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Hudson J, Cruickshank M, Quinton R, Aucott L, Wu F, Grossmann M, Bhasin S, Snyder PJ, Ellenberg SS, Travison TG, Brock GB, Gianatti EJ, van der Schouw YT, Emmelot-Vonk MH, Giltay EJ, Hackett G, Ramachandran S, Svartberg J, Hildreth KL, Antonic KG, Tenover JL, Tan HM, Ho Chee Kong C, Tan WS, Marks LS, Ross RJ, Schwartz RS, Manson P, Roberts SA, Skovsager Andersen M, Velling Magnussen L, Aceves-Martins M, Gillies K, Hernández R, Oliver N, Dhillo WS, Bhattacharya S, Brazzelli M, Jayasena CN. Symptomatic benefits of testosterone treatment in patient subgroups: a systematic review, individual participant data meta-analysis, and aggregate data meta-analysis. Lancet Healthy Longev 2023; 4:e561-e572. [PMID: 37804846 DOI: 10.1016/s2666-7568(23)00169-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Testosterone replacement therapy is known to improve sexual function in men younger than 40 years with pathological hypogonadism. However, the extent to which testosterone alleviates sexual dysfunction in older men and men with obesity is unclear, despite the fact that testosterone is being increasingly prescribed to these patient populations. We aimed to evaluate whether subgroups of men with low testosterone derive any symptomatic benefit from testosterone treatment. METHODS We did a systematic review and meta-analysis to evaluate characteristics associated with symptomatic benefit of testosterone treatment versus placebo in men aged 18 years and older with a baseline serum total testosterone concentration of less than 12 nmol/L. We searched major electronic databases (MEDLINE, Embase, Science Citation Index, and the Cochrane Central Register of Controlled Trials) and clinical trial registries for reports published in English between Jan 1, 1992, and Aug 27, 2018. Anonymised individual participant data were requested from the investigators of all identified trials. Primary (cardiovascular) outcomes from this analysis have been published previously. In this report, we present the secondary outcomes of sexual function, quality of life, and psychological outcomes at 12 months. We did a one-stage individual participant data meta-analysis with a random-effects linear regression model, and a two-stage meta-analysis integrating individual participant data with aggregated data from studies that did not provide individual participant data. This study is registered with PROSPERO, CRD42018111005. FINDINGS 9871 citations were identified through database searches. After exclusion of duplicates and publications not meeting inclusion criteria, 225 full texts were assessed for inclusion, of which 109 publications reporting 35 primary studies (with a total 5601 participants) were included. Of these, 17 trials provided individual participant data (3431 participants; median age 67 years [IQR 60-72]; 3281 [97%] of 3380 aged ≥40 years) Compared with placebo, testosterone treatment increased 15-item International Index of Erectile Function (IIEF-15) total score (mean difference 5·52 [95% CI 3·95-7·10]; τ2=1·17; n=1412) and IIEF-15 erectile function subscore (2·14 [1·40-2·89]; τ2=0·64; n=1436), reaching the minimal clinically important difference for mild erectile dysfunction. These effects were not found to be dependent on participant age, obesity, presence of diabetes, or baseline serum total testosterone. However, absolute IIEF-15 scores reached during testosterone treatment were subject to thresholds in patient age and baseline serum total testosterone. Testosterone significantly improved Aging Males' Symptoms score, and some 12-item or 36-item Short Form Survey quality of life subscores compared with placebo, but it did not significantly improve psychological symptoms (measured by Beck Depression Inventory). INTERPRETATION In men aged 40 years or older with baseline serum testosterone of less than 12 nmol/L, short-to-medium-term testosterone treatment could provide clinically meaningful treatment for mild erectile dysfunction, irrespective of patient age, obesity, or degree of low testosterone. However, due to more severe baseline symptoms, the absolute level of sexual function reached during testosterone treatment might be lower in older men and men with obesity. FUNDING National Institute for Health and Care Research Health Technology Assessment Programme.
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Affiliation(s)
- Jemma Hudson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Richard Quinton
- Translational & Clinical Research Institute, University of Newcastle, Newcastle upon Tyne, UK
| | - Lorna Aucott
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Frederick Wu
- Division of Diabetes, Endocrinology & Gastroenterology, University of Manchester, Manchester, UK
| | - Mathis Grossmann
- University of Melbourne Austin Health, Heidelberg, VIC, Australia
| | | | - Peter J Snyder
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan S Ellenberg
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Gerald B Brock
- Department of Surgery, Western University and Omega Fertility Center, London, ON, Canada
| | - Emily J Gianatti
- Department of Endocrinology, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Marielle H Emmelot-Vonk
- Department of Geriatrics, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Erik J Giltay
- Department of Psychiatry, Leiden University Medical Centre, Leiden, Netherlands
| | - Geoff Hackett
- School of Health and Life Sciences, Aston University, Birmingham, UK
| | | | - Johan Svartberg
- Division of Internal Medicine, Section of Endocrinology, University Hospital of North Norway, Tromsø, Norway; Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Kerry L Hildreth
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kristina Groti Antonic
- Department of Endocrinology, University Medical Centre, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Joyce Lisa Tenover
- Geriatric Medicine, VA Palo Alto Health Care System, Palo Alto, CA, USA; School of Medicine, Stanford University, Stanford, CA, USA
| | - Hui Meng Tan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Wei Shen Tan
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Leonard S Marks
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Richard J Ross
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Robert S Schwartz
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Paul Manson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | | | | | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Rodolfo Hernández
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Nick Oliver
- Faculty of Medicine, Imperial College London, London, UK
| | | | - Siladitya Bhattacharya
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Miriam Brazzelli
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Andersen M, Antonic K, Aucott L, Bhasin S, Bhattacharya S, Brazzelli M, Cruickshank M, Dhillo W, Ellenberg S, Emmelot-Vonk M, Gianatti E, Giltay E, Grossmann M, Hackett G, Hildreth K, Hudson J, Marks L, Quinton R, Snyder P, Svartberg J, Tan H, Tenover L, Travison T, Wu F, Jayasena C. OR25-5 Adverse Cardiovascular Events and Cause Mortality in Men During Testosterone Treatment: Individual Patient and Aggregate Data Meta-Analyses. J Endocr Soc 2022. [PMCID: PMC9627540 DOI: 10.1210/jendso/bvac150.1414] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background The cardiovascular safety of testosterone treatment in low testosterone is widely acknowledged to be unclear. Testosterone increases haematocrit, thereby potentially increasing venous thromboembolism risk. The FDA lists cardiovascular risk and stroke as adverse effects of testosterone. Systematic reviews and meta-analyses of published data have limited ability to confirm source data quality and categorisation. Some published meta-analyses have included participants with distinct risk profiles (e.g. cancer, HIV), with serum testosterone atypical for hypogonadism (>12nmol/L), short durations of testosterone treatment, and studies without placebo treatment. Furthermore, subtypes of cardiovascular or cerebrovascular events (e.g. stable angina) during testosterone treatment are seldom published, so have not been analysed previously. Objective Evaluate frequencies of all-cause mortality, and all cardiovascular or cerebrovascular event subtypes, and analyse efficacy of testosterone monotherapy compared to placebo for men with low testosterone, using individual patient data (IPD) and aggregate data meta-analyses. Methods MEDLINE, EMBASE, Science Citation Index, CENTRAL and clinical trial registries (PROSPERO CRD42018111005) were searched for placebo-controlled RCTs including men with serum testosterone <12nmol/L. One-stage meta-analyses were performed for studies providing IPD and two-stage meta-analyses were performed to integrate IPD and aggregated data. Primary outcomes were all-cause mortality and cardiovascular and/or cerebrovascular events at 12 months or nearest time point. Results IPD were obtained from 17 of 35 eligible RCTs (3431/5601 participants) in men with low testosterone. Most participants had functional hypogonadism. Risks of cardiovascular and/or cerebrovascular events were similar between the testosterone and placebo arms (testosterone 120/1601, 7.5%; placebo, 110/1519, 7.2% OR 1.07, 95% CI 0.81-1.42 p=0.62). Frequencies of all cardiovascular or cerebrovascular event subtypes were also similar between testosterone and placebo arms, but testosterone increased risks of oedema and erythrocytosis. No subgroups at higher cardiovascular and/or cerebrovascular event risk were identified. Fewer deaths were recorded in the testosterone arm, but this difference was non-significant (testosterone, 6/1621, 0.4%; placebo, 12/1537, 0.8% OR 0.46, 95% CI 0.17-1.24 p=0.13). Testosterone significantly reduced serum total cholesterol, high-density lipoprotein (HDL), and triglycerides versus placebo. No significant differences in serum low-density lipoprotein (LDL), blood pressure, glycaemic parameters, diabetes incidence or prostate outcomes were observed between groups. Testosterone had positive, albeit varied, effects on quality of life and sexual function. Conclusions This is the most comprehensive study to date interrogating the safety of testosterone treatment in men with low testosterone. We were unable to find evidence from our IPD meta-analyses that testosterone increases risks of mortality or cardiovascular and/or cerebrovascular events in the short- to medium-term in men with low testosterone, most of whom have various forms of functional hypogonadism. These data provide some reassurance to men with low testosterone and their clinicians about the safety of testosterone in the short-to-medium term although more long-term data are required.Acknowledgement: NIHR TestES Consortium. Presentation: Monday, June 13, 2022 12:00 p.m. - 12:15 p.m.
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Grimnes G, Svartberg J, Joakimsen RM, Olsen IB, Oltmanns G, Aahlin EK, Moi L. A man in his sixties with dyspnoea and oedema. Tidsskr Nor Laegeforen 2020; 140:19-0751. [PMID: 32900170 DOI: 10.4045/tidsskr.19.0751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND/CASE PRESENTATION A man in his sixties with chronic obstructive pulmonary disease was hospitalised due to oedema and dyspnoea during the previous weeks. He was hypertensive, with 10 kg weight gain, generalised oedema, proximal myopathy and moon face. The assessment was consistent with ectopic ACTH-dependent Cushing's syndrome. A 15 mm lung tumour was detected on CT, with inconclusive cytological examination, and negative FDG/PET CT and octreotide scintigraphy. He developed necrotising pancreatitis and a duodenal perforation, which were surgically treated. His cortisol levels and Cushingoid appearance normalised after surgery, and it was concluded that his hypercortisolism was part of a physiological response. He remained clinically in habitual shape until two years later, when he again developed Cushingoid stigmata. A new octreotide scintigraphy was negative, but FDG/PET CT revealed increased FDG uptake in the lung lesion. Before a lung biopsy was performed, the patient developed necrotising pancreatitis. He was treated conservatively and died in respiratory failure. Autopsy revealed a NET in the lung and necrotising pancreatitis. INTERPRETATION The case demonstrates diagnostic challenges in the assessment of ectopic ACTH-dependent cyclic Cushing's syndrome. Is also suggests that pancreatitis could be triggered by hypercortisolism.
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Naseribafrouei A, Eliassen BM, Melhus M, Svartberg J, Broderstad AR. Estimated 8-year cumulative incidence of diabetes mellitus among Sami and non-Sami inhabitants of Northern Norway - The SAMINOR Study. BMC Endocr Disord 2019; 19:66. [PMID: 31234837 PMCID: PMC6591838 DOI: 10.1186/s12902-019-0399-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Received: 10/05/2018] [Accepted: 06/19/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The aim of the study was to estimate and compare the 8-year cumulative incidence of diabetes mellitus (DM) among Sami and non-Sami inhabitants of rural districts in Northern Norway. METHODS Longitudinal study based on linkage of two cross-sectional surveys, the SAMINOR 1 Survey (2003-2004) and the SAMINOR 2 Clinical Survey (2012-2014). Ten municipalities in rural Northern Norway were included in the study. DM-free participants aged 30 and 36-71 years in SAMINOR 1 were followed from 2 years after SAMINOR 1 to attendance in SAMINOR 2. The average follow-up time was 8.1 years. Of 5875 subjects who had participated in SAMINOR 1 and could potentially be followed to SAMINOR 2, 3303 were included in the final analysis. Self-reported DM and/or HbA1c ≥ 6.5% were used to identify incident cases of DM. RESULTS At baseline, body mass index (BMI) and waist-to-height ratio (WHtR) were higher among Sami than among their non-Sami counterparts. After 8 years of follow-up, 201 incident cases of DM were identified (6.1% both Sami and non-Sami subjects). No statistically significant difference was observed in the cumulative incidence of DM between the Sami and non-Sami. CONCLUSIONS No statistically significant difference in the 8-year cumulative incidence of DM among Sami and non-Sami was observed, although Sami men and women had higher baseline BMI and WHtR.
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Affiliation(s)
- Ali Naseribafrouei
- Centre for Sami Health Research, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Box 6050 Langnes, N-9037 Tromsø, Norway
| | | | - Marita Melhus
- Centre for Sami Health Research, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Box 6050 Langnes, N-9037 Tromsø, Norway
| | - Johan Svartberg
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
- Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ann Ragnhild Broderstad
- Centre for Sami Health Research, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Box 6050 Langnes, N-9037 Tromsø, Norway
- Department of Medicine, University Hospital of North Norway, Harstad, Norway
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Michalsen VL, Kvaløy K, Svartberg J, Siri SRA, Melhus M, Broderstad AR. Change in prevalence and severity of metabolic syndrome in the Sami and non-Sami population in rural Northern Norway using a repeated cross-sectional population-based study design: the SAMINOR Study. BMJ Open 2019; 9:e027791. [PMID: 31201190 PMCID: PMC6576075 DOI: 10.1136/bmjopen-2018-027791] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To examine the change in both the prevalence and severity of metabolic syndrome (MetS) in the Sami and non-Sami in Northern Norway due to a lack of knowledge regarding the development of MetS in this population. DESIGN Repeated cross-sectional study. SETTING The study is based on data from the SAMINOR 1 Survey (2003-2004, n=6550) and the SAMINOR 2 Clinical Survey (2012-2014, n=6004), conducted in 10 municipalities in Northern Norway. PARTICIPANTS Men and women aged 40-79 years were invited. We excluded participants not handing in the questionnaire and with missing information concerning ethnicity questions or MetS risk factors resulting in a final sample of 6308 (36.0% Sami) subjects in SAMINOR 1 and 5866 (40.9% Sami) subjects in SAMINOR 2. OUTCOME MEASURES MetS prevalence was determined using the harmonised Adult Treatment Panel III (ATP-III) criteria, and severity was assessed with the MetS severity Z-score. Generalised estimating equations with an interaction term (survey × ethnicity) were used to compare prevalence and severity between the two surveys while accounting for partly repeated measurements. RESULTS The overall, age-standardised ATP-III-MetS prevalence was 31.2% (95% CI: 29.8 to 32.6) in SAMINOR 1 and 35.6% (95% CI: 34.0 to 37.3) in SAMINOR 2. Both the ATP-III-MetS prevalence and the mean MetS severity Z-score increased between the surveys in all subgroups, except the ATP-III-MetS prevalence in non-Sami women, which remained stable. Over time, Sami men showed a slightly larger increase in MetS severity than non-Sami men (p<0.001): the score increased by 0.20 (95% CI: 0.14 to 0.25) and 0.06 (95% CI: 0.01 to 0.10) in Sami and non-Sami men, respectively. Abdominal obesity increased markedly between the surveys in all subgroups. CONCLUSION The prevalence and severity of MetS increased over time in rural Northern Norway. Abdominal obesity appeared to drive the increase in ATP-III-MetS prevalence. Sami men had a slightly larger increase in severity than non-Sami.
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Affiliation(s)
- Vilde L Michalsen
- Department of Community Health, Centre for Sami Health Research, UiT The Arctic University of Norway, Tromsø, Norway
| | - Kirsti Kvaløy
- Department of Community Health, Centre for Sami Health Research, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Public Health and Nursing, HUNT Research Centre, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Johan Svartberg
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
- Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Susanna R A Siri
- Department of Community Health, Centre for Sami Health Research, UiT The Arctic University of Norway, Tromsø, Norway
| | - Marita Melhus
- Department of Community Health, Centre for Sami Health Research, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ann R Broderstad
- Department of Community Health, Centre for Sami Health Research, UiT The Arctic University of Norway, Tromsø, Norway
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Jorde R, Kubiak J, Svartberg J, Fuskevåg OM, Figenschau Y, Martinaityte I, Grimnes G. Vitamin D supplementation has no effect on cognitive performance after four months in mid-aged and older subjects. J Neurol Sci 2019; 396:165-171. [DOI: 10.1016/j.jns.2018.11.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/13/2018] [Accepted: 11/15/2018] [Indexed: 12/21/2022]
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Naseribafrouei A, Eliassen BM, Melhus M, Svartberg J, Broderstad AR. The prevalence of diabetes mellitus among Sami and non-Sami inhabitants of Northern Norway - the SAMINOR 1 Survey (2003-2004) and the SAMINOR 2 Clinical Survey (2012-2014). Rural Remote Health 2018; 18:4623. [PMID: 30543755 DOI: 10.22605/rrh4623] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION This study aimed to compare the prevalence of diabetes mellitus (DM) between Sami and non-Sami inhabitants of Northern Norway participating in the SAMINOR 1 Survey and the SAMINOR 2 Clinical Survey, and to track DM prevalence over time. METHODS SAMINOR 1 (2003-2004) and SAMINOR 2 (2012-2014) are cross-sectional, population-based studies that each recruited Sami and non-Sami inhabitants. The data used in this article were restricted to participants aged 40-79 years in 10 municipalities in Northern Norway. Participants completed self-administered questionnaires and underwent clinical examination and blood sampling. Both questionnaire information and non-fasting/random plasma glucose levels were used to ascertain DM. The study included 6288 and 5765 participants with complete data on DM and outcomes, ie 54.6% and 46.3% of the invited samples, respectively. RESULTS No difference in the prevalence of DM between Sami and non-Sami participants was observed, in either survey. Women had a statistically significantly lower DM prevalence than men in SAMINOR 2. Mean waist-to-height ratio and waist circumference increased substantially in both sexes; mean body mass index increased only slightly in men and remained unchanged in women. The total, age-standardized DM prevalence in SAMINOR 1 and 2 was 10.0% (95% confidence interval (CI) 9.2-10.7) and 11.2% (95%CI 10.4-12.0), respectively, and the proportion of self-reported (ie known) DM increased from 49.2% to 73.0%. In almost the same time span (2004-2015), the use of oral glucose-lowering agents increased. CONCLUSION Overall, no ethnic difference was observed in DM prevalence. Overall DM prevalence was high, but did not change significantly from SAMINOR 1 to SAMINOR 2. The percentage of known versus unknown cases of DM increased, as did the prescription of medication for DM between 2004 and 2015.
