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Pedersen J, Jarløv AE, Rasmussen ÅK, Stochholm K. Incidence, Treatment, and Survival of Adrenocortical Carcinoma in Denmark 2003-2019. J Endocr Soc 2024; 8:bvae012. [PMID: 38370442 PMCID: PMC10872687 DOI: 10.1210/jendso/bvae012] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Indexed: 02/20/2024] Open
Abstract
Objectives Adrenocortical carcinoma (ACC) is a malignant tumor originating from the adrenal cortex. The aim of the study was to report the incidence of ACC and survival of ACC in Denmark. The secondary objective was to describe the impact of treatment with mitotane on survival. Design Retrospective population study of patients diagnosed with ACC between 2003 and 2019 in Denmark. Methods Individuals at risk for ACC were identified in the national Danish Health registries, and diagnosis of ACC was confirmed by review of the health records. Data on demographics, presentation, treatment, recurrence, and death was evaluated. Results 138 patients were included in the study with more females (59.4%) than males (40.6%). Incidence rate was 1.4 per million per year. The incidence rate ratio significantly increased only in females by 1.06 [95% confidence interval (CI): 1.02-1.12] per year. Overall median survival was 1.93 (95% CI: 1.24-3.00) years with no differences between males and females. The proportion of patients treated with mitotane (either as adjuvant treatment or as part of a chemotherapeutic regime) was 72.3%. Survival was significantly decreased in women not treated with mitotane compared to women treated with mitotane (either as adjuvant or as part of a chemotherapeutic regime) hazards ratio .30 (95% CI: .10-.89), adjusted for European Network for the Study of Adrenal Tumours score, age at diagnosis, and year of diagnosis, but survival was unaffected by mitotane treatment in men. Conclusion Incidence of ACC in Denmark was 1.4 per million per year and increased in women but not in males during the study period 2003-2019.
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Affiliation(s)
- Jens Pedersen
- Department of Medicine, Division of Endocrinology, Herlev and Gentofte Hospital, 2730 Herlev, Denmark
| | - Anne Elisabeth Jarløv
- Department of Endocrinology and Metabolism, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Åse Krogh Rasmussen
- Department of Endocrinology and Metabolism, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Kirstine Stochholm
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, 8200 Aarhus, Denmark
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2
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Stochholm K, Holmgård C, Davis SM, Gravholt CH, Berglund A. Incidence, prevalence, age at diagnosis, and mortality in individuals with 45,X/46,XY mosaicism: A population-based registry study. Genet Med 2024; 26:100987. [PMID: 37781900 DOI: 10.1016/j.gim.2023.100987] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/03/2023] Open
Abstract
PURPOSE To assess the population-based incidence, prevalence, and age at diagnosis of individuals with 45,X/46,XY mosaicism (and associated variants) and describe the associated mortality pattern. In addition, a systematic literature review of papers providing prevalence data of 45,X/46,XY mosaicism was performed. METHODS A population-based epidemiological study of all individuals diagnosed with 45,X/46,XY mosaicism between 1960 and 2019. Mortality was analyzed using data from the Danish Causes of Death Register. One-hundred randomly age- and sex-matched general population controls per case were identified for comparison. RESULTS One-hundred-thirty-seven males and 46 females with 45,X/46,XY mosaicism were identified. The apparent prevalence was 5.6 per 100,000 liveborn males and 2.1 per 100,000 liveborn females. The incidence of males with 45,X/46,XY increased during the study (P > .0001) but was stable for females (P = .4). Males were significantly older than females when diagnosed (median age = 29.1, interquartile range: 3.4-41.3) years versus 13.3 (interquartile range: 2.1-19.1) years, P = .002). All-cause mortality was doubled in males with 45,X/46,XY (Hazard Ratio = 2.0, 95% confidence interval: 1.2-3.3) and quadrupled in females (Hazard Ratio = 4.0, confidence interval: 2.0-7.9). CONCLUSION The apparent population-based prevalence of males and females with 45,X/46,XY is 5.6 and 2.1 per 100,000 liveborn males and females, respectively. Diagnosis of males with 45,X/46,XY males is increasing. 45,X/46,XY mosaicism is associated with an increased all-cause mortality.
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Affiliation(s)
- Kirstine Stochholm
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Camilla Holmgård
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Shanlee M Davis
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; eXtraOrdinarY Kids Clinic and Research Program, Children's Hospital Colorado, Aurora, CO
| | - Claus H Gravholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Agnethe Berglund
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark.
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Iversen P, Kramer S, Ebbehoj A, Søndergaard E, Stochholm K, Poulsen PL, Hjorthaug K. [ 18F]FDOPA PET/CT is superior to [ 68Ga]DOTATOC PET/CT in diagnostic imaging of pheochromocytoma. EJNMMI Res 2023; 13:108. [PMID: 38110755 PMCID: PMC10728412 DOI: 10.1186/s13550-023-01056-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/30/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Both [18F]FDOPA (FDOPA) and [68Ga]DOTATOC PET/CT (DOTATOC) are widely used for detection of pheochromocytomas/paraganglioma (PPGL). However, direct comparisons of the performance of the two tracers are only available in small series. We conducted a retrospective comparative analysis of FDOPA and DOTATOC to assess their sensitivity and accuracy in detecting PPGL when administered based on suspicion of PPGL. We consecutively included patients referred on suspicion of PPGL or PPGL recurrence who were scanned with both FDOPA and DOTATOC. Both scans were reviewed retrospectively by two experienced observers, who were blinded to the final diagnosis. The assessment was made both visually and quantitatively. The final diagnosis was primarily based on pathology. RESULTS In total, 113 patients were included (97 suspected of primary PPGL and 16 suspected of recurrence). Of the 97 patients, 51 had pheochromocytomas (PCC) (in total 55 lesions) and 6 had paragangliomas (PGL) (in total 7 lesions). FDOPA detected and correctly localized all 55 PCC, while DOTATOC only detected 25 (sensitivity 100% vs. 49%, p < 0.0001; specificity 95% vs. 98%, p = 1.00). The negative predictive value (100% vs. 63%, p < 0.001) and diagnostic accuracy (98% vs. 70%, p < 0.01) were higher for FDOPA compared to DOTATOC. FDOPA identified 6 of 6 patients with hormone producing PGL, of which one was negative on DOTATOC. Diagnostic performances of FDOPA and DOTATOC were similar in the 16 patients with previous PPGL suspected of recurrence. CONCLUSIONS FDOPA is superior to DOTATOC for localization of PCC. In contrast to DOTATOC, FDOPA also identified all PGL but with a limited number of patient cases.
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Affiliation(s)
- Peter Iversen
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, 8200, Aarhus N, Denmark.
| | - Stine Kramer
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, 8200, Aarhus N, Denmark
| | - Andreas Ebbehoj
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200, Aarhus N, Denmark
| | - Esben Søndergaard
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200, Aarhus N, Denmark
| | - Kirstine Stochholm
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200, Aarhus N, Denmark
| | - Per Løgstrup Poulsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200, Aarhus N, Denmark
| | - Karin Hjorthaug
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, 8200, Aarhus N, Denmark
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Ridder LO, Stochholm K, Mortensen KH, Andersen NH, Gravholt CH. The TGFβ system and TIMP1 and 3 genotypes in Turner syndrome-Relation with aortic congenital malformations. Clin Endocrinol (Oxf) 2023; 99:545-551. [PMID: 36890688 DOI: 10.1111/cen.14907] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/14/2023] [Accepted: 03/06/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVE Cardiovascular complications and congenital malformations are known traits in Turner syndrome (TS), which increases mortality. Women with TS have varying phenotype and cardiovascular risks. A biomarker assessing the risk for cardiovascular complications could potentially reduce mortality in high-risk TS and reduce screening in TS participants with low cardiovascular risk. DESIGN, PATIENTS, PARTICIPANTS AND MEASUREMENTS As part of a study initiated in 2002, 87 TS participants and 64 controls were invited to magnetic resonance imaging of the aorta, anthropometry, and biochemical markers. TS participants were re-examined thrice lastly in 2016. The focus of this paper is the additional measurements of transforming growth factor beta (TGFβ), matrix metalloproteinase (MMP's), tissue inhibitor of matrix metalloproteinase (TIMP), peripheral blood DNA and their associations with TS and the cardiovascular risk and congenital heart disease. RESULTS TS participants had lower TGFβ1 and TGFβ2 values compared to controls. snp11547635 heterozygosity was not associated with any biomarkers but was associated with increased risk of aortic regurgitation. TIMP4 and TGFβ1 were correlated with the aortic diameter at several measuring positions. During follow-up, the antihypertensive treatment decreased the descending aortic diameter and increased TGFβ1 and TGFβ2 levels in TS. CONCLUSION TGFβ and TIMP's are altered in TS and may play a role in the development of coarctation and dilated aorta. snp11547635 heterozygosity was not found to impact biochemical markers. Further studies should investigate these biomarkers to further unravel the pathogenesis of the increased cardiovascular risk in TS participants.
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Affiliation(s)
- Lukas Ochsner Ridder
- Department of Endocrinology and Internal Medicine, University Hospital, Aarhus, Denmark
- Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark
| | - Kirstine Stochholm
- Department of Endocrinology and Internal Medicine, University Hospital, Aarhus, Denmark
| | | | | | - Claus Højbjerg Gravholt
- Department of Endocrinology and Internal Medicine, University Hospital, Aarhus, Denmark
- Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
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5
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Kenborg L, Ebbehoj A, Ejerskov C, Handrup MM, Østergaard JR, Hove H, Doser K, Krøyer A, Mulvihill JJ, Winther JF, Stochholm K. Endocrine morbidity in neurofibromatosis 1: a nationwide, register-based cohort study. Eur J Endocrinol 2023; 189:190-198. [PMID: 37542520 DOI: 10.1093/ejendo/lvad101] [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: 04/17/2023] [Revised: 06/30/2023] [Accepted: 07/17/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE Previous studies have found that neurofibromatosis 1 (NF1) is associated with an increased risk for endocrine disorders, but no comprehensive overview of the risk for specific endocrine disorders has been published. We assessed endocrine morbidity in individuals with NF1 from information on hospital admissions, surgery for endocrine disorders, and relevant medication. DESIGN A nationwide population registry-based cohort study. METHODS We identified 2467 individuals with NF1 diagnosed between 1977 and 2013 from the Danish National Patient Register and the RAREDIS database and 20 132 randomly sampled age- and sex-matched population comparisons. Information on endocrine diseases was identified using registrations of discharge diagnoses, surgery, and medication prescriptions. The rates of endocrine disorders in individuals with NF1 were compared with those in the comparison cohort in Cox proportional hazard models. RESULTS Individuals with NF1 had a higher rate than the comparison group of any endocrine discharge diagnosis (hazard ratio [HR] 1.72, 95% confidence interval [CI]: 1.58-1.87), endocrine-related surgery (2.03, 1.39-2.96), and prescribed medications (1.32, 1.23-1.42). Increased HRs were observed for diseases and surgical operations of several glands, including pheochromocytoma, and for osteoporosis, and osteoporotic fractures. Decreased rates were observed with drugs for type 2 diabetes. Women with NF1 had higher HRs for surgery of the ovaries, uterus, and sterilization, but lower rates of surgeries of cervix and prescriptions for birth control pills. CONCLUSIONS Neurofibromatosis 1 is associated with a variety of endocrine disorders, surgery, and medication related to endocrine disease. Awareness of endocrine morbidity is important in the clinical follow-up of individuals with NF1.
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Affiliation(s)
- Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, 2100 Copenhagen E, Denmark
| | - Andreas Ebbehoj
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Cecilie Ejerskov
- Centre for Rare Diseases, Department of Paediatric and Adolescent Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Mette Møller Handrup
- Centre for Rare Diseases, Department of Paediatric and Adolescent Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - John R Østergaard
- Centre for Rare Diseases, Department of Paediatric and Adolescent Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Hanne Hove
- The RAREDIS Database, Centre for Rare Diseases, Department of Paediatrics, Copenhagen University Hospital, 2100 Copenhagen E, Denmark
- Centre for Rare Diseases, Department of Paediatrics, Rigshospitalet, 2100 Copenhagen E, Denmark
| | - Karoline Doser
- Childhood Cancer Research Group, Danish Cancer Society Research Center, 2100 Copenhagen E, Denmark
| | - Anja Krøyer
- Childhood Cancer Research Group, Danish Cancer Society Research Center, 2100 Copenhagen E, Denmark
| | - John J Mulvihill
- Department of Pediatrics, University of Oklahoma, Norman, OK 73019-3073, United States
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, 2100 Copenhagen E, Denmark
- Faculty of Health, Department of Clinical Medicine, Aarhus University and University Hospital, 8200 Aarhus N, Denmark
| | - Kirstine Stochholm
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
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Ridder LO, Berglund A, Stochholm K, Chang S, Gravholt CH. Morbidity, mortality, and socioeconomics in Klinefelter syndrome and 47,XYY syndrome: a comparative review. Endocr Connect 2023; 12:e230024. [PMID: 37098811 PMCID: PMC10160544 DOI: 10.1530/ec-23-0024] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/24/2023] [Indexed: 04/27/2023]
Abstract
Context Klinefelter syndrome (KS, 47,XXY) and 47,XYY syndrome are genetic conditions characterized by a supernumerary sex chromosome. The conditions share many traits, but considerable phenotypic differences are seen between the two. Focusing on morbidity, mortality, and socioeconomics, this review highlights similarities and differences. Methods Relevant literature was identified through PubMed with the following search terms; 'Klinefelter', '47,XXY', '47,XYY', and 'Jacobs syndrome'. Included journal articles were chosen at the authors' discretion. Results KS and 47,XYY are the most common sex chromosome disorders in males, with an expected prevalence of 152 and 98 per 100,000 newborn males, respectively. Non-diagnosis is extensive, as only about 38% of KS and 18% of 47,XYY are diagnosed. Both conditions are associated with an increased mortality risk and increased risk of a variety of diseases and other health-related problems affecting virtually every organ system. Early diagnosis seems to predict a lesser comorbidity burden. Neurocognitive deficits as well as social and behavioral problems are commonly described. Both syndromes are associated with poor socioeconomicfor example, lower income and educational level and higher rates of crime. Infertility is a hallmark of KS, but fertility seems also reduced in 47,XYY. Conclusion Being born as a boy with an extra X or Y chromosome is associated with increased mortality and excess morbidity, partially expressed in a sex chromosome-specific pattern.Both syndromes continue to be greatly underdiagnosed, even thoughearly intervention may improve the overall outcome. Earlier diagnosis to initiate timely counseling and treatment should be emphasized.
