAD. Results Step 1: Two hours after infusion of 100 mg HC, there was a marked increase in FKBP5, MMP9, and DSIPI expression levels. MMP9 and DSIPI expression levels correlated with serum cortisol. Step 2: Expression levels of CEBPB, DDIT4, FKBP5, DSIPI, and VDR were increased and levels of ADARB1, ARIDB5, and POU2F1 decreased in normal versus very low morning cortisol. Normal serum cortisol levels positively correlated with DSIPI, DDIT4, and FKBP5 expression. Conclusions We introduce gene expression as a novel approach to guide GC replacement in AAD. We suggest that gene expression of DSIPI, DDIT4, and FKBP5 are particularly promising candidate biomarkers of GC replacement, followed by MMP9, CEBPB, VDR, ADARB1, ARID5B, and POU2F1.
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Affiliation(s)
- Åse Bjorvatn Sævik
- Department of Clinical Science, University of Bergen, Bergen, Norway.,K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway
| | - Anette B Wolff
- Department of Clinical Science, University of Bergen, Bergen, Norway.,K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway
| | - Sigridur Björnsdottir
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | - Eirik Bratland
- Department of Clinical Science, University of Bergen, Bergen, Norway.,K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway.,Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Per M Knappskog
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway.,Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Paal Methlie
- Department of Clinical Science, University of Bergen, Bergen, Norway.,K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Siri Carlsen
- Department of Endocrinology, Stavanger University Hospital, Stavanger, Norway
| | - Magnus Isaksson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Sophie Bensing
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Olle Kämpe
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway.,Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine (Solna), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Eystein S Husebye
- Department of Clinical Science, University of Bergen, Bergen, Norway.,K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Medicine (Solna), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Kristian Løvås
- Department of Clinical Science, University of Bergen, Bergen, Norway.,K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Marianne Øksnes
- Department of Clinical Science, University of Bergen, Bergen, Norway.,K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway.,Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
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11
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Didriksen NM, Sævik ÅB, Sortland LS, Øksnes M, Husebye ES. Sex-Specific Limitations in Physical Health in Primary Adrenal Insufficiency. Front Endocrinol (Lausanne) 2021; 12:718660. [PMID: 34733237 PMCID: PMC8558514 DOI: 10.3389/fendo.2021.718660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/29/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patients with primary adrenal insufficiency (PAI) suffer reduced quality of life (QoL), but comparisons with large-scale normative data are scarce. The clinical characteristics associated with reduced QoL are largely unknown. METHODS Cross-sectional data on clinical characteristics and QoL scores from 494 patients were included. QoL was measured using RAND-36 (generic) and AddiQoL (-30 and -8, disease-specific). RAND-36 is reported as subdomain scores as well as physical (PCS) and metal (MCS) summary scores and compared with normative data. RESULTS Perception of physical role was consistently decreased across age groups in patients with PAI compared with normative data [75 (0-100) vs. 100 (50-100), p<0.001]. Men with PAI reported significantly lower scores for social functioning [88 (75-100) vs. 100 (75-100), p<0.001], as well as for vitality and physical role. In women, the greatest impairment was seen in physical role [50 (0-100) vs. 100 (50-100), p<0.001], followed by social functioning, vitality, physical function, general health, mental health, and emotional role. Overall, better QoL was associated with male sex (AddiQoL-30: 89 ± 13 vs. 82 ± 13, p<0.002), younger age (e.g. 20-29 vs. 80-89 years: PCS 59 [50-62] vs. 46 [37-53], p<0.001), autoimmune etiology [PCS: 53 (45-59) vs.. 45 (38-54), p<0.001], and absence of autoimmune comorbidity [PCS: 54 (45-59) vs. 50 (43-58), p<0.001]. There were no significant differences in QoL scores between different doses or dosing regimens of glucocorticoid or mineralocorticoid replacement. CONCLUSION QoL is reduced in patients with PAI, especially perception of physical role in women and social functioning in men. Among patients with PAI, female sex, higher age, non-autoimmune etiology, and autoimmune comorbidity was associated with lower QoL-scores.