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Affiliation(s)
- Ali Naseribafrouei
- Centre for Sami Health Research, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
| | - Bent-Martin Eliassen
- Centre for Sami Health Research, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
| | - Marita Melhus
- Centre for Sami Health Research, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
| | - Johan Svartberg
- Division of Internal Medicine, University Hospital of North Norway, Tromso, Norway; and Tromso Endocrine Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromso, Norway
| | - Ann Ragnhild Broderstad
- Centre for Sami Health Research, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway; and Department of Medicine, University Hospital of Northern Norway, Harstad, Norway
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Naseribafrouei A, Eliassen BM, Melhus M, Svartberg J, Broderstad AR. Prevalence of pre-diabetes and type 2 diabetes mellitus among Sami and non-Sami men and women in Northern Norway - The SAMINOR 2 Clinical Survey. Int J Circumpolar Health 2018; 77:1463786. [PMID: 29697016 PMCID: PMC5917894 DOI: 10.1080/22423982.2018.1463786] [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: 11/05/2022] Open
Abstract
The aim of this study was to determine and compare the prevalence of pre-diabetes and type 2 diabetes mellitus (T2DM) among Sami and non-Sami men and women of rural districts in Northern Norway. The SAMINOR 2 Clinical Survey is a cross-sectional population-based study performed in 2012–2014 in 10 municipalities of Northern Norway. A total of 12,455 Sami and non-Sami inhabitants aged 40–79 years were invited to participate and 5878 were included in the analyses. Participants with self-reported T2DM and/or a glycated haemoglobin (HbA1c) result ≥6.5% were categorised as having T2DM. Those with 5.7%≤HbA1c<6.5% were categorised as pre-diabetics. In men, the total age-standardised prevalence of pre-diabetes (37.9% vs 31.4%) and T2DM (10.8% vs 9.5%) were higher in Sami compared with non-Sami; the ethnic difference was statistically significant for both pre-diabetes (OR 1.42, p < 0.001) and T2DM (OR 1.31, p = 0.042). In women, pre-diabetes (36.4% vs 33.5%) and T2DM (8.6% vs 7.0%) were also more common in Sami than non-Sami; the differences in both pre-diabetes (OR 1.20, p = 0.025) and T2DM (OR 1.38, p = 0.021) were also statistically significant. The observed ethnic difference in the waist-to-height ratio (WHtR) was a plausible explanation for the ethnic difference in the prevalence of pre-diabetes and T2DM.
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Affiliation(s)
- Ali Naseribafrouei
- a Centre for Sami Health Research, Department of Community Medicine, Faculty of Health Sciences , UiT The Arctic University of Norway , Tromsø , Norway
| | - Bent-Martin Eliassen
- a Centre for Sami Health Research, Department of Community Medicine, Faculty of Health Sciences , UiT The Arctic University of Norway , Tromsø , Norway
| | - Marita Melhus
- a Centre for Sami Health Research, Department of Community Medicine, Faculty of Health Sciences , UiT The Arctic University of Norway , Tromsø , Norway
| | - Johan Svartberg
- b Division of Internal Medicine , University Hospital of North Norway , Tromsø , Norway.,c Tromsø Endocrine Research Group, Department of Clinical Medicine , UiT The Arctic University of Norway , Tromsø , Norway
| | - Ann Ragnhild Broderstad
- a Centre for Sami Health Research, Department of Community Medicine, Faculty of Health Sciences , UiT The Arctic University of Norway , Tromsø , Norway.,d Department of Medicine , University Hospital of North Norway , Harstad , Norway
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Saevik ÅB, Åkerman AK, Grønning K, Nermoen I, Valland SF, Finnes TE, Isaksson M, Dahlqvist P, Bergthorsdottir R, Ekwall O, Skov J, Nedrebø BG, Hulting AL, Wahlberg J, Svartberg J, Höybye C, Bleskestad IH, Jørgensen AP, Kämpe O, Øksnes M, Bensing S, Husebye ES. Clues for early detection of autoimmune Addison's disease - myths and realities. J Intern Med 2018; 283:190-199. [PMID: 29098731 DOI: 10.1111/joim.12699] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Early detection of autoimmune Addison's disease (AAD) is important as delay in diagnosis may result in a life-threatening adrenal crisis and death. The classical clinical picture of untreated AAD is well-described, but methodical investigations are scarce. OBJECTIVE Perform a retrospective audit of patient records with the aim of identifying biochemical markers for early diagnosis of AAD. MATERIAL AND METHODS A multicentre retrospective study including 272 patients diagnosed with AAD at hospitals in Norway and Sweden during 1978-2016. Scrutiny of medical records provided patient data and laboratory values. RESULTS Low sodium occurred in 207 of 247 (84%), but only one-third had elevated potassium. Other common nonendocrine tests were largely normal. TSH was elevated in 79 of 153 patients, and hypoglycaemia was found in 10%. Thirty-three per cent were diagnosed subsequent to adrenal crisis, in whom electrolyte disturbances were significantly more pronounced (P < 0.001). Serum cortisol was consistently decreased (median 62 nmol L-1 [1-668]) and significantly lower in individuals with adrenal crisis (38 nmol L-1 [2-442]) than in those without (81 nmol L-1 [1-668], P < 0.001). CONCLUSION The most consistent biochemical finding of untreated AAD was low sodium independent of the degree of glucocorticoid deficiency. Half of the patients had elevated TSH levels. Only a minority presented with marked hyperkalaemia or other nonhormonal abnormalities. Thus, unexplained low sodium and/or elevated TSH should prompt consideration of an undiagnosed AAD, and on clinical suspicion bring about assay of cortisol and ACTH. Presence of 21-hydroxylase autoantibodies confirms autoimmune aetiology. Anticipating additional abnormalities in routine blood tests may delay diagnosis.
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Affiliation(s)
- Å B Saevik
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - A-K Åkerman
- Department of Medicine, Örebro University Hospital, Örebro, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - K Grønning
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - I Nermoen
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Akershus University Hospital, University of Oslo, Lørenskog, Norway
| | - S F Valland
- Division of Endocrinology, Innlandet Hospital Trust, Hamar, Norway
| | - T E Finnes
- Division of Endocrinology, Innlandet Hospital Trust, Hamar, Norway
| | - M Isaksson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - P Dahlqvist
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - R Bergthorsdottir
- Department of Endocrinology, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - O Ekwall
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J Skov
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Endocrine Division, Department of Medicine, Karlstad City Hospital, Karlstad, Sweden
| | - B G Nedrebø
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Medicine, Haugesund Hospital, Haugesund, Norway
| | - A-L Hulting
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - J Wahlberg
- Division of Endocrinology, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - J Svartberg
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway.,Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - C Höybye
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - I H Bleskestad
- Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway
| | - A P Jørgensen
- Department of Endocrinology, Oslo University Hospital, Oslo, Norway
| | - O Kämpe
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,K.G. Jebsen center for Autoimmune Disorders, University of Bergen, Bergen, Norway
| | - M Øksnes
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - S Bensing
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - E S Husebye
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,K.G. Jebsen center for Autoimmune Disorders, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
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10
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Agledahl I, Svartberg J, Hansen B, Brodin E. Plasma free tissue factor pathway inhibitor (TFPI) levels and TF-induced thrombin generation ex vivo in men with low testosterone levels. Thromb Haemost 2017. [DOI: 10.1160/th08-10-0667] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryLow testosterone levels in men have been associated with cardiovascular risk factors, some prothrombotic factors, and lately also an increased risk of both cardiovascular disease and all-cause mortality. Experimental studies have shown increased synthesis and release of tissue factor pathway inhibitor (TFPI) by physiological levels of testosterone in endothelial cells. Our hypothesis was that elderly men with low testosterone levels would have lower plasma levels of plasma free TFPI with subsequent increased thrombin generation. Elderly men with low (n=37) and normal (n=41) testosterone levels were recruited from a general population, and tissue factor (TF)-induced thrombin generation ex vivo and plasma free TFPI Ag were measured. Elderly men with low testosterone levels had lower plasma free TFPI Ag (10.9 ± 2.3 ng/ml vs. 12.3 ± 3.0 ng/ml, p=0.027) and shorter initiation phase of TF-induced coagulation assessed by lag-time (5.1 ± 1.0 min vs. 5.7 ± 1.3, p=0.039). The differences between groups remained significant and were strengthened after adjustment for waist circumference and other cardiovascular risk factors. Lag-time increased linearly across quartiles of plasma free TFPI Ag (p<0.001). Multiple regression analysis revealed that total and free testosterone were independent predictors of plasma free TFPI Ag. Our findings suggest that low testosterone levels in elderly men is associated with low plasma free TFPI Ag and subsequent shortened initiation phase of TF-induced coagulation.
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11
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Lerstad G, Grimnes G, Brækkan SK, Vik A, Brox J, Svartberg J, Jorde R, Hansen JB, Brodin EE. Serum levels of vitamin D are not associated with future risk of venous thromboembolism. Thromb Haemost 2017; 109:885-90. [DOI: 10.1160/th12-10-0728] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 02/09/2013] [Indexed: 01/20/2023]
Abstract
SummaryPrevious studies have provided indirect evidence for a possible association between vitamin D status and risk of venous thromboembolism (VTE). However, no study has so far investigated the association between serum levels of 25-hydroxyvitamin D (25(OH)D), the biomarker of vitamin D status, and risk of VTE. The aim of our study was to investigate whether high levels of 25(OH)D were associated with decreased risk of VTE in a prospective population-based study. Serum levels of 25(OH)D were measured in 6,021 men and women, aged 25–84 years, who participated in the Tromsø Study in 1994–1995. Incident VTE-events were registered from date of inclusion through the end of follow-up, September 1, 2007. Cox-regression models were used to calculate hazard ratios (HR) with 95% confidence interval (CI) for VTE. There were 201 incident VTE-events during a median of 10.7 years of follow-up. The risk of VTE did not decrease per one standard deviation (SD) (19.8 nmol/l) increase in serum 25(OH)D (multivariable HR 1.02; 95% CI 0.91–1.22). Moreover, subjects with serum 25(OH)D ≥ 70 nmol/l (upper quartile) did not have decreased risk of VTE compared to those ≤ 44 nmol/l (lower quartile) in age- and sex-adjusted analysis (HR 0.91, 95% CI: 0.60–1.37, p for trend across quartiles 0.9) or multivariable analysis adjusted for age, sex, body mass index, smoking, and physical activity (HR 0.76, 95% CI: 0.45–1.28, p for trend across quartiles 0.9). Subgroup analyses showed no associations between serum levels of 25(OH)D and unprovoked or provoked VTE. In conclusion, in our study, normal serum levels of 25(OH)D were not associated with future risk of VTE, suggesting that vitamin D status does not play an important role in the pathogenesis of VTE. However, our findings did not apply to subjects with vitamin D deficiency (< 30 nmol/l) due to lack of statistical power among these subjects.
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12
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Lerstad G, Brodin EE, Svartberg J, Jorde R, Brox J, Brækkan SK, Hansen JB. Associations between serum levels of calcium, parathyroid hormone and future risk of venous thromboembolism: the Tromsø study. Eur J Endocrinol 2017; 176:625-634. [PMID: 28246149 DOI: 10.1530/eje-16-1037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Received: 12/17/2016] [Revised: 02/21/2017] [Accepted: 02/27/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The relationship between serum levels of calcium, parathyroid hormone (PTH) and risk of venous thromboembolism (VTE) has not been addressed in population-based cohorts. We investigated the associations between serum levels of calcium and PTH, with future risk of VTE in a general adult population. DESIGN Population-based cohort. METHODS A total of 27 712 subjects (25-87 years) who participated in Tromsø 4 (1994-1995) and Tromsø 5 (2001-2002) surveys were included in the study, and total calcium and PTH were measured in 27 685 and 8547 subjects respectively. Incident VTE was recorded through December 31, 2012. Cox-regression models with calcium and PTH as time-varying exposures were used to calculate hazard ratios (HR) of VTE by quartiles of calcium and PTH. Quartiles of calcium and PTH were also combined to assess the effect of discordants of both PTH and calcium (e.g. highest and lowest quartiles of both calcium and PTH) on VTE risk using the middle two quartiles as reference. RESULTS There were 712 VTEs during 15.0 years of median follow-up. Serum levels of calcium and PTH were not associated with risk of VTE. However, subjects with discordant high serum levels of both calcium and PTH (calcium ≥2.45 mmol/L and PTH ≥4.0 pmol/L) had increased risk of VTE compared to those in subjects with normal calcium and PTH (multivariable HR: 1.78, 95% CI: 1.12-2.84). CONCLUSIONS Serum levels of calcium and PTH separately were not associated with future risk of VTE, but subjects with high levels of both calcium and PTH had increased risk of VTE compared to those in subjects with normal levels.
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Affiliation(s)
- Gunhild Lerstad
- Department of Clinical MedicineK.G. Jebsen Thrombosis Research and Expertise Center (TREC)
| | - Ellen E Brodin
- Department of Clinical MedicineK.G. Jebsen Thrombosis Research and Expertise Center (TREC)
- Division of Internal MedicineAkershus University Hospital, Lørenskog, Norway
| | - Johan Svartberg
- Department of Clinical MedicineEndocrine Research Group, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
- Division of Internal MedicineUniversity Hospital of North Norway, Tromsø, Norway
| | - Rolf Jorde
- Department of Clinical MedicineEndocrine Research Group, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
- Division of Internal MedicineUniversity Hospital of North Norway, Tromsø, Norway
| | - Jan Brox
- Department of Clinical MedicineK.G. Jebsen Thrombosis Research and Expertise Center (TREC)
- Department of Laboratory MedicineUniversity Hospital of North Norway, Tromsø, Norway
| | - Sigrid K Brækkan
- Department of Clinical MedicineK.G. Jebsen Thrombosis Research and Expertise Center (TREC)
- Division of Internal MedicineUniversity Hospital of North Norway, Tromsø, Norway
| | - John-Bjarne Hansen
- Department of Clinical MedicineK.G. Jebsen Thrombosis Research and Expertise Center (TREC)
- Division of Internal MedicineUniversity Hospital of North Norway, Tromsø, Norway
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13
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Seland M, Smeland KB, Bjøro T, Falk RS, Fosså SD, Gjesdal CG, Godang K, Holte H, Svartberg J, Syversen U, Bollerslev J, Kiserud CE. Bone mineral density is close to normal for age in long-term lymphoma survivors treated with high-dose therapy with autologous stem cell transplantation. Acta Oncol 2017; 56:590-598. [PMID: 28077016 DOI: 10.1080/0284186x.2016.1267870] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Few studies have assessed bone health in lymphoma survivors treated with high-dose therapy with autologous stem cell transplantation (HDT-ASCT). Therefore, we aimed to assess bone mineral density (BMD) at six different skeletal sites and to investigate associations between clinical factors and BMD in these survivors. MATERIAL AND METHODS Eligible lymphoma survivors were aged ≥18 years at diagnosis and at HDT-ASCT given between 1987 and 2008. Participants responded to questionnaires, blood samples were drawn, and a dual energy X-ray absorptiometry (DXA) was performed. Mean Z-score was applied for assessment of BMD in relation to age. Prevalence of Z-scores ≥-1, between -1 and -2, and ≤-2 is reported for each measurement site and for the lumbar spine, femoral neck, and hip in combination. Likewise, T-scores were applied to assess the prevalence of normal BMD (≥-1), osteopenia (between -1 and -2.5), and osteoporosis (≤-2.5). RESULTS We included 228 lymphoma survivors, of whom 62% were males. The median age at survey was 56 years, and median observation time from HDT-ASCT was eight years. Among males, Z-scores were lower at the left femoral neck and higher at the ultra-distal (UD) radius and whole body compared to the Lunar reference database. In females, Z-scores were lower at UD radius and one-third (33%) radius and higher at the whole body. Using a classification based on Z-scores at the lumbar spine, femoral neck, and hip in combination, 25% of males and 16% of females had Z-scores <-1 and >-2, while 8% and 6% had Z-scores ≤-2. According to T-scores, 35% of males and 41% of females had osteopenia, while 8% and 13% had osteoporosis, respectively. CONCLUSION BMD was close to normal for age in this population of long-term lymphoma survivors treated with HDT-ASCT.
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Affiliation(s)
- Mette Seland
- National Advisory Unit on Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Knut B. Smeland
- National Advisory Unit on Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Trine Bjøro
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ragnhild S. Falk
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Sophie D. Fosså
- National Advisory Unit on Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Clara G. Gjesdal
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Kristin Godang
- Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Harald Holte
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Johan Svartberg
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
- Tromsø Endocrine Research Group, Institute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Unni Syversen
- Department of Endocrinology, St. Olav’s Hospital, Trondheim, Norway
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jens Bollerslev
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Cecilie E. Kiserud
- National Advisory Unit on Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway
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14
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Opsahl EM, Brauckhoff M, Schlichting E, Helset K, Svartberg J, Brauckhoff K, Mæhle L, Engebretsen LF, Sigstad E, Grøholt KK, Akslen LA, Jørgensen LH, Varhaug JE, Bjøro T. A Nationwide Study of Multiple Endocrine Neoplasia Type 2A in Norway: Predictive and Prognostic Factors for the Clinical Course of Medullary Thyroid Carcinoma. Thyroid 2016; 26:1225-38. [PMID: 27400880 DOI: 10.1089/thy.2015.0673] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Multiple endocrine neoplasia type 2A (MEN 2A) is an autosomal dominant syndrome caused by activating germline mutations in the RET (REarranged during Transfection) proto-oncogene. MEN 2A has a strong (>95%) and age-dependent (5-25 years) clinical penetrance of medullary thyroid carcinoma (MTC). Several major studies have analyzed the predictive and prognostic factors for MEN 2A to find indicators that predict the optimal timing of prophylactic thyroidectomy. The aims of this study were to describe all known RET positive MEN 2A patients diagnosed in Norway and to evaluate the clinical course of MTC, as well as its predictive and prognostic factors. METHODS This nationwide retrospective cohort study included data for 65 (14 index and 51 screening patients) out of a total of 67 MEN 2A patients with the RET gene mutation who were diagnosed in Norway since 1974. Data were collected by reviewing patient files. The variables analyzed were genotype, phenotype, preoperative basal calcitonin, age at thyroid surgery, central lymph node dissection and nodal status at primary surgery, number of surgical procedures, and biochemical cure. Of the 65 patients, 60 had undergone thyroid surgery. The median follow-up period was 9.9 years. The patients were divided into pre-RET-and RET-era, which included patients who had thyroid surgery before January 1, 1994, and after, respectively. RESULTS In index and screening patients, MTC was found, respectively, in 100% and 45% of cases, central lymph node dissection at primary surgery was done for 64% and 52% of patients, and the median total number of surgical procedures was two (range 1-6) and one (range 1-4). At primary surgery, all patients (n = 13) with lymph node metastases had preoperative basal calcitonin levels ≥68 pg/mL, and all patients (n = 17) without central lymph node dissection and preoperative basal calcitonin <40 pg/mL were biochemically cured. Multivariate analysis showed that preoperative basal calcitonin was a significant predictive factor for MTC superior to age at thyroid surgery when analyzing the entire period (p = 0.009) and the RET-era separately (p = 0.021). Prognostic factors for biochemical cure were preoperative basal calcitonin, central lymph node dissection, and nodal status at primary surgery (p = 0.037, p = 0.002, and p = 0.005) when analyzing the entire period, but only nodal status at primary surgery when the RET-era was considered separately (p = 0.006). CONCLUSIONS Preoperative basal calcitonin alone can serve as an indicator for optimal timing and the extent of thyroid surgery for MEN 2A patients that could be considered safe. The results are consistent with previously reported data.
