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Astor MC, Løvås K, Debowska A, Eriksen EF, Evang JA, Fossum C, Fougner KJ, Holte SE, Lima K, Moe RB, Myhre AG, Kemp EH, Nedrebø BG, Svartberg J, Husebye ES. Epidemiology and Health-Related Quality of Life in Hypoparathyroidism in Norway. J Clin Endocrinol Metab 2016; 101:3045-53. [PMID: 27186861 PMCID: PMC4971340 DOI: 10.1210/jc.2016-1477] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/12/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The epidemiology of hypoparathyroidism (HP) is largely unknown. We aimed to determine prevalence, etiologies, health related quality of life (HRQOL) and treatment pattern of HP. METHODS Patients with HP and 22q11 deletion syndrome (DiGeorge syndrome) were identified in electronic hospital registries. All identified patients were invited to participate in a survey. Among patients who responded, HRQOL was determined by Short Form 36 and Hospital Anxiety and Depression scale. Autoantibodies were measured and candidate genes (CaSR, AIRE, GATA3, and 22q11-deletion) were sequenced for classification of etiology. RESULTS We identified 522 patients (511 alive) and estimated overall prevalence at 102 per million divided among postsurgical HP (64 per million), nonsurgical HP (30 per million), and pseudo-HP (8 per million). Nonsurgical HP comprised autosomal dominant hypocalcemia (21%), autoimmune polyendocrine syndrome type 1 (17%), DiGeorge/22q11 deletion syndrome (15%), idiopathic HP (44%), and others (4%). Among the 283 respondents (median age, 53 years [range, 9-89], 75% females), seven formerly classified as idiopathic were reclassified after genetic and immunological analyses, whereas 26 (37% of nonsurgical HP) remained idiopathic. Most were treated with vitamin D (94%) and calcium (70%), and 10 received PTH. HP patients scored significantly worse than the normative population on Short Form 36 and Hospital Anxiety and Depression scale; patients with postsurgical scored worse than those with nonsurgical HP and pseudo-HP, especially on physical health. CONCLUSIONS We found higher prevalence of nonsurgical HP in Norway than reported elsewhere. Genetic testing and autoimmunity screening of idiopathic HP identified a specific cause in 21%. Further research is necessary to unravel the causes of idiopathic HP and to improve the reduced HRQOL reported by HP patients.
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Affiliation(s)
- Marianne C Astor
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - Kristian Løvås
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - Aleksandra Debowska
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - Erik F Eriksen
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - Johan A Evang
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - Christian Fossum
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - Kristian J Fougner
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - Synnøve E Holte
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - Kari Lima
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - Ragnar B Moe
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - Anne Grethe Myhre
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - E Helen Kemp
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - Bjørn G Nedrebø
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - Johan Svartberg
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
| | - Eystein S Husebye
- Department of Clinical Science (M.C.A., K.L., E.S.H.), University of Bergen, Bergen, Norway; Department of Medicine (M.C.A., K.L., E.S.H.), Haukeland University Hospital, Bergen, Norway; Department of Medicine (A.D.), Vestfold Hospital, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine (E.F.E.), Oslo University Hospital, Oslo, Norway; Section of Specialized Endocrinology (J.A.E.), Oslo University Hospital, Rikshospitalet, Norway; Department of Medicine (C.F.), Innlandet Hospital, Gjøvik, Norway; Department of Endocrinology (K.K.F.), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Medicine (S.E.H.), Sørlandet Hospital, Arendal, Norway; Department of Medicine (K.L.), Akershus University Hospital, University of Oslo, Oslo, Norway; Department of Medicine (R.B.M.), Østfold Hospital, Fredrikstad, Norway; Department of Pediatrics (K.L., A.G.M.), Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Oncology and Metabolism (E.H.K.), University of Sheffield, Sheffield, UK; Department of Medicine (B.G.N.), Haugesund Hospital, Haugesund, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine (J.S.), UiT The Arctic University of Norway, Tromsø, Norway
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