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Affiliation(s)
- Lukas Ochsner Ridder
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Agnethe Berglund
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Genetics and Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kirstine Stochholm
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark
| | - Simon Chang
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark
- Unit for Thrombosis Research, Hospital of South West Jutland and University of Southern Denmark, Esbjerg, Denmark
| | - Claus H Gravholt
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Unit for Thrombosis Research, Hospital of South West Jutland and University of Southern Denmark, Esbjerg, Denmark
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7
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Ebbehoj A, Søndergaard E, Jepsen P, Stochholm K, Svane HML, Madsen M, Poulsen PL, Jørgensen JOL. The Socioeconomic Consequences of Cushing's Syndrome: A Nationwide Cohort Study. J Clin Endocrinol Metab 2022; 107:e2921-e2929. [PMID: 35311897 DOI: 10.1210/clinem/dgac174] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 01/24/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT The long-term somatic and psychiatric consequences of Cushing's syndrome are well-described, but the socioeconomic consequences are largely unknown. OBJECTIVE We studied employment status, educational level, risk of depression, and other socioeconomic outcomes of Cushing's syndrome in the years before diagnosis and after surgery. DESIGN Nationwide register-based cohort study. METHODS We used a validated algorithm to identify 424 patients operated for adrenal (n = 199) or pituitary Cushing's syndrome (n = 225) in Denmark from January 1, 1986 to December 31, 2017. We obtained socioeconomic registry data from 10 years before diagnosis (year -10) to 10 years after surgery (year +10) and included a sex- and age-matched reference population. We identified prognostic factors for returning to work using modified Poisson regression. RESULTS Compared to the reference population, the patients' employment was permanently reduced from year -6 [relative risk (RR) 0.92, 95% CI 0.84-0.99] to year +10 (RR 0.66, 95% CI 0.57-0.76). Sick leave (RR 2.15, 95% CI 1.40-3.32) and disability pension (RR 2.60, 95% CI 2.06-3.27) were still elevated in year +10. Annual income, education, parenthood, relationship status, and risk of depression were also negatively impacted, but parenthood and relationship status normalized after surgery. Among patients, negative predictors of full-time employment after surgery included female sex, low education, comorbidity, and depression. CONCLUSION Cushing's syndrome negatively affects a wide spectrum of socioeconomic variables many years before diagnosis of which only some normalize after treatment. The data underpin the importance of early diagnosis and continuous follow-up of Cushing's syndrome and, not least, the pervasive health threats of glucocorticoid excess.
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Affiliation(s)
- Andreas Ebbehoj
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Esben Søndergaard
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Jepsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Kirstine Stochholm
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Morten Madsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Per Løgstrup Poulsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Otto Lunde Jørgensen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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8
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Kjeldsen S, Andersen N, Groth K, Larsen D, Hjortdal J, Berglund A, Gravholt C, Stochholm K. Ocular morbidity in Marfan syndrome: a nationwide epidemiological study. Br J Ophthalmol 2022:bjophthalmol-2021-320871. [PMID: 35318224 DOI: 10.1136/bjophthalmol-2021-320871] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/04/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Ophthalmic complications are profound in Marfan syndrome (MFS). However, the overall burden is not well described. Our purpose was to evaluate the ocular morbidity in a nationwide perspective. METHODS We identified the ocular morbidity in patients with MFS (n=407) by use of Danish national healthcare registers, using number and timing of hospital contacts related to ophthalmic diagnoses, to ophthalmic surgery and to prescriptions for ophthalmic medication. An age-matched and gender-matched background population (n=40 700) was used as comparator. RESULTS Among MFS, 56% (226/407) of the patients had at least one registration of an ophthalmic diagnosis as inpatient or outpatient during the study period (HR of 8.0 (95% CI 7.0 to 9.2)). Seven out of 11 main groups of diagnoses were affected, including 'Lens', 'Choroid and retina', 'Ocular muscles, binocular movement, accommodation and refraction', 'Glaucoma', Visual disturbances and blindness', 'Vitreous body and globe', and 'Sclera, cornea, iris and ciliary body'. The number of surgical procedures as well as the use of ophthalmic medication in patients with MFS was significantly increased. CONCLUSION This nationwide epidemiological study of ocular morbidity in MFS demonstrates a profound burden and emphasises the need for thorough and experienced ophthalmological surveillance.
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Affiliation(s)
- Sia Kjeldsen
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Andersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Kristian Groth
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Dorte Larsen
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Hjortdal
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Agnethe Berglund
- Department of Clinical Genetics, Aalborg University Hospital, Aalborg, Denmark
| | - Claus Gravholt
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kirstine Stochholm
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark.,Centre of Rare Diseases, Pediatrics, Aarhus University Hospital, Aarhus, Denmark
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9
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Andersen NH, Hauge EM, Baad-Hansen T, Groth KA, Berglund A, Gravholt CH, Stochholm K. Musculoskeletal diseases in Marfan syndrome: a nationwide registry study. Orphanet J Rare Dis 2022; 17:118. [PMID: 35248143 PMCID: PMC8898450 DOI: 10.1186/s13023-022-02272-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/20/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Marfan syndrome is associated with abnormalities in the musculoskeletal system including scoliosis, pectus deformities, protrusio acetabuli, and foot deformities. Over a life span, many patients with Marfan syndrome will need treatment; however, the musculoskeletal morbidity over a life span is not well described. The aim of the present study was to assess the overall burden of musculoskeletal disease in patients with Marfan syndrome.
Materials and methods
A registry-based, nationwide epidemiological study of patients with a Ghent II verified Marfan syndrome diagnosis from 1977 to 2014. Each patient was matched on age, and sex with up to 100 controls from the background population.
Results
We identified 407 patients with Marfan syndrome and 40,700 controls and compared their musculoskeletal diagnoses and surgical treatments using Cox proportional hazards ratio (HR). The risk of a registration of a musculoskeletal diagnosis in patients with Marfan syndrome was significantly increased compared to controls (HR: 1.94 (1.69–2.24). One out of six with Marfan syndrome was registered with scoliosis (HR: 36.7 (27.5–48.9). Scoliosis was more common in women with Marfan syndrome compared to men (HR: 4.30 (1.73–1.08)). One out of 11 were registered with a pectus deformity HR: 40.8 (28.1–59.3), and one out of six with a deformity of the foot. Primarily pes planus (HR: 26.0 (15.2–44.3). The proportion of patients with Marfan syndrome (94/407) that underwent musculoskeletal surgery was also significantly higher (HR: 1.76 (1.43–2.16)). The major areas of surgery were the spine, pectups correction, and surgery of the foot/ankle. Ten patients with Marfan syndrome had elective orthopedic surgery without being recognized and diagnosed with Marfan syndrome until later in life. None of these had scoliosis, pectus deformity or a foot deformity. Among patients with an aortic dissection, the age at dissection was 34.3 years in those with at least one major musculoskeletal abnormality. In patients without a major abnormality the age at dissection was 45.1 years (p < 0.01).
Conclusions
The extent of musculoskeletal disease is quite significant in Marfan syndrome, and many will need corrective surgery during their life span. Surgeons should be aware of undiagnosed patients with Marfan syndrome when treating patients with a Marfan syndrome like-phenotype.
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Berglund A, Stochholm K, Gravholt CH. The comorbidity landscape of 47,XXX syndrome: A nationwide epidemiologic study. Genet Med 2021; 24:475-487. [PMID: 34906506 DOI: 10.1016/j.gim.2021.10.012] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/21/2021] [Accepted: 10/20/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study aimed to describe the comorbidity pattern in 47,XXX syndrome. METHODS This was a registry-based study of hospital diagnoses and prescribed medication in a nationwide cohort of females with 47,XXX (n = 103) and 46,XX/47,XXX (n = 57) in which they were compared with 16,000 age-matched general population female controls. RESULTS The overall occurrence of hospital diagnoses was significantly increased in females with 47,XXX when compared with controls (incidence rate ratio = 2.1, CI = 1.7-2.5), and when divided into 19 organ-specific groups, there was a significantly increased risk in the following 14 groups: infection, blood, endocrine and metabolism, mental, nervous system, eye, ear, respiratory, oral cavity and gastrointestinal, musculoskeletal, perinatal, congenital malformations, external factors, and "other." The risk of being prescribed any medication was not significantly increased in females with 47,XXX when compared with controls (hazard ratio = 1.2, CI = 0.9-1.4). However, when stratified according to medication groups, a significantly increased risk was detected in 4 of 13 groups. The overall occurrence of hospital diagnoses was also significantly increased when females with 46,XX/47,XXX were compared with controls (incidence risk ratio = 1.3, CI = 1.01-1.8), but generally, in comparison with controls, females with 46,XX/47,XXX were less severely affected than females with 47,XXX. CONCLUSION The 47,XXX syndrome is associated with an increased occurrence of a wide variety of diseases. Increased awareness of this may contribute to improve counseling and clinical assessment of these patients.
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Affiliation(s)
- Agnethe Berglund
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark; Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Kirstine Stochholm
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Claus Højbjerg Gravholt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
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11
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Folkestad L, Stochholm K, Groth K, Hove H, Andersen NH, Gravholt CH. Fracture Rates and Fracture Risk in Patients With Marfan Syndrome: A Nationwide Register-Based Cohort Study. J Bone Miner Res 2021; 36:901-909. [PMID: 33567127 DOI: 10.1002/jbmr.4258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 11/03/2020] [Revised: 01/13/2021] [Accepted: 01/20/2021] [Indexed: 12/21/2022]
Abstract
Marfan syndrome (MFS), a rare genetic disease, has a prevalence of 6.5 in 100,000. Studies show that patients with MFS have reduced areal bone mineral density (BMD) compared with non-MFS individuals. We have previously shown that patients with MFS have reduced volumetric BMD and compromised trabecular and cortical bone microarchitecture. The present study was a registry-based, nationwide, population-based, cohort study using register data, aimed to evaluate fracture risk and fracture rates in MFS. We included 406 (196 women) patients with MFS through the Danish National Patient Register and 40,724 (19,327 women) persons, randomly selected and matched from the Civil Registry System. A total of 21.9% of the MFS and 18.9% of the reference population had experienced at least one fracture from 1995 to 2018. The fracture incidence rate was 27.5 per 1000 person-years in the MFS cohort (highest in young men and old women with MFS), and 20.3 per 1000 person-years in the reference population. The overall incidence rate ratio between the MFS and the reference population was 1.35 (95% confidence interval [CI ] 1.18-1.55) for all fractures. When evaluating the risk of being registered with an osteoporosis diagnosis in the Danish National Patient Register, starting relevant treatment for osteoporosis or experiencing a hip or spine fracture, 10.3% of the MFS cohort and 3.3% of the reference population could be classified as being osteoporotic. The between-group subhazard ratio was 3.97 (95% CI 2.56-6.25). Patients with MFS started treatment with an antiosteoporotic drug at a younger age than the reference population (57 [interquartile range 55-67] versus 71 [63-73]) years. The life expectancy in MFS is increasing, resulting in more patients facing diseases that are related to old age, such as age-related bone loss and increased risk of fractures. Our data suggest that bone health and fracture prevention needs to be part of the standard care for patients with MFS. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Lars Folkestad
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kirstine Stochholm
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kristian Groth
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hanne Hove
- Department of Pediatrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,The RAREDIS Database, Section of Rare Diseases, Department of Clinical Genetics and Pediatrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Claus H Gravholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
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12
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Ebbehoj A, Stochholm K, Jacobsen SF, Trolle C, Jepsen P, Robaczyk MG, Rasmussen ÅK, Feldt-Rasmussen U, Thomsen RW, Søndergaard E, Poulsen PL. Incidence and Clinical Presentation of Pheochromocytoma and Sympathetic Paraganglioma: A Population-based Study. J Clin Endocrinol Metab 2021; 106:e2251-e2261. [PMID: 33479747 DOI: 10.1210/clinem/dgaa965] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 11/09/2020] [Indexed: 12/17/2022]
Abstract
CONTEXT Pheochromocytoma and sympathetic paraganglioma (PPGL) are rare catecholamine-secreting tumors but recent studies suggest increasing incidence. Traditionally, PPGL are described to present with paroxysmal symptoms and hypertension, but existing data on clinical presentation of PPGL come from referral centers. OBJECTIVE We aimed to describe time trends in clinical presentation and incidence of PPGL in a population-based study. METHODS We conducted a nationwide retrospective cohort study of a previously validated cohort of 567 patients diagnosed with PPGL in Denmark 1977-2015. We collected clinical data from medical records of a geographic subcohort of 192 patients. We calculated age-standardized incidence rates (SIRs) and prevalence for the nationwide cohort and descriptive statistics on presentation for the subset with clinical data. RESULTS SIRs increased from 1.4 (95% CI 0.2-2.5) per million person-years in 1977 to 6.6 (95% CI 4.4-8.7) per million person-years in 2015, corresponding to a 4.8-fold increase. The increase was mainly due to incidentally found tumors that were less than 4 cm and diagnosed in patients older than 50 years with no or limited paroxysmal symptoms of catecholamine excess. On December 31, 2015, prevalence of PPGL was 64.4 (CI 95% 57.7-71.2) per million inhabitants. Of 192 patients with clinical data, 171 (89.1%) had unilateral pheochromocytoma, while unilateral paraganglioma (n = 13, 6.8%) and multifocal PPGL (n = 8, 4.2%) were rare. CONCLUSION Incidence of PPGL has increased 4.8-fold from 1977 to 2015 due to a "new" group of older patients presenting with smaller incidentally found PPGL tumors and few or no paroxysmal symptoms.
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Affiliation(s)
- Andreas Ebbehoj
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kirstine Stochholm
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Christian Trolle
- Diagnostic Center, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - Peter Jepsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Åse Krogh Rasmussen
- Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Esben Søndergaard
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Per Løgstrup Poulsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
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13
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Viuff MH, Stochholm K, Grønbaek H, Berglund A, Juul S, Gravholt CH. Increased occurrence of liver and gastrointestinal diseases and anaemia in women with Turner syndrome - a nationwide cohort study. Aliment Pharmacol Ther 2021; 53:821-829. [PMID: 33550624 DOI: 10.1111/apt.16277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/07/2020] [Accepted: 01/14/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Liver and gastrointestinal diseases are frequent in women with Turner syndrome. However, their association with bleeding disorders, anaemia and the impact of hormone replacement therapy is unknown. AIMS To investigate the risk of liver and gastrointestinal diseases, haemorrhage and anaemia in women with Turner syndrome compared with the female background population, and the long-term impact of hormone replacement therapy on these conditions. METHODS One thousand one hundred and fifty-six women with Turner syndrome diagnosed during 1960-2014 were identified using the Danish Cytogenetic Central Registry and linked with personal-level data from the National Patient Registry and the Medication Statistics Registry. Statistics Denmark randomly identified 115 577 age-matched female controls. Negative binomial regression was used to analyse hospital discharge diagnoses. Medical prescriptions, mortality and the effect of hormone replacement therapy were estimated using stratified Cox regression. RESULTS Liver disease increased 13-fold (IRR 12.9 (95% CI 5.8-28.8)), due to toxic liver disease (IRR 8.0 (95% CI 1.8-35.4)), liver insufficiency (IRR 6.7 (95% CI 1.7-26.9)), fibrosis/cirrhosis (IRR 16.5 (95% CI 2.2-122.1)) and unspecified liver disease (IRR 10.6 (95% CI 4.4-25.3)). Furthermore, presence of abnormal liver enzymes increased 12-fold (IRR 12.4 (95% CI 4.2-36.6)). The risk of gastrointestinal haemorrhage (IRR 3.4 (95% CI 1.8-6.2)), anaemia (IRR 3.2 (95% CI 2.0-5.0)) and coagulation disorders (IRR 2.9 (95% CI 1.1-7.1)) was increased. However these diagnoses were not associated with inflammatory bowel disease. Gastrointestinal mortality was increased three-fold (HR 3.1 (95% CI 1.5-6.2)), partly due to death by liver disease (HR 3.0 (95% CI 1.1-8.2)), gastrointestinal haemorrhage (HR 29.6 (95% CI 3.1-285.1)) and capillary malformations (HR 18.6 (95% CI 4.1-85.0)). There was no effect of hormone replacement therapy on gastrointestinal risk but a trend towards a beneficial impact on liver diseases. CONCLUSIONS The risk of being diagnosed with liver disease was higher than previously reported. The occurrence of gastrointestinal haemorrhage and anaemia was increased in Turner syndrome. There was no effect of hormone replacement therapy on gastrointestinal risk but a trend towards a beneficial impact on liver diseases was detected.