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Affiliation(s)
| | - Åse Bjorvatn Sævik
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway
| | - Linn Solveig Sortland
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Marianne Øksnes
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Eystein Sverre Husebye
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- *Correspondence: Eystein Sverre Husebye,
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12
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Ueland GÅ, Methlie P, Øksnes M, Thordarson HB, Sagen J, Kellmann R, Mellgren G, Ræder M, Dahlqvist P, Dahl SR, Thorsby PM, Løvås K, Husebye ES. The Short Cosyntropin Test Revisited: New Normal Reference Range Using LC-MS/MS. J Clin Endocrinol Metab 2018; 103:1696-1703. [PMID: 29452421 DOI: 10.1210/jc.2017-02602] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 02/09/2018] [Indexed: 02/13/2023]
Abstract
BACKGROUND The cosyntropin test is used to diagnose adrenal insufficiency (AI) and nonclassical congenital adrenal hyperplasia (NCCAH). Current cutoffs for cortisol and 17-hydroxyprogesterone (17-OHP) are derived from nonstandardized immunoassays. Liquid chromatography tandem mass spectrometry (LC-MS/MS) offers direct measurement of steroids, prompting the need to re-establish normal ranges. OBJECTIVE The goal of this study was to define cutoff values for cortisol and 17-OHP in serum by LC-MS/MS 30 and 60 minutes after intravenous administration of 250 µg tetracosactide acetate to healthy volunteers and to compare the results with LC-MS/MS with routine immunoassays. METHODS Cosyntropin testing was performed in healthy subjects (n = 138) and in patients referred for evaluation of adrenocortical function (n = 94). Steroids were assayed by LC-MS/MS and compared with two immunoassays used in routine diagnostics (Immulite and Roche platforms). The cutoff level for cortisol was defined as the 2.5% percentile in healthy subjects not using oral estrogens (n = 121) and for 17-OHP as the 97.5% percentile. RESULTS Cortisol cutoff levels for LC-MS/MS were 412 and 485 nmol/L at 30 and 60 minutes, respectively. Applying the new cutoffs, 13 of 60 (22%) subjects who had AI according to conventional criteria now had a normal test result. For 17-OHP, the cutoff levels were 8.9 and 9.0 nmol/L at 30 and 60 minutes, respectively. CONCLUSIONS LC-MS/MS provides cutoff levels for cortisol and 17-OHP after cosyntropin stimulation that are lower than those based on immunoassays, possibly because cross-reactivity between steroid intermediates and cortisol is eliminated. This reduces the number of false-positive tests for AI and false-negative tests for NCCAH.
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Affiliation(s)
- Grethe Å Ueland
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K.G. Jebsen Senter for Autoimmune Sykdommer, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Paal Methlie
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K.G. Jebsen Senter for Autoimmune Sykdommer, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Marianne Øksnes
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K.G. Jebsen Senter for Autoimmune Sykdommer, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Jørn Sagen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Ralf Kellmann
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Gunnar Mellgren
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | | | - Per Dahlqvist
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Sandra R Dahl
- Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital Aker, Oslo, Norway
| | - Per M Thorsby
- Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital Aker, Oslo, Norway
| | - Kristian Løvås
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K.G. Jebsen Senter for Autoimmune Sykdommer, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Eystein S Husebye
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K.G. Jebsen Senter for Autoimmune Sykdommer, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
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13
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Saevik ÅB, Åkerman AK, Grønning K, Nermoen I, Valland SF, Finnes TE, Isaksson M, Dahlqvist P, Bergthorsdottir R, Ekwall O, Skov J, Nedrebø BG, Hulting AL, Wahlberg J, Svartberg J, Höybye C, Bleskestad IH, Jørgensen AP, Kämpe O, Øksnes M, Bensing S, Husebye ES. Clues for early detection of autoimmune Addison's disease - myths and realities. J Intern Med 2018; 283:190-199. [PMID: 29098731 DOI: 10.1111/joim.12699] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Early detection of autoimmune Addison's disease (AAD) is important as delay in diagnosis may result in a life-threatening adrenal crisis and death. The classical clinical picture of untreated AAD is well-described, but methodical investigations are scarce. OBJECTIVE Perform a retrospective audit of patient records with the aim of identifying biochemical markers for early diagnosis of AAD. MATERIAL AND METHODS A multicentre retrospective study including 272 patients diagnosed with AAD at hospitals in Norway and Sweden during 1978-2016. Scrutiny of medical records provided patient data and laboratory values. RESULTS Low sodium occurred in 207 of 247 (84%), but only one-third had elevated potassium. Other common nonendocrine tests were largely normal. TSH was elevated in 79 of 153 patients, and hypoglycaemia was found in 10%. Thirty-three per cent were diagnosed subsequent to adrenal crisis, in whom electrolyte disturbances were significantly more pronounced (P < 0.001). Serum cortisol was consistently decreased (median 62 nmol L-1 [1-668]) and significantly lower in individuals with adrenal crisis (38 nmol L-1 [2-442]) than in those without (81 nmol L-1 [1-668], P < 0.001). CONCLUSION The most consistent biochemical finding of untreated AAD was low sodium independent of the degree of glucocorticoid deficiency. Half of the patients had elevated TSH levels. Only a minority presented with marked hyperkalaemia or other nonhormonal abnormalities. Thus, unexplained low sodium and/or elevated TSH should prompt consideration of an undiagnosed AAD, and on clinical suspicion bring about assay of cortisol and ACTH. Presence of 21-hydroxylase autoantibodies confirms autoimmune aetiology. Anticipating additional abnormalities in routine blood tests may delay diagnosis.