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Affiliation(s)
- Else Marie Opsahl
- 1 Department of Oncology, Section for Breast and Endocrine Surgery, Oslo University Hospital , Oslo, Norway
- 2 Institute of Clinical Medicine, University of Oslo , Oslo, Norway
| | - Michael Brauckhoff
- 3 Department of Breast and Endocrine Surgery, Haukeland University Hospital , Bergen, Norway
- 4 Department of Clinical Science, University of Bergen , Bergen, Norway
| | - Ellen Schlichting
- 1 Department of Oncology, Section for Breast and Endocrine Surgery, Oslo University Hospital , Oslo, Norway
| | - Kristin Helset
- 5 Department of Breast and Endocrine Surgery, St. Olavs University Hospital , Trondheim, Norway
| | - Johan Svartberg
- 6 Division of Internal Medicine, University Hospital of North Norway , Tromsø, Norway
- 7 Institute of Clinical Medicine, UIT, The Arctic University of Norway , Tromsø, Norway
| | - Katrin Brauckhoff
- 3 Department of Breast and Endocrine Surgery, Haukeland University Hospital , Bergen, Norway
| | - Lovise Mæhle
- 8 Department of Medical Genetics, Oslo University Hospital , Oslo, Norway
| | | | - Eva Sigstad
- 10 Department of Pathology, Oslo University Hospital , Oslo, Norway
| | | | - Lars Andreas Akslen
- 11 Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen , Bergen, Norway
- 12 Department of Pathology, Haukeland University Hospital , Bergen, Norway
| | | | - Jan Erik Varhaug
- 3 Department of Breast and Endocrine Surgery, Haukeland University Hospital , Bergen, Norway
- 4 Department of Clinical Science, University of Bergen , Bergen, Norway
| | - Trine Bjøro
- 2 Institute of Clinical Medicine, University of Oslo , Oslo, Norway
- 14 Department of Medical Biochemistry, Oslo University Hospital , Oslo, Norway
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15
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Bruserud Ø, Oftedal BE, Landegren N, Erichsen MM, Bratland E, Lima K, Jørgensen AP, Myhre AG, Svartberg J, Fougner KJ, Bakke Å, Nedrebø BG, Mella B, Breivik L, Viken MK, Knappskog PM, Marthinussen MC, Løvås K, Kämpe O, Wolff AB, Husebye ES. A Longitudinal Follow-up of Autoimmune Polyendocrine Syndrome Type 1. J Clin Endocrinol Metab 2016; 101:2975-83. [PMID: 27253668 PMCID: PMC4971337 DOI: 10.1210/jc.2016-1821] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/27/2016] [Indexed: 11/19/2022]
Abstract
CONTEXT Autoimmune polyendocrine syndrome type 1 (APS1) is a childhood-onset monogenic disease defined by the presence of two of the three major components: hypoparathyroidism, primary adrenocortical insufficiency, and chronic mucocutaneous candidiasis (CMC). Information on longitudinal follow-up of APS1 is sparse. OBJECTIVE To describe the phenotypes of APS1 and correlate the clinical features with autoantibody profiles and autoimmune regulator (AIRE) mutations during extended follow-up (1996-2016). PATIENTS All known Norwegian patients with APS1. RESULTS Fifty-two patients from 34 families were identified. The majority presented with one of the major disease components during childhood. Enamel hypoplasia, hypoparathyroidism, and CMC were the most frequent components. With age, most patients presented three to five disease manifestations, although some had milder phenotypes diagnosed in adulthood. Fifteen of the patients died during follow-up (median age at death, 34 years) or were deceased siblings with a high probability of undisclosed APS1. All except three had interferon-ω) autoantibodies, and all had organ-specific autoantibodies. The most common AIRE mutation was c.967_979del13, found in homozygosity in 15 patients. A mild phenotype was associated with the splice mutation c.879+1G>A. Primary adrenocortical insufficiency and type 1 diabetes were associated with protective human leucocyte antigen genotypes. CONCLUSIONS Multiple presumable autoimmune manifestations, in particular hypoparathyroidism, CMC, and enamel hypoplasia, should prompt further diagnostic workup using autoantibody analyses (eg, interferon-ω) and AIRE sequencing to reveal APS1, even in adults. Treatment is complicated, and mortality is high. Structured follow-up should be performed in a specialized center.
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Affiliation(s)
- Øyvind Bruserud
- Department of Clinical Science (Ø.B., B.E.O., E.B., B.G.N., L.B., P.M.K., K.Lo., A.B.W., E.S.H.), University of Bergen, 5021 Bergen, Norway; Department of Medicine (Solna) (N.L., O.K.), Karolinska Institutet, 171 76 Stockholm, Sweden; Science for Life Laboratory (N.L.), Department of Medical Sciences, University of Uppsala, 751 05 Uppsala, Sweden; Department of Medicine (M.M.E., K.Lo., E.S.H.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Medicine (K.Li.,), Akershus University Hospital, 1474 Nordbyhagen, Norway; Department of Endocrinology (K.Li., A.P.J.), Oslo University Hospital, 0372 Oslo, Norway; Department of Pediatrics (A.G.M.), Oslo University Hospital, 0424 Oslo, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, 9019 Tromsø, Norway; Institute of Clinical Medicine (J.S.), University of Tromsø, The Artic University of Norway, 9019 Tromsø, Norway; Department of Endocrinology (K.J.F.), St. Olavs Hospital, 7006 Trondheim, Norway; Department of Medicine (Å.B.), Stavanger University Hospital, 4011 Stavanger, Norway; Department of Medicine (B.G.N.), Haugesund Hospital, 5504 Haugesund, Norway; Department of Medicine (B.M.), Østfold Hospital, 1603 Fredrikstad, Norway; Department of Immunology (M.K.V.), Oslo University Hospital, 0372 Oslo, Norway; University of Oslo (M.K.V.), 0372 Oslo, Norway; Center for Medical Genetics and Molecular Medicine (P.M.K.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Dentistry (M.C.M.), Faculty of Medicine and Dentistry, University of Bergen, 5021 Bergen, Norway; and Oral Health Centre of Expertise in Western Norway (M.C.M.), 5021 Bergen, Norway
| | - Bergithe E Oftedal
- Department of Clinical Science (Ø.B., B.E.O., E.B., B.G.N., L.B., P.M.K., K.Lo., A.B.W., E.S.H.), University of Bergen, 5021 Bergen, Norway; Department of Medicine (Solna) (N.L., O.K.), Karolinska Institutet, 171 76 Stockholm, Sweden; Science for Life Laboratory (N.L.), Department of Medical Sciences, University of Uppsala, 751 05 Uppsala, Sweden; Department of Medicine (M.M.E., K.Lo., E.S.H.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Medicine (K.Li.,), Akershus University Hospital, 1474 Nordbyhagen, Norway; Department of Endocrinology (K.Li., A.P.J.), Oslo University Hospital, 0372 Oslo, Norway; Department of Pediatrics (A.G.M.), Oslo University Hospital, 0424 Oslo, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, 9019 Tromsø, Norway; Institute of Clinical Medicine (J.S.), University of Tromsø, The Artic University of Norway, 9019 Tromsø, Norway; Department of Endocrinology (K.J.F.), St. Olavs Hospital, 7006 Trondheim, Norway; Department of Medicine (Å.B.), Stavanger University Hospital, 4011 Stavanger, Norway; Department of Medicine (B.G.N.), Haugesund Hospital, 5504 Haugesund, Norway; Department of Medicine (B.M.), Østfold Hospital, 1603 Fredrikstad, Norway; Department of Immunology (M.K.V.), Oslo University Hospital, 0372 Oslo, Norway; University of Oslo (M.K.V.), 0372 Oslo, Norway; Center for Medical Genetics and Molecular Medicine (P.M.K.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Dentistry (M.C.M.), Faculty of Medicine and Dentistry, University of Bergen, 5021 Bergen, Norway; and Oral Health Centre of Expertise in Western Norway (M.C.M.), 5021 Bergen, Norway
| | - Nils Landegren
- Department of Clinical Science (Ø.B., B.E.O., E.B., B.G.N., L.B., P.M.K., K.Lo., A.B.W., E.S.H.), University of Bergen, 5021 Bergen, Norway; Department of Medicine (Solna) (N.L., O.K.), Karolinska Institutet, 171 76 Stockholm, Sweden; Science for Life Laboratory (N.L.), Department of Medical Sciences, University of Uppsala, 751 05 Uppsala, Sweden; Department of Medicine (M.M.E., K.Lo., E.S.H.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Medicine (K.Li.,), Akershus University Hospital, 1474 Nordbyhagen, Norway; Department of Endocrinology (K.Li., A.P.J.), Oslo University Hospital, 0372 Oslo, Norway; Department of Pediatrics (A.G.M.), Oslo University Hospital, 0424 Oslo, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, 9019 Tromsø, Norway; Institute of Clinical Medicine (J.S.), University of Tromsø, The Artic University of Norway, 9019 Tromsø, Norway; Department of Endocrinology (K.J.F.), St. Olavs Hospital, 7006 Trondheim, Norway; Department of Medicine (Å.B.), Stavanger University Hospital, 4011 Stavanger, Norway; Department of Medicine (B.G.N.), Haugesund Hospital, 5504 Haugesund, Norway; Department of Medicine (B.M.), Østfold Hospital, 1603 Fredrikstad, Norway; Department of Immunology (M.K.V.), Oslo University Hospital, 0372 Oslo, Norway; University of Oslo (M.K.V.), 0372 Oslo, Norway; Center for Medical Genetics and Molecular Medicine (P.M.K.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Dentistry (M.C.M.), Faculty of Medicine and Dentistry, University of Bergen, 5021 Bergen, Norway; and Oral Health Centre of Expertise in Western Norway (M.C.M.), 5021 Bergen, Norway
| | - Martina M Erichsen
- Department of Clinical Science (Ø.B., B.E.O., E.B., B.G.N., L.B., P.M.K., K.Lo., A.B.W., E.S.H.), University of Bergen, 5021 Bergen, Norway; Department of Medicine (Solna) (N.L., O.K.), Karolinska Institutet, 171 76 Stockholm, Sweden; Science for Life Laboratory (N.L.), Department of Medical Sciences, University of Uppsala, 751 05 Uppsala, Sweden; Department of Medicine (M.M.E., K.Lo., E.S.H.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Medicine (K.Li.,), Akershus University Hospital, 1474 Nordbyhagen, Norway; Department of Endocrinology (K.Li., A.P.J.), Oslo University Hospital, 0372 Oslo, Norway; Department of Pediatrics (A.G.M.), Oslo University Hospital, 0424 Oslo, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, 9019 Tromsø, Norway; Institute of Clinical Medicine (J.S.), University of Tromsø, The Artic University of Norway, 9019 Tromsø, Norway; Department of Endocrinology (K.J.F.), St. Olavs Hospital, 7006 Trondheim, Norway; Department of Medicine (Å.B.), Stavanger University Hospital, 4011 Stavanger, Norway; Department of Medicine (B.G.N.), Haugesund Hospital, 5504 Haugesund, Norway; Department of Medicine (B.M.), Østfold Hospital, 1603 Fredrikstad, Norway; Department of Immunology (M.K.V.), Oslo University Hospital, 0372 Oslo, Norway; University of Oslo (M.K.V.), 0372 Oslo, Norway; Center for Medical Genetics and Molecular Medicine (P.M.K.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Dentistry (M.C.M.), Faculty of Medicine and Dentistry, University of Bergen, 5021 Bergen, Norway; and Oral Health Centre of Expertise in Western Norway (M.C.M.), 5021 Bergen, Norway
| | - Eirik Bratland
- Department of Clinical Science (Ø.B., B.E.O., E.B., B.G.N., L.B., P.M.K., K.Lo., A.B.W., E.S.H.), University of Bergen, 5021 Bergen, Norway; Department of Medicine (Solna) (N.L., O.K.), Karolinska Institutet, 171 76 Stockholm, Sweden; Science for Life Laboratory (N.L.), Department of Medical Sciences, University of Uppsala, 751 05 Uppsala, Sweden; Department of Medicine (M.M.E., K.Lo., E.S.H.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Medicine (K.Li.,), Akershus University Hospital, 1474 Nordbyhagen, Norway; Department of Endocrinology (K.Li., A.P.J.), Oslo University Hospital, 0372 Oslo, Norway; Department of Pediatrics (A.G.M.), Oslo University Hospital, 0424 Oslo, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, 9019 Tromsø, Norway; Institute of Clinical Medicine (J.S.), University of Tromsø, The Artic University of Norway, 9019 Tromsø, Norway; Department of Endocrinology (K.J.F.), St. Olavs Hospital, 7006 Trondheim, Norway; Department of Medicine (Å.B.), Stavanger University Hospital, 4011 Stavanger, Norway; Department of Medicine (B.G.N.), Haugesund Hospital, 5504 Haugesund, Norway; Department of Medicine (B.M.), Østfold Hospital, 1603 Fredrikstad, Norway; Department of Immunology (M.K.V.), Oslo University Hospital, 0372 Oslo, Norway; University of Oslo (M.K.V.), 0372 Oslo, Norway; Center for Medical Genetics and Molecular Medicine (P.M.K.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Dentistry (M.C.M.), Faculty of Medicine and Dentistry, University of Bergen, 5021 Bergen, Norway; and Oral Health Centre of Expertise in Western Norway (M.C.M.), 5021 Bergen, Norway
| | - Kari Lima
- Department of Clinical Science (Ø.B., B.E.O., E.B., B.G.N., L.B., P.M.K., K.Lo., A.B.W., E.S.H.), University of Bergen, 5021 Bergen, Norway; Department of Medicine (Solna) (N.L., O.K.), Karolinska Institutet, 171 76 Stockholm, Sweden; Science for Life Laboratory (N.L.), Department of Medical Sciences, University of Uppsala, 751 05 Uppsala, Sweden; Department of Medicine (M.M.E., K.Lo., E.S.H.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Medicine (K.Li.,), Akershus University Hospital, 1474 Nordbyhagen, Norway; Department of Endocrinology (K.Li., A.P.J.), Oslo University Hospital, 0372 Oslo, Norway; Department of Pediatrics (A.G.M.), Oslo University Hospital, 0424 Oslo, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, 9019 Tromsø, Norway; Institute of Clinical Medicine (J.S.), University of Tromsø, The Artic University of Norway, 9019 Tromsø, Norway; Department of Endocrinology (K.J.F.), St. Olavs Hospital, 7006 Trondheim, Norway; Department of Medicine (Å.B.), Stavanger University Hospital, 4011 Stavanger, Norway; Department of Medicine (B.G.N.), Haugesund Hospital, 5504 Haugesund, Norway; Department of Medicine (B.M.), Østfold Hospital, 1603 Fredrikstad, Norway; Department of Immunology (M.K.V.), Oslo University Hospital, 0372 Oslo, Norway; University of Oslo (M.K.V.), 0372 Oslo, Norway; Center for Medical Genetics and Molecular Medicine (P.M.K.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Dentistry (M.C.M.), Faculty of Medicine and Dentistry, University of Bergen, 5021 Bergen, Norway; and Oral Health Centre of Expertise in Western Norway (M.C.M.), 5021 Bergen, Norway
| | - Anders P Jørgensen
- Department of Clinical Science (Ø.B., B.E.O., E.B., B.G.N., L.B., P.M.K., K.Lo., A.B.W., E.S.H.), University of Bergen, 5021 Bergen, Norway; Department of Medicine (Solna) (N.L., O.K.), Karolinska Institutet, 171 76 Stockholm, Sweden; Science for Life Laboratory (N.L.), Department of Medical Sciences, University of Uppsala, 751 05 Uppsala, Sweden; Department of Medicine (M.M.E., K.Lo., E.S.H.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Medicine (K.Li.,), Akershus University Hospital, 1474 Nordbyhagen, Norway; Department of Endocrinology (K.Li., A.P.J.), Oslo University Hospital, 0372 Oslo, Norway; Department of Pediatrics (A.G.M.), Oslo University Hospital, 0424 Oslo, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, 9019 Tromsø, Norway; Institute of Clinical Medicine (J.S.), University of Tromsø, The Artic University of Norway, 9019 Tromsø, Norway; Department of Endocrinology (K.J.F.), St. Olavs Hospital, 7006 Trondheim, Norway; Department of Medicine (Å.B.), Stavanger University Hospital, 4011 Stavanger, Norway; Department of Medicine (B.G.N.), Haugesund Hospital, 5504 Haugesund, Norway; Department of Medicine (B.M.), Østfold Hospital, 1603 Fredrikstad, Norway; Department of Immunology (M.K.V.), Oslo University Hospital, 0372 Oslo, Norway; University of Oslo (M.K.V.), 0372 Oslo, Norway; Center for Medical Genetics and Molecular Medicine (P.M.K.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Dentistry (M.C.M.), Faculty of Medicine and Dentistry, University of Bergen, 5021 Bergen, Norway; and Oral Health Centre of Expertise in Western Norway (M.C.M.), 5021 Bergen, Norway
| | - Anne G Myhre
- Department of Clinical Science (Ø.B., B.E.O., E.B., B.G.N., L.B., P.M.K., K.Lo., A.B.W., E.S.H.), University of Bergen, 5021 Bergen, Norway; Department of Medicine (Solna) (N.L., O.K.), Karolinska Institutet, 171 76 Stockholm, Sweden; Science for Life Laboratory (N.L.), Department of Medical Sciences, University of Uppsala, 751 05 Uppsala, Sweden; Department of Medicine (M.M.E., K.Lo., E.S.H.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Medicine (K.Li.,), Akershus University Hospital, 1474 Nordbyhagen, Norway; Department of Endocrinology (K.Li., A.P.J.), Oslo University Hospital, 0372 Oslo, Norway; Department of Pediatrics (A.G.M.), Oslo University Hospital, 0424 Oslo, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, 9019 Tromsø, Norway; Institute of Clinical Medicine (J.S.), University of Tromsø, The Artic University of Norway, 9019 Tromsø, Norway; Department of Endocrinology (K.J.F.), St. Olavs Hospital, 7006 Trondheim, Norway; Department of Medicine (Å.B.), Stavanger University Hospital, 4011 Stavanger, Norway; Department of Medicine (B.G.N.), Haugesund Hospital, 5504 Haugesund, Norway; Department of Medicine (B.M.), Østfold Hospital, 1603 Fredrikstad, Norway; Department of Immunology (M.K.V.), Oslo University Hospital, 0372 Oslo, Norway; University of Oslo (M.K.V.), 0372 Oslo, Norway; Center for Medical Genetics and Molecular Medicine (P.M.K.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Dentistry (M.C.M.), Faculty of Medicine and Dentistry, University of Bergen, 5021 Bergen, Norway; and Oral Health Centre of Expertise in Western Norway (M.C.M.), 5021 Bergen, Norway
| | - Johan Svartberg