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Affiliation(s)
- Mette Hansen Viuff
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - Kirstine Stochholm
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - Henning Grønbaek
- Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Agnethe Berglund
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - Svend Juul
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Claus Højbjerg Gravholt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
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14
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Groth KA, Nielsen BB, Sheyanth IN, Gravholt CH, Andersen NH, Stochholm K. Maternal health and pregnancy outcome in diagnosed and undiagnosed Marfan syndrome: A registry-based study. Am J Med Genet A 2021; 185:1414-1420. [PMID: 33590700 DOI: 10.1002/ajmg.a.62122] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/15/2021] [Accepted: 01/30/2021] [Indexed: 11/09/2022]
Abstract
In Marfan syndrome (MFS), pregnancy is considered as high risk due to the deficiency of fibrillin in the connective tissue and increased risk of aortic dissection. The objective was to demonstrate the consequences on maternal health, in women with diagnosed and undiagnosed MFS at the time of pregnancy and childbirth. By using national health care registries, we identified all pregnancy related outcomes, from women with MFS (n = 183) and an age-matched background population (n = 18,300). We found 91 pregnancies during follow-up. Significantly fewer women with MFS gave birth, compared to the background population. No women with known MFS had a pregnancy related aortic dissection but complications related to the cervix were increased (HR:19.8 [95% CI:2.2-177.5]). Fifty women with MFS were undiagnosed at the time of their first pregnancy and/or childbirth. Among these, there were more birth canal related complications HR:27.2 (95% CI: 2.3-315.0), preeclampsia (HR:2.25 [95% CI: 1.11-4.60]), fetal deaths (HR:12.3 [95% CI: 1.51-99.8]), and all delivery-related dissections came from this subgroup. In conclusion, undiagnosed women with MFS experienced more pregnancy and childbirth related complications including fetal death, birth canal issues, preeclampsia, and aortic disease, which emphasizes the need for an early MFS diagnosis and special care during pregnancy and childbirth.
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Affiliation(s)
- Kristian A Groth
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Birgitte B Nielsen
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Inger N Sheyanth
- Department of Clinical Genetics, Aalborg University Hospital, Aalborg, Denmark
| | - Claus H Gravholt
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Niels H Andersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Kirstine Stochholm
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
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15
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Viuff MH, Stochholm K, Lin A, Berglund A, Juul S, Gravholt CH. Cancer occurrence in Turner syndrome and the effect of sex hormone substitution therapy. Eur J Endocrinol 2021; 184:79-88. [PMID: 33112259 DOI: 10.1530/eje-20-0702] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/14/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Although the overall risk of cancer is not increased in Turner syndrome, the pattern of cancer occurrence differs from the general population. We aim to describe the cancer morbidity pattern in Turner syndrome and evaluate the effect of long-term hormone replacement therapy (HRT). DESIGN Nationwide epidemiological study. METHODS 1156 females with Turner syndrome diagnosed during 1960-2014, were linked with data from the Danish National Patient Registry. Statistics Denmark randomly identified 115 578 female controls. Stratified Cox regression was used to analyze cancer morbidity, mortality and effect of HRT. RESULTS Overall risk of cancer was not elevated (hazard ratio 1.04 (95% CI: 0.80-1.36)). The risk of skin cancer and benign skin neoplasms was two-fold increased, while the risk of breast cancer was decreased (hazard ratio 0.4 (0.2-0.9)). Turner syndrome (45,X) had a two- to five-fold increased risk of benign CNS tumors, colon and rectal cancers, benign skin neoplasms and skin cancer. Turner syndrome women with a 45,X/46,XX karyotype had an increased risk of tongue cancer. HRT had no impact on the risk of any cancer investigated in this study. CONCLUSIONS The lack of one X chromosome might play a role in skin neoplasms, CNS tumors, colon and rectal cancers. The risk of breast cancer is lower than in the general population. Long-term HRT during the premenopausal age range seems not to exert a cancerous effect in Turner syndrome. Increased vigilance concerning specific types of cancer in Tuner syndrome harboring a 45,X karyotype is needed.
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Affiliation(s)
- Mette Hansen Viuff
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - Kirstine Stochholm
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - Angela Lin
- Medical Genetics Unit, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
| | - Agnethe Berglund
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Genetics, Aarhus University, Aarhus, Denmark
| | - Svend Juul
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Claus Højbjerg Gravholt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
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16
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Dal J, Nielsen EH, Rasmussen UF, Andersen M, Feltoft CL, Vestergaard P, Stochholm K, Jørgensen JOL. Disease Control and Gender Predict the Socioeconomic Effects of Acromegaly: A Nationwide Cohort Study. J Clin Endocrinol Metab 2020; 105:5864154. [PMID: 32593172 DOI: 10.1210/clinem/dgaa405] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/07/2020] [Accepted: 06/20/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Acromegaly is an insidious disease associated with severe somatic morbidity but data on socioeconomic status are scarce. OBJECTIVE To study the socioeconomic status in acromegaly in a population-based follow-up study. METHODS All incident cases of acromegaly (n = 576) during the period 1977-2010 were included. For every patient, 100 persons were sampled from the general population matched for date of birth and gender (comparison cohort). Cox regression and hazard ratios (HR), conditional logistic regression and linear regression with 95% confidence intervals (CI) were used. OUTCOME MEASURES Retirement, social security benefit, annual income, cohabitation, separation, parenthood and educational level. RESULTS The proportion of retired individuals was significantly higher in patients with acromegaly after the time of diagnosis (HR, 1.43; 95% CI, 1.26-1.62) and also during the 5-year pre-diagnostic period (HR, 1.15; 95% CI, 1.03-1.28). More individuals with acromegaly received social security benefit compared with the comparison cohort during the initial period after the time of diagnosis. Among patients who maintained a job, the annual income was similar to the comparison cohort. Compared with the background population, cohabitation was lower (HR, 0.69; 95% CI, 0.50-0.95) as was parenthood (HR, 0.56; 95% CI, 0.39-0.80), whereas neither educational level (HR, 0.61; 95% CI, 0.35-1.06) nor separation (HR, 1.13; 95% CI, 0.86-1.47) were different. Female gender and insufficient disease control were associated with a significantly worse socioeconomic status. CONCLUSIONS 1) Socioeconomic status is impaired in patients with acromegaly even before a diagnosis of acromegaly. 2) Females and patients without disease remission have worse outcomes. 3) Early diagnosis and effective treatment of acromegaly could be important factors in mitigating the negative impact on socioeconomic factors.
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Affiliation(s)
- Jakob Dal
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetic Center North Jutland, Aalborg, Denmark
| | - Eigil H Nielsen
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Ulla-Feldt Rasmussen
- Department of Endocrinology and Metabolism, National University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Marianne Andersen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Claus L Feltoft
- Department of Endocrinology, Herlev University Hospital, Denmark
| | - Peter Vestergaard
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetic Center North Jutland, Aalborg, Denmark
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Berglund A, Stochholm K, Gravholt CH. The epidemiology of sex chromosome abnormalities. Am J Med Genet C Semin Med Genet 2020; 184:202-215. [PMID: 32506765 DOI: 10.1002/ajmg.c.31805] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/11/2020] [Accepted: 05/11/2020] [Indexed: 12/19/2022]
Abstract
Sex chromosome abnormalities (SCAs) are characterized by gain or loss of entire sex chromosomes or parts of sex chromosomes with the best-known syndromes being Turner syndrome, Klinefelter syndrome, 47,XXX syndrome, and 47,XYY syndrome. Since these syndromes were first described more than 60 years ago, several papers have reported on diseases and health related problems, neurocognitive deficits, and social challenges among affected persons. However, the generally increased comorbidity burden with specific comorbidity patterns within and across syndromes as well as early death of affected persons was not recognized until the last couple of decades, where population-based epidemiological studies were undertaken. Moreover, these epidemiological studies provided knowledge of an association between SCAs and a negatively reduced socioeconomic status in terms of education, income, retirement, cohabitation with a partner and parenthood. This review is on the aspects of epidemiology in Turner, Klinefelter, 47,XXX and 47,XYY syndrome.
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Affiliation(s)
- Agnethe Berglund
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kirstine Stochholm
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Claus Højbjerg Gravholt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
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18
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Viuff MH, Stochholm K, Grønbæk H, Berglund A, Juul S, Gravholt CH. SAT-025 Increased Occurrence of Anemia, Gastrointestinal and Liver Diseases in Women with Turner Syndrome - a Nationwide Registry Study. J Endocr Soc 2020. [PMCID: PMC7207356 DOI: 10.1210/jendso/bvaa046.061] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Gastrointestinal disorders, such as celiac disease, inflammatory bowel diseases and liver disease have previously been described with increased occurrence in women with Turner syndrome. However, evidence towards increased occurrence of bleeding disorders and anemia are sparse. Likewise, the impact of hormone replacement therapy on gastrointestinal disorders remains unknown. Aim: To investigate the risk of bleeding disorders, anemia, gastrointestinal and hepatological disease in women with TS compared with the female background population and to assess the effect of HRT on these conditions. Design: National cohort study Method: 1,156 females with TS diagnosed during 1960–2014 were identified using the Danish Cytogenetic Central Registry and linked with personal-level data from the National Patient Registry and the Medication Statistics Registry. Statistics Denmark randomly identified 115,577 age-matched female controls. Negative binomial regression was used to analyze hospital discharge diagnoses. Medical prescriptions, mortality and the effect of hormone replacement therapy were estimated using stratified Cox regression. Results: The risk of anemia, coagulation disorders and gastrointestinal hemorrhage were all increased three-fold in women with TS compared with controls. Gastrointestinal disorders were twice as frequent in TS individuals, with a three-fold increased risk of inflammatory bowel disease and a twelve-fold increased risk of liver disease and elevated liver enzymes. Both gastrointestinal and hepatological mortality were increased three-fold in TS women. Conclusion: Anemia, gastrointestinal hemorrhage, inflammatory bowel disease is more frequent in women with Turner syndrome compared with controls. The risk of liver disease may be higher than previously reported.
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Affiliation(s)
| | | | | | | | - Svend Juul
- Aarhus University Hospital, Aarhus N, Denmark
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Smerdel MP, Skytte AB, Jelsig AM, Ebbehøj E, Stochholm K. Revised Danish guidelines for the cancer surveillance of patients with Cowden Syndrome. Eur J Med Genet 2020; 63:103873. [PMID: 32058060 DOI: 10.1016/j.ejmg.2020.103873] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 11/05/2019] [Accepted: 02/01/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Cowden syndrome is a cancer predisposition syndrome caused by pathogenic variants in PTEN. The affected patients possess an increased risk of breast, thyroid, renal, colorectal, endometrial cancers as well as malignant melanoma. Thus prophylactic surveillance and follow up is crucial for these patients. METHODS A review of the literature including existing guidelines from the years 1996 until 2017 was carried out. In total, 2078 scientific papers were identified through database searches on Cowden syndrome. Among these, 11 manuscripts were included based on scientific relevance and quality. Expert consensus was reached to define management guidelines. RESULTS The literature revealed a high risk of cancer in specific organs for patients diagnosed with Cowden Syndrome. Alternative management guidelines were proposed and discussed. CONCLUSIONS Here we propose a revised set of management guidelines for patients with Cowden syndrome in Denmark to address the increased risk of various cancer types.
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Affiliation(s)
- Maja Patricia Smerdel
- Department of Clinical Genetics, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark.
| | - Anne-Bine Skytte
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
| | - Anne Marie Jelsig
- Clinical Genetic Clinic, Kennedy Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Eva Ebbehøj
- Department of Internal Medicine and Diabetes, Aarhus University Hospital, Aarhus, Denmark.
| | - Kirstine Stochholm
- Department of Pediatrics, Center of Rare Diseases, Aarhus University Hospital and Department of Internal Medicine and Diabetes, Aarhus University Hospital, Aarhus, Denmark.
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20
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Viuff MH, Berglund A, Juul S, Andersen NH, Stochholm K, Gravholt CH. Sex Hormone Replacement Therapy in Turner Syndrome: Impact on Morbidity and Mortality. J Clin Endocrinol Metab 2020; 105:5572683. [PMID: 31545360 DOI: 10.1210/clinem/dgz039] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 06/24/2019] [Accepted: 09/20/2019] [Indexed: 02/09/2023]
Abstract
CONTEXT The long-term effects of female hormone replacement therapy (HRT) in Turner syndrome (TS) are unknown. OBJECTIVE To examine morbidity, mortality and medicinal use in TS and the impact of HRT in 45,X women. DESIGN AND SETTING National cohort study, following all TS individuals ever diagnosed in Denmark from 1977 to 2014. PATIENTS AND METHODS In the Danish Cytogenetic Central Registry, we identified 1156 females diagnosed with TS from 1960 to 2014, and, subsequently, Statistics Denmark randomly identified 115 577 age-matched female controls. TS women and their matched controls were linked with person-level data from the National Patient Registry and the Medication Statistics Registry, and they were compared concerning mortality, hospitalizations, and medical prescriptions. Among 329 45,X women, 44 had never been HRT treated, and 285 had been treated at some point. HRT treated women were compared with untreated concerning mortality, hospitalizations, and medical prescriptions. RESULTS Endocrine and cardiovascular mortality and morbidity were significantly increased in TS compared with the matched controls. Comparing HRT treated with nontreated 45,X women, we found a similar mortality (hazard ratio 0.83, 95% confidence interval 0.38-1.79). Among the HRT-treated 45,X women, we found a significantly lower use of antihypertensives, antidiabetics, and thyroid hormones and significantly reduced hospitalization rates for stroke and osteoporotic fractures. CONCLUSION Women with TS have an increased overall mortality and morbidity. HRT seems to have a beneficial effect on endocrine conditions, hypertension, and stroke in women with 45,X karyotype, with no clear impact on mortality.