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Affiliation(s)
- Å B Saevik
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - A-K Åkerman
- Department of Medicine, Örebro University Hospital, Örebro, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - K Grønning
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - I Nermoen
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Akershus University Hospital, University of Oslo, Lørenskog, Norway
| | - S F Valland
- Division of Endocrinology, Innlandet Hospital Trust, Hamar, Norway
| | - T E Finnes
- Division of Endocrinology, Innlandet Hospital Trust, Hamar, Norway
| | - M Isaksson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - P Dahlqvist
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - R Bergthorsdottir
- Department of Endocrinology, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - O Ekwall
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J Skov
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Endocrine Division, Department of Medicine, Karlstad City Hospital, Karlstad, Sweden
| | - B G Nedrebø
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Medicine, Haugesund Hospital, Haugesund, Norway
| | - A-L Hulting
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - J Wahlberg
- Division of Endocrinology, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - J Svartberg
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway.,Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - C Höybye
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - I H Bleskestad
- Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway
| | - A P Jørgensen
- Department of Endocrinology, Oslo University Hospital, Oslo, Norway
| | - O Kämpe
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,K.G. Jebsen center for Autoimmune Disorders, University of Bergen, Bergen, Norway
| | - M Øksnes
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - S Bensing
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - E S Husebye
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,K.G. Jebsen center for Autoimmune Disorders, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
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14
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Vogt EC, Øksnes M, Suleiman F, Juma BA, Thordarson HB, Ommedal O, Søfteland E. Assessment of diabetic polyneuropathy in Zanzibar: Comparison between traditional methods and an automated point-of-care nerve conduction device. J Clin Transl Endocrinol 2017; 10:9-14. [PMID: 29204366 PMCID: PMC5691212 DOI: 10.1016/j.jcte.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/12/2017] [Accepted: 09/12/2017] [Indexed: 01/19/2023]
Abstract
We screened for signs of neuropathy in a diabetes population in Zanzibar. Nerve conduction study by NC-stat DPNCheck found neuropathy in 45%. Monofilament results suggestive of neuropathy in 61%. Compared to nerve conduction study, monofilament had a 59% specificity. Hyperglycaemia and hypertension are highly prevalent risk factors in this population.
Aim Scant information is available about the prevalence of diabetic polyneuropathy, as well as the applicability of screening tools in sub-Saharan Africa. We aimed to investigate these issues in Zanzibar (Tanzania). Methods One hundred consecutive diabetes patients were included from the diabetes clinic at Mnazi Mmoja Hospital. Clinical characteristics were recorded. Further, we investigated: a) self-reported numbness of the lower limbs, b) ten-point monofilament test, c) the Sibbald 60-s Tool and d) nerve conduction studies (NCS, using an automated handheld point-of-care device, the NC-stat DPNCheck). Results Mean age was 54 years, 90% had type 2 diabetes, and with 9 year average disease duration. Mean HbA1c was 8.5% (69 mmol/mol), blood pressure 155/88 mmHg. Sixty-two% reported numbness, 61% had positive monofilament and 79% positive Sibbald tool. NCS defined neuropathy in 45% of the patients. Only the monofilament showed appreciable concordance with the NCS, Cohen’s κ 0.43. Conclusions The patient population was characterised by poor glycaemic control and hypertension. In line with this, neuropathy was rampant. The monofilament test tended to define more cases of probable neuropathy than the NCS, however specificity was rather low. Plantar skin thickening may have led to false positives in this population. Overall concordance was, however, appreciable, and could support continued use of monofilament as a neuropathy screening tool. The NC-stat DPNCheck could be useful in cases of diagnostic uncertainty or for research purposes in a low resource setting.
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Affiliation(s)
- Elinor C. Vogt
- Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway
- Corresponding author at: Haukeland University Hospital, Department of Medicine, PO Box 1400, N-5021 Bergen, Norway.Haukeland University HospitalDepartment of MedicinePO Box 1400N-5021 BergenNorway
| | - Marianne Øksnes
- Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway
- Department of Clinical Science, University of Bergen, Norway
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Faiza Suleiman
- Medical Department, Mnazi Mmoja Hospital, Stone Town, Zanzibar, Tanzania
| | - Buthayna Ali Juma
- Medical Department, Mnazi Mmoja Hospital, Stone Town, Zanzibar, Tanzania
| | | | - Ola Ommedal
- Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway
| | - Eirik Søfteland
- Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway
- Hormone Laboratory, Haukeland University Hospital, 5021 Bergen, Norway
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15
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Helseth R, Carlsen SM, Bollerslev J, Svartberg J, Øksnes M, Skeie S, Fougner SL. Preoperative octreotide therapy and surgery in acromegaly: associations between glucose homeostasis and treatment response. Endocrine 2016; 51:298-307. [PMID: 26179177 DOI: 10.1007/s12020-015-0679-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 06/29/2015] [Indexed: 01/15/2023]
Abstract
In acromegaly, high GH/IGF-1 levels associate with abnormal glucose metabolism. Somatostatin analogs (SSAs) reduce GH and IGF-1 but inhibit insulin secretion. We studied glucose homeostasis in de novo patients with acromegaly and changes in glucose metabolism after treatment with SSA and surgery. In this post hoc analysis from a randomized controlled trial, 55 de novo patients with acromegaly, not using antidiabetic medication, were included. Before surgery, 26 patients received SSAs for 6 months. HbA1c, fasting glucose, and oral glucose tolerance test were performed at baseline, after SSA pretreatment and at 3 months postoperative. Area under curve of glucose (AUC-G) was calculated. Glucose homeostasis was compared to baseline levels of GH and IGF-1, change after SSA pretreatment, and remission both after SSA pretreatment and 3 months postoperative. In de novo patients, IGF-1/GH levels did not associate with baseline glucose parameters. After SSA pretreatment, changes in GH/IGF-1 correlated positively to change in HbA1c levels (both p < 0.03). HbA1c, fasting glucose, and AUC-G increased significantly during SSA pretreatment in patients not achieving hormonal control (all p < 0.05) but did not change significantly in patients with normalized hormone levels. At 3 months postoperative, HbA1c, fasting glucose, and AUC-G were significantly reduced in both cured and not cured patients (all p < 0.05). To conclude, in de novo patients with acromegaly, disease activity did not correlate with glucose homeostasis. Surgical treatment of acromegaly improved glucose metabolism in both cured and not cured patients, while SSA pretreatment led to deterioration in glucose homeostasis in patients not achieving biochemical control.