- Department of Clinical Science (Ø.B., B.E.O., E.B., B.G.N., L.B., P.M.K., K.Lo., A.B.W., E.S.H.), University of Bergen, 5021 Bergen, Norway; Department of Medicine (Solna) (N.L., O.K.), Karolinska Institutet, 171 76 Stockholm, Sweden; Science for Life Laboratory (N.L.), Department of Medical Sciences, University of Uppsala, 751 05 Uppsala, Sweden; Department of Medicine (M.M.E., K.Lo., E.S.H.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Medicine (K.Li.,), Akershus University Hospital, 1474 Nordbyhagen, Norway; Department of Endocrinology (K.Li., A.P.J.), Oslo University Hospital, 0372 Oslo, Norway; Department of Pediatrics (A.G.M.), Oslo University Hospital, 0424 Oslo, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, 9019 Tromsø, Norway; Institute of Clinical Medicine (J.S.), University of Tromsø, The Artic University of Norway, 9019 Tromsø, Norway; Department of Endocrinology (K.J.F.), St. Olavs Hospital, 7006 Trondheim, Norway; Department of Medicine (Å.B.), Stavanger University Hospital, 4011 Stavanger, Norway; Department of Medicine (B.G.N.), Haugesund Hospital, 5504 Haugesund, Norway; Department of Medicine (B.M.), Østfold Hospital, 1603 Fredrikstad, Norway; Department of Immunology (M.K.V.), Oslo University Hospital, 0372 Oslo, Norway; University of Oslo (M.K.V.), 0372 Oslo, Norway; Center for Medical Genetics and Molecular Medicine (P.M.K.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Dentistry (M.C.M.), Faculty of Medicine and Dentistry, University of Bergen, 5021 Bergen, Norway; and Oral Health Centre of Expertise in Western Norway (M.C.M.), 5021 Bergen, Norway
| | - Kristian J Fougner
- Department of Clinical Science (Ø.B., B.E.O., E.B., B.G.N., L.B., P.M.K., K.Lo., A.B.W., E.S.H.), University of Bergen, 5021 Bergen, Norway; Department of Medicine (Solna) (N.L., O.K.), Karolinska Institutet, 171 76 Stockholm, Sweden; Science for Life Laboratory (N.L.), Department of Medical Sciences, University of Uppsala, 751 05 Uppsala, Sweden; Department of Medicine (M.M.E., K.Lo., E.S.H.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Medicine (K.Li.,), Akershus University Hospital, 1474 Nordbyhagen, Norway; Department of Endocrinology (K.Li., A.P.J.), Oslo University Hospital, 0372 Oslo, Norway; Department of Pediatrics (A.G.M.), Oslo University Hospital, 0424 Oslo, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, 9019 Tromsø, Norway; Institute of Clinical Medicine (J.S.), University of Tromsø, The Artic University of Norway, 9019 Tromsø, Norway; Department of Endocrinology (K.J.F.), St. Olavs Hospital, 7006 Trondheim, Norway; Department of Medicine (Å.B.), Stavanger University Hospital, 4011 Stavanger, Norway; Department of Medicine (B.G.N.), Haugesund Hospital, 5504 Haugesund, Norway; Department of Medicine (B.M.), Østfold Hospital, 1603 Fredrikstad, Norway; Department of Immunology (M.K.V.), Oslo University Hospital, 0372 Oslo, Norway; University of Oslo (M.K.V.), 0372 Oslo, Norway; Center for Medical Genetics and Molecular Medicine (P.M.K.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Dentistry (M.C.M.), Faculty of Medicine and Dentistry, University of Bergen, 5021 Bergen, Norway; and Oral Health Centre of Expertise in Western Norway (M.C.M.), 5021 Bergen, Norway
| | - Åsne Bakke
- Department of Clinical Science (Ø.B., B.E.O., E.B., B.G.N., L.B., P.M.K., K.Lo., A.B.W., E.S.H.), University of Bergen, 5021 Bergen, Norway; Department of Medicine (Solna) (N.L., O.K.), Karolinska Institutet, 171 76 Stockholm, Sweden; Science for Life Laboratory (N.L.), Department of Medical Sciences, University of Uppsala, 751 05 Uppsala, Sweden; Department of Medicine (M.M.E., K.Lo., E.S.H.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Medicine (K.Li.,), Akershus University Hospital, 1474 Nordbyhagen, Norway; Department of Endocrinology (K.Li., A.P.J.), Oslo University Hospital, 0372 Oslo, Norway; Department of Pediatrics (A.G.M.), Oslo University Hospital, 0424 Oslo, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, 9019 Tromsø, Norway; Institute of Clinical Medicine (J.S.), University of Tromsø, The Artic University of Norway, 9019 Tromsø, Norway; Department of Endocrinology (K.J.F.), St. Olavs Hospital, 7006 Trondheim, Norway; Department of Medicine (Å.B.), Stavanger University Hospital, 4011 Stavanger, Norway; Department of Medicine (B.G.N.), Haugesund Hospital, 5504 Haugesund, Norway; Department of Medicine (B.M.), Østfold Hospital, 1603 Fredrikstad, Norway; Department of Immunology (M.K.V.), Oslo University Hospital, 0372 Oslo, Norway; University of Oslo (M.K.V.), 0372 Oslo, Norway; Center for Medical Genetics and Molecular Medicine (P.M.K.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Dentistry (M.C.M.), Faculty of Medicine and Dentistry, University of Bergen, 5021 Bergen, Norway; and Oral Health Centre of Expertise in Western Norway (M.C.M.), 5021 Bergen, Norway
| | - Bjørn G Nedrebø
- Department of Clinical Science (Ø.B., B.E.O., E.B., B.G.N., L.B., P.M.K., K.Lo., A.B.W., E.S.H.), University of Bergen, 5021 Bergen, Norway; Department of Medicine (Solna) (N.L., O.K.), Karolinska Institutet, 171 76 Stockholm, Sweden; Science for Life Laboratory (N.L.), Department of Medical Sciences, University of Uppsala, 751 05 Uppsala, Sweden; Department of Medicine (M.M.E., K.Lo., E.S.H.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Medicine (K.Li.,), Akershus University Hospital, 1474 Nordbyhagen, Norway; Department of Endocrinology (K.Li., A.P.J.), Oslo University Hospital, 0372 Oslo, Norway; Department of Pediatrics (A.G.M.), Oslo University Hospital, 0424 Oslo, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, 9019 Tromsø, Norway; Institute of Clinical Medicine (J.S.), University of Tromsø, The Artic University of Norway, 9019 Tromsø, Norway; Department of Endocrinology (K.J.F.), St. Olavs Hospital, 7006 Trondheim, Norway; Department of Medicine (Å.B.), Stavanger University Hospital, 4011 Stavanger, Norway; Department of Medicine (B.G.N.), Haugesund Hospital, 5504 Haugesund, Norway; Department of Medicine (B.M.), Østfold Hospital, 1603 Fredrikstad, Norway; Department of Immunology (M.K.V.), Oslo University Hospital, 0372 Oslo, Norway; University of Oslo (M.K.V.), 0372 Oslo, Norway; Center for Medical Genetics and Molecular Medicine (P.M.K.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Dentistry (M.C.M.), Faculty of Medicine and Dentistry, University of Bergen, 5021 Bergen, Norway; and Oral Health Centre of Expertise in Western Norway (M.C.M.), 5021 Bergen, Norway
| | - Bjarne Mella
- Department of Clinical Science (Ø.B., B.E.O., E.B., B.G.N., L.B., P.M.K., K.Lo., A.B.W., E.S.H.), University of Bergen, 5021 Bergen, Norway; Department of Medicine (Solna) (N.L., O.K.), Karolinska Institutet, 171 76 Stockholm, Sweden; Science for Life Laboratory (N.L.), Department of Medical Sciences, University of Uppsala, 751 05 Uppsala, Sweden; Department of Medicine (M.M.E., K.Lo., E.S.H.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Medicine (K.Li.,), Akershus University Hospital, 1474 Nordbyhagen, Norway; Department of Endocrinology (K.Li., A.P.J.), Oslo University Hospital, 0372 Oslo, Norway; Department of Pediatrics (A.G.M.), Oslo University Hospital, 0424 Oslo, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, 9019 Tromsø, Norway; Institute of Clinical Medicine (J.S.), University of Tromsø, The Artic University of Norway, 9019 Tromsø, Norway; Department of Endocrinology (K.J.F.), St. Olavs Hospital, 7006 Trondheim, Norway; Department of Medicine (Å.B.), Stavanger University Hospital, 4011 Stavanger, Norway; Department of Medicine (B.G.N.), Haugesund Hospital, 5504 Haugesund, Norway; Department of Medicine (B.M.), Østfold Hospital, 1603 Fredrikstad, Norway; Department of Immunology (M.K.V.), Oslo University Hospital, 0372 Oslo, Norway; University of Oslo (M.K.V.), 0372 Oslo, Norway; Center for Medical Genetics and Molecular Medicine (P.M.K.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Dentistry (M.C.M.), Faculty of Medicine and Dentistry, University of Bergen, 5021 Bergen, Norway; and Oral Health Centre of Expertise in Western Norway (M.C.M.), 5021 Bergen, Norway
| | - Lars Breivik
- Department of Clinical Science (Ø.B., B.E.O., E.B., B.G.N., L.B., P.M.K., K.Lo., A.B.W., E.S.H.), University of Bergen, 5021 Bergen, Norway; Department of Medicine (Solna) (N.L., O.K.), Karolinska Institutet, 171 76 Stockholm, Sweden; Science for Life Laboratory (N.L.), Department of Medical Sciences, University of Uppsala, 751 05 Uppsala, Sweden; Department of Medicine (M.M.E., K.Lo., E.S.H.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Medicine (K.Li.,), Akershus University Hospital, 1474 Nordbyhagen, Norway; Department of Endocrinology (K.Li., A.P.J.), Oslo University Hospital, 0372 Oslo, Norway; Department of Pediatrics (A.G.M.), Oslo University Hospital, 0424 Oslo, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, 9019 Tromsø, Norway; Institute of Clinical Medicine (J.S.), University of Tromsø, The Artic University of Norway, 9019 Tromsø, Norway; Department of Endocrinology (K.J.F.), St. Olavs Hospital, 7006 Trondheim, Norway; Department of Medicine (Å.B.), Stavanger University Hospital, 4011 Stavanger, Norway; Department of Medicine (B.G.N.), Haugesund Hospital, 5504 Haugesund, Norway; Department of Medicine (B.M.), Østfold Hospital, 1603 Fredrikstad, Norway; Department of Immunology (M.K.V.), Oslo University Hospital, 0372 Oslo, Norway; University of Oslo (M.K.V.), 0372 Oslo, Norway; Center for Medical Genetics and Molecular Medicine (P.M.K.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Dentistry (M.C.M.), Faculty of Medicine and Dentistry, University of Bergen, 5021 Bergen, Norway; and Oral Health Centre of Expertise in Western Norway (M.C.M.), 5021 Bergen, Norway
| | - Marte K Viken
- Department of Clinical Science (Ø.B., B.E.O., E.B., B.G.N., L.B., P.M.K., K.Lo., A.B.W., E.S.H.), University of Bergen, 5021 Bergen, Norway; Department of Medicine (Solna) (N.L., O.K.), Karolinska Institutet, 171 76 Stockholm, Sweden; Science for Life Laboratory (N.L.), Department of Medical Sciences, University of Uppsala, 751 05 Uppsala, Sweden; Department of Medicine (M.M.E., K.Lo., E.S.H.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Medicine (K.Li.,), Akershus University Hospital, 1474 Nordbyhagen, Norway; Department of Endocrinology (K.Li., A.P.J.), Oslo University Hospital, 0372 Oslo, Norway; Department of Pediatrics (A.G.M.), Oslo University Hospital, 0424 Oslo, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, 9019 Tromsø, Norway; Institute of Clinical Medicine (J.S.), University of Tromsø, The Artic University of Norway, 9019 Tromsø, Norway; Department of Endocrinology (K.J.F.), St. Olavs Hospital, 7006 Trondheim, Norway; Department of Medicine (Å.B.), Stavanger University Hospital, 4011 Stavanger, Norway; Department of Medicine (B.G.N.), Haugesund Hospital, 5504 Haugesund, Norway; Department of Medicine (B.M.), Østfold Hospital, 1603 Fredrikstad, Norway; Department of Immunology (M.K.V.), Oslo University Hospital, 0372 Oslo, Norway; University of Oslo (M.K.V.), 0372 Oslo, Norway; Center for Medical Genetics and Molecular Medicine (P.M.K.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Dentistry (M.C.M.), Faculty of Medicine and Dentistry, University of Bergen, 5021 Bergen, Norway; and Oral Health Centre of Expertise in Western Norway (M.C.M.), 5021 Bergen, Norway
| | - Per M Knappskog
- Department of Clinical Science (Ø.B., B.E.O., E.B., B.G.N., L.B., P.M.K., K.Lo., A.B.W., E.S.H.), University of Bergen, 5021 Bergen, Norway; Department of Medicine (Solna) (N.L., O.K.), Karolinska Institutet, 171 76 Stockholm, Sweden; Science for Life Laboratory (N.L.), Department of Medical Sciences, University of Uppsala, 751 05 Uppsala, Sweden; Department of Medicine (M.M.E., K.Lo., E.S.H.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Medicine (K.Li.,), Akershus University Hospital, 1474 Nordbyhagen, Norway; Department of Endocrinology (K.Li., A.P.J.), Oslo University Hospital, 0372 Oslo, Norway; Department of Pediatrics (A.G.M.), Oslo University Hospital, 0424 Oslo, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, 9019 Tromsø, Norway; Institute of Clinical Medicine (J.S.), University of Tromsø, The Artic University of Norway, 9019 Tromsø, Norway; Department of Endocrinology (K.J.F.), St. Olavs Hospital, 7006 Trondheim, Norway; Department of Medicine (Å.B.), Stavanger University Hospital, 4011 Stavanger, Norway; Department of Medicine (B.G.N.), Haugesund Hospital, 5504 Haugesund, Norway; Department of Medicine (B.M.), Østfold Hospital, 1603 Fredrikstad, Norway; Department of Immunology (M.K.V.), Oslo University Hospital, 0372 Oslo, Norway; University of Oslo (M.K.V.), 0372 Oslo, Norway; Center for Medical Genetics and Molecular Medicine (P.M.K.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Dentistry (M.C.M.), Faculty of Medicine and Dentistry, University of Bergen, 5021 Bergen, Norway; and Oral Health Centre of Expertise in Western Norway (M.C.M.), 5021 Bergen, Norway
| | - Mihaela C Marthinussen
- Department of Clinical Science (Ø.B., B.E.O., E.B., B.G.N., L.B., P.M.K., K.Lo., A.B.W., E.S.H.), University of Bergen, 5021 Bergen, Norway; Department of Medicine (Solna) (N.L., O.K.), Karolinska Institutet, 171 76 Stockholm, Sweden; Science for Life Laboratory (N.L.), Department of Medical Sciences, University of Uppsala, 751 05 Uppsala, Sweden; Department of Medicine (M.M.E., K.Lo., E.S.H.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Medicine (K.Li.,), Akershus University Hospital, 1474 Nordbyhagen, Norway; Department of Endocrinology (K.Li., A.P.J.), Oslo University Hospital, 0372 Oslo, Norway; Department of Pediatrics (A.G.M.), Oslo University Hospital, 0424 Oslo, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, 9019 Tromsø, Norway; Institute of Clinical Medicine (J.S.), University of Tromsø, The Artic University of Norway, 9019 Tromsø, Norway; Department of Endocrinology (K.J.F.), St. Olavs Hospital, 7006 Trondheim, Norway; Department of Medicine (Å.B.), Stavanger University Hospital, 4011 Stavanger, Norway; Department of Medicine (B.G.N.), Haugesund Hospital, 5504 Haugesund, Norway; Department of Medicine (B.M.), Østfold Hospital, 1603 Fredrikstad, Norway; Department of Immunology (M.K.V.), Oslo University Hospital, 0372 Oslo, Norway; University of Oslo (M.K.V.), 0372 Oslo, Norway; Center for Medical Genetics and Molecular Medicine (P.M.K.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Dentistry (M.C.M.), Faculty of Medicine and Dentistry, University of Bergen, 5021 Bergen, Norway; and Oral Health Centre of Expertise in Western Norway (M.C.M.), 5021 Bergen, Norway
| | - Kristian Løvås
- Department of Clinical Science (Ø.B., B.E.O., E.B., B.G.N., L.B., P.M.K., K.Lo., A.B.W., E.S.H.), University of Bergen, 5021 Bergen, Norway; Department of Medicine (Solna) (N.L., O.K.), Karolinska Institutet, 171 76 Stockholm, Sweden; Science for Life Laboratory (N.L.), Department of Medical Sciences, University of Uppsala, 751 05 Uppsala, Sweden; Department of Medicine (M.M.E., K.Lo., E.S.H.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Medicine (K.Li.,), Akershus University Hospital, 1474 Nordbyhagen, Norway; Department of Endocrinology (K.Li., A.P.J.), Oslo University Hospital, 0372 Oslo, Norway; Department of Pediatrics (A.G.M.), Oslo University Hospital, 0424 Oslo, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, 9019 Tromsø, Norway; Institute of Clinical Medicine (J.S.), University of Tromsø, The Artic University of Norway, 9019 Tromsø, Norway; Department of Endocrinology (K.J.F.), St. Olavs Hospital, 7006 Trondheim, Norway; Department of Medicine (Å.B.), Stavanger University Hospital, 4011 Stavanger, Norway; Department of Medicine (B.G.N.), Haugesund Hospital, 5504 Haugesund, Norway; Department of Medicine (B.M.), Østfold Hospital, 1603 Fredrikstad, Norway; Department of Immunology (M.K.V.), Oslo University Hospital, 0372 Oslo, Norway; University of Oslo (M.K.V.), 0372 Oslo, Norway; Center for Medical Genetics and Molecular Medicine (P.M.K.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Dentistry (M.C.M.), Faculty of Medicine and Dentistry, University of Bergen, 5021 Bergen, Norway; and Oral Health Centre of Expertise in Western Norway (M.C.M.), 5021 Bergen, Norway
| | - Olle Kämpe
- Department of Clinical Science (Ø.B., B.E.O., E.B., B.G.N., L.B., P.M.K., K.Lo., A.B.W., E.S.H.), University of Bergen, 5021 Bergen, Norway; Department of Medicine (Solna) (N.L., O.K.), Karolinska Institutet, 171 76 Stockholm, Sweden; Science for Life Laboratory (N.L.), Department of Medical Sciences, University of Uppsala, 751 05 Uppsala, Sweden; Department of Medicine (M.M.E., K.Lo., E.S.H.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Medicine (K.Li.,), Akershus University Hospital, 1474 Nordbyhagen, Norway; Department of Endocrinology (K.Li., A.P.J.), Oslo University Hospital, 0372 Oslo, Norway; Department of Pediatrics (A.G.M.), Oslo University Hospital, 0424 Oslo, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, 9019 Tromsø, Norway; Institute of Clinical Medicine (J.S.), University of Tromsø, The Artic University of Norway, 9019 Tromsø, Norway; Department of Endocrinology (K.J.F.), St. Olavs Hospital, 7006 Trondheim, Norway; Department of Medicine (Å.B.), Stavanger University Hospital, 4011 Stavanger, Norway; Department of Medicine (B.G.N.), Haugesund Hospital, 5504 Haugesund, Norway; Department of Medicine (B.M.), Østfold Hospital, 1603 Fredrikstad, Norway; Department of Immunology (M.K.V.), Oslo University Hospital, 0372 Oslo, Norway; University of Oslo (M.K.V.), 0372 Oslo, Norway; Center for Medical Genetics and Molecular Medicine (P.M.K.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Dentistry (M.C.M.), Faculty of Medicine and Dentistry, University of Bergen, 5021 Bergen, Norway; and Oral Health Centre of Expertise in Western Norway (M.C.M.), 5021 Bergen, Norway
| | - Anette B Wolff