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Affiliation(s)
- Mette H Viuff
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - Agnethe Berglund
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - Svend Juul
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Niels H Andersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Kirstine Stochholm
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - Claus H Gravholt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
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Abstract
Turner syndrome is a rare condition in women that is associated with either complete or partial loss of one X chromosome, often in mosaic karyotypes. Turner syndrome is associated with short stature, delayed puberty, ovarian dysgenesis, hypergonadotropic hypogonadism, infertility, congenital malformations of the heart, endocrine disorders such as type 1 and type 2 diabetes mellitus, osteoporosis and autoimmune disorders. Morbidity and mortality are increased in women with Turner syndrome compared with the general population and the involvement of multiple organs through all stages of life necessitates a multidisciplinary approach to care. Despite an often conspicuous phenotype, the diagnostic delay can be substantial and the average age at diagnosis is around 15 years of age. However, numerous important clinical advances have been achieved, covering all specialty fields involved in the care of girls and women with Turner syndrome. Here, we present an updated Review of Turner syndrome, covering advances in genetic and genomic mechanisms of disease, associated disorders and multidisciplinary approaches to patient management, including growth hormone therapy and hormone replacement therapy.
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Affiliation(s)
- Claus H Gravholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Mette H Viuff
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Sara Brun
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kirstine Stochholm
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Centre for Rare Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Niels H Andersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Abstract
The acute metabolic actions of hGH were discovered in GH-deficient adults (GHDA) 60 years ago and placebo controlled trials of prolonged rhGH replacement therapy appeared 30 years after. Untreated GHDA causes excess morbidity and mortality from cardiovascular disease and the clinical features include fatigue, reduced aerobic exercise capacity, abdominal obesity, reduced lean body mass, osteopenia, and elevated levels of circulating cardiovascular risk biomarkers. Several of these abnormalities normalize with GH replacement. Frequent side effects are fluid retention and insulin resistance, which are reversible and dose-dependent. The dose requirement declines with age and is higher in women. Continuation of GH replacement into adulthood is indicated in some patients with childhood-onset disease so the diagnosis must be reassessed. Observational data show that mortality in GH replaced patients is reduced compared to untreated patients. Thus, GH replacement in GHDA has proven beneficial and safe.
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Affiliation(s)
- Jens Ol Jørgensen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, E-mail:
| | - Kasper Hermansen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus
| | - Kirstine Stochholm
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus
| | - Anders Juul
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Viuff M, Berglund A, Juul S, Andersen N, Stochholm K, Gravholt C. SAT-284 Sex Hormone Replacement Therapy in Turner Syndrome and the Impact on Morbidity and Mortality. J Endocr Soc 2019. [PMCID: PMC6552127 DOI: 10.1210/js.2019-sat-284] [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
Background: In Turner Syndrome (TS) it is recommended to induce puberty around 11-12 years of age, by initiating hormone replacement therapy (HRT), when premature ovarian failure is diagnosed. However, evidence for the long-term effects on morbidity and mortality is sparse and it is unknown how many TS receive HRT as recommended according to guidelines. Aim: To describe the incidence of cardiovascular and endocrine related morbidity and mortality, and the association with HRT in TS. Design: Nationwide epidemiological study using Danish registries on medications and healthcare contacts. Methods: We identified 1.156 women with Turner Syndrome diagnosed from 1960-2014 using The Danish Cytogenetic Central Registry and linked them with the Danish National Patient Register and the Medication Statistics Register. Statistics Denmark randomly identified 115.578 controls matched on gender and age. We used Stratified Cox regression to analyze morbidity, mortality and prescriptions, computing proportional hazard ratios (HR). Results: Women with TS had more than doubled risk of cardiovascular diseases such as arrhythmia, heart failure, hypertension, ischemic heart disease, stroke, and endocrine diseases such as thyroid disorders. Similar a 4-fold increase in the risk of diabetes type I and II and osteoporosis was seen. Many TS (17-33% depending on karyotype) never received HRT. Overall mortality in TS was 3-fold increased. Among TS with 45,X receiving HRT, mortality was lower than among HRT non-treated 45,X (HR 5.0 (3.0-8.2) vs. HR 3.0 (1.9-4.5)). We saw a significant reduction in use of antihypertensive medication (HR 0.5 (95% CI 0.4-0.7)), antidiabetics (HR 0.4 (95% CI 0.2-0.9)) and thyroid hormones (HR 0.5 (95% CI 0.3-0.9)) in HRT treated 45,X women compared to HRT non-treated 45,X women. Conclusion: 17-33% of TS women never received HRT. Mortality is increased 3-fold in all TS compared with controls, and 45,X women that did receive HRT had a lover mortality than those who did not. HRT have a beneficial effect on endocrine conditions, hypertension and stroke.
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Affiliation(s)
- Mette Viuff
- Aarhus University Hospital, Aarhus, , Denmark
| | | | - Svend Juul
- Aarhus University Hospital, Aarhus, , Denmark
| | | | - Kirstine Stochholm
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, , Denmark
| | - Claus Gravholt
- Department of Endocrinology & Internal Medicine, Aarhus University Hospital, Aarhus, , Denmark
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Berglund A, Viuff M, Stochholm K, Gravholt C. SUN-225 The 47,XYY Syndrome Is Associated with Increased Morbidity: A Nationwide Registry Study. J Endocr Soc 2019. [PMCID: PMC6553246 DOI: 10.1210/js.2019-sun-225] [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
Background: Although the 47,XYY syndrome is one of the most common sex chromosome abnormalities in males, as being diagnosed in 18 per 100,000 newborns, little is known about the long-term health outcomes of this condition. Objective: To describe morbidity in a national cohort of 47,XYY males as compared to the general male population using complete data on hospital admissions and prescribed medication. Design and setting: A nationwide registry study with complete follow-up in a uniform public health care system. Participants: A total of 251 males with 47,XYY (n=205), 46,XY/47,XYY (n=28) or compatible karyotypes (n=18) diagnosed during 1965-2014 and a randomly selected age-matched control cohort of 25,100 males from the general population. Results: The risk of being admitted to hospital owing to any diagnosis was significantly increased in 47,XYY compared to controls (HR=1.8, CI:1.6-2.4). Dividing diagnoses into 18 diagnostic groups showed an increased risk of admission in all but three groups. The highest HR was observed for congenital malformations (HR=6.1, CI: 4.8-7.6); psychiatric diseases (HR=5.7, CI: 4.5-7.1); endocrine and metabolic disorders (HR=3.2, CI: 2.4-4.4); neurologic diseases (HR=3.0, CI:2.2-4.0); and urogenital system disorders (HR=3.0, CI: 2.4-3.7). Overall, 47,XYY had an increased risk of receiving medicinal prescriptions compared to controls (HR=1.3, CI:1.1-1.5), and it was significantly increased in 11 out of 14 medicinal prescription groups. The highest HR was observed for medication related to the blood (HR=2.5, CI:1.8-3.5) and the nervous system (HR=2.2, CI:1.9-2.7) as well as for urogenital system disorders and sex hormones (HR=2.7, CI: 2.0-3.7). Conclusions: This study of an unselected nationwide cohort of males affected by the 47,XYY syndrome shows that an additional Y chromosome is associated with an increased morbidity as interpreted from data of hospital admissions and medicinal prescriptions. Approximately 80% of males affected by the 47,XYY syndrome suffer from non-diagnosis, and it remains unknown whether these data extend to those not yet diagnosed.
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Affiliation(s)
| | - Mette Viuff
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, , Denmark
| | - Kirstine Stochholm
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, , Denmark
| | - Claus Gravholt
- Department of Endocrinology & Internal Medicine, Aarhus University Hospital, Aarhus, , Denmark
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Mathiesen JS, Kroustrup JP, Vestergaard P, Stochholm K, Poulsen PL, Rasmussen ÅK, Feldt-Rasmussen U, Schytte S, Londero SC, Pedersen HB, Hahn CH, Bentzen J, Möller S, Gaustadnes M, Rossing M, Nielsen FC, Brixen K, Frederiksen AL, Godballe C. Survival and Long-Term Biochemical Cure in Medullary Thyroid Carcinoma in Denmark 1997-2014: A Nationwide Study. Thyroid 2019; 29:368-377. [PMID: 30618340 PMCID: PMC6437622 DOI: 10.1089/thy.2018.0564] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Survival of medullary thyroid carcinoma (MTC) subgroups in relation to the general population is poorly described. Data on the factors predicting long-term biochemical cure in MTC patients are nonexistent at a population level. A nationwide retrospective cohort study of MTC in Denmark from 1997 to 2014 was conducted, aiming to detect subgroups with survival similar to that of the general population and to identify prognostic factors for disease-specific survival and long-term biochemical cure. METHODS The study included 220 patients identified from the nationwide Danish MTC cohort between 1997 and 2014. As a representative sample of the general population, a reference population matched 50:1 to the MTC cohort was used. RESULTS Patients diagnosed with hereditary MTC by screening (hazard ratio [HR] = 1.5 [confidence interval (CI) 0.5-4.3]), patients without regional metastases (HR = 1.4 [CI 0.9-2.3]), and patients with stage I (HR = 1.3 [CI 0.6-3.1]), stage II (HR = 1.1 [CI 0.6-2.3]), and III (HR = 1.3 [CI 0.4-4.2]) disease had an overall survival similar to the reference population. On multivariate analysis, the presence of distant metastases (HR = 12.3 [CI 6.0-25.0]) predicted worse disease-specific survival, while the absence of regional lymph node metastases (odds ratio = 40.1 [CI 12.0-133.7]) was the only independent prognostic factor for long-term biochemical cure. CONCLUSIONS Patients with hereditary MTC diagnosed by screening, patients without regional metastases, and patients with stages I, II, and III disease may have similar survival as the general population. The presence of distant metastases predicted worse disease-specific survival, while the absence of regional metastases predicted long-term biochemical cure.
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Affiliation(s)
- Jes Sloth Mathiesen
- Department of ORL—Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Address correspondence to: Jes Sloth Mathiesen, MD, Department of ORL—Head & Neck Surgery and Audiology, Odense University Hospital, J. B. Winsløvs Vej 4, DK-5000 Odense, Denmark
| | - Jens Peter Kroustrup
- Department of Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Vestergaard
- Department of Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Gentofte, Denmark
| | - Kirstine Stochholm
- Department of Internal Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Center for Rare Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Per Løgstrup Poulsen
- Department of Internal Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Åse Krogh Rasmussen
- Department of Medical Endocrinology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sten Schytte
- Department of ORL—Head & Neck Surgery and Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Christoffer Holst Hahn
- Department of ORL—Head & Neck Surgery, and Copenhagen University Hospital, Copenhagen, Denmark
| | - Jens Bentzen
- Department of Oncology, Herlev Hospital, Herlev, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Mette Gaustadnes
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Maria Rossing
- Center for Genomic Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Finn Cilius Nielsen
- Center for Genomic Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kim Brixen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anja Lisbeth Frederiksen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Christian Godballe
- Department of ORL—Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
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26
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Berglund A, Viuff MH, Skakkebæk A, Chang S, Stochholm K, Gravholt CH. Changes in the cohort composition of turner syndrome and severe non-diagnosis of Klinefelter, 47,XXX and 47,XYY syndrome: a nationwide cohort study. Orphanet J Rare Dis 2019; 14:16. [PMID: 30642344 PMCID: PMC6332849 DOI: 10.1186/s13023-018-0976-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 12/11/2018] [Indexed: 01/15/2023] Open
Abstract
Background Knowledge on the prevalence of sex chromosome abnormalities (SCAs) is limited, and delayed diagnosis or non-diagnosis of SCAs are a continuous concern. We aimed to investigate change over time in incidence, prevalence and age at diagnosis among Turner syndrome (TS), Klinefelter syndrome (KS), Triple X syndrome (Triple X) and Double Y syndrome (Double Y). Methods This study is a nationwide cohort study in a public health care system. The Danish Cytogenetic Central Registry (DCCR) holds information on all karyotypes performed in Denmark since 1961. We identified all individuals in the DCCR with a relevant SCA during 1961–2014; TS: n = 1156; KS: n = 1235; Triple X: n = 197; and Double Y: n = 287. From Statistics Denmark, which holds an extensive collection of data on the Danish population, complete data concerning dates of death and migrations in and out of Denmark were retrieved for all individuals. Results The prevalence among newborns was as follows: TS: 59 per 100,000 females; KS: 57 per 100,000 males; Triple X: 11 per 100,000 females; and Double Y: 18 per 100,000 males. Compared with the expected number among newborns, all TS, 38% of KS, 13% of Triple X, and 18% of Double Y did eventually receive a diagnosis. The incidence of TS with other karyotypes than 45,X (P < 0.0001), KS (P = 0.02), and Double Y (P = 0.03) increased during the study period whereas the incidence of 45,X TS decreased (P = 0.0006). The incidence of Triple X was stable (P = 0.22). Conclusions The prevalence of TS is higher than previously identified, and the karyotypic composition of the TS population is changing. Non-diagnosis is extensive among KS, Triple X and Double Y, whereas all TS seem to become diagnosed. The diagnostic activity has increased among TS with other karyotypes than 45,X as well as among KS and Double Y.
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Affiliation(s)
- Agnethe Berglund
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. .,Department of Molecular Medicine, Aarhus University Hospital, Brendstrupgaardsvej 21A, 8200, Aarhus N, Denmark.
| | - Mette Hansen Viuff
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Brendstrupgaardsvej 21A, 8200, Aarhus N, Denmark
| | - Anne Skakkebæk
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.,Department of Clinical Genetics, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark
| | - Simon Chang
- Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Clinical Biochemistry, Hospital of South West Jutland, Finsensgade 35, 6700, Esbjerg, Denmark
| | - Kirstine Stochholm
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.,Department of Pediatrics, Center of Rare Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Claus Højbjerg Gravholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Brendstrupgaardsvej 21A, 8200, Aarhus N, Denmark
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Mathiesen JS, Kroustrup JP, Vestergaard P, Stochholm K, Poulsen PL, Rasmussen ÅK, Feldt-Rasmussen U, Schytte S, Londero SC, Pedersen HB, Hahn CH, Bentzen J, Möller S, Gaustadnes M, Rossing M, Nielsen FC, Brixen K, Frederiksen AL, Godballe C. Completeness of RET testing in patients with medullary thyroid carcinoma in Denmark 1997-2013: a nationwide study. Clin Epidemiol 2019; 11:93-99. [PMID: 30666164 PMCID: PMC6330966 DOI: 10.2147/clep.s183268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background The completeness of REarranged during Transfection (RET) testing in patients with medullary thyroid carcinoma (MTC) was recently reported as 60%. However, the completeness on a population level is unknown. Similarly, it is unknown if the first Danish guidelines from 2002, recommending RET testing in all MTC patients, improved completeness in Denmark. We conducted a nationwide retrospective cohort study aiming to evaluate the completeness of RET testing in the Danish MTC cohort. Additionally, we aimed to assess the completeness before and after publication of the first Danish guidelines and characterize MTC patients who had not been tested. Methods The study included 200 patients identified from the nationwide Danish MTC cohort 1997–2013. To identify RET tested MTC patients before December 31, 2014, the MTC cohort was cross-checked with the nationwide Danish RET cohort 1994–2014. To characterize MTC patients who had not been RET tested, we reviewed their medical records and compared them with MTC patients who had been tested. Results Completeness of RET testing in the overall MTC cohort was 87% (95% CI: 0.81–0.91; 173/200). In the adjusted MTC cohort, after excluding patients diagnosed with hereditary MTC by screening, completeness was 83% (95% CI: 0.76–0.88; 131/158). Completeness was 88% (95% CI: 0.75–0.95; 42/48) and 81% (95% CI: 0.72–0.88) (89/110) before and after publication of the first Danish guidelines, respectively. Patients not RET tested had a higher median age at diagnosis compared to those RET tested. Median time to death was shorter in those not tested relative to those tested. Conclusion The completeness of RET testing in MTC patients in Denmark seems to be higher than reported in other cohorts. No improvement in completeness was detected after publication of the first Danish guidelines. In addition, data indicate that advanced age and low life expectancy at MTC diagnosis may serve as prognostic indicators to identify patients having a higher likelihood of missing the compulsory RET test.