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Affiliation(s)
- R Helseth
- Department of Internal Medicine, Drammen Hospital, Vestre Viken, Drammen, Norway
| | - S M Carlsen
- Department of Endocrinology, Medical Clinic, St. Olavs University Hospital, 7006, Trondheim, Norway
- Unit for Applied Clinical Research, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - J Bollerslev
- Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - J Svartberg
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
- Tromsø Endocrine Research Group, Institute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - M Øksnes
- Department of Medicine and Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - S Skeie
- Division of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - S L Fougner
- Department of Endocrinology, Medical Clinic, St. Olavs University Hospital, 7006, Trondheim, Norway.
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16
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Simunkova K, Jovanovic N, Rostrup E, Methlie P, Øksnes M, Nilsen RM, Hennø H, Tilseth M, Godang K, Kovac A, Løvås K, Husebye ES. Effect of a pre-exercise hydrocortisone dose on short-term physical performance in female patients with primary adrenal failure. Eur J Endocrinol 2016; 174:97-105. [PMID: 26494876 DOI: 10.1530/eje-15-0630] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 10/21/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Many patients with primary adrenal insufficiency (Addison's disease) take extra doses of glucocorticoids during stressful events, but a benefit has not been demonstrated in controlled trials. Here, we investigated the effects of a pre-exercise hydrocortisone dose on cardiorespiratory, hormonal and metabolic parameters in response to short-term strenuous physical activity. DESIGN This was a randomized placebo-controlled, two-week cross-over clinical trial. PARTICIPANTS Ten women with Addison's disease and 10 age-matched healthy females participated in the study. MEASUREMENTS All women in the study underwent maximal incremental exercise testing. A stress dose of 10 mg hydrocortisone or placebo was given 1 h prior to exercise on two occasions. Blood samples were drawn before, and 0, 15 and 30 min post exercise. Oxygen uptake, maximal aerobic capacity, endocrine and metabolic responses to physical activity, as well as health status by questionnaires were evaluated. RESULTS Maximal aerobic capacity and duration of exercise were significantly lower in patients than in healthy subjects and did not improve with the treatment. After an extra hydrocortisone dose serum cortisol was significantly higher than in the healthy subjects (P<0.001). Post-exercise glucose and adrenaline levels were significantly lower and free fatty acids insignificantly higher in patients irrespective of stress dose. Stress dosing did not alter other metabolic or hormonal parameters or quality of life after the exercise. CONCLUSIONS The patients did not benefit from an extra dose of hydrocortisone in short strenuous exercise. Stress dosing may not be justified in this setting. Whether stress dosing is beneficial in other types of physical activity will have to be examined further.
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Affiliation(s)
- Katerina Simunkova
- Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway
| | - Nevena Jovanovic
- Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway
| | - Espen Rostrup
- Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway
| | - Paal Methlie
- Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway
| | - Marianne Øksnes
- Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway
| | - Roy Miodini Nilsen
- Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway
| | - Hanne Hennø
- Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway
| | - Mira Tilseth
- Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway
| | - Kristin Godang
- Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway
| | - Ana Kovac
- Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway
| | - Kristian Løvås
- Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway
| | - Eystein S Husebye
- Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway
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17
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Björnsdottir S, Øksnes M, Isaksson M, Methlie P, Nilsen RM, Hustad S, Kämpe O, Hulting AL, Husebye ES, Løvås K, Nyström T, Bensing S. Circadian hormone profiles and insulin sensitivity in patients with Addison's disease: a comparison of continuous subcutaneous hydrocortisone infusion with conventional glucocorticoid replacement therapy. Clin Endocrinol (Oxf) 2015; 83:28-35. [PMID: 25400085 DOI: 10.1111/cen.12670] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 10/21/2014] [Accepted: 11/12/2014] [Indexed: 11/30/2022]
Abstract
CONTEXT Conventional glucocorticoid replacement therapy in patients with Addison's disease (AD) is unphysiological with possible adverse effects on mortality, morbidity and quality of life. The diurnal cortisol profile can likely be restored by continuous subcutaneous hydrocortisone infusion (CSHI). OBJECTIVE The aim of this study was to compare circadian hormone rhythms and insulin sensitivity in conventional thrice-daily regimen of glucocorticoid replacement therapy with CSHI treatment in patients with AD. DESIGN AND SETTING An open, randomized, two-period, 12-week crossover multicentre trial in Norway and Sweden. PATIENTS Ten Norwegian patients were admitted for 24-h sampling of hormone profiles. Fifteen Swedish patients underwent euglycaemic-hyperinsulinaemic clamp. INTERVENTION Thrice-daily regimen of oral hydrocortisone (OHC) and CSHI treatment. MAIN OUTCOME MEASURE We measured the circadian rhythm of cortisol, adrenocorticotropic hormone (ACTH), growth hormone (GH), insulin-like growth factor-1, (IGF-1), IGF-binding protein-3 (IGFBP-3), glucose, insulin and triglycerides during OHC and CSHI treatment. Euglycaemic-hyperinsulinaemic clamp was used to assess insulin sensitivity. RESULTS Continuous subcutaneous hydrocortisone infusion provided a more physiological circadian cortisol curve including a late-night cortisol surge. ACTH levels showed a near normal circadian variation for CSHI. CSHI prevented a continuous decrease in glucose during the night. No difference in insulin sensitivity was observed between the two treatment arms. CONCLUSION Continuous subcutaneous hydrocortisone infusion replacement re-established a circadian cortisol rhythm and normalized the ACTH levels. Patients with CSHI replacement had a more stable night-time glucose level compared with OHC without compromising insulin sensitivity. Thus, restoring night-time cortisol levels might be advantageous for patients with AD.