- Department of Clinical Science (Ø.B., B.E.O., E.B., B.G.N., L.B., P.M.K., K.Lo., A.B.W., E.S.H.), University of Bergen, 5021 Bergen, Norway; Department of Medicine (Solna) (N.L., O.K.), Karolinska Institutet, 171 76 Stockholm, Sweden; Science for Life Laboratory (N.L.), Department of Medical Sciences, University of Uppsala, 751 05 Uppsala, Sweden; Department of Medicine (M.M.E., K.Lo., E.S.H.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Medicine (K.Li.,), Akershus University Hospital, 1474 Nordbyhagen, Norway; Department of Endocrinology (K.Li., A.P.J.), Oslo University Hospital, 0372 Oslo, Norway; Department of Pediatrics (A.G.M.), Oslo University Hospital, 0424 Oslo, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, 9019 Tromsø, Norway; Institute of Clinical Medicine (J.S.), University of Tromsø, The Artic University of Norway, 9019 Tromsø, Norway; Department of Endocrinology (K.J.F.), St. Olavs Hospital, 7006 Trondheim, Norway; Department of Medicine (Å.B.), Stavanger University Hospital, 4011 Stavanger, Norway; Department of Medicine (B.G.N.), Haugesund Hospital, 5504 Haugesund, Norway; Department of Medicine (B.M.), Østfold Hospital, 1603 Fredrikstad, Norway; Department of Immunology (M.K.V.), Oslo University Hospital, 0372 Oslo, Norway; University of Oslo (M.K.V.), 0372 Oslo, Norway; Center for Medical Genetics and Molecular Medicine (P.M.K.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Dentistry (M.C.M.), Faculty of Medicine and Dentistry, University of Bergen, 5021 Bergen, Norway; and Oral Health Centre of Expertise in Western Norway (M.C.M.), 5021 Bergen, Norway
| | - Eystein S Husebye
- Department of Clinical Science (Ø.B., B.E.O., E.B., B.G.N., L.B., P.M.K., K.Lo., A.B.W., E.S.H.), University of Bergen, 5021 Bergen, Norway; Department of Medicine (Solna) (N.L., O.K.), Karolinska Institutet, 171 76 Stockholm, Sweden; Science for Life Laboratory (N.L.), Department of Medical Sciences, University of Uppsala, 751 05 Uppsala, Sweden; Department of Medicine (M.M.E., K.Lo., E.S.H.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Medicine (K.Li.,), Akershus University Hospital, 1474 Nordbyhagen, Norway; Department of Endocrinology (K.Li., A.P.J.), Oslo University Hospital, 0372 Oslo, Norway; Department of Pediatrics (A.G.M.), Oslo University Hospital, 0424 Oslo, Norway; Division of Internal Medicine (J.S.), University Hospital of North Norway, 9019 Tromsø, Norway; Institute of Clinical Medicine (J.S.), University of Tromsø, The Artic University of Norway, 9019 Tromsø, Norway; Department of Endocrinology (K.J.F.), St. Olavs Hospital, 7006 Trondheim, Norway; Department of Medicine (Å.B.), Stavanger University Hospital, 4011 Stavanger, Norway; Department of Medicine (B.G.N.), Haugesund Hospital, 5504 Haugesund, Norway; Department of Medicine (B.M.), Østfold Hospital, 1603 Fredrikstad, Norway; Department of Immunology (M.K.V.), Oslo University Hospital, 0372 Oslo, Norway; University of Oslo (M.K.V.), 0372 Oslo, Norway; Center for Medical Genetics and Molecular Medicine (P.M.K.), Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Dentistry (M.C.M.), Faculty of Medicine and Dentistry, University of Bergen, 5021 Bergen, Norway; and Oral Health Centre of Expertise in Western Norway (M.C.M.), 5021 Bergen, Norway
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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: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 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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Jorde R, Sollid ST, Svartberg J, Joakimsen RM, Grimnes G, Hutchinson MYS. Prevention of urinary tract infections with vitamin D supplementation 20,000 IU per week for five years. Results from an RCT including 511 subjects. Infect Dis (Lond) 2016; 48:823-8. [DOI: 10.1080/23744235.2016.1201853] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Rolf Jorde
- Department of Clinical Medicine, Tromsø Endocrine Research Group, UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Stina T. Sollid
- Department of Clinical Medicine, Tromsø Endocrine Research Group, UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Johan Svartberg
- Department of Clinical Medicine, Tromsø Endocrine Research Group, UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Ragnar M. Joakimsen
- Department of Clinical Medicine, Tromsø Endocrine Research Group, UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Guri Grimnes
- Department of Clinical Medicine, Tromsø Endocrine Research Group, UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Moira Y. S. Hutchinson
- Division of Head and Motion, Department of Rheumatology, Nordland Hospital, Bodø, Norway
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Jorde R, Sollid ST, Svartberg J, Schirmer H, Joakimsen RM, Njølstad I, Fuskevåg OM, Figenschau Y, Hutchinson MYS. Vitamin D 20,000 IU per Week for Five Years Does Not Prevent Progression From Prediabetes to Diabetes. J Clin Endocrinol Metab 2016; 101:1647-55. [PMID: 26829443 DOI: 10.1210/jc.2015-4013] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [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] [Indexed: 12/26/2022]
Abstract
CONTEXT Vitamin D deficiency is associated with insulin resistance and risk of future diabetes. OBJECTIVE The objective of the study was to test whether supplementation with vitamin D to subjects with prediabetes will prevent progression to type 2 diabetes mellitus (T2DM). DESIGN This was a randomized controlled trial performed in 2008 through 2015. SETTING The study was conducted at the clinical research unit at a teaching hospital. PATIENTS Five hundred eleven subjects (mean age 62 y, 314 males) with prediabetes diagnosed with an oral glucose tolerance test as part of the Tromsø Study 2007–2008 were included. A total of 256 were randomized to vitamin D and 255 to placebo. Twenty-nine subjects in the vitamin D and 24 in the placebo group withdrew because of adverse events. INTERVENTIONS Interventions included vitamin D (cholecalciferol) 20 000 IU/wk vs placebo for 5 years. Annual oral glucose tolerance tests were performed. MAIN OUTCOME MEASURE Progression to T2DM was the main outcome measure. Secondary outcomes were change in glucose levels, insulin resistance, serum lipids, and blood pressure. RESULTS The mean baseline serum 25-hydroxyvitamin D level was 60 nmol/L (24 ng/mL). One hundred three in the vitamin D and 112 in the placebo group developed T2DM (hazard risk 0.90; 95% confidence interval 0.69–1.18, Cox regression, P = .45, intention to treat analysis). No consistent significant effects on the other outcomes were seen. Subgroup analyses in subjects with low baseline 25-hydroxyvitamin D yielded similar results. No serious side effects related to the intervention were recorded. CONCLUSIONS In subjects without vitamin D deficiency, vitamin D supplementation is unlikely to prevent progression from prediabetes to diabetes. Very large studies with inclusion of vitamin D-deficient subjects will probably be needed to show such a putative effect. This study tested if supplementation with vitamin D to subjects with prediabetes will prevent progression to type 2 diabetes (T2DM).
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Affiliation(s)
- Rolf Jorde
- Tromsø Endocrine Research Group (R.J., S.T.S., J.S., R.M.J., Y.F.), Department of Clinical Medicine, Department of Clinical Medicine (H.S.), Epidemiology of Chronic Diseases Research Group (I.N.), Department of Community Medicine, Department of Medical Biology (Y.F.), UiT The Arctic University of Norway, 9037 Tromsø, Norway; Division of Internal Medicine (R.J., S.T.S., J.S., R.M.J.), Division of Diagnostic Services (O.M.F., Y.F.), University Hospital of North Norway, 9038 Tromsø, Norway; and Division of Head and Motion (M.Y.S.H.), Department of Rheumatology, Nordland Hospital, 8092 Bodø, Norway
| | - Stina T Sollid
- Tromsø Endocrine Research Group (R.J., S.T.S., J.S., R.M.J., Y.F.), Department of Clinical Medicine, Department of Clinical Medicine (H.S.), Epidemiology of Chronic Diseases Research Group (I.N.), Department of Community Medicine, Department of Medical Biology (Y.F.), UiT The Arctic University of Norway, 9037 Tromsø, Norway; Division of Internal Medicine (R.J., S.T.S., J.S., R.M.J.), Division of Diagnostic Services (O.M.F., Y.F.), University Hospital of North Norway, 9038 Tromsø, Norway; and Division of Head and Motion (M.Y.S.H.), Department of Rheumatology, Nordland Hospital, 8092 Bodø, Norway
| | - Johan Svartberg
- Tromsø Endocrine Research Group (R.J., S.T.S., J.S., R.M.J., Y.F.), Department of Clinical Medicine, Department of Clinical Medicine (H.S.), Epidemiology of Chronic Diseases Research Group (I.N.), Department of Community Medicine, Department of Medical Biology (Y.F.), UiT The Arctic University of Norway, 9037 Tromsø, Norway; Division of Internal Medicine (R.J., S.T.S., J.S., R.M.J.), Division of Diagnostic Services (O.M.F., Y.F.), University Hospital of North Norway, 9038 Tromsø, Norway; and Division of Head and Motion (M.Y.S.H.), Department of Rheumatology, Nordland Hospital, 8092 Bodø, Norway
| | - Henrik Schirmer
- Tromsø Endocrine Research Group (R.J., S.T.S., J.S., R.M.J., Y.F.), Department of Clinical Medicine, Department of Clinical Medicine (H.S.), Epidemiology of Chronic Diseases Research Group (I.N.), Department of Community Medicine, Department of Medical Biology (Y.F.), UiT The Arctic University of Norway, 9037 Tromsø, Norway; Division of Internal Medicine (R.J., S.T.S., J.S., R.M.J.), Division of Diagnostic Services (O.M.F., Y.F.), University Hospital of North Norway, 9038 Tromsø, Norway; and Division of Head and Motion (M.Y.S.H.), Department of Rheumatology, Nordland Hospital, 8092 Bodø, Norway
| | - Ragnar M Joakimsen
- Tromsø Endocrine Research Group (R.J., S.T.S., J.S., R.M.J., Y.F.), Department of Clinical Medicine, Department of Clinical Medicine (H.S.), Epidemiology of Chronic Diseases Research Group (I.N.), Department of Community Medicine, Department of Medical Biology (Y.F.), UiT The Arctic University of Norway, 9037 Tromsø, Norway; Division of Internal Medicine (R.J., S.T.S., J.S., R.M.J.), Division of Diagnostic Services (O.M.F., Y.F.), University Hospital of North Norway, 9038 Tromsø, Norway; and Division of Head and Motion (M.Y.S.H.), Department of Rheumatology, Nordland Hospital, 8092 Bodø, Norway
| | - Inger Njølstad
- Tromsø Endocrine Research Group (R.J., S.T.S., J.S., R.M.J., Y.F.), Department of Clinical Medicine, Department of Clinical Medicine (H.S.), Epidemiology of Chronic Diseases Research Group (I.N.), Department of Community Medicine, Department of Medical Biology (Y.F.), UiT The Arctic University of Norway, 9037 Tromsø, Norway; Division of Internal Medicine (R.J., S.T.S., J.S., R.M.J.), Division of Diagnostic Services (O.M.F., Y.F.), University Hospital of North Norway, 9038 Tromsø, Norway; and Division of Head and Motion (M.Y.S.H.), Department of Rheumatology, Nordland Hospital, 8092 Bodø, Norway
| | - Ole M Fuskevåg
- Tromsø Endocrine Research Group (R.J., S.T.S., J.S., R.M.J., Y.F.), Department of Clinical Medicine, Department of Clinical Medicine (H.S.), Epidemiology of Chronic Diseases Research Group (I.N.), Department of Community Medicine, Department of Medical Biology (Y.F.), UiT The Arctic University of Norway, 9037 Tromsø, Norway; Division of Internal Medicine (R.J., S.T.S., J.S., R.M.J.), Division of Diagnostic Services (O.M.F., Y.F.), University Hospital of North Norway, 9038 Tromsø, Norway; and Division of Head and Motion (M.Y.S.H.), Department of Rheumatology, Nordland Hospital, 8092 Bodø, Norway
| | - Yngve Figenschau
- Tromsø Endocrine Research Group (R.J., S.T.S., J.S., R.M.J., Y.F.), Department of Clinical Medicine, Department of Clinical Medicine (H.S.), Epidemiology of Chronic Diseases Research Group (I.N.), Department of Community Medicine, Department of Medical Biology (Y.F.), UiT The Arctic University of Norway, 9037 Tromsø, Norway; Division of Internal Medicine (R.J., S.T.S., J.S., R.M.J.), Division of Diagnostic Services (O.M.F., Y.F.), University Hospital of North Norway, 9038 Tromsø, Norway; and Division of Head and Motion (M.Y.S.H.), Department of Rheumatology, Nordland Hospital, 8092 Bodø, Norway
| | - Moira Y S Hutchinson
- Tromsø Endocrine Research Group (R.J., S.T.S., J.S., R.M.J., Y.F.), Department of Clinical Medicine, Department of Clinical Medicine (H.S.), Epidemiology of Chronic Diseases Research Group (I.N.), Department of Community Medicine, Department of Medical Biology (Y.F.), UiT The Arctic University of Norway, 9037 Tromsø, Norway; Division of Internal Medicine (R.J., S.T.S., J.S., R.M.J.), Division of Diagnostic Services (O.M.F., Y.F.), University Hospital of North Norway, 9038 Tromsø, Norway; and Division of Head and Motion (M.Y.S.H.), Department of Rheumatology, Nordland Hospital, 8092 Bodø, Norway
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Helseth R, Carlsen SM, Bollerslev J, Svartberg J, Øksnes M, Skeie S, Fougner SL. Preoperative octreotide therapy and surgery in acromegaly: associations between glucose homeostasis and treatment response. Endocrine 2016; 51:298-307. [PMID: 26179177 DOI: 10.1007/s12020-015-0679-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 06/29/2015] [Indexed: 01/15/2023]
Abstract
In acromegaly, high GH/IGF-1 levels associate with abnormal glucose metabolism. Somatostatin analogs (SSAs) reduce GH and IGF-1 but inhibit insulin secretion. We studied glucose homeostasis in de novo patients with acromegaly and changes in glucose metabolism after treatment with SSA and surgery. In this post hoc analysis from a randomized controlled trial, 55 de novo patients with acromegaly, not using antidiabetic medication, were included. Before surgery, 26 patients received SSAs for 6 months. HbA1c, fasting glucose, and oral glucose tolerance test were performed at baseline, after SSA pretreatment and at 3 months postoperative. Area under curve of glucose (AUC-G) was calculated. Glucose homeostasis was compared to baseline levels of GH and IGF-1, change after SSA pretreatment, and remission both after SSA pretreatment and 3 months postoperative. In de novo patients, IGF-1/GH levels did not associate with baseline glucose parameters. After SSA pretreatment, changes in GH/IGF-1 correlated positively to change in HbA1c levels (both p < 0.03). HbA1c, fasting glucose, and AUC-G increased significantly during SSA pretreatment in patients not achieving hormonal control (all p < 0.05) but did not change significantly in patients with normalized hormone levels. At 3 months postoperative, HbA1c, fasting glucose, and AUC-G were significantly reduced in both cured and not cured patients (all p < 0.05). To conclude, in de novo patients with acromegaly, disease activity did not correlate with glucose homeostasis. Surgical treatment of acromegaly improved glucose metabolism in both cured and not cured patients, while SSA pretreatment led to deterioration in glucose homeostasis in patients not achieving biochemical control.
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Affiliation(s)
- R Helseth
- Department of Internal Medicine, Drammen Hospital, Vestre Viken, Drammen, Norway
| | - S M Carlsen
- Department of Endocrinology, Medical Clinic, St. Olavs University Hospital, 7006, Trondheim, Norway
- Unit for Applied Clinical Research, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - J Bollerslev
- Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - J Svartberg
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
- Tromsø Endocrine Research Group, Institute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - M Øksnes
- Department of Medicine and Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - S Skeie
- Division of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - S L Fougner
- Department of Endocrinology, Medical Clinic, St. Olavs University Hospital, 7006, Trondheim, Norway.
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20
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Lerstad G, Enga KF, Jorde R, Brodin EE, Svartberg J, Brækkan SK, Hansen JB. Thyroid function, as assessed by TSH, and future risk of venous thromboembolism: the Tromsø study. Eur J Endocrinol 2015; 173:83-90. [PMID: 25899580 DOI: 10.1530/eje-15-0185] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/20/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The relationship between thyroid function and the risk of venous thromboembolism (VTE) has not been addressed in population-based cohorts. We investigated the association between TSH levels and the risk of VTE in a general adult population. DESIGN Population-based cohort study. METHODS TSH was measured in 11 962 subjects aged 25-89 years who participated in Tromsø 4-6 starting in 1994-1995. Incident VTE events were recorded through 31st December 2010. Cox's regression models with TSH as a time-varying covariate were used to calculate hazard ratios (HRs) of VTE by TSH categories (low TSH: <0.05 mU/l; moderately reduced TSH: 0.05-0.19 mU/l; normal TSH: 0.20-4.00 mU/l; moderately elevated TSH: 4.01-5.00 mU/l; and high TSH: >5.00 mU/l) and within the normal range of TSH, modeling TSH as a continuous variable. RESULTS There were 289 VTEs during 8.2 years of median follow-up. Subjects with low (prevalence: 0.22%) and high (3.01%) TSH had slightly higher risk estimates for VTE than did subjects with normal TSH (multivariable HRs: 2.16, 95% CI 0.69-6.76 and 1.55, 95% CI 0.87-2.77 respectively), but the CIs were wide. Moreover, there was no association between TSH within the normal range and VTE (HR per 1 mU/l increase: 0.95, 95% CI 0.82-1.11). CONCLUSION Serum levels of TSH within the normal range were not associated with a risk of VTE, whereas low and high TSH levels were rare and associated with a moderately higher risk of VTE. The present findings suggest that only a minor proportion of the VTE risk in the population can be attributed to thyroid dysfunction.