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Affiliation(s)
- Jes Sloth Mathiesen
- Department of ORL Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark, .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark,
| | - Jens Peter Kroustrup
- Department of Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Vestergaard
- Department of Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark.,Steno Diabetes Center North Jutland, Aalborg, Denmark
| | - Kirstine Stochholm
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark.,Center for Rare Diseases, Aarhus University Hospital, Aarhus, Denmark
| | | | - Åse Krogh Rasmussen
- Department of Medical Endocrinology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sten Schytte
- Department of ORL Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Christoffer Holst Hahn
- Department of ORL Head & Neck Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jens Bentzen
- Department of Oncology, Herlev Hospital, Herlev, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark, .,Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Mette Gaustadnes
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Maria Rossing
- Center for Genomic Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Finn Cilius Nielsen
- Center for Genomic Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kim Brixen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark,
| | - Anja Lisbeth Frederiksen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark, .,Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Christian Godballe
- Department of ORL Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark,
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28
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Mathiesen JS, Kroustrup JP, Vestergaard P, Stochholm K, Poulsen PL, Rasmussen ÅK, Feldt-Rasmussen U, Schytte S, Pedersen HB, Hahn CH, Bentzen J, Möller S, Gaustadnes M, Rossing M, Nielsen FC, Brixen K, Frederiksen AL, Godballe C. Incidence and prevalence of multiple endocrine neoplasia 2A in Denmark 1901-2014: a nationwide study. Clin Epidemiol 2018; 10:1479-1487. [PMID: 30349395 PMCID: PMC6190626 DOI: 10.2147/clep.s174606] [Citation(s) in RCA: 15] [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] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background The incidence and prevalence of multiple endocrine neoplasia 2A (MEN2A) have only been reported once in a nationwide setting. However, it is unclear whether the figures are representative of other populations, as the major component of the syndrome, hereditary medullary thyroid carcinoma (MTC), has been reported as rare in the same country. We conducted a nationwide retrospective cohort study of MEN2A in Denmark from 1901 to 2014, aiming to describe the incidence and prevalence. Methods This study included 250 unique MEN2A patients born or resident in Denmark before December 31, 2014. Patients were identified through the Danish REarranged during Transfection (RET) cohort, linkage of MEN2A pedigrees, the Danish MTC cohort, a nationwide collaboration of MEN2 centers, cross-checking of other relevant cohorts, and a systematic literature search. Results The incidence from 1971 to 2000 was 28 (95% CI: 21–37) per million live births per year. Incidence for the specific mutations or for the overall MEN2A group did not change significantly from 1901 to 2014 (P>0.05). Point prevalence at January 1, 2015, was 24 per million (95% CI: 20–28). Conclusion The incidence and prevalence of MEN2A in Denmark seem higher than those reported in other countries. This is likely explained by the Danish C611Y founder effect. Also, our data indicate no significant change in MEN2A incidence during the last century.
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Affiliation(s)
- Jes Sloth Mathiesen
- Department of ORL Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark, .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark,
| | - Jens Peter Kroustrup
- Department of Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Vestergaard
- Department of Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark.,Steno Diabetes Center North Jutland, Aalborg, Denmark
| | - Kirstine Stochholm
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, DK-8000 Aarhus, Denmark.,Center for Rare Diseases, Aarhus University Hospital, Aarhus N, Denmark
| | - Per Løgstrup Poulsen
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, DK-8000 Aarhus, Denmark
| | - Åse Krogh Rasmussen
- Department of Medical Endocrinology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sten Schytte
- Department of ORL Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Christoffer Holst Hahn
- Department of ORL Head and Neck Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jens Bentzen
- Department of Oncology, Herlev Hospital, Herlev, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark, .,Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Mette Gaustadnes
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Maria Rossing
- Center for Genomic Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Finn Cilius Nielsen
- Center for Genomic Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kim Brixen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark,
| | - Anja Lisbeth Frederiksen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark, .,Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Christian Godballe
- Department of ORL Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark,
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Groth KA, Stochholm K, Hove H, Andersen NH, Gravholt CH. Causes of Mortality in the Marfan Syndrome(from a Nationwide Register Study). Am J Cardiol 2018; 122:1231-1235. [PMID: 30149886 DOI: 10.1016/j.amjcard.2018.06.034] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 05/02/2018] [Revised: 06/18/2018] [Accepted: 06/26/2018] [Indexed: 01/12/2023]
Abstract
The Marfan syndrome (MFS) is strongly associated with aortic disease causing a high prevalence of prophylactic aortic surgery, aortic dissection, and sudden death. The aim of the present study was to evaluate mortality in a nationwide Danish MFS population diagnosed by the Ghent II criteria. In a register-based setting, we identified all Danish patients with MFS (n = 412, men n = 215) by assessment of their medical records. We established a gender and age matched control cohort based on 41,000 control patients (men n = 21,500). MFS cases risk time was 6,669 patient years. We applied Cox regression using each case and his/her control as one stratum, adjusting for age and calendar time. We found a significantly decreased lifespan of 50years compared with 60years among controls. The mortality hazard ratio among MFS compared with controls was significantly increased to3.6 (CI 2.8-4.7, p < 0.001); men 4.0 (CI 2.8-5.7, p < 0.001); women 3.2 (CI 2.1-4.8,p < 0.001). Aorta disease represented the main reason for the overall increased mortality with a hazard ratio of 194.6 (CI 67.4-561.7, p < 0.0001); men 208.7 (CI 53.8-809.1, p < 0.001); women 173.4 (CI 31.5-954.5, p < 0.001). In addition, an unexplained mortality due to respiratory illness was not attributed to pneumothorax. Excluding cardiovascular and respiratory causes of death, we found no indication that MFS is associated with increased mortality for other reasons.
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Affiliation(s)
- Kristian A Groth
- Department of Cardiology, Aarhus University Hospital, Aarhus,Denmark; Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Kirstine Stochholm
- Centre for Rare Diseases, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark; Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus,Denmark
| | - Hanne Hove
- Department of Clinical Genetics, Copenhagen University Hospital, Copenhagen, Denmark; The RAREDIS Database, Section of Rare Diseases, Department of Clinical Genetics, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels H Andersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Claus H Gravholt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus,Denmark
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30
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Ebbehoj A, Jacobsen SF, Trolle C, Robaczyk MG, Rasmussen ÅK, Feldt-Rasmussen U, Thomsen RW, Poulsen PL, Stochholm K, Søndergaard E. Pheochromocytoma in Denmark during 1977-2016: validating diagnosis codes and creating a national cohort using patterns of health registrations. Clin Epidemiol 2018; 10:683-695. [PMID: 29942158 PMCID: PMC6005306 DOI: 10.2147/clep.s163065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Pheochromocytoma and catecholamine-secreting paraganglioma (PPGL) are rare but potentially life-threatening tumors. We aimed to validate diagnosis codes for PPGL in the Danish National Patient Registry, the Danish National Pathology Registry, and the Danish Registry of Causes of Death and to create a national cohort of incident PPGL patients by linking these three registries. Patients and methods We obtained data from the three abovementioned registries for all individuals registered with pheochromocytoma or catecholamine hypersecretion in Denmark during 1977–2016 (average population 5.30 million). We then reviewed health records for all individuals living in the North Denmark Region and Central Denmark Region (average population 1.75 million) to validate the diagnosis of PPGL. We tested a number of algorithms for accurately identifying true cases of PPGL to maximize positive predictive values (PPVs) and completeness. The best algorithm was subsequently validated in an external sample. Results We identified 2626 individuals with a PPGL diagnosis code in Denmark, including 787 (30.0%) in the North Denmark Region and Central Denmark Region. In this subsample, we retrieved the health records of 771/787 (98.0%) individuals and confirmed 198 incident PPGL patients (25.3%). The PPV of PPGL diagnosis codes was 21.7% in the Danish National Patient Registry, 50.0% in the Danish Registry of Causes of Death, and 79.5% in the Danish National Pathology Registry. By combining patterns of registrations in the three registries, we could increase the PPV to 93.1% (95% confidence interval [CI]: 88.5–96.3) and completeness to 88.9% (95% CI: 83.7–92.9), thus creating a national PPGL cohort of 588 patients. PPV for the optimal algorithm was 95.3% (95% CI: 88.5–98.7) in the external validation sample. Conclusion Diagnosis codes for pheochromocytoma had low PPV in several individual health registries. However, with a combination of registries we were able to identify a near-complete national cohort of PPGL patients in Denmark, as a valuable source for epidemiological research.
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Affiliation(s)
- Andreas Ebbehoj
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Christian Trolle
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | | | - Per Løgstrup Poulsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kirstine Stochholm
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Esben Søndergaard
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
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31
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Mathiesen JS, Kroustrup JP, Vestergaard P, Stochholm K, Poulsen PL, Rasmussen ÅK, Feldt-Rasmussen U, Schytte S, Londero SC, Pedersen HB, Hahn CH, Djurhuus BD, Bentzen J, Möller S, Gaustadnes M, Rossing M, Nielsen FC, Brixen K, Frederiksen AL, Godballe C. Incidence and prevalence of sporadic and hereditary MTC in Denmark 1960-2014: a nationwide study. Endocr Connect 2018; 7:829-839. [PMID: 29760189 PMCID: PMC6000757 DOI: 10.1530/ec-18-0157] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 04/26/2018] [Accepted: 05/14/2018] [Indexed: 12/20/2022]
Abstract
Recent studies have shown a significant increase in the temporal trend of medullary thyroid carcinoma (MTC) incidence. However, it remains unknown to which extent sporadic medullary thyroid carcinoma (SMTC) and hereditary MTC (HMTC) affect the MTC incidence over time. We conducted a nationwide retrospective study using previously described RET and MTC cohorts combined with review of medical records, pedigree comparison and relevant nationwide registries. The study included 474 MTC patients diagnosed in Denmark between 1960 and 2014. In the nationwide period from 1997 to 2014, we recorded a mean age-standardized incidence of all MTC, SMTC and HMTC of 0.19, 0.13 and 0.06 per 100,000 per year, respectively. The average annual percentage change in incidence for all MTC, SMTC and HMTC were 1.0 (P = 0.542), 2.8 (P = 0.125) and -3.1 (P = 0.324), respectively. The corresponding figures for point prevalence at January 1, 2015 were 3.8, 2.5 and 1.3 per 100,000, respectively. The average annual percentage change in prevalence from 1998 to 2015 for all MTC, SMTC and HMTC was 2.8 (P < 0.001), 3.8 (P < 0.001) and 1.5 (P = 0.010), respectively. We found no significant change in the incidence of all MTC, SMTC and HMTC possibly due to our small sample size. However, due to an increasing trend in the incidence of all MTC and opposing trends of SMTC (increasing) and HMTC (decreasing) incidence, it seems plausible that an increase for all MTC seen by others may be driven by the SMTC group rather than the HMTC group.
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Affiliation(s)
- Jes Sloth Mathiesen
- Department of ORL Head & Neck SurgeryOdense University Hospital, Odense, Denmark
- Department of Clinical ResearchUniversity of Southern Denmark, Odense, Denmark
| | - Jens Peter Kroustrup
- Department of Clinical Medicine and EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Peter Vestergaard
- Department of Clinical Medicine and EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Kirstine Stochholm
- Department of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, Denmark
- Center for Rare DiseasesAarhus University Hospital, Aarhus N, Denmark
| | - Per Løgstrup Poulsen
- Department of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, Denmark
| | - Åse Krogh Rasmussen
- Department of Medical EndocrinologyCopenhagen University Hospital, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical EndocrinologyCopenhagen University Hospital, Copenhagen, Denmark
| | - Sten Schytte
- Department of ORL Head & Neck SurgeryAarhus University Hospital, Aarhus, Denmark
| | | | | | - Christoffer Holst Hahn
- Department of ORL Head & Neck SurgeryCopenhagen University Hospital, Copenhagen, Denmark
| | | | - Jens Bentzen
- Department of OncologyHerlev Hospital, Herlev, Denmark
| | - Sören Möller
- Department of Clinical ResearchUniversity of Southern Denmark, Odense, Denmark
- Odense Patient data Explorative Network (OPEN)Odense University Hospital, Odense, Denmark
| | - Mette Gaustadnes
- Department of Molecular MedicineAarhus University Hospital, Aarhus, Denmark
| | - Maria Rossing
- Center for Genomic MedicineCopenhagen University Hospital, Copenhagen, Denmark
| | - Finn Cilius Nielsen
- Center for Genomic MedicineCopenhagen University Hospital, Copenhagen, Denmark
| | - Kim Brixen
- Department of Clinical ResearchUniversity of Southern Denmark, Odense, Denmark
| | - Anja Lisbeth Frederiksen
- Department of Clinical ResearchUniversity of Southern Denmark, Odense, Denmark
- Department of Clinical GeneticsOdense University Hospital, Odense, Denmark
| | - Christian Godballe
- Department of ORL Head & Neck SurgeryOdense University Hospital, Odense, Denmark
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32
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Berglund A, Johannsen TH, Stochholm K, Viuff MH, Fedder J, Main KM, Gravholt CH. Morbidity, Mortality, and Socioeconomics in Females With 46,XY Disorders of Sex Development: A Nationwide Study. J Clin Endocrinol Metab 2018; 103:1418-1428. [PMID: 29165629 DOI: 10.1210/jc.2017-01888] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 08/24/2017] [Accepted: 11/15/2017] [Indexed: 12/29/2022]
Abstract
CONTEXT Little is known about long-term health outcomes in phenotypic females with 46,XY disorders of sex development (XY females), and the socioeconomic profile has not been described in detail. OBJECTIVE To describe morbidity, mortality, and socioeconomic status in XY females in a comparison to the general population. DESIGN Nationwide registry study with complete follow-up. SETTING Uniform public health care system. PARTICIPANTS A total of 123 XY females karyotyped in Denmark during 1960 to 2012 and a randomly selected age-matched control cohort of 12,300 females and 12,300 males from the general population. MAIN OUTCOME MEASURES Overall mortality and morbidity as well as cause-specific morbidity; medicine use and socioeconomics (education, income, cohabitation, motherhood, and retirement). RESULTS Compared with female controls, overall morbidity was increased in XY females [hazard ratio (HR), 1.72; 95% confidence interval (CI), 1.43 to 2.08] but not when excluding diagnoses associated with the specific disorder of sex development (DSD) diagnosis or pregnancy and birth (HR, 1.13; CI, 0.93 to 1.37). Mortality was similar to controls (HR, 0.79; CI, 0.35 to 1.77). Cohabitation (HR, 0.44; CI, 0.33 to 0.58) and motherhood (HR, 0.10; CI, 0.05 to 0.18) were reduced in XY females but education (HR, 0.92; CI, 0.61 to 1.37) was similar to controls. Income was higher than among controls in the older years. CONCLUSIONS Morbidity was not increased in XY females when excluding diagnoses associated to the DSD condition per se. Judged on education and income, XY females perform well in the labor market. However, DSD seems to impact on the prospects of family life.