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Affiliation(s)
- Sigridur Björnsdottir
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Marianne Øksnes
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Magnus Isaksson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Paal Methlie
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Roy M Nilsen
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Steinar Hustad
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Olle Kämpe
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Anna-Lena Hulting
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Eystein S Husebye
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Kristian Løvås
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Thomas Nyström
- Division of Internal Medicine, Department of Clinical Science and Education, Södersjukhuset AB, Stockholm, Sweden
| | - Sophie Bensing
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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18
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Quinkler M, Miodini Nilsen R, Zopf K, Ventz M, Øksnes M. Modified-release hydrocortisone decreases BMI and HbA1c in patients with primary and secondary adrenal insufficiency. Eur J Endocrinol 2015; 172:619-26. [PMID: 25656494 DOI: 10.1530/eje-14-1114] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Patients with adrenal insufficiency (AI) have impaired health-related quality of life (HRQoL), which is thought to be in part due to unphysiological glucocorticoid replacement therapy. The aim was to compare once-daily hydrocortisone (HC) dual-release tablet (modified-release) with conventional HC therapy regarding clinical data and HRQoL. DESIGN AND METHODS We conducted an open, prospective trial at one endocrine center. There were 15 of 26 patients with primary AI, nine of 18 patients with secondary AI, and six congenital adrenal hyperplasia patients switched to modified-release HC therapy by their own decision. We evaluated clinical outcome and disease-specific HRQoL by using AddiQoL questionnaire at baseline and at follow-up (median 202 days (85-498)). RESULTS Patients on modified-release HC (n=30) showed significant decreases in BMI (26.0±0.75-25.6±0.71, P for change=0.006) and HbA1c (6.04±0.29-5.86±0.28, P for change=0.005), whereas patients remaining on conventional HC (n=20) showed no change in these parameters (P for interaction=0.029 and 0.017 respectively). No significant change in AddiQoL score were found in the modified-release HC group (83.8 baseline and 84.9 at follow-up; P for change=0.629). In the conventional HC group, there was a significant decrease in scores (84.0 baseline and 80.9 at follow-up; P for change=0.016), with a between-treatment P for interaction of 0.066. The fatigue subscore of AddiQoL showed the same pattern with a significant decrease (P for change=0.024) in patients on conventional HC therapy (P for interaction=0.116). CONCLUSIONS Modified-release HC decreases BMI and HbA1c compared with conventional HC treatment. In addition, it seems to stabilize HRQoL over time.