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Affiliation(s)
- Gunhild Lerstad
- Department of Clinical MedicineK.G. Jebsen Thrombosis Research and Expertise Center (TREC)Hematological Research Group (HERG)Department of Clinical MedicineEndocrine Research GroupDepartment of Clinical Medicine, University of Tromsø, N-9037 Tromsø, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, Norway Department of Clinical MedicineK.G. Jebsen Thrombosis Research and Expertise Center (TREC)Hematological Research Group (HERG)Department of Clinical MedicineEndocrine Research GroupDepartment of Clinical Medicine, University of Tromsø, N-9037 Tromsø, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, Norway
| | - Kristin F Enga
- Department of Clinical MedicineK.G. Jebsen Thrombosis Research and Expertise Center (TREC)Hematological Research Group (HERG)Department of Clinical MedicineEndocrine Research GroupDepartment of Clinical Medicine, University of Tromsø, N-9037 Tromsø, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, Norway
| | - Rolf Jorde
- Department of Clinical MedicineK.G. Jebsen Thrombosis Research and Expertise Center (TREC)Hematological Research Group (HERG)Department of Clinical MedicineEndocrine Research GroupDepartment of Clinical Medicine, University of Tromsø, N-9037 Tromsø, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, Norway Department of Clinical MedicineK.G. Jebsen Thrombosis Research and Expertise Center (TREC)Hematological Research Group (HERG)Department of Clinical MedicineEndocrine Research GroupDepartment of Clinical Medicine, University of Tromsø, N-9037 Tromsø, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, Norway
| | - Ellen E Brodin
- Department of Clinical MedicineK.G. Jebsen Thrombosis Research and Expertise Center (TREC)Hematological Research Group (HERG)Department of Clinical MedicineEndocrine Research GroupDepartment of Clinical Medicine, University of Tromsø, N-9037 Tromsø, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, Norway Department of Clinical MedicineK.G. Jebsen Thrombosis Research and Expertise Center (TREC)Hematological Research Group (HERG)Department of Clinical MedicineEndocrine Research GroupDepartment of Clinical Medicine, University of Tromsø, N-9037 Tromsø, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, Norway Department of Clinical MedicineK.G. Jebsen Thrombosis Research and Expertise Center (TREC)Hematological Research Group (HERG)Department of Clinical MedicineEndocrine Research GroupDepartment of Clinical Medicine, University of Tromsø, N-9037 Tromsø, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, Norway
| | - Johan Svartberg
- Department of Clinical MedicineK.G. Jebsen Thrombosis Research and Expertise Center (TREC)Hematological Research Group (HERG)Department of Clinical MedicineEndocrine Research GroupDepartment of Clinical Medicine, University of Tromsø, N-9037 Tromsø, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, Norway Department of Clinical MedicineK.G. Jebsen Thrombosis Research and Expertise Center (TREC)Hematological Research Group (HERG)Department of Clinical MedicineEndocrine Research GroupDepartment of Clinical Medicine, University of Tromsø, N-9037 Tromsø, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, Norway
| | - Sigrid K Brækkan
- Department of Clinical MedicineK.G. Jebsen Thrombosis Research and Expertise Center (TREC)Hematological Research Group (HERG)Department of Clinical MedicineEndocrine Research GroupDepartment of Clinical Medicine, University of Tromsø, N-9037 Tromsø, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, Norway Department of Clinical MedicineK.G. Jebsen Thrombosis Research and Expertise Center (TREC)Hematological Research Group (HERG)Department of Clinical MedicineEndocrine Research GroupDepartment of Clinical Medicine, University of Tromsø, N-9037 Tromsø, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, Norway Department of Clinical MedicineK.G. Jebsen Thrombosis Research and Expertise Center (TREC)Hematological Research Group (HERG)Department of Clinical MedicineEndocrine Research GroupDepartment of Clinical Medicine, University of Tromsø, N-9037 Tromsø, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, Norway
| | - John-Bjarne Hansen
- Department of Clinical MedicineK.G. Jebsen Thrombosis Research and Expertise Center (TREC)Hematological Research Group (HERG)Department of Clinical MedicineEndocrine Research GroupDepartment of Clinical Medicine, University of Tromsø, N-9037 Tromsø, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, Norway Department of Clinical MedicineK.G. Jebsen Thrombosis Research and Expertise Center (TREC)Hematological Research Group (HERG)Department of Clinical MedicineEndocrine Research GroupDepartment of Clinical Medicine, University of Tromsø, N-9037 Tromsø, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, Norway Department of Clinical MedicineK.G. Jebsen Thrombosis Research and Expertise Center (TREC)Hematological Research Group (HERG)Department of Clinical MedicineEndocrine Research GroupDepartment of Clinical Medicine, University of Tromsø, N-9037 Tromsø, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, Norway
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Sollid ST, Hutchinson MYS, Fuskevåg OM, Figenschau Y, Joakimsen RM, Schirmer H, Njølstad I, Svartberg J, Kamycheva E, Jorde R. No effect of high-dose vitamin D supplementation on glycemic status or cardiovascular risk factors in subjects with prediabetes. Diabetes Care 2014; 37:2123-31. [PMID: 24947792 DOI: 10.2337/dc14-0218] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [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: 02/03/2023]
Abstract
OBJECTIVE In observational studies, low serum 25-hydroxyvitamin D [25(OH)D] concentrations have been associated with insulin resistance and other risk factors for cardiovascular disease. RESEARCH DESIGN AND METHODS We present 1-year data from an ongoing 5-year trial in 511 individuals with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) randomly assigned to 20,000 IU/week vitamin D3 or placebo. An oral glucose tolerance test was performed at baseline and after 1 year. RESULTS Mean baseline serum 25(OH)D was 59.9 nmol/L and 61.1 nmol/L in the vitamin D and placebo groups, respectively, and increased by 45.8 nmol/L and 3.4 nmol/L, respectively. With adjustment for baseline concentrations, no differences in measures of glucose metabolism, insulin secretion or sensitivity, blood pressure, or hs-CRP were found after 1 year. There was a slight, but significant decrease in total and LDL cholesterol in the vitamin D group compared with the placebo group, but as there was also a decrease in HDL cholesterol, the change in the total/HDL cholesterol ratio did not differ significantly. Only analyzing subjects with 25(OH)D <50 nmol/L did not change the results. CONCLUSIONS This study shows that vitamin D supplementation does not improve glycemic indices, blood pressure, or lipid status in subjects with IFG and/or IGT.
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Affiliation(s)
- Stina Therese Sollid
- Tromsø Endocrine Research Group, The University of Tromsø - The Arctic University of Norway, Tromsø, NorwayDivision of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Moira Y S Hutchinson
- Tromsø Endocrine Research Group, The University of Tromsø - The Arctic University of Norway, Tromsø, NorwayDivision of Rehabilitation Services, University Hospital of North Norway, Tromsø, Norway
| | - Ole M Fuskevåg
- Division of Diagnostic Services, University Hospital of North Norway, Tromsø, Norway
| | - Yngve Figenschau
- Division of Diagnostic Services, University Hospital of North Norway, Tromsø, NorwayDepartment of Medical Biology, The University of Tromsø - The Arctic University of Norway, Tromsø, Norway
| | - Ragnar M Joakimsen
- Tromsø Endocrine Research Group, The University of Tromsø - The Arctic University of Norway, Tromsø, NorwayDivision of Internal Medicine, University Hospital of North Norway, Tromsø, NorwayDepartment of Clinical Medicine, The University of Tromsø - The Arctic University of Norway, Tromsø, Norway
| | - Henrik Schirmer
- Department of Clinical Medicine, The University of Tromsø - The Arctic University of Norway, Tromsø, Norway
| | - Inger Njølstad
- Department of Community Medicine, The University of Tromsø - The Arctic University of Norway, Tromsø, Norway
| | - Johan Svartberg
- Tromsø Endocrine Research Group, The University of Tromsø - The Arctic University of Norway, Tromsø, NorwayDivision of Internal Medicine, University Hospital of North Norway, Tromsø, NorwayDepartment of Clinical Medicine, The University of Tromsø - The Arctic University of Norway, Tromsø, Norway
| | - Elena Kamycheva
- Tromsø Endocrine Research Group, The University of Tromsø - The Arctic University of Norway, Tromsø, NorwayDivision of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Rolf Jorde
- Tromsø Endocrine Research Group, The University of Tromsø - The Arctic University of Norway, Tromsø, NorwayDivision of Internal Medicine, University Hospital of North Norway, Tromsø, NorwayDepartment of Clinical Medicine, The University of Tromsø - The Arctic University of Norway, Tromsø, Norway
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Fougner SL, Bollerslev J, Svartberg J, Øksnes M, Cooper J, Carlsen SM. Preoperative octreotide treatment of acromegaly: long-term results of a randomised controlled trial. Eur J Endocrinol 2014; 171:229-35. [PMID: 24866574 DOI: 10.1530/eje-14-0249] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Randomised studies have demonstrated a beneficial effect of pre-surgical treatment with somatostatin analogues (SSA) in acromegaly when evaluated early postoperatively. The objective of this study was to evaluate the long-term surgical cure rates. METHODS Newly diagnosed patients were randomised to direct surgery (n=30) or 6-month pretreatment with octreotide LAR (n=32). The patients were evaluated 1 and 5 years postoperatively. Cure was defined as normal IGF1 levels and by normal IGF1 level combined with nadir GH <2 mU/l in an oral glucose tolerance test, all without additional post-operative treatment. A meta-analysis using the other published randomised study with long-term analyses on preoperative SSA treatment was performed. RESULTS The proportion of patients receiving post-operative acromegaly treatment was equal in the two groups. When using the combined criteria for cure, 10/26 (38%) macroadenomas were cured in the pretreatment group compared with 6/25 (24%) in the direct surgery group 1 year postoperatively (P=0.27), and 9/22 (41%) vs 6/22 (27%) macroadenomas, respectively, 5 years postoperatively (P=0.34). In the meta-analysis, 16/45 (36%) macroadenomas were cured using combined criteria in the pretreatment group vs 8/45 (18%) in the direct surgery group after 6-12 months (P=0.06), and 15/41 (37%) vs 8/42 (19%), respectively, in the long-term (P=0.08). CONCLUSION This study does not prove a beneficial effect of SSA pre-surgical treatment, but in the meta-analysis a trend towards significance can be claimed. A potential favourable, clinically relevant response cannot be excluded.
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Affiliation(s)
- S L Fougner
- Department of EndocrinologyMedical Clinic, St Olavs University Hospital, 7006 Trondheim, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, NorwayTromsø Endocrine Research GroupInstitute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, NorwayDepartment of MedicineCentre for Clinical Research, Haukeland University Hospital, Bergen, NorwayDepartment of EndocrinologyStavanger University Hospital, Stavanger, NorwayUnit for Applied Clinical ResearchNorwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - J Bollerslev
- Department of EndocrinologyMedical Clinic, St Olavs University Hospital, 7006 Trondheim, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, NorwayTromsø Endocrine Research GroupInstitute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, NorwayDepartment of MedicineCentre for Clinical Research, Haukeland University Hospital, Bergen, NorwayDepartment of EndocrinologyStavanger University Hospital, Stavanger, NorwayUnit for Applied Clinical ResearchNorwegian University of Science and Technology (NTNU), Trondheim, NorwayDepartment of EndocrinologyMedical Clinic, St Olavs University Hospital, 7006 Trondheim, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, NorwayTromsø Endocrine Research GroupInstitute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, NorwayDepartment of MedicineCentre for Clinical Research, Haukeland University Hospital, Bergen, NorwayDepartment of EndocrinologyStavanger University Hospital, Stavanger, NorwayUnit for Applied Clinical ResearchNorwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - J Svartberg
- Department of EndocrinologyMedical Clinic, St Olavs University Hospital, 7006 Trondheim, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, NorwayTromsø Endocrine Research GroupInstitute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, NorwayDepartment of MedicineCentre for Clinical Research, Haukeland University Hospital, Bergen, NorwayDepartment of EndocrinologyStavanger University Hospital, Stavanger, NorwayUnit for Applied Clinical ResearchNorwegian University of Science and Technology (NTNU), Trondheim, NorwayDepartment of EndocrinologyMedical Clinic, St Olavs University Hospital, 7006 Trondheim, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, NorwayTromsø Endocrine Research GroupInstitute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, NorwayDepartment of MedicineCentre for Clinical Research, Haukeland University Hospital, Bergen, NorwayDepartment of EndocrinologyStavanger University Hospital, Stavanger, NorwayUnit for Applied Clinical ResearchNorwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - M Øksnes
- Department of EndocrinologyMedical Clinic, St Olavs University Hospital, 7006 Trondheim, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, NorwayTromsø Endocrine Research GroupInstitute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, NorwayDepartment of MedicineCentre for Clinical Research, Haukeland University Hospital, Bergen, NorwayDepartment of EndocrinologyStavanger University Hospital, Stavanger, NorwayUnit for Applied Clinical ResearchNorwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - J Cooper
- Department of EndocrinologyMedical Clinic, St Olavs University Hospital, 7006 Trondheim, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, NorwayTromsø Endocrine Research GroupInstitute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, NorwayDepartment of MedicineCentre for Clinical Research, Haukeland University Hospital, Bergen, NorwayDepartment of EndocrinologyStavanger University Hospital, Stavanger, NorwayUnit for Applied Clinical ResearchNorwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - S M Carlsen
- Department of EndocrinologyMedical Clinic, St Olavs University Hospital, 7006 Trondheim, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, NorwayTromsø Endocrine Research GroupInstitute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, NorwayDepartment of MedicineCentre for Clinical Research, Haukeland University Hospital, Bergen, NorwayDepartment of EndocrinologyStavanger University Hospital, Stavanger, NorwayUnit for Applied Clinical ResearchNorwegian University of Science and Technology (NTNU), Trondheim, NorwayDepartment of EndocrinologyMedical Clinic, St Olavs University Hospital, 7006 Trondheim, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayDivision of Internal MedicineUniversity Hospital of North Norway, Tromsø, NorwayTromsø Endocrine Research GroupInstitute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, NorwayDepartment of MedicineCentre for Clinical Research, Haukeland University Hospital, Bergen, NorwayDepartment of EndocrinologyStavanger University Hospital, Stavanger, NorwayUnit for Applied Clinical ResearchNorwegian University of Science and Technology (NTNU), Trondheim, Norway
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Jorde R, Schirmer H, Wilsgaard T, Joakimsen RM, Mathiesen EB, Njølstad I, Løchen ML, Figenschau Y, Svartberg J, Hutchinson MS, Kjærgaard M, Jørgensen L, Grimnes G. The phosphodiesterase 8B gene rs4704397 is associated with thyroid function, risk of myocardial infarction, and body height: the Tromsø study. Thyroid 2014; 24:215-22. [PMID: 23941514 DOI: 10.1089/thy.2013.0177] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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] [Indexed: 01/07/2023]
Abstract
OBJECTIVE High serum thyrotropin (TSH) levels predict cardiovascular disease (CVD). Recently several single nucleotide polymorphisms (SNPs) associated with TSH levels have been identified, one of them being the rs4704397 SNP in the phosphodiesterase 8B (PDE8B) gene. If the relation between thyroid function and CVD is causal, one could also expect rs4704397 genotypes to predict CVD and possibly health in general. METHODS DNA was prepared and genotyping performed for rs4704397 in subjects who participated in the fourth survey of the Tromsø Study in 1994-1995 and who were registered with the endpoints myocardial infarction (MI), type 2 diabetes (T2DM), cancer, or death, as well as a randomly selected control group. Similarly, genotyping was performed in subjects who had participated in clinical trials where serum TSH, free T4 (fT4), and free T3 (fT3) were measured. RESULTS From the Tromsø Study, 8938 subjects without thyroid disease or thyroid medication were successfully genotyped for rs4704397. Among these, 2098 were registered with MI, 1025 with T2DM, 2748 with cancer, and 3592 had died. The minor homozygote genotype (A:A) had a median serum TSH level that was 0.29 mIU/L higher than in the major homozygote genotype (G:G). The A:A genotype had a significantly increased risk of MI as compared to the G:G genotype (1.14 [1.00-1.29], hazard ratio [confidence interval], Cox regression with adjustment for age, sex, and body mass index). No significant associations were seen with the other endpoints or CVD risk factors. Furthermore, subjects with the G:G genotype were significantly taller than subjects with the A:A genotype (mean difference 1.5 cm). In 584 subjects with serum TSH, fT4, and fT3 measurements, the subjects with the A:A genotype had significantly higher serum TSH and nonsignificantly lower serum fT3 (mean difference 0.15 pmol/L) levels than subjects with the G:G genotype. CONCLUSION rs4704397 is associated with thyroid function, risk of MI, and body height. However, confirmation in other cohorts is needed before firm conclusions can be drawn.
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Affiliation(s)
- Rolf Jorde
- 1 Tromsø Endocrine Research Group, University of Tromsø , Tromsø, Norway
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Lerstad G, Brodin EE, Enga KF, Jorde R, Schirmer H, Njølstad I, Svartberg J, Braekkan SK, Hansen JB. Hyperglycemia, assessed according to HbA1c , and future risk of venous thromboembolism: the Tromsø study. J Thromb Haemost 2014; 12:313-9. [PMID: 24382156 DOI: 10.1111/jth.12498] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 09/12/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND HbA1c , a marker of average plasma glucose level during the previous 8-12 weeks, is associated with the future risk of cardiovascular disease and all-cause mortality. OBJECTIVES To examine the association between hyperglycemia, assessed according to HbA1c , and the future risk of venous thromboembolism (VTE) in a population-based cohort. METHODS HbA1c was measured in 16 156 unique subjects (25-87 years) who participated in one or more surveys of the Tromsø study (Tromsø 4, 1994-1995; Tromsø 5, 2001-2002; and Tromsø 6, 2007-2008). All subjects were followed, and incident VTE events were recorded up to 31 December 2010. RESULTS There were 333 validated first VTE events, of which 137 were unprovoked, during a median follow-up of 7.1 years. HbA1c was not associated with the future risk of VTE in analyses treating HbA1c as a continuous variable, or in categorized analyses. The risk of VTE increased by 5% per one standard deviation (0.7%) increase in HbA1c (multivariable-adjusted hazard ratio [HR] 1.05; 95% confidence interval [CI] 0.97-1.14), and subjects with HbA1c ≥ 6.5% had a 27% higher risk than those with HbA1c < 5.7% (multivariable-adjusted HR 1.27; 95% CI 0.72-2.26). There was no significant linear trend for an increased risk of VTE across categories of HbA1c (P = 0.27). CONCLUSIONS Serum levels of HbA1c were not associated with the future risk of VTE in multivariable analysis. Our findings suggest that hyperglycemia does not play an important role in the pathogenesis of VTE.