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MESH Headings
- Adolescent
- Adult
- Case-Control Studies
- Castration/methods
- Child
- Child, Preschool
- Denmark/epidemiology
- Female
- Gonadal Dysgenesis, 46,XY/drug therapy
- Gonadal Dysgenesis, 46,XY/epidemiology
- Gonadal Dysgenesis, 46,XY/genetics
- Gonadal Dysgenesis, 46,XY/surgery
- Humans
- Infant
- Infant, Newborn
- Male
- Morbidity
- Neoplasms/epidemiology
- Neoplasms/genetics
- Retirement
- Socioeconomic Factors
- Young Adult
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Affiliation(s)
- Agnethe Berglund
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus C, Denmark
| | - Trine H Johannsen
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kirstine Stochholm
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus C, Denmark
- Center of Rare Diseases, Department of Pediatrics, Aarhus University Hospital, Aarhus N, Denmark
| | - Mette H Viuff
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus C, Denmark
| | - Jens Fedder
- Center of Andrology and Fertility Clinic, Odense University Hospital, Odense C, Denmark
| | - Katharina M Main
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Claus H Gravholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus C, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark
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Stochholm K, Kiess W. Long-term safety of growth hormone-A combined registry analysis. Clin Endocrinol (Oxf) 2018; 88:515-528. [PMID: 29055168 DOI: 10.1111/cen.13502] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [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: 03/02/2017] [Revised: 10/03/2017] [Accepted: 10/17/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Preliminary data from the French cohort of the Safety and Appropriateness of Growth hormone treatments in Europe (SAGhE) study raised concerns regarding the safety of recombinant human GH, suggesting that GH may increase mortality and incidence of stroke in patients treated during childhood for GH deficiency or short stature. We evaluated published safety data, focusing on mortality, neoplasms, cerebrovascular events and diabetes across a number of large-scale pharmaceutical company GH registries. DESIGN A literature review was conducted using PubMed, EMBASE and Google Scholar to identify all relevant safety data from manufacturers' GH registries published between 1988 and April 2016. Results were hand-sorted to exclude nonrelevant publications; bibliographic references from retrieved articles were evaluated for any additional references. RESULTS The published data do not support an increased risk of mortality in children or adults treated with GH. There was no evidence of an increased risk of stroke, new malignancy, leukaemia, nonleukaemic extracranial tumours or recurrence of intracranial malignancy in patients without risk factors. The risk of a second neoplasm is increased, particularly if patients have received radiation therapy for a central nervous system tumour. There may be an increased risk of type 2 diabetes in GH-treated patients, but this appears to be confined to those with pre-existing risk factors. CONCLUSIONS Patients with risk factors for malignancy or type 2 diabetes should be treated with caution and monitored during follow-up, but current published data provide reassurance on the long-term safety profile of GH in patients receiving GH treatment.
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Affiliation(s)
- Kirstine Stochholm
- Department of Internal Medicine and Diabetes, Endocrinology, Aarhus University Hospital, Aarhus, Denmark
- Department of Pediatrics, Center of Rare Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Wieland Kiess
- Department of Women and Child Health, Hospital for Children and Adolescents, University Hospitals, University of Leipzig, Leipzig, Germany
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Gravholt CH, Dollerup OL, Duval L, Mejlgaard E, Stribolt K, Vang S, Laursen BE, Knudsen M, Thorsen K, Hersmus R, Looijenga LHJ, Stochholm K. A Rare Case of Embryonal Carcinoma in a Patient with Turner Syndrome without Y Chromosomal Material but Mutations in KIT, AKT1, and ZNF358 Demonstrated Using Exome Sequencing. Sex Dev 2017; 11:262-268. [PMID: 29197878 DOI: 10.1159/000484398] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2017] [Indexed: 11/19/2022] Open
Abstract
Gonadoblastoma and malignant transformations thereof can occur in females with Turner syndrome (TS) and Y chromosomal material. However, in females with TS and no Y chromosomal material, this is rarely seen. We report a female with an apparent 45,X karyotype (in blood and tumor) who was diagnosed with a metastatic embryonal carcinoma. Exome sequencing of blood and the tumor was done, and no Y chromosomal material was detected, while predicted deleterious mutations in KIT (likely driver), AKT1, and ZNF358 were identified in the tumor. The patient was treated with chemotherapy (first-line: cisplatin, etoposide, and bleomycin; second-line: paclitaxel and gemcitabine), and after that surgical debulking was performed. She is currently well and without signs of relapse. We conclude that embryonal carcinoma can apparently occur in 45,X TS without signs of Y chromosomal material.
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Affiliation(s)
- Claus H Gravholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
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35
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Mathiesen JS, Kroustrup JP, Vestergaard P, Stochholm K, Poulsen PL, Rasmussen ÅK, Feldt-Rasmussen U, Gaustadnes M, Ørntoft TF, Rossing M, Nielsen FC, Albrechtsen A, Brixen K, Godballe C, Frederiksen AL. Founder Effect of the RET C611Y Mutation in Multiple Endocrine Neoplasia 2A in Denmark: A Nationwide Study. Thyroid 2017; 27:1505-1510. [PMID: 29020875 DOI: 10.1089/thy.2017.0404] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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] [Indexed: 12/27/2022]
Abstract
BACKGROUND Multiple endocrine neoplasia (MEN) 2A and 2B are caused by REarranged during Transfection (RET) germline mutations. In a recent nationwide study, an unusually high prevalence (33%) of families with the C611Y mutation was reported, and it was hypothesized that this might be due to a founder effect. The first nationwide study of haplotypes in MEN2A families was conducted, with the aim of investigating the relatedness and occurrence of de novo mutations among Danish families carrying similar mutations. METHODS The study included 21 apparently unrelated MEN2A families identified from a nationwide Danish RET cohort from 1994 to 2014. Twelve, two, two, three, and two families carried the C611Y, C618F, C618Y, C620R, and C634R mutations, respectively. Single nucleotide polymorphism chip data and identity by descent analysis were used to assess relatedness. RESULTS A common founder mutation was found among all 12 C611Y families and between both C618Y families. No relatedness was identified in the remaining families. CONCLUSION The data suggest that all families with the C611Y germline mutation in Denmark originate from a recent common ancestor, probably explaining the unusually high prevalence of this mutation. Additionally, the results indicate that the C611Y mutation rarely arises de novo, thus underlining the need for thorough multigenerational genetic work up in carriers of this mutation.
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Affiliation(s)
- Jes Sloth Mathiesen
- 1 Department of ORL Head and Neck Surgery, Odense University Hospital , Odense, Denmark
- 2 Department of Clinical Research, University of Southern Denmark , Odense, Denmark
| | - Jens Peter Kroustrup
- 3 Department of Clinical Medicine and Endocrinology, Aalborg University Hospital , Aalborg, Denmark
| | - Peter Vestergaard
- 3 Department of Clinical Medicine and Endocrinology, Aalborg University Hospital , Aalborg, Denmark
| | - Kirstine Stochholm
- 4 Department of Internal Medicine and Endocrinology, Aarhus University Hospital , Aarhus, Denmark
| | - Per Løgstrup Poulsen
- 4 Department of Internal Medicine and Endocrinology, Aarhus University Hospital , Aarhus, Denmark
| | - Åse Krogh Rasmussen
- 5 Department of Medical Endocrinology, Copenhagen University Hospital , Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- 5 Department of Medical Endocrinology, Copenhagen University Hospital , Copenhagen, Denmark
| | - Mette Gaustadnes
- 6 Department of Molecular Medicine, Aarhus University Hospital , Aarhus, Denmark
| | - Torben Falck Ørntoft
- 6 Department of Molecular Medicine, Aarhus University Hospital , Aarhus, Denmark
| | - Maria Rossing
- 7 Center for Genomic Medicine, Copenhagen University Hospital , Copenhagen, Denmark
| | - Finn Cilius Nielsen
- 7 Center for Genomic Medicine, Copenhagen University Hospital , Copenhagen, Denmark
| | - Anders Albrechtsen
- 8 Bioinformatics Center, Department of Biology, University of Copenhagen , Copenhagen, Denmark
| | - Kim Brixen
- 2 Department of Clinical Research, University of Southern Denmark , Odense, Denmark
| | - Christian Godballe
- 1 Department of ORL Head and Neck Surgery, Odense University Hospital , Odense, Denmark
| | - Anja Lisbeth Frederiksen
- 2 Department of Clinical Research, University of Southern Denmark , Odense, Denmark
- 9 Department of Clinical Genetics, Odense University Hospital , Odense, Denmark
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36
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Gravholt CH, Andersen NH, Conway GS, Dekkers OM, Geffner ME, Klein KO, Lin AE, Mauras N, Quigley CA, Rubin K, Sandberg DE, Sas TCJ, Silberbach M, Söderström-Anttila V, Stochholm K, van Alfen-van derVelden JA, Woelfle J, Backeljauw PF. Clinical practice guidelines for the care of girls and women with Turner syndrome: proceedings from the 2016 Cincinnati International Turner Syndrome Meeting. Eur J Endocrinol 2017; 177:G1-G70. [PMID: 28705803 DOI: 10.1530/eje-17-0430] [Citation(s) in RCA: 570] [Impact Index Per Article: 81.4] [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] [Received: 05/24/2017] [Accepted: 06/07/2017] [Indexed: 12/14/2022]
Abstract
Turner syndrome affects 25-50 per 100,000 females and can involve multiple organs through all stages of life, necessitating multidisciplinary approach to care. Previous guidelines have highlighted this, but numerous important advances have been noted recently. These advances cover all specialty fields involved in the care of girls and women with TS. This paper is based on an international effort that started with exploratory meetings in 2014 in both Europe and the USA, and culminated with a Consensus Meeting held in Cincinnati, Ohio, USA in July 2016. Prior to this meeting, five groups each addressed important areas in TS care: 1) diagnostic and genetic issues, 2) growth and development during childhood and adolescence, 3) congenital and acquired cardiovascular disease, 4) transition and adult care, and 5) other comorbidities and neurocognitive issues. These groups produced proposals for the present guidelines. Additionally, four pertinent questions were submitted for formal GRADE (Grading of Recommendations, Assessment, Development and Evaluation) evaluation with a separate systematic review of the literature. These four questions related to the efficacy and most optimal treatment of short stature, infertility, hypertension, and hormonal replacement therapy. The guidelines project was initiated by the European Society for Endocrinology and the Pediatric Endocrine Society, in collaboration with The European Society for Pediatric Endocrinology, The Endocrine Society, European Society of Human Reproduction and Embryology, The American Heart Association, The Society for Endocrinology, and the European Society of Cardiology. The guideline has been formally endorsed by the European Society for Endocrinology, the Pediatric Endocrine Society, the European Society for Pediatric Endocrinology, the European Society of Human Reproduction and Embryology and the Endocrine Society. Advocacy groups appointed representatives who participated in pre-meeting discussions and in the consensus meeting.
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Affiliation(s)
- Claus H Gravholt
- Departments of Endocrinology and Internal Medicine
- Departments of Molecular Medicine
| | - Niels H Andersen
- Departments of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Gerard S Conway
- Department of Women's Health, University College London, London, UK
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Mitchell E Geffner
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Karen O Klein
- Rady Children's Hospital, University of California, San Diego, California, USA
| | - Angela E Lin
- Department of Pediatrics, Medical Genetics Unit, Mass General Hospital for Children, Boston, Massachusetts, USA
| | - Nelly Mauras
- Division of Endocrinology, Nemours Children's Health System, Jacksonville, Florida, USA
| | | | - Karen Rubin
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - David E Sandberg
- Division of Psychology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Theo C J Sas
- Department of Pediatric Endocrinology, Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Pediatrics, Dordrecht, The Netherlands
| | - Michael Silberbach
- Department of Pediatrics, Doernbecher Children's Hospital, Portland, Oregon, USA
| | | | - Kirstine Stochholm
- Departments of Endocrinology and Internal Medicine
- Center for Rare Diseases, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | | | - Joachim Woelfle
- Department of Pediatric Endocrinology, Children's Hospital, University of Bonn, Bonn, Germany
| | - Philippe F Backeljauw
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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37
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Mathiesen JS, Kroustrup JP, Vestergaard P, Madsen M, Stochholm K, Poulsen PL, Krogh Rasmussen Å, Feldt-Rasmussen U, Schytte S, Pedersen HB, Hahn CH, Bentzen J, Gaustadnes M, Ørntoft TF, Hansen TVO, Nielsen FC, Brixen K, Frederiksen AL, Godballe C. Incidence and prevalence of multiple endocrine neoplasia 2B in Denmark: a nationwide study. Endocr Relat Cancer 2017; 24:L39-L42. [PMID: 28438782 DOI: 10.1530/erc-17-0122] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 04/24/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Jes Sloth Mathiesen
- Department of ORL Head & Neck SurgeryOdense University Hospital, Odense, Denmark
- Institute of Clinical ResearchUniversity of Southern Denmark, Odense, Denmark
| | - Jens Peter Kroustrup
- Department of Clinical Medicine and EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Peter Vestergaard
- Department of Clinical Medicine and EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Mette Madsen
- Department of PediatricsAalborg University Hospital, Aalborg, Denmark
| | - Kirstine Stochholm
- Department of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, Denmark
| | - Per Løgstrup Poulsen
- Department of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, Denmark
| | - Åse Krogh Rasmussen
- Department of Medical EndocrinologyCopenhagen University Hospital, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical EndocrinologyCopenhagen University Hospital, Copenhagen, Denmark
| | - Sten Schytte
- Department of ORL Head & Neck SurgeryAarhus University Hospital, Aarhus, Denmark
| | | | - Christoffer Holst Hahn
- Department of ORL Head & Neck SurgeryCopenhagen University Hospital, Copenhagen, Denmark
| | - Jens Bentzen
- Department of OncologyHerlev Hospital, Herlev, Denmark
| | - Mette Gaustadnes
- Department of Molecular MedicineAarhus University Hospital, Aarhus, Denmark
| | | | | | - Finn Cilius Nielsen
- Center for Genomic MedicineCopenhagen University Hospital, Copenhagen, Denmark
| | - Kim Brixen
- Institute of Clinical ResearchUniversity of Southern Denmark, Odense, Denmark
| | - Anja Lisbeth Frederiksen
- Institute of Clinical ResearchUniversity of Southern Denmark, Odense, Denmark
- Department of Clinical GeneticsOdense University Hospital, Odense, Denmark
| | - Christian Godballe
- Department of ORL Head & Neck SurgeryOdense University Hospital, Odense, Denmark
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Berglund A, Johannsen T, Stochholm K, Aksglaede L, Fedder J, Viuff M, Main K, Gravholt C. Incidence, prevalence, diagnostic delay, morbidity, mortality and socioeconomic status in males with 46,XX disorders of sex development: a nationwide study. Hum Reprod 2017; 32:1751-1760. [DOI: 10.1093/humrep/dex210] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/17/2017] [Indexed: 01/03/2023] Open
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Ebbehoj AL, Sondergaard E, Trolle C, Stochholm K, Poulsen PL. The epidemiology of pheochromocytoma: increasing incidence and changing clinical presentation. A population-based retrospective study 1977-2015. ACTA ACUST UNITED AC 2017. [DOI: 10.1530/endoabs.49.oc1.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mathiesen JS, Kroustrup JP, Vestergaard P, Stochholm K, Poulsen PL, Rasmussen ÅK, Feldt-Rasmussen U, Gaustadnes M, Ørntoft TF, Hansen TVO, Nielsen FC, Brixen K, Godballe C, Frederiksen AL. Distribution of RET Mutations in Multiple Endocrine Neoplasia 2 in Denmark 1994-2014: A Nationwide Study. Thyroid 2017; 27:215-223. [PMID: 27809725 PMCID: PMC5314724 DOI: 10.1089/thy.2016.0411] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Germline mutations of the REarranged during Transfection (RET) proto-oncogene cause multiple endocrine neoplasia 2 (MEN2). It is unclear whether the distribution of RET mutations varies among populations. The first nationwide study of the distribution of RET mutations was conducted, and the results were compared to those of other populations. METHODS This retrospective cohort study included 1583 patients who underwent RET gene testing in one of three centers covering all of Denmark between September 1994 and December 2014. Primary testing method was Sanger sequencing, which included exons 8-11 and 13-16. Mutations were defined according to the ARUP database July 1, 2016. RESULTS RET mutations were identified in 163 patients from 36 apparently unrelated families. Among the 36 families 13 (36.1%) carried mutations in codon 611, four (11.1%) in codon 618, three (8.3%) in codon 620, one (2.8%) in codon 631, six (16.7%) in codon 634, one (2.8%) in codon 790, one (2.8%) in codon 804, one (2.8%) in codon 852, one (2.8%) in codon 883, and five (13.9%) in codon 918. Among the 13 families with codon 611 mutations, 12 had the p.C611Y mutation. CONCLUSIONS The distribution of RET mutations in Denmark appears to differ from that of other populations. Mutations in codon 611 were the most prevalent, followed by more frequently reported mutations. This might be due to a possible founder effect for the p.C611Y mutation. However, further studies are needed to find possible explanations for the skewed mutational spectrum in Denmark.