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Affiliation(s)
- Marcus Quinkler
- Endocrinology in CharlottenburgStuttgarter Platz 1, 10627 Berlin, GermanyClinical EndocrinologyCharité Campus Mitte, Charité University Medicine Berlin, Berlin, GermanyCentre for Clinical ResearchHaukeland University Hospital, Bergen, NorwayDepartment of Clinical ScienceUniversity of Bergen, Bergen, NorwayDepartment of MedicineHaukeland University Hospital, Bergen, Norway Endocrinology in CharlottenburgStuttgarter Platz 1, 10627 Berlin, GermanyClinical EndocrinologyCharité Campus Mitte, Charité University Medicine Berlin, Berlin, GermanyCentre for Clinical ResearchHaukeland University Hospital, Bergen, NorwayDepartment of Clinical ScienceUniversity of Bergen, Bergen, NorwayDepartment of MedicineHaukeland University Hospital, Bergen, Norway
| | - Roy Miodini Nilsen
- Endocrinology in CharlottenburgStuttgarter Platz 1, 10627 Berlin, GermanyClinical EndocrinologyCharité Campus Mitte, Charité University Medicine Berlin, Berlin, GermanyCentre for Clinical ResearchHaukeland University Hospital, Bergen, NorwayDepartment of Clinical ScienceUniversity of Bergen, Bergen, NorwayDepartment of MedicineHaukeland University Hospital, Bergen, Norway
| | - Kathrin Zopf
- Endocrinology in CharlottenburgStuttgarter Platz 1, 10627 Berlin, GermanyClinical EndocrinologyCharité Campus Mitte, Charité University Medicine Berlin, Berlin, GermanyCentre for Clinical ResearchHaukeland University Hospital, Bergen, NorwayDepartment of Clinical ScienceUniversity of Bergen, Bergen, NorwayDepartment of MedicineHaukeland University Hospital, Bergen, Norway
| | - Manfred Ventz
- Endocrinology in CharlottenburgStuttgarter Platz 1, 10627 Berlin, GermanyClinical EndocrinologyCharité Campus Mitte, Charité University Medicine Berlin, Berlin, GermanyCentre for Clinical ResearchHaukeland University Hospital, Bergen, NorwayDepartment of Clinical ScienceUniversity of Bergen, Bergen, NorwayDepartment of MedicineHaukeland University Hospital, Bergen, Norway
| | - Marianne Øksnes
- Endocrinology in CharlottenburgStuttgarter Platz 1, 10627 Berlin, GermanyClinical EndocrinologyCharité Campus Mitte, Charité University Medicine Berlin, Berlin, GermanyCentre for Clinical ResearchHaukeland University Hospital, Bergen, NorwayDepartment of Clinical ScienceUniversity of Bergen, Bergen, NorwayDepartment of MedicineHaukeland University Hospital, Bergen, Norway Endocrinology in CharlottenburgStuttgarter Platz 1, 10627 Berlin, GermanyClinical EndocrinologyCharité Campus Mitte, Charité University Medicine Berlin, Berlin, GermanyCentre for Clinical ResearchHaukeland University Hospital, Bergen, NorwayDepartment of Clinical ScienceUniversity of Bergen, Bergen, NorwayDepartment of MedicineHaukeland University Hospital, Bergen, Norway
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19
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Abstract
Adrenal insufficiency (glucocorticoid deficiency) comprises a group of rare diseases, including primary adrenal insufficiency, secondary adrenal insufficiency and congenital adrenal hyperplasia. Lifesaving glucocorticoid therapy was introduced over 60 years ago, but since then a number of advances in treatment have taken place. Specifically, little is known about short- and long-term treatment effects, and morbidity and mortality. Over the past decade, systematic cohort and registry studies have described reduced health-related quality of life, an unfavourable metabolic profile and increased mortality in patients with adrenal insufficiency, which may relate to unphysiological glucocorticoid replacement. This has led to the development of new modes of replacement that aim to mimic normal glucocorticoid physiology. Here, evidence for the inadequacy of conventional glucocorticoid therapy and recent developments in treatment are reviewed, with an emphasis on primary adrenal insufficiency.
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Affiliation(s)
- Marianne Øksnes
- Department of Clinical Science, University of Bergen, Norway; Department of Medicine, Haukeland University Hospital, Bergen, Norway.
| | | | - Kristian Løvås
- Department of Clinical Science, University of Bergen, Norway; Department of Medicine, Haukeland University Hospital, Bergen, Norway
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20
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Fougner SL, Bollerslev J, Svartberg J, Øksnes M, Cooper J, Carlsen SM. Preoperative octreotide treatment of acromegaly: long-term results of a randomised controlled trial. Eur J Endocrinol 2014; 171:229-35. [PMID: 24866574 DOI: 10.1530/eje-14-0249] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Randomised studies have demonstrated a beneficial effect of pre-surgical treatment with somatostatin analogues (SSA) in acromegaly when evaluated early postoperatively. The objective of this study was to evaluate the long-term surgical cure rates. METHODS Newly diagnosed patients were randomised to direct surgery (n=30) or 6-month pretreatment with octreotide LAR (n=32). The patients were evaluated 1 and 5 years postoperatively. Cure was defined as normal IGF1 levels and by normal IGF1 level combined with nadir GH <2 mU/l in an oral glucose tolerance test, all without additional post-operative treatment. A meta-analysis using the other published randomised study with long-term analyses on preoperative SSA treatment was performed. RESULTS The proportion of patients receiving post-operative acromegaly treatment was equal in the two groups. When using the combined criteria for cure, 10/26 (38%) macroadenomas were cured in the pretreatment group compared with 6/25 (24%) in the direct surgery group 1 year postoperatively (P=0.27), and 9/22 (41%) vs 6/22 (27%) macroadenomas, respectively, 5 years postoperatively (P=0.34). In the meta-analysis, 16/45 (36%) macroadenomas were cured using combined criteria in the pretreatment group vs 8/45 (18%) in the direct surgery group after 6-12 months (P=0.06), and 15/41 (37%) vs 8/42 (19%), respectively, in the long-term (P=0.08). CONCLUSION This study does not prove a beneficial effect of SSA pre-surgical treatment, but in the meta-analysis a trend towards significance can be claimed. A potential favourable, clinically relevant response cannot be excluded.