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Affiliation(s)
- G Lerstad
- Department of Clinical Medicine, Hematologic Research Group (HERG), University of Tromsø, Tromsø, Norway
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Svartberg J, Schirmer H, Wilsgaard T, Mathiesen EB, Njølstad I, Løchen ML, Jorde R. Single-nucleotide polymorphism, rs1799941 in the Sex Hormone-Binding Globulin (SHBG) gene, related to both serum testosterone and SHBG levels and the risk of myocardial infarction, type 2 diabetes, cancer and mortality in men: the Tromsø Study. Andrology 2013; 2:212-8. [PMID: 24327369 DOI: 10.1111/j.2047-2927.2013.00174.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 11/07/2013] [Accepted: 11/20/2013] [Indexed: 12/20/2022]
Abstract
Low testosterone levels are associated with metabolic and cardiovascular disease risk factor, and have been shown to predict type 2 diabetes mellitus (T2DM), myocardial infarction (MI) and all-cause mortality. It is not known if these associations are causal or not. Recently, it has been shown that the serum testosterone levels are associated with single-nucleotide polymorphisms (SNPs), and we therefore studied the associations between one of these SNPs, rs1799941 on the Sex Hormone-Binding Globulin (SHBG) gene, and MI, T2DM, cancer and death. DNA was prepared from men who participated in the fourth survey of the Tromsø Study in 1994-1995 and who were registered with the endpoints MI, T2DM, cancer or death and a randomly selected control group. For mortality, the observation time was set from 1994, and for the other endpoints from birth. The endpoint data were completed up to 2010-2013. Genetic analyses were successfully performed in 5309 men, of whom 1454 were registered with MI, 638 with T2DM, 1534 with cancer and in 2226 who had died. Men with the minor homozygote genotype had significantly higher levels of total testosterone (14.7%) and SHBG (24.7%) compared with men with the major homozygote genotype, whereas free testosterone levels did not differ significantly between the genotypes. The SNP rs1799941 was not significantly associated with MI, T2DM, cancer or mortality. Thus, our result does not support a causal relationship between total testosterone and SHBG and MI, T2DM, cancer or mortality, suggesting that low testosterone more likely is a marker of poor health.
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Affiliation(s)
- J Svartberg
- Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway; Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
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Didriksen A, Grimnes G, Hutchinson MS, Kjærgaard M, Svartberg J, Joakimsen RM, Jorde R. The serum 25-hydroxyvitamin D response to vitamin D supplementation is related to genetic factors, BMI, and baseline levels. Eur J Endocrinol 2013; 169:559-67. [PMID: 23935129 DOI: 10.1530/eje-13-0233] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [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] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The serum 25-hydroxyvitamin D (25(OH)D) level is not only dependent on vitamin D intake and production in the skin but also dependent on genetic factors. Thus, in large genome-wide association studies, it has been shown that single nucleotide polymorphisms (SNPs) in the vitamin D binding protein (DBP), as well as in enzymes related to activation or degradation of vitamin D and its metabolites, are as important for the serum 25(OH)D level as the effect of season. How these SNPs affect the serum 25(OH)D response to vitamin D supplementation is uncertain. DESIGN AND METHODS Data were pooled from three randomized controlled trials where 40, 000 IU vitamin D/week was given for 6 months. Serum 25(OH)D was measured before and at the end of the intervention, and the subjects were genotyped for SNPs related to the serum 25(OH)D level. RESULTS Baseline 25(OH)D levels were significantly related to SNPs in the DBP and CYP2R1 genes. Those with SNPs associated with the lowest baseline 25(OH)D levels also had the smallest increase (delta) after supplementation. Those with the lowest baseline serum 25(OH)D (without regard to genotypes) had the highest increase (delta) after supplementation. Subjects with high BMI had lowest baseline 25(OH)D levels and also the smallest increase (delta) after supplementation. CONCLUSIONS The serum 25(OH)D response to supplementation depends on genes, baseline level, and BMI. However, whether this is clinically important or not depends on the therapeutic window of vitamin D, an issue that is still not settled.
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Affiliation(s)
- Allan Didriksen
- Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, 9037 Tromsø, Norway
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Jorde R, Grimnes G, Hutchinson MS, Kjærgaard M, Kamycheva E, Svartberg J. Supplementation with vitamin D does not increase serum testosterone levels in healthy males. Horm Metab Res 2013; 45:675-81. [PMID: 23686706 DOI: 10.1055/s-0033-1345139] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Cross-sectional studies indicate a positive relation between serum 25-hydroxyvitamin D [25(OH)D] and testosterone. It is not known if this relation is causal, which in theory could be in both directions. A cross-sectional population based study was designed with pooled data from 3 vitamin D randomized clinical trials (RCTs) performed in Tromsø with weight reduction, insulin sensitivity, and depression scores as endpoints, and one testosterone RCT in subjects with low serum testosterone (<11.0 nmol/l) and with body composition as endpoint. Serum 25(OH)D and androgens were measured in 893 males in the cross-sectional part, at baseline and after 6-12 months of supplementation with vitamin D 20 000 IU-40 000 IU per week vs. placebo in the vitamin D RCTs (n=282), and at baseline and after one year treatment with testosterone undecanoate 1 000 mg or placebo injections (at baseline and after 6, 16, 28, and 40 weeks) in the testosterone RCT (n=37). In the cross-sectional study, serum 25(OH)D was found to be a significant and positive predictor of serum testosterone. In the vitamin D RCTs, no significant effect on serum total or free testosterone levels was seen, and in the testosterone RCT no significant effect on serum 25(OH)D was seen. This was unchanged in sub-analyses in subjects with low serum 25(OH)D (or testosterone) levels. In conclusion, in subjects without significant vitamin D deficiency, there is no increase in serum testosterone after high dose vitamin D supplementation. Similarly, in subjects with moderately low serum testosterone levels, substitution with testosterone does not increase serum 25(OH)D.
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Affiliation(s)
- R Jorde
- Department of Clinical Medicine, Tromsø Endocrine Research Group, University of Tromsø, Norway.
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Abstract
Estradiol (E2) is, apart from its role as a reproductive hormone, also important for cardiac function and bone maturation in both genders. It has also been shown to play a role in insulin production, energy expenditure and in inducing lipolysis. The aim of the study was to investigate if low circulating testosterone or E2 levels in combination with variants in the estrogen receptor alpha (ESR1) and estrogen receptor beta (ESR2) genes were of importance for the risk of type-2 diabetes. The single nucleotide polymorphisms rs2207396 and rs1256049, in ESR1 and ESR2, respectively, were analysed by allele specific PCR in 172 elderly men from the population-based Tromsø study. The results were adjusted for age. In individuals with low total (≤11 nmol/L) or free testosterone (≤0.18 nmol/L) being carriers of the variant A-allele in ESR1 was associated with 7.3 and 15.9 times, respectively, increased odds ratio of being diagnosed with diabetes mellitus type 2 (p = 0.025 and p = 0.018, respectively). Lower concentrations of E2 did not seem to increase the risk of being diagnosed with diabetes. In conclusion, in hypogonadal men, the rs2207396 variant in ESR1 predicts the risk of type 2 diabetes.
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Affiliation(s)
- Carl Linnér
- Department of Clinical Sciences, Molecular Genetic Reproductive Medicine, Lund University, Malmö, Sweden.
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Svartberg J. Ubalansert om testosteronmangel. Tidsskriftet 2013. [DOI: 10.4045/tidsskr.13.0384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Hutchinson MS, Joakimsen RM, Njølstad I, Schirmer H, Figenschau Y, Svartberg J, Jorde R. Effects of Age and Sex on Estimated Diabetes Prevalence Using Different Diagnostic Criteria: The Tromsø OGTT Study. Int J Endocrinol 2013; 2013:613475. [PMID: 23365572 PMCID: PMC3556443 DOI: 10.1155/2013/613475] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 12/04/2012] [Accepted: 12/05/2012] [Indexed: 12/30/2022] Open
Abstract
HbA(1c) 6.5% has recently been recommended as an alternative diagnostic criterion for diabetes. The aims of the study were to evaluate the effects of age, sex, and other factors on prevalence of diabetes and to compare risk profiles of subjects with diabetes when defined by HbA(1c) and glucose criteria. Subjects were recruited among participants in the longitudinal population-based Tromsø Study. HbA(1c), fasting plasma glucose, and 2-hour plasma glucose were measured in 3,476 subjects. In total, 294 subjects met one or more of the diagnostic criteria for diabetes; 95 met the HbA(1c) criterion only, 130 met the glucose criteria only, and 69 met both. Among subjects with diabetes detected by glucose criteria (regardless of HbA(1c)), isolated raised 2-hour plasma glucose was more common in subjects aged ≥ 60 years as compared to younger subjects and in elderly women as compared to elderly men. Subjects with diabetes detected by glucose criteria only had worse cardiometabolic risk profiles than those detected by HbA(1c) only. In conclusion, the current HbA(1c) and glucose criteria defined different subjects with diabetes with only modest overlap. Among a substantial proportion of elderly subjects, and especially elderly women, the 2-hour plasma glucose was the only abnormal value.
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Affiliation(s)
- Moira Strand Hutchinson
- Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, 9037 Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, 9038 Tromsø, Norway
- *Moira Strand Hutchinson:
| | - Ragnar Martin Joakimsen
- Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, 9037 Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, 9038 Tromsø, Norway
| | - Inger Njølstad
- Department of Community Medicine, University of Tromsø, 9037 Tromsø, Norway
| | - Henrik Schirmer
- Division of Internal Medicine, University Hospital of North Norway, 9038 Tromsø, Norway
| | - Yngve Figenschau
- Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, 9037 Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, 9038 Tromsø, Norway
- Department of Medical Biology, University of Tromsø, 9037 Tromsø, Norway
- Division of Laboratory Medicine, University Hospital of North Norway, 9038 Tromsø, Norway
| | - Johan Svartberg
- Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, 9037 Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, 9038 Tromsø, Norway
| | - Rolf Jorde
- Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, 9037 Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, 9038 Tromsø, Norway
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Vikan T, Hansen JB, Svartberg J, Brodin E. Testosterone, Hemostasis, and Cardiovascular Diseases in Men. Semin Thromb Hemost 2012. [DOI: 10.1055/s-0032-1330054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Torkel Vikan
- Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - John-Bjarne Hansen
- Hematological Research Group (HERG), University of Tromsø, Tromsø, Norway
| | - Johan Svartberg
- Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - Ellen Brodin
- Hematological Research Group (HERG), University of Tromsø, Tromsø, Norway
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Kjærgaard M, Waterloo K, Wang CEA, Almås B, Figenschau Y, Hutchinson MS, Svartberg J, Jorde R. Effect of vitamin D supplement on depression scores in people with low levels of serum 25-hydroxyvitamin D: nested case-control study and randomised clinical trial. Br J Psychiatry 2012; 201:360-8. [PMID: 22790678 DOI: 10.1192/bjp.bp.111.104349] [Citation(s) in RCA: 145] [Impact Index Per Article: 12.1] [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: 01/30/2023]
Abstract
AIMS To compare depressive symptoms in participants with low and high serum 25-hydroxyvitamin D (25(OH)D) levels and to examine whether supplementation with vitamin D(3) would improve symptoms in those with low serum 25(OH)D levels. METHOD Participants with low 25(OH)D levels were randomised to either placebo or 40 000 IU vitamin D(3) per week for 6 months. Individuals with high serum 25(OH)D levels were used as nested controls. Depressive symptoms were evaluated with the Beck Depression Inventory, Hospital Anxiety and Depression Scale, Seasonal Pattern Assessment Scale and Montgomery-Åsberg Depression Rating Scale. The study was registered at ClinicalTrials.gov (NCT00960232). RESULTS Participants with low 25(OH)D levels (n = 230) at baseline were more depressed (P<0.05) than participants with high 25(OH)D levels (n = 114). In the intervention study no significant effect of high-dose vitamin D was found on depressive symptom scores when compared with placebo. CONCLUSIONS Low levels of serum 25(OH)D are associated with depressive symptoms, but no effect was found with vitamin D supplementation.
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Affiliation(s)
- Marie Kjærgaard
- Medical Clinic, University Hospital of North Norway N-9038 Tromsø, Norway.
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Nermoen I, Brønstad I, Fougner KJ, Svartberg J, Øksnes M, Husebye ES, Løvås K. Genetic, anthropometric and metabolic features of adult Norwegian patients with 21-hydroxylase deficiency. Eur J Endocrinol 2012; 167:507-16. [PMID: 22802425 DOI: 10.1530/eje-12-0196] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to determine the genetic, anthropometric and metabolic features in an unselected population of adult Norwegian patients with 21-hydroxylase deficiency (21OHD). PATIENTS, METHODS AND DESIGN: Sixty-four 21OHD patients participated (23 men and 41 women; median age 38.5 years; range 19-72 years) in a cross-sectional study including DNA sequencing of CYP21A2, anthropometric measurements including dual X-ray absorptiometry scanning and biochemical analyses. The results were compared with reference cohorts from the general population. RESULTS We identified four novel and plausibly disease-causing CYP21A2 mutations. Gene deletions/conversions (42.1% of alleles), the splice mutation I2 splice (23.0%) and point mutation I172 N (22.2%) were common. The genotype corresponded to clinical phenotype in 92% of the patients. The prevalence of osteopenia was 48% in males and 34% in females. Both men and women had normal BMI but markedly increased fat mass compared with the normal population. Diastolic blood pressure was higher than normal. Thirty-nine per cent of the women had testosterone levels above the normal range; 13% of the men had testosterone levels below normal. Reduced final height was more pronounced in men (median -11.2 cm, -1.77 SDS) than in women (-6.3 cm, -1.07 SDS). CONCLUSIONS In this population-based survey of 21OHD, we identified four novel mutations and high concordance between genotype and phenotype. The patients had increased fat mass, increased diastolic blood pressure, reduced final height and high frequency of osteopenia among males. These results show unfavourable metabolic features in 21OHD patients indicating a need for improvement of treatment and follow-up.
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Affiliation(s)
- Ingrid Nermoen
- Institute of Clinical Medicine, Akershus University Hospital, University of Oslo, Oslo, Norway.
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Brodin E, Lerstad G, Grimnes G, Brækkan SK, Svartberg J, Jorde R, Hansen JB. C0110 Serum levels of vitamin D is not associated with future risk of venous thromboembolism–the Tromsø Study. Thromb Res 2012. [DOI: 10.1016/j.thromres.2012.08.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Jorde R, Schirmer H, Wilsgaard T, Joakimsen RM, Mathiesen EB, Njølstad I, Løchen ML, Figenschau Y, Berg JP, Svartberg J, Grimnes G. Polymorphisms related to the serum 25-hydroxyvitamin D level and risk of myocardial infarction, diabetes, cancer and mortality. The Tromsø Study. PLoS One 2012; 7:e37295. [PMID: 22649517 PMCID: PMC3359337 DOI: 10.1371/journal.pone.0037295] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 04/17/2012] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Low serum 25(OH)D levels are associated with cardiovascular risk factors, and also predict future myocardial infarction (MI), type 2 diabetes (T2DM), cancer and all-cause mortality. Recently several single nucleotide polymorphisms (SNPs) associated with serum 25-hydroxyvitamin D (25(OH)D) level have been identified. If these relations are causal one would expect a similar association between these SNPs and health. METHODS DNA was prepared from subjects who participated in the fourth survey of the Tromsø Study in 1994-1995 and who were registered with the endpoints MI, T2DM, cancer or death as well as a randomly selected control group. The endpoint registers were complete up to 2007-2010. Genotyping was performed for 17 SNPs related to the serum 25(OH)D level. RESULTS A total of 9528 subjects were selected for genetic analyses which were successfully performed for at least one SNP in 9471 subjects. Among these, 2025 were registered with MI, 1092 with T2DM, 2924 with cancer and 3828 had died. The mean differences in serum 25(OH)D levels between SNP genotypes with the lowest and highest serum 25(OH)D levels varied from 0.1 to 7.8 nmol/L. A genotype score based on weighted risk alleles regarding low serum 25(OH)D levels was established. There was no consistent association between the genotype score or individuals SNPs and MI, T2DM, cancer, mortality or risk factors for disease. However, for rs6013897 genotypes (located at the 24-hydroxylase gene (CYP24A1)) there was a significant association with breast cancer (P<0.05). CONCLUSION Our results do not support nor exclude a causal relationship between serum 25(OH)D levels and MI, T2DM, cancer or mortality, and our observation on breast cancer needs confirmation. Further genetic studies are warranted, particularly in populations with vitamin D deficiency. TRIAL REGISTRATION ClinicalTrials.gov NCT01395303.
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Affiliation(s)
- Rolf Jorde
- Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, and Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway.
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Jorde R, Svartberg J, Joakimsen RM, Coucheron DH. Plasma profile of microRNA after supplementation with high doses of vitamin D3 for 12 months. BMC Res Notes 2012; 5:245. [PMID: 22594500 PMCID: PMC3414768 DOI: 10.1186/1756-0500-5-245] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 05/17/2012] [Indexed: 12/17/2022] Open
Abstract
Background Recently a large number of short non-coding-RNAs (microRNAs, (miRNA)) have been identified. These miRNAs act as post-transcriptional regulators where they generally have an inhibitory function. miRNAs are present in all human cells, and they are also detected in serum or plasma. The miRNAs have a broad range of actions, and their biogenesis must therefore be under tight control. One putative regulator of miRNA biogenesis or miRNA level could be vitamin D, an ancient hormone with effects on cell growth and differentiation, apoptosis and the immune system. In our study miRNA were reversed transcribed in total RNA isolated from plasma and analyzed by quantitative real-time PCR (qPCR) using the miRCURY LNA Universal RT microRNA PCR system (Exiqon). In 10 pilot subjects 136 miRNAs were detected in one or more plasma samples drawn at baseline and after 12 months of vitamin D supplementation. The twelve miRNAs that showed the greatest change in expression in these pilots were further analyzed by RT-qPCR of RNA from baseline and 12 months plasma samples in 40 subjects given high dose vitamin D3 (20.000 – 40.000 IU per week) and 37 subjects given placebo. Results At baseline there was a significant and positive correlation between serum 25-hydroxyvitamin D and miR-532-3p expression (r = 0.24, P = 0.04). The change in expression of miR-221 from baseline to 12 months (ddCp value) was also significantly different between the vitamin D and placebo group (P =0.04), mainly due to a change in the placebo group. Conclusions We have not been able to demonstrate a consistent effect of vitamin D supplementation on the expression profile of miRNA in plasma. However, further studies are needed as this approach might potentially throw light on unknown aspects of vitamin D physiology.
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Affiliation(s)
- Rolf Jorde
- Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway.
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Jorde R, Svartberg J, Joakimsen RM, Grimnes G. Associations between Polymorphisms Related to Calcium Metabolism and Human Height: The Tromsø Study. Ann Hum Genet 2012; 76:200-10. [DOI: 10.1111/j.1469-1809.2012.00703.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nermoen I, Rørvik J, Holmedal SH, Hykkerud DL, Fougner KJ, Svartberg J, Husebye ES, Løvås K. High frequency of adrenal myelolipomas and testicular adrenal rest tumours in adult Norwegian patients with classical congenital adrenal hyperplasia because of 21-hydroxylase deficiency. Clin Endocrinol (Oxf) 2011; 75:753-9. [PMID: 21689130 DOI: 10.1111/j.1365-2265.2011.04151.x] [Citation(s) in RCA: 70] [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: 11/30/2022]
Abstract
BACKGROUND Increased frequencies of adrenal tumours and testicular adrenal rest tumours (TART) have been reported in patients with 21-hydroxylase deficiency (21OHD). OBJECTIVE Patients, methods and design From a cross-sectional population-based study of 101 adult Norwegian patients with 21OHD, sixty-two participated in this study (23 men, 39 women; age range 18-75); thirty-two were salt wasting (SW) and 30 simple virilizing (SV); they were assessed with adrenal computed tomography (CT), testicular ultrasound and hormone measurement in the morning after overnight medication fast. RESULTS Nine adrenal tumours were detected in seven (11%) patients (bilateral in 2); four were myelolipomas and one a phaeochromocytoma. Seventeen (27%) had normal adrenal size, whereas 36 (58%) had persisting hyperplasia, and seven (11%) adrenal hypoplasia. Abnormal adrenals were more common in SW than in SV. TART occurred exclusively in SW and was present in seven (57%) of these men. Testicular volumes were small compared with normative data. Morning ACTH and 17-hydroxyprogesterone levels correlated positively with adrenal dimensions and frequency of TART. CONCLUSION In this unselected population of patients with classical 21OHD, we found high frequencies of adrenal tumours, particularly myelolipomas, and of hyperplasia and hypoplasia, and TART in SW. It is important that physicians are aware that benign adrenal and testicular tumours occur frequently in 21OHD. Furthermore, these findings may reflect inappropriate glucocorticoid therapy, making a case for the advancement of novel physiological treatment modalities.