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Affiliation(s)
- Jes Sloth Mathiesen
- Department of Otolaryngology—Head and Neck Surgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jens Peter Kroustrup
- Department of Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Vestergaard
- Department of Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Kirstine Stochholm
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - Per Løgstrup Poulsen
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - Åse Krogh Rasmussen
- Department of Endocrinology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Endocrinology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mette Gaustadnes
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Finn Cilius Nielsen
- Center for Genomic Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kim Brixen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Christian Godballe
- Department of Otolaryngology—Head and Neck Surgery, Odense University Hospital, Odense, Denmark
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Berglund A, Johannsen TH, Stochholm K, Viuff MH, Fedder J, Main KM, Gravholt CH. Incidence, Prevalence, Diagnostic Delay, and Clinical Presentation of Female 46,XY Disorders of Sex Development. J Clin Endocrinol Metab 2016; 101:4532-4540. [PMID: 27603905 DOI: 10.1210/jc.2016-2248] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [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: 11/19/2022]
Abstract
CONTEXT The prevalence of phenotypic females with a 46,XY karyotype is low, thus current knowledge about age and clinical presentation at diagnosis is sparse even for the most frequent conditions, androgen insensitivity syndrome (AIS), and gonadal dysgenesis. OBJECTIVE To estimate incidence, prevalence, age at diagnosis, and clinical presentation at diagnosis in 46,XY females. DESIGN AND SETTING A nationwide study covering all known females with a 46,XY karyotype in Denmark since 1960. The diagnosis of 46,XY disorder of sex development (DSD) was determined by medical record evaluation, data from the Danish National Patient Registry, and genetic testing, if available. PATIENTS A total of 166 females registered as 46,XY females in the Danish Cytogenetic Central Registry were identified. RESULTS A total of 124 females were classified as having 46,XY DSD, 78 with AIS and 25 with gonadal dysgenesis, whereas the remaining subjects had a variety of different diagnoses. The prevalence of 46,XY females was 6.4 per 100 000 live born females, and for AIS and gonadal dysgenesis, it was 4.1 and 1.5 per 100 000, respectively. Median age at diagnosis was 7.5 years (95% confidence interval, 4.0-13.5; range, 0-34 y) in AIS and 17.0 years (95% confidence interval, 15.5-19.0; range, 0-28 y) in gonadal dysgenesis (P = .001). Clinical presentation was dependent on cause of DSD. CONCLUSIONS The first estimate on prevalence of 46,XY females is 6.4 per 100 000 live born females. The presentation of AIS and gonadal dysgenesis is distinctly different, with AIS being diagnosed during childhood and gonadal dysgenesis during pubertal years. The presenting phenotype is dependent on the cause of 46,XY DSD.
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Affiliation(s)
- Agnethe Berglund
- Department of Endocrinology and Internal Medicine (A.B., K.S., M.H.V., C.H.G.), Aarhus University Hospital, 8000 Aarhus C, Denmark; Department of Growth and Reproduction (T.H.J., K.M.M.), Rigshospitalet, University of Copenhagen, and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC) (T.H.J., K.M.M.), Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark; Center of Rare Diseases (K.S.), Department of Pediatrics, and Department of Molecular Medicine (C.H.G.), Aarhus University Hospital, 8200 Aarhus N, Denmark; and Fertility Clinic (J.F.), Odense University Hospital, 5000 Odense C, Denmark
| | - Trine H Johannsen
- Department of Endocrinology and Internal Medicine (A.B., K.S., M.H.V., C.H.G.), Aarhus University Hospital, 8000 Aarhus C, Denmark; Department of Growth and Reproduction (T.H.J., K.M.M.), Rigshospitalet, University of Copenhagen, and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC) (T.H.J., K.M.M.), Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark; Center of Rare Diseases (K.S.), Department of Pediatrics, and Department of Molecular Medicine (C.H.G.), Aarhus University Hospital, 8200 Aarhus N, Denmark; and Fertility Clinic (J.F.), Odense University Hospital, 5000 Odense C, Denmark
| | - Kirstine Stochholm
- Department of Endocrinology and Internal Medicine (A.B., K.S., M.H.V., C.H.G.), Aarhus University Hospital, 8000 Aarhus C, Denmark; Department of Growth and Reproduction (T.H.J., K.M.M.), Rigshospitalet, University of Copenhagen, and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC) (T.H.J., K.M.M.), Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark; Center of Rare Diseases (K.S.), Department of Pediatrics, and Department of Molecular Medicine (C.H.G.), Aarhus University Hospital, 8200 Aarhus N, Denmark; and Fertility Clinic (J.F.), Odense University Hospital, 5000 Odense C, Denmark
| | - Mette H Viuff
- Department of Endocrinology and Internal Medicine (A.B., K.S., M.H.V., C.H.G.), Aarhus University Hospital, 8000 Aarhus C, Denmark; Department of Growth and Reproduction (T.H.J., K.M.M.), Rigshospitalet, University of Copenhagen, and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC) (T.H.J., K.M.M.), Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark; Center of Rare Diseases (K.S.), Department of Pediatrics, and Department of Molecular Medicine (C.H.G.), Aarhus University Hospital, 8200 Aarhus N, Denmark; and Fertility Clinic (J.F.), Odense University Hospital, 5000 Odense C, Denmark
| | - Jens Fedder
- Department of Endocrinology and Internal Medicine (A.B., K.S., M.H.V., C.H.G.), Aarhus University Hospital, 8000 Aarhus C, Denmark; Department of Growth and Reproduction (T.H.J., K.M.M.), Rigshospitalet, University of Copenhagen, and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC) (T.H.J., K.M.M.), Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark; Center of Rare Diseases (K.S.), Department of Pediatrics, and Department of Molecular Medicine (C.H.G.), Aarhus University Hospital, 8200 Aarhus N, Denmark; and Fertility Clinic (J.F.), Odense University Hospital, 5000 Odense C, Denmark
| | - Katharina M Main
- Department of Endocrinology and Internal Medicine (A.B., K.S., M.H.V., C.H.G.), Aarhus University Hospital, 8000 Aarhus C, Denmark; Department of Growth and Reproduction (T.H.J., K.M.M.), Rigshospitalet, University of Copenhagen, and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC) (T.H.J., K.M.M.), Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark; Center of Rare Diseases (K.S.), Department of Pediatrics, and Department of Molecular Medicine (C.H.G.), Aarhus University Hospital, 8200 Aarhus N, Denmark; and Fertility Clinic (J.F.), Odense University Hospital, 5000 Odense C, Denmark
| | - Claus H Gravholt
- Department of Endocrinology and Internal Medicine (A.B., K.S., M.H.V., C.H.G.), Aarhus University Hospital, 8000 Aarhus C, Denmark; Department of Growth and Reproduction (T.H.J., K.M.M.), Rigshospitalet, University of Copenhagen, and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC) (T.H.J., K.M.M.), Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark; Center of Rare Diseases (K.S.), Department of Pediatrics, and Department of Molecular Medicine (C.H.G.), Aarhus University Hospital, 8200 Aarhus N, Denmark; and Fertility Clinic (J.F.), Odense University Hospital, 5000 Odense C, Denmark
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Allen DB, Backeljauw P, Bidlingmaier M, Biller BMK, Boguszewski M, Burman P, Butler G, Chihara K, Christiansen J, Cianfarani S, Clayton P, Clemmons D, Cohen P, Darendeliler F, Deal C, Dunger D, Erfurth EM, Fuqua JS, Grimberg A, Haymond M, Higham C, Ho K, Hoffman AR, Hokken-Koelega A, Johannsson G, Juul A, Kopchick J, Lee P, Pollak M, Radovick S, Robison L, Rosenfeld R, Ross RJ, Savendahl L, Saenger P, Sorensen HT, Stochholm K, Strasburger C, Swerdlow A, Thorner M. GH safety workshop position paper: a critical appraisal of recombinant human GH therapy in children and adults. Eur J Endocrinol 2016; 174:P1-9. [PMID: 26563978 PMCID: PMC4674592 DOI: 10.1530/eje-15-0873] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/11/2015] [Indexed: 01/10/2023]
Abstract
Recombinant human GH (rhGH) has been in use for 30 years, and over that time its safety and efficacy in children and adults has been subject to considerable scrutiny. In 2001, a statement from the GH Research Society (GRS) concluded that 'for approved indications, GH is safe'; however, the statement highlighted a number of areas for on-going surveillance of long-term safety, including cancer risk, impact on glucose homeostasis, and use of high dose pharmacological rhGH treatment. Over the intervening years, there have been a number of publications addressing the safety of rhGH with regard to mortality, cancer and cardiovascular risk, and the need for long-term surveillance of the increasing number of adults who were treated with rhGH in childhood. Against this backdrop of interest in safety, the European Society of Paediatric Endocrinology (ESPE), the GRS, and the Pediatric Endocrine Society (PES) convened a meeting to reappraise the safety of rhGH. The ouput of the meeting is a concise position statement.
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Affiliation(s)
- D B Allen
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - P Backeljauw
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - M Bidlingmaier
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - B M K Biller
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - M Boguszewski
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - P Burman
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - G Butler
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - K Chihara
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - J Christiansen
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - S Cianfarani
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - P Clayton
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - D Clemmons
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - P Cohen
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - F Darendeliler
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - C Deal
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - D Dunger
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - E M Erfurth
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - J S Fuqua
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - A Grimberg
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - M Haymond
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - C Higham
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - K Ho
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - A R Hoffman
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - A Hokken-Koelega
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - G Johannsson
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - A Juul
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - J Kopchick
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - P Lee
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - M Pollak
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - S Radovick
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - L Robison
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - R Rosenfeld
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - R J Ross
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - L Savendahl
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - P Saenger
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - H T Sorensen
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - K Stochholm
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - C Strasburger
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - A Swerdlow
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
| | - M Thorner
- University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin, USACincinnati Children's Hospital Medical CenterCincinnati, Ohio, USAMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyMassachusetts General HospitalBoston, Massachusetts, UKFederal University of ParanaCuritiba, BrazilDepartment of EndocrinologySkane University Hospital, Malmö, SwedenUniversity College London Hospitaland UCL Institute of Child Health, London, UKHyogo Prefectural Kakogawa Medical CenterHyogo, JapanAarhus University HospitalAarhus, DenmarkMolecular Endocrinology Unit'Bambino Gesù' Children's Hospital, Tor Vergata University, Rome, ItalyUniversity of Manchester and Manchester Academic Health Science CentreManchester, UKUNC School of MedicineChapel Hill, North Carolina, USAUSC Leonard Davis School of GerontologyUniversity of Southern California, Los Angeles, California, USAIstanbul Faculty of MedicineIstanbul, TurkeyCentre Hospitalier Universitaire-Ste-JustineMontreal, Quebec, CanadaUniversity of CambridgeCambridge, UKIndiana University School of MedicineIndianapolis, Indiana, USAPerelman School of MedicineChildren's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USABaylor College of MedicineHouston, Texas, USAChristie Hospital NHS Foundation TrustManchester, UKPrincess Alexandra HospitalBrisbane, Queensland, AustraliaStanford University School of MedicineStanford, California, AustraliaErasmus University Medical CenterRotterdam, The NetherlandsDepartment of EndocrinologySahlgrenska Academy, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Gothenburg, SwedenDepartment of Growth and Reproduction and EDMaRCRigshospitalet, København, DenmarkEdison Biotechnology InstituteOhio University, Athens, Ohio, USAPenn State College of MedicineHershey Medical Center, Hershey, Pennsylvania, USAMcGill UniversityLondon, UKJohns Hopkins University School of MedicineBaltimore, Marylan
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Groth KA, Hove H, Kyhl K, Folkestad L, Gaustadnes M, Vejlstrup N, Stochholm K, Østergaard JR, Andersen NH, Gravholt CH. Prevalence, incidence, and age at diagnosis in Marfan Syndrome. Orphanet J Rare Dis 2015; 10:153. [PMID: 26631233 PMCID: PMC4668669 DOI: 10.1186/s13023-015-0369-8] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/22/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Marfan syndrome is a genetic disorder with considerable morbidity and mortality. Presently, clinicians use the 2010 revised Ghent nosology, which includes optional genetic sequencing of the FBN1 gene, to diagnose patients. So far, only a few studies based on older diagnostic criteria have reported a wide range of prevalence and incidence. Our aim was to study prevalence, incidence, and age at diagnosis in patients with Marfan syndrome. METHOD Using unique Danish patient-registries, we identified all possible Marfan syndrome patients recorded by the Danish healthcare system (1977-2014). Following, we confirmed or rejected the diagnosis according to the 2010 revised Ghent nosology. RESULTS We identified a total of 1628 persons with possible Marfan syndrome. We confirmed the diagnosis in 412, whereof 46 were deceased, yielding a maximum prevalence of 6.5/100,000 at the end of 2014. The annual median incidence was 0.19/100,000 (range: 0.0-0.7) which increased significantly with an incidence rate ratio of 1.03 (95% CI: 1.02-1.04, p < 0.001). We found a median age at diagnose of 19.0 years (range: 0.0-74). The age at diagnosis increased during the study period, uninfluenced by the changes in diagnostic criteria. We found no gender differences. CONCLUSION The increasing prevalence of Marfan syndrome during the study period is possibly due to build-up of a registry. Since early diagnosis is essential in preventing aortic events, diagnosing Marfan syndrome remains a task for both pediatricians and physicians caring for adults.