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Affiliation(s)
- S L Fougner
- Department of EndocrinologyMedical Clinic, St Olavs University Hospital, 7006 Trondheim, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, NorwayTromsø Endocrine Research GroupInstitute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, NorwayDepartment of MedicineCentre for Clinical Research, Haukeland University Hospital, Bergen, NorwayDepartment of EndocrinologyStavanger University Hospital, Stavanger, NorwayUnit for Applied Clinical ResearchNorwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - J Bollerslev
- Department of EndocrinologyMedical Clinic, St Olavs University Hospital, 7006 Trondheim, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, NorwayTromsø Endocrine Research GroupInstitute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, NorwayDepartment of MedicineCentre for Clinical Research, Haukeland University Hospital, Bergen, NorwayDepartment of EndocrinologyStavanger University Hospital, Stavanger, NorwayUnit for Applied Clinical ResearchNorwegian University of Science and Technology (NTNU), Trondheim, NorwayDepartment of EndocrinologyMedical Clinic, St Olavs University Hospital, 7006 Trondheim, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, NorwayTromsø Endocrine Research GroupInstitute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, NorwayDepartment of MedicineCentre for Clinical Research, Haukeland University Hospital, Bergen, NorwayDepartment of EndocrinologyStavanger University Hospital, Stavanger, NorwayUnit for Applied Clinical ResearchNorwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - J Svartberg
- Department of EndocrinologyMedical Clinic, St Olavs University Hospital, 7006 Trondheim, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, NorwayTromsø Endocrine Research GroupInstitute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, NorwayDepartment of MedicineCentre for Clinical Research, Haukeland University Hospital, Bergen, NorwayDepartment of EndocrinologyStavanger University Hospital, Stavanger, NorwayUnit for Applied Clinical ResearchNorwegian University of Science and Technology (NTNU), Trondheim, NorwayDepartment of EndocrinologyMedical Clinic, St Olavs University Hospital, 7006 Trondheim, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, NorwayTromsø Endocrine Research GroupInstitute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, NorwayDepartment of MedicineCentre for Clinical Research, Haukeland University Hospital, Bergen, NorwayDepartment of EndocrinologyStavanger University Hospital, Stavanger, NorwayUnit for Applied Clinical ResearchNorwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - M Øksnes
- Department of EndocrinologyMedical Clinic, St Olavs University Hospital, 7006 Trondheim, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, NorwayTromsø Endocrine Research GroupInstitute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, NorwayDepartment of MedicineCentre for Clinical Research, Haukeland University Hospital, Bergen, NorwayDepartment of EndocrinologyStavanger University Hospital, Stavanger, NorwayUnit for Applied Clinical ResearchNorwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - J Cooper
- Department of EndocrinologyMedical Clinic, St Olavs University Hospital, 7006 Trondheim, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, NorwayTromsø Endocrine Research GroupInstitute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, NorwayDepartment of MedicineCentre for Clinical Research, Haukeland University Hospital, Bergen, NorwayDepartment of EndocrinologyStavanger University Hospital, Stavanger, NorwayUnit for Applied Clinical ResearchNorwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - S M Carlsen
- Department of EndocrinologyMedical Clinic, St Olavs University Hospital, 7006 Trondheim, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, NorwayTromsø Endocrine Research GroupInstitute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, NorwayDepartment of MedicineCentre for Clinical Research, Haukeland University Hospital, Bergen, NorwayDepartment of EndocrinologyStavanger University Hospital, Stavanger, NorwayUnit for Applied Clinical ResearchNorwegian University of Science and Technology (NTNU), Trondheim, NorwayDepartment of EndocrinologyMedical Clinic, St Olavs University Hospital, 7006 Trondheim, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, NorwayTromsø Endocrine Research GroupInstitute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, NorwayDepartment of MedicineCentre for Clinical Research, Haukeland University Hospital, Bergen, NorwayDepartment of EndocrinologyStavanger University Hospital, Stavanger, NorwayUnit for Applied Clinical ResearchNorwegian University of Science and Technology (NTNU), Trondheim, Norway
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Øksnes M. Behandling og livskvalitet ved Addisons sykdom. Tidsskriftet 2014. [DOI: 10.4045/tidsskr.14.1040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Nermoen I, Brønstad I, Fougner KJ, Svartberg J, Øksnes M, Husebye ES, Løvås K. Genetic, anthropometric and metabolic features of adult Norwegian patients with 21-hydroxylase deficiency. Eur J Endocrinol 2012; 167:507-16. [PMID: 22802425 DOI: 10.1530/eje-12-0196] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to determine the genetic, anthropometric and metabolic features in an unselected population of adult Norwegian patients with 21-hydroxylase deficiency (21OHD). PATIENTS, METHODS AND DESIGN: Sixty-four 21OHD patients participated (23 men and 41 women; median age 38.5 years; range 19-72 years) in a cross-sectional study including DNA sequencing of CYP21A2, anthropometric measurements including dual X-ray absorptiometry scanning and biochemical analyses. The results were compared with reference cohorts from the general population. RESULTS We identified four novel and plausibly disease-causing CYP21A2 mutations. Gene deletions/conversions (42.1% of alleles), the splice mutation I2 splice (23.0%) and point mutation I172 N (22.2%) were common. The genotype corresponded to clinical phenotype in 92% of the patients. The prevalence of osteopenia was 48% in males and 34% in females. Both men and women had normal BMI but markedly increased fat mass compared with the normal population. Diastolic blood pressure was higher than normal. Thirty-nine per cent of the women had testosterone levels above the normal range; 13% of the men had testosterone levels below normal. Reduced final height was more pronounced in men (median -11.2 cm, -1.77 SDS) than in women (-6.3 cm, -1.07 SDS). CONCLUSIONS In this population-based survey of 21OHD, we identified four novel mutations and high concordance between genotype and phenotype. The patients had increased fat mass, increased diastolic blood pressure, reduced final height and high frequency of osteopenia among males. These results show unfavourable metabolic features in 21OHD patients indicating a need for improvement of treatment and follow-up.