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Affiliation(s)
- Ingrid Nermoen
- Institute of Clinical Medicine, Akershus University Hospital, University of Oslo, Norway.
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Carlsen SM, Svartberg J, Schreiner T, Aanderud S, Johannesen O, Skeie S, Lund-Johansen M, Fougner SL, Bollerslev J. Six-month preoperative octreotide treatment in unselected, de novo patients with acromegaly: effect on biochemistry, tumour volume, and postoperative cure. Clin Endocrinol (Oxf) 2011; 74:736-43. [PMID: 21521254 DOI: 10.1111/j.1365-2265.2011.03982.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [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] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Treatment with somatostatin analogues is the primary medical treatment of acromegaly. Controversies still exist whether acute octreotide effect predicts long-term biochemical effects, tumour regression or surgical cure. This prospective study investigates effect of 6-month treatment with octreotide long-acting repeatable (LAR) on insulin-like growth factor-1 (IGF-1) and growth hormone (GH) levels, pituitary function, tumour regression and postoperative cure in de novo acromegalic patients. DESIGN AND METHODS After a baseline evaluation including fasting hormone levels, MRI scan and an acute 50 μg octreotide test, 32 patients were treated with octreotide LAR 20 mg every 28th day for 6 months before surgery. Treatment effects on IGF-1 and GH levels, serum hormone levels and tumour volume were monitored. Surgical cure was evaluated 3 months postoperatively. RESULTS Mean tumour volume reduction was 35%, in one-third of the patients more than 50%, while approximately one-third achieved biochemical remission evaluated by normalized IGF-1 levels. The GH reduction following an acute octreotide test was 81 ± 19% and associated with long-term GH reduction (r = 0·78, P < 0·0005). However, neither acute (r = 0·29, P = 0·12) nor the long-term octreotide effect (r = 0·11, P = 0·58) on GH levels was associated with tumour volume reduction and did not predict subsequent surgical cure. CONCLUSION Six months of long-acting octreotide using a fixed dose, 1/3 of the patients came in biochemical remission, while 2/3 had significant tumour reduction. Moreover, an acute effect of octreotide seemed to be a prerequisite for long-term effect.
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Affiliation(s)
- Sven M Carlsen
- Unit of Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Norwegian University for Science and Technology, Trondheim, Norway.
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Abstract
AIMS To investigate changes in cardiovascular risk factors over 14 years in relation to diabetes status. METHODS The study is based on 10,327 subjects who attended the Tromsø Study in 1994 and were screened again in 2007-8. At baseline there were 79 prevalent cases, and 397 incident cases of type 2 diabetes mellitus (DM2) were diagnosed between 1994 and 2008. RESULTS Cases with DM2 had decreasing levels of high-density lipoprotein cholesterol (HDL-C), total cholesterol and blood pressure (BP) and increasing levels of triglycerides, body mass index (BMI), and anti-hypertensive treatment during 14 years of follow-up. Despite decreasing BP, more than 75% of the treated cases had BP above 135/80 at the end of follow-up. Similarly, less than 35% of incident cases using statins had low-density lipoprotein cholesterol (LDL-C) below the recommended threshold value of 2.6 mmol/l. CONCLUSIONS Despite greater relative reduction in cardiovascular risk factors among people with DM2 compared to those without, treatment targets were met in less than 50% of subjects with DM2. Thirteen percent reached the combined targets for glucose, BP and LDL-C control. This indicates a need for more effective strategies to control cardiovascular risk factors especially among individuals with DM2.
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Affiliation(s)
- Josepha Joseph
- Department of Community Medicine, University of Tromsø, Tromsø, Norway.
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Abstract
AIMS To investigate the association between endogenous testosterone levels and psychological health symptoms in men from a general population. METHODS Total testosterone and sex hormone-binding globulin levels were analysed and free testosterone levels was calculated in 3413 men participating in the fifth Tromsø study in 2001. Self-administered questionnaires including information about education, marital status, smoking habits and the Hopkins Symptom Checklist-10 (SCL-10, a 10-item psychological health questionnaire) were completed. The cross-sectional data were analysed with partial association and analysis of variance and covariance. RESULTS The complete SCL-10 was not associated with total or free testosterone, but symptoms of anxiety were negatively associated with both total and free testosterone (p<0.05). Men presumed to be testosterone deficient, with testosterone levels in the lowest 10th percentile, had increased SCL-10 score compared to men with higher testosterone levels (p=0.021), before and after adjusting for age, waist circumference, marital status, education and smoking. There was an even stronger association between men presumed to be testosterone deficient and symptoms of anxiety (p<0.001). However, men with more pronounced symptoms indicating mental disorder did not have lower testosterone levels. CONCLUSIONS Men presumed being testosterone deficient had a higher symptom score, in particularly regarding anxiety, but they did not have pathological symptoms. Thus, lower testosterone levels was only associated with subthreshold symptoms of anxiety and depression.
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Joseph J, Svartberg J, Njølstad I, Schirmer H. Risk factors for type 2 diabetes in groups stratified according to metabolic syndrome: a 10-year follow-up of the Tromsø Study. Eur J Epidemiol 2011; 26:117-24. [PMID: 21188479 PMCID: PMC3043259 DOI: 10.1007/s10654-010-9540-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [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: 06/18/2010] [Accepted: 12/15/2010] [Indexed: 01/21/2023]
Abstract
Many incident cases of type 2 diabetes do not fulfil the metabolic syndrome, which accordingly has been questioned both as a research and clinical tool. The aim of this study was to determine differences in risk factors for type 2 diabetes between groups with high or low metabolic score. The study population were 26,093 men and women attending the Tromsø Study in 1994, followed through 2005, and who did not have diabetes when entering the study. A total of 492 incident cases of type 2 diabetes were registered. A metabolic score was defined according to a modified version of the National Cholesterol Education Program Adult Treatment Panel III. For those fulfilling ≥ 3 metabolic score criteria, increasing age, body mass index (BMI), triglycerides and a family history of diabetes were independent predictors. Age, BMI, and triglycerides predicted type 2 diabetes more strongly in subjects with low metabolic score, whereas high HDL cholesterol was not protective in this low risk group. The risk associated with a positive family history was unaffected by level of metabolic score. In addition smoking, low education and in men also physical inactivity were independent risk factors only in those with low metabolic score. Adding these non-metabolic risk factors increased correct classification from an ROC area of 77.2 to 87.1% (P value < 0.0001). One half of the incident cases of type 2 diabetes were missed by using high metabolic score for risk prediction.
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Affiliation(s)
- Josepha Joseph
- Department of Community Medicine, University of Tromsø, 9037 Tromsø, Norway.
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Abstract
Men have a higher incidence of cardiovascular disease (CVD) than women, and adverse thrombotic events increase with age. Recent experimental cross-sectional, and case-control studies have shown that testosterone may affect the hemostatic/fibrinolytic system in men in several ways. It has been hypothesized that physiological doses of testosterone would have a beneficial effect on tissue factor-induced thrombin generation and the development of CVD. The search for eternal youth has created a market for testosterone treatment in aging men during the last few years. However, whether testosterone supplementation could be useful in the treatment of testosterone-deficient elderly men is still controversial. The present review focuses on the coagulation system and CVD from the perspective of testosterone.
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Affiliation(s)
- Ellen Brodin
- Hematological Research Group (HERG), Department of Clinical Medicine, University of Tromsø, Tromsø, Norway.
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Nermoen I, Husebye ES, Svartberg J, Løvås K. Subjective health status in men and women with congenital adrenal hyperplasia: a population-based survey in Norway. Eur J Endocrinol 2010; 163:453-9. [PMID: 20551222 DOI: 10.1530/eje-10-0284] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [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: 11/08/2022]
Abstract
BACKGROUND Patients with classical congenital adrenal hyperplasia (CAH) require life-long corticosteroid therapy, with uncertain health outcome. Investigations of subjective health status in unselected populations of adult patients are needed. OBJECTIVE To identify all adult Norwegian patients with CAH and obtain population-based data on subjective and psychological health status, working ability and fertility. PATIENTS, METHODS AND DESIGN: Classical CAH patients were identified through search in electronic diagnosis registries at all the university hospitals in Norway. The diagnosis was verified by scrutiny of medical records. The patients were invited to a questionnaire survey including medical history, and the Short Form-36 (SF-36) and Quality of Life Scale questionnaires. The questionnaire responses and fertility data were compared with normative data. RESULTS We identified 104 adult patients (101 alive) with classical CAH (63% female), yielding overall incidence at 1/20,000 live births (1/16,000 in females). Seventy-two (72%) responded; median age 38 years (range 18-72). All the SF-36 scales were significantly impaired, most pronounced for general health and vitality perception. Working disability was reported by 19% of the patients, compared with 10% in the general population. The female patients were often single, and the CAH women had only 21% of the expected number of children compared with the general population. CONCLUSION In this population-based survey of patients with classical CAH, we found that subjective health status and working ability were impaired, and that fertility was reduced in females. There is a need for improvement of the medical treatment and the general care of this patient group.
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Affiliation(s)
- Ingrid Nermoen
- Faculty Division, Akershus University Hospital, University of Oslo, 1478 Lørenskog, Norway.
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Joseph J, Svartberg J, Njølstad I, Schirmer H. Incidence of and risk factors for type-2 diabetes in a general population: The Tromsø Study. Scand J Public Health 2010; 38:768-75. [DOI: 10.1177/1403494810380299] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Aims: To determine the gender-specific incidence and risk factors of type-2 diabetes mellitus (T2DM) in a general population. Methods: The study is based on 12,431 men and 13,737 women aged 25-98 years, attending the Tromsø Study in 1994 and followed through 2005, who did not have diabetes when entering the study. Sex-specific hazard ratios were estimated from Cox proportional hazard models. Results: A total of 522 cases of T2DM were registered, 308 among men and 214 among women. The age-standardised incidence rate was higher in men than in women, 2.6 (95% CI 2.32—2.90) and 1.6 (95% CI 1.40—1.83) per 1000 person-years, respectively. In multivariate survival analysis, age, body mass index (BMI), triglycerides, high-density lipoprotein (HDL) cholesterol, hypertension, family history of diabetes, low education and smoking were independent predictors of T2DM in both genders (p>0.05). Total cholesterol and lack of leisure-time physical activity were independent predictors in men only. We found an interaction between HDL cholesterol and triglyceride levels (p>0.001) and between triglyceride levels and a positive family history of diabetes (p = 0.04). These interactions were independent of BMI. A positive family history combined with triglycerides in the highest tertile and BMI >25 kg/m2 conveyed a 10-year risk of T2DM of 10% (95% CI 8—12%) vs. 0.2% (95% CI 0.08—0.31%) for the lowest risk group. Conclusions: A family history of diabetes, elevated BMI, and high triglyceride levels identifies independent of cardiovascular risk factors, a group with especially high risk of T2DM.
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Affiliation(s)
- Josepha Joseph
- Department of Community Medicine, University of Tromsø, Tromsø, Norway,
| | - Johan Svartberg
- Department of Medicine, University Hospital of North Norway, Tromsø, Norway, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - Inger Njølstad
- Department of Community Medicine, University of Tromsø, Tromsø, Norway
| | - Henrik Schirmer
- Department of Community Medicine, University of Tromsø, Tromsø, Norway, Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
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Abstract
PURPOSE OF REVIEW To evaluate the recent literature on the effect of the use of androgens in men with chronic obstructive pulmonary disease (COPD). RECENT FINDINGS Men with COPD have been found to have reduced endogenous testosterone levels in some studies, and they also share several traits with hypogonadal men, such as loss of lean body mass and strength, suggesting that substitution with androgens might be a rational therapy. There are, however, only a few published placebo-controlled trials investigating the effects of androgens in men with COPD, and only one during the last 2 years. After a review of these manuscripts they were summarized. SUMMARY The effect of androgens in men with COPD is modest, and pulmonary function was in general not improved in men using androgens. The use of androgens to increase muscle mass and strength in patients participating in rehabilitation programs is promising, and also regarding the beneficial effects on sexuality. However, more research is needed to determine if androgen therapy could be a treatment option for men with COPD.
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Affiliation(s)
- Johan Svartberg
- Division of Internal Medicine, University Hospital of North Norway, University of Tromsø, Tromsø, Norway.
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Vikan T, Schirmer H, Njølstad I, Svartberg J. Low testosterone and sex hormone-binding globulin levels and high estradiol levels are independent predictors of type 2 diabetes in men. Eur J Endocrinol 2010; 162:747-54. [PMID: 20061333 DOI: 10.1530/eje-09-0943] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To study the impact of endogenous sex hormone levels in community-dwelling men on later risk for type 2 diabetes. DESIGN Population-based prospective cohort study. METHODS For the analyses, 1454 men who participated in the fourth Tromsø study (1994-1995) were used. Cases of diabetes were retrieved and validated until 31.12.05 following a detailed protocol. The prospective association between sex hormones and diabetes was examined using Cox proportional hazard regression analysis, allowing for multivariate adjustments. RESULTS There was a significantly lowered multi-adjusted risk for later diabetes with higher normal total testosterone levels, both linearly per s.d. increase (hazard ratio (HR) 0.71, confidence interval (CI) 0.54-0.92) and in the higher quartiles of total testosterone than in the lowest quartiles (HR 0.53, CI 0.33-0.84). A reduced multi-adjusted risk for incident diabetes was also found for men with higher sex hormone-binding globulin (SHBG) levels, both linearly per s.d. increase (HR 0.55, CI 0.39-0.79) and when comparing the third (HR 0.38, CI 0.18-0.81) and the fourth quartile (HR 0.37, CI 0.17-0.82) to the lowest quartile. The associations with total testosterone and SHBG were no longer significant after inclusion of waist circumference to the multivariate models. Estradiol (E(2)) was positively associated with incident diabetes after multivariate adjustments including waist circumference when comparing the second (HR 0.49, CI 0.26-0.93) and the third (HR 0.51, CI 0.27-0.96) quartile to the highest quartile. CONCLUSION Men with higher E(2) levels had an increased risk of later diabetes independent of obesity, while men with lower total testosterone and SHBG had an increased risk of diabetes that appeared to be dependent on obesity.
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Affiliation(s)
- Torkel Vikan
- Division of Internal Medicine, Department of Cardiology, University Hospital of North Norway, Tromsø 9038, Norway
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Agledahl I, Brodin E, Svartberg J, Hansen JB. Impact of long-term testosterone treatment on plasma levels of free TFPI and TF-induced thrombin generation ex vivo in elderly men with low testosterone levels. Thromb Haemost 2010; 102:945-50. [PMID: 19888533 DOI: 10.1160/th09-02-0090] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Men have a higher incidence of cardiovascular disease (CVD) than women of similar age, and it has been suggested that testosterone may influence the development of CVD. Recently, we demonstrated that elderly men with low testosterone levels had lower plasma levels of free tissue factor pathway inhibitor (TFPI) Ag associated with shortened tissue factor (TF)-induced coagulation initiation in a population based case-control study. Our hypothesis was that one year of testosterone treatment to physiological levels in elderly men would increase the levels of free TFPI Ag in plasma and have a favorable effect on TF-induced coagulation. Twenty-six men with low testosterone levels (< or =11.0 nM) were randomly assigned to treatment with intramuscular testosterone depot injections (testosterone undecanoate 1,000 mg) or placebo in a double-blinded study. Each participant received a total of five injections, at baseline, 6, 16, 28 and 40 weeks, and TF-induced thrombin generation ex vivo and plasma free TFPI Ag were measured after one year. At the end of the study total and free testosterone levels were significantly higher in the testosterone treated group (14.9 +/- 4.5 nM vs. 8.1 +/- 2.4 nM; p < 0.001, and 363.3 +/- 106.6 pM vs. 187.3 +/- 63.2 pM; p < 0.001, respectively). Testosterone treatment for one year did neither cause significant changes in TF-induced thrombin generation ex vivo nor changes in plasma levels of free TFPI Ag. In conclusion, normalising testosterone levels by testosterone treatment for 12 months in elderly men did not affect TF-induced coagulation or plasma TFPI levels. The potential antithrombotic role of testosterone therapy remains to be elucidated.
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Affiliation(s)
- Ingvild Agledahl
- Department of Medicine, Institute of Clinical Medicine, University of Tromsø, 9037 Tromsø, Norway
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Radtke MA, Nermoen I, Kollind M, Skeie S, Sørheim JI, Svartberg J, Hals I, Moen T, Dørflinger GH, Grill V. Six months of diazoxide treatment at bedtime in newly diagnosed subjects with type 1 diabetes does not influence parameters of {beta}-cell function and autoimmunity but improves glycemic control. Diabetes Care 2010; 33:589-94. [PMID: 20028939 PMCID: PMC2827514 DOI: 10.2337/dc09-1436] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Continuous beta-cell rest with diazoxide preserves residual endogenous insulin production in type 1 diabetes. However, side effects have hampered therapeutic usefulness. In a double-blind study, we tested whether lower, intermittent dosing of diazoxide had beneficial effects on insulin production, metabolic control, and autoimmunity markers in the absence of side effects. RESEARCH DESIGN AND METHODS Forty-one newly diagnosed type 1 diabetic patients were randomized to 6 months of treatment with placebo or 100 mg diazoxide at bedtime. A1C, C-peptide (fasting and glucagon stimulated), and FoxP3(+) regulatory T-cells (Tregs) were measured. Patients were followed for 6 months after intervention. RESULTS Of six dropouts, three were due to perceived side effects; one subject in the diazoxide group experienced rash, another dizziness, and one in the placebo group sleep disturbance. Adverse effects in others were absent. Diazoxide treatment reduced A1C from 8.6% at baseline to 6.0% at 6 months and 6.5% at 12 months. Corresponding A1C value in the placebo arm were 8.3, 7.3, and 7.5% (P < 0.05 for stronger reduction in the diazoxide group). Fasting and stimulated C-peptide decreased during 12 months similarly in both arms (mean -0.30 and -0.18 nmol/l in the diazoxide arm and -0.08 and -0.09 nmol/l in the placebo arm). The proportion of Tregs was similar in both arms and remained stable during intervention but was significantly lower compared with nondiabetic subjects. CONCLUSIONS Six months of low-dose diazoxide was without side effects and did not measurably affect insulin production but was associated with improved metabolic control.
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Affiliation(s)
- Maria Anita Radtke
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Svartberg J. Oversiktlig om andrologi. Tidsskriftet 2010. [DOI: 10.4045/tidsskr.10.0750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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