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Affiliation(s)
- Kristian A Groth
- Department of Cardiology, Aarhus University Hospital, DK-8200, Aarhus N, Denmark.
- Department of Molecular Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark.
| | - Hanne Hove
- Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, DK-2100, Copenhagen, Denmark
- The RAREDIS Database, Section of Rare Diseases, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, DK-2100, Copenhagen, Denmark
| | - Kasper Kyhl
- Department of Cardiology, Rigshospitalet, DK-2100, Copenhagen, Denmark
| | - Lars Folkestad
- Department of Endocrinology, Odense University Hospital, DK-5000, Odense C, Denmark
- Institute of Clinical Reasearch, University of Southern Denmark, DK-5000, Odense C, Denmark
| | - Mette Gaustadnes
- Department of Molecular Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, DK-2100, Copenhagen, Denmark
| | - Kirstine Stochholm
- Centre for Rare Diseases, Department of Paediatrics, Aarhus University Hospital, DK-8200, Aarhus N, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, DK-8000, Aarhus C, Denmark
| | - John R Østergaard
- Centre for Rare Diseases, Department of Paediatrics, Aarhus University Hospital, DK-8200, Aarhus N, Denmark
| | - Niels H Andersen
- Department of Cardiology, Aarhus University Hospital, DK-8200, Aarhus N, Denmark
| | - Claus H Gravholt
- Department of Molecular Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, DK-8000, Aarhus C, Denmark
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Berglund A, Gravholt CH, Olsen MS, Christiansen JS, Stochholm K. Growth hormone replacement does not increase mortality in patients with childhood-onset growth hormone deficiency. Clin Endocrinol (Oxf) 2015; 83:677-83. [PMID: 26147754 DOI: 10.1111/cen.12848] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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: 04/08/2015] [Revised: 06/09/2015] [Accepted: 07/01/2015] [Indexed: 11/29/2022]
Abstract
CONTEXT Long-term safety of growth hormone (GH) treatment is an area of much debate. Studies including children treated with GH not only due to GHD, but also due to non-GHD causes like idiopathic short stature or like short stature in children born small for gestational age have suggested that GH treatment is associated with increased mortality or stroke. OBJECTIVE To study the impact of GH replacement on overall and cause-specific mortality in childhood-onset GHD (CO GHD) patients. DESIGN A nationwide population-based registry study on patients with CO GHD and general population controls matched on age and gender. Mortality hazard ratios (HRs) were computed comparing patients and controls, and comparing GH-replaced patients and non-GH-replaced patients, using Cox regression. Comparing GH- and non-GH-replaced patients HRs were adjusted for birth year, year of diagnosis, gender, irradiation, ACTH insufficiency and primary disease. PATIENTS AND CONTROLS A total of 494 patients with CO GHD each matched with 100 general population controls were included. RESULTS Mortality was substantially increased comparing patients with CO GHD and general population controls, HR = 7·51 (95% CI = 6·06-9·31). Comparing GH-replaced patients with non-GH-replaced patients mortality was significantly decreased in total (HR = 0·27, CI = 0·17-0·43) and due to malignancy (HR = 0·14, CI = 0·07-0·28) in GH-replaced patients. Adjusting for relevant confounders, this decrease remained significant both in total (HR = 0·56, CI = 0·32-0·96) and due to malignancy (HR = 0·33, CI = 0·16-0·69). Overall and cause-specific mortality was increased in both GH-replaced and non-GH-replaced patients compared to general population controls, but mortality was generally highest in non-GH-replaced patients. CONCLUSION The present data from a national cohort of patients with CO GHD do not support the suggestion that GH replacement is associated with increased mortality.
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Affiliation(s)
- Agnethe Berglund
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark
| | - Claus Højbjerg Gravholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Denmark
| | | | | | - Kirstine Stochholm
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark
- Department of Pediatrics, Center of Rare Diseases, Aarhus University Hospital, Denmark
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Viuff MH, Stochholm K, Uldbjerg N, Nielsen BB, Gravholt CH. Only a minority of sex chromosome abnormalities are detected by a national prenatal screening program for Down syndrome. Hum Reprod 2015; 30:2419-26. [DOI: 10.1093/humrep/dev192] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 07/13/2015] [Indexed: 01/15/2023] Open
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Abstract
CONTEXT Systematic data on safety of growth hormone (GH) replacement therapy in adult GH deficiency is lacking. OBJECTIVE To systematically describe safety of adult GH replacement therapy on glucose metabolism and long term safety. DESIGN A systematic web-based search of PubMed was performed guided by the Standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). OUTCOME Randomised controlled trials of ≥3 months and open trials for ≥12 months with more than 50 adult patients (50 patient years, prospective and retrospective) including adverse event reporting as well as articles on mortality primarily on adult onset patients, reporting mortality ratios on GH treated patients, were included for the review. RESULTS Based on the defined selection criteria 94 studies were included. The short-term early placebo controlled trials did not demonstrate an increased frequency of diabetes mellitus (DM) and the long-term open studies did not consistently show an increased incidence of DM during GH replacement. The concern that long-term GH replacement might increase the risk of primary cancer, secondary neoplasia after tumour treatment and recurrence of previous tumours was not evident in the study data. CONCLUSION Based on available data, short- and long-term adult GH replacement in patients with severe GH deficiency and hypopituitarism is safe. However, the small number of subjects, limitation of long-term of GH treatment data and absence of an adequate control population is still a limitation for the interpretation of these data.
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Affiliation(s)
- Kirstine Stochholm
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, 8000, Aarhus C, Denmark
| | - Gudmundur Johannsson
- Department of Endocrinology, Grstr 8, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden; Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Göteborg, Grstr 8, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden
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Klose M, Stochholm K, Janukonyté J, Christensen LL, Cohen AS, Wagner A, Laurberg P, Christiansen JS, Andersen M, Feldt-Rasmussen U. Patient reported outcome in posttraumatic pituitary deficiency: results from The Danish National Study on posttraumatic hypopituitarism. Eur J Endocrinol 2015; 172:753-62. [PMID: 25766045 DOI: 10.1530/eje-14-1069] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 12/05/2014] [Accepted: 03/12/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Posttraumatic pituitary hormone deficiency is often suggested. The impact of these predominantly mild and often irreproducible deficiencies on outcome is less clear. The aim of the present study was to describe patient reported outcome in a national a priori unselected cohort of patients with traumatic brain injury (TBI) in relation to deficiencies identified upon pituitary assessment. DESIGN AND METHODS We conducted a nationwide population-based cohort study. Participants were Danish patients with a head trauma diagnosis recorded in the Danish Board of Health diagnostic code registry; 439 patients (and 124 healthy controls) underwent assessment of anterior pituitary function 2.5 years (median) after TBI. Questionnaires on health-related quality of life (QoL) (SF36, EuroQoL-5D, QoL assessment of GH deficiency in adults) and fatigue (MFI-20) were completed in parallel to pituitary assessment. RESULTS Patients with TBI had significant detriments in QoL. Impairment (mainly physical scales) related to pituitary deficiency, although only partially confirmed after adjustment for demographic differences. Hypogonadotropic hypogonadism related to several QoL scores. Increasing impairments were observed with declining total testosterone concentrations (men), but not free testosterone concentrations or any other hormone concentrations. Total testosterone was not independently related to impaired QoL and fatigue, after adjustment for demographics, and treatment with antidiabetics, opioids, antidepressants, and anticonvulsants. CONCLUSIONS Only a very limited relationship between pituitary hormone deficiencies and QoL/fatigue was demonstrated. Due to the dominating influence of concurrent comorbidities, pituitary deficiencies were not independently related to QoL/fatigue. Causality is still to be shown, and whether substitution therapy could be of additional relevance in selected patients needs to be proven.
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Affiliation(s)
- Marianne Klose
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Kirstine Stochholm
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Jurgita Janukonyté
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Louise Lehman Christensen
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Arieh S Cohen
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Aase Wagner
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Peter Laurberg
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Jens Sandahl Christiansen
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Marianne Andersen
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
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Knorr S, Stochholm K, Vlachová Z, Bytoft B, Clausen TD, Jensen RB, Juul S, Ovesen P, Damm P, Beck-Nielsen H, Jensen DM, Gravholt CH. Multisystem Morbidity and Mortality in Offspring of Women With Type 1 Diabetes (the EPICOM Study): A Register-Based Prospective Cohort Study. Diabetes Care 2015; 38:821-6. [PMID: 25710920 DOI: 10.2337/dc14-2907] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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] [Received: 12/08/2014] [Accepted: 01/23/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study examined the long-term consequences for offspring born to mothers with pregestational type 1 diabetes regarding mortality, hospital admissions, and medication. We also examined the association between HbA1c levels during pregnancy and mortality and incidence of hospital admissions. RESEARCH DESIGN AND METHODS We performed a prospective combined clinical and register-based cohort study comparing mortality, hospital admissions, and use of medication in offspring (n = 1,326) of women with pregestational type 1 diabetes (index children) with matched control subjects (n = 131,884). We also examined the association between HbA1c levels during pregnancy and mortality and the incidence of hospital admissions. Participants were monitored from birth to the age of 13-21 years. RESULTS Overall mortality was significantly increased for index children (hazard ratio 2.10, 95% CI 1.33-3.30, P = 0.001). The incidence of hospital admissions for index children was significantly increased (incidence rate ratio [IRR] 1.45, 95% CI 1.38-1.53, P < 0.001), and this was the case for all age groups until the age of 15 years. The incidence of hospital admissions among index children was positively associated with maternal HbA1c before pregnancy and in the first trimester. In addition, the overall use of medication was increased in index children (IRR 1.13, 95% CI 1.07-1.19, P < 0.001). CONCLUSIONS Type 1 diabetes during pregnancy has long-term implications on the health of offspring, with increased mortality, incidence of hospital admissions, and use of medication. Among mothers with type 1 diabetes, glycemic regulation is positively associated with incidence of hospital admissions in offspring.
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Affiliation(s)
- Sine Knorr
- Department of Endocrinology and Internal Medicine and Department of Molecular Medicine, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kirstine Stochholm
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Zuzana Vlachová
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Birgitte Bytoft
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tine D Clausen
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
| | - Rikke Beck Jensen
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Svend Juul
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Per Ovesen
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Skejby, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Dorte M Jensen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Claus Højbjerg Gravholt
- Department of Endocrinology and Internal Medicine and Department of Molecular Medicine, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Haraldsdottir TL, Rudolf F, Bjerregaard-Andersen M, Joaquím LC, Stochholm K, Gomes VF, Beck-Nielsen H, Ostergaard L, Aaby P, Wejse C. Diabetes mellitus prevalence in tuberculosis patients and the background population in Guinea-Bissau: a disease burden study from the capital Bissau. Trans R Soc Trop Med Hyg 2015; 109:400-7. [PMID: 25918218 DOI: 10.1093/trstmh/trv030] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 03/23/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Data regarding the association between diabetes mellitus (DM) and tuberculosis (TB) in Africa are scare. We did a DM screening survey among TB patients and non-TB controls in Guinea-Bissau. METHODS The study was conducted at the Bandim Health Project (BHP) in the capital Bissau. From July 2010 to July 2011, newly diagnosed TB cases were identified through a TB notification system. Concurrently, non-TB controls were selected randomly from the BHP's demographic surveillance database and visited at home. Participants were tested using fasting blood glucose (FBG) measurements. DM was diagnosed as FBG ≥ 7 mmol/l. Our survey was linked to the patient database at the only existing Diabetes Clinic in Bissau. RESULTS TB patients (n=110) were older than the controls (n=572) (35 vs 31 years; p=0.02), more often male (55% vs 37%; p<0.001) and had a lower body mass index (18.7 vs 24.2 kg/m(2); p<0.001). The prevalence of DM was 2.8% (3/107) for TB patients and 2.1% (11/531) for controls (p=0.64). Excluding two controls already receiving anti-diabetic treatment, the prevalence of DM was 2.8% (3/107) vs 1.7% (9/529) (p=0.44). CONCLUSIONS The prevalence of DM was low, also among TB patients. No association between DM and TB was found.
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Affiliation(s)
- Thorny L Haraldsdottir
- Bandim Health Project, Apartado 861, 1004 Bissau Codex, Guinea-Bissau Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Frauke Rudolf
- Bandim Health Project, Apartado 861, 1004 Bissau Codex, Guinea-Bissau Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Bjerregaard-Andersen
- Bandim Health Project, Apartado 861, 1004 Bissau Codex, Guinea-Bissau Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institute, Copenhagen, Denmark Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Luis Carlos Joaquím
- Bandim Health Project, Apartado 861, 1004 Bissau Codex, Guinea-Bissau The National Diabetes Association (ANDD), Bissau, Guinea-Bissau
| | - Kirstine Stochholm
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Victor F Gomes
- Bandim Health Project, Apartado 861, 1004 Bissau Codex, Guinea-Bissau
| | | | - Lars Ostergaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Aaby
- Bandim Health Project, Apartado 861, 1004 Bissau Codex, Guinea-Bissau Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institute, Copenhagen, Denmark
| | - Christian Wejse
- Bandim Health Project, Apartado 861, 1004 Bissau Codex, Guinea-Bissau Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark GloHAU, Center for Global Health, Department of Public Health, Aarhus University, Denmark
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Mathiesen JS, Stochholm K, Poulsen PL, Vestergaard EM, Christiansen P, Vestergaard P. Aggressive medullary thyroid carcinoma in a ten-year-old patient with multiple endocrine neoplasia 2B due to the A883F mutation. Thyroid 2015; 25:139-40. [PMID: 25244518 DOI: 10.1089/thy.2014.0177] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jes Sloth Mathiesen
- 1 Department of ENT Head & Neck Surgery, Odense University Hospital , Odense C, Denmark
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