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Affiliation(s)
- Ingrid Nermoen
- Institute of Clinical Medicine, Akershus University Hospital, University of Oslo, Oslo, Norway.
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Øksnes M, Bensing S, Hulting AL, Kämpe O, Hackemann A, Meyer G, Badenhoop K, Betterle C, Parolo A, Giordano R, Falorni A, Papierska L, Jeske W, Kasperlik-Zaluska AA, Chatterjee VKK, Husebye ES, Løvås K. Quality of life in European patients with Addison's disease: validity of the disease-specific questionnaire AddiQoL. J Clin Endocrinol Metab 2012; 97:568-76. [PMID: 22090270 DOI: 10.1210/jc.2011-1901] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Patients with Addison's disease (AD) self-report impairment in specific dimensions on well-being questionnaires. An AD-specific quality-of-life questionnaire (AddiQoL) was developed to aid evaluation of patients. OBJECTIVE We aimed to translate and determine construct validity, reliability, and concurrent validity of the AddiQoL questionnaire. METHODS After translation, the final versions were tested in AD patients from Norway (n = 107), Sweden (n = 101), Italy (n = 165), Germany (n = 200), and Poland (n = 50). Construct validity was examined by exploratory factor analysis and Rasch analysis, aiming at unidimensionality and fit to the Rasch model. Reliability was determined by Cronbach's coefficient-α and Person separation index. Longitudinal reliability was tested by differential item functioning in stable patient subgroups. Concurrent validity was examined in Norwegian (n = 101) and Swedish (n = 107) patients. RESULTS Exploratory factor analysis and Rasch analysis identified six items with poor psychometric properties. The 30 remaining items fitted the Rasch model and proved unidimensional, supported by appropriate item and person fit residuals and a nonsignificant χ(2) probability. Crohnbach's α-coefficient 0.93 and Person separation index 0.86 indicate high reliability. Longitudinal reliability was excellent. Correlation with Short Form-36 and Psychological General Well-Being Index scores was high. A shorter subscale comprising eight items also proved valid and reliable. Testing of AddiQoL-30 in this large patient cohort showed significantly worse scores with increasing age and in women compared with men but no difference between patients with isolated AD and those with concomitant diseases. CONCLUSION The validation process resulted in a revised 30-item AddiQoL questionnaire and an eight-item AddiQoL short version with good psychometric properties and high reliability.
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Affiliation(s)
- Marianne Øksnes
- Institute of Medicine, Haukeland University Hospital, Jonas Liesvei 65, N-5021 Bergen, Norway.
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Vik-Mo EO, Øksnes M, Pedersen PH, Wentzel-Larsen T, Rødahl E, Thorsen F, Schreiner T, Aanderud S, Lund-Johansen M. Gamma knife stereotactic radiosurgery of Nelson syndrome. Eur J Endocrinol 2009; 160:143-8. [PMID: 18996962 DOI: 10.1530/eje-08-0687] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Gamma knife radiosurgery (GKR) can be used as primary or adjuvant therapy for the treatment of an ACTH-producing pituitary tumor after bilateral adrenalectomy, called Nelson syndrome (NS). We have examined the effect of GKR on tumor growth and ACTH-hypersecretion, and characterized the adverse events of this treatment in patients with NS. DESIGN Cross-sectional follow-up study. First, retrospective data pre- and post-GKR were collected. Patients then underwent a predefined survey including radiological, endocrinological, ophthalmological, and neurosurgical evaluation. SUBJECTS Ten patients treated with GKR for NS after previous bilateral adrenalectomy. The mean follow-up was 7 years. No patient was lost to follow-up. RESULTS Tumor growth was stopped in all patients. The ACTH levels declined in eight patients, and normalized in one patient. There was a significant drop in ACTH levels, with a half-time of 2.8 years. No patient developed visual field defects or any other cranial nerve dysfunction as a result of treatment. Four patients started hormone substitution therapy during the follow-up period. The substitution therapy of three pituitary axes present at GKR treatment could be stopped during the same period. One patient developed a glioblastoma in the left parieto-occipital region 14 years after GKR, far from the field of treatment. As the radiation level was below 1Gy to this area, it is unlikely that the GKR treatment itself induced the malignant tumor. CONCLUSION In patients with NS, GKR is an effective adjuvant treatment, carrying relatively few adverse effects. Although the risk of developing a secondary neoplasia after GKR is present, it is probably extremely low.
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Affiliation(s)
- Einar Osland Vik-Mo
- Department of Neurosurgery, Haukeland University Hospital, 5053 Bergen, Norway.
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