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Feldt-Rasmussen U, Effraimidis G, Bliddal S, Klose M. Risks of suboptimal and excessive thyroid hormone replacement across ages. J Endocrinol Invest 2024; 47:1083-1090. [PMID: 38015369 PMCID: PMC11035408 DOI: 10.1007/s40618-023-02229-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/13/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Hypothyroidism is prevalent at all ages and represents a non-communicable disease with preventable consequences. METHOD Narrative review. REVIEW In children and adolescents, the most devastating consequences of undertreatment with levothyroxine (LT4) are poor growth and development. Delayed treatment in congenital hypothyroidism can lead to permanent brain damage. In young to middle-aged adults, symptoms are often overlooked, and treatment delayed by many years. The resulting consequences are also at this age group compromised brain and physical function but less severe and partly reversible with treatment. The under-treated condition often results in a higher risk of, e.g., increased cardiovascular disease burden, obesity, hypertension, poor physical capacity, and poor quality of life. Excessive replacement is at all adult age groups associated with increased risk of cardiac death, osteoporosis, loss of muscle function, psychological instability and poor quality of life. In young fertile women, the consequences of undertreatment with LT4 are subnormal fertility, recurrent pregnancy loss, compromised fetal growth, and neurocognitive development. On the other hand, excessive LT4 treatment has been related to gestational hypertension, preeclampsia and preterm birth. In the elderly, care must be given to avoid confusing a slightly high age-related serum TSH with requirement for LT4 treatment in a truly hypothyroid patient. Excessive LT4 treatment in patients of high age is associated with an increased mortality. CONCLUSION Suboptimal and excessive LT4 replacement of the preventable non-communicable disease hypothyroidism requires more focus from the healthcare system and from the global political systems to prevent the personally devastating and socioeconomically challenging consequences.
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Affiliation(s)
- U Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
- Institute of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark.
- Department of Medical Endocrinology and Metabolism PE 2132, Rigshospitalet, National University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - G Effraimidis
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Endocrinology and Metabolic Diseases, Larissa University Hospital, Larissa, Greece
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - S Bliddal
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - M Klose
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Rosendal C, Arlien-Søborg MC, Nielsen EH, Andersen MS, Feltoft CL, Klose M, Andreassen M, Bruun NH, Jørgensen JOL, Dal J. Changes in acromegaly comorbidities, treatment, and outcome over three decades: a nationwide cohort study. Front Endocrinol (Lausanne) 2024; 15:1380436. [PMID: 38638137 PMCID: PMC11024468 DOI: 10.3389/fendo.2024.1380436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Objective To study the time-dependent changes in disease features of Danish patients with acromegaly, including treatment modalities, biochemical outcome, and comorbidities, with a particular focus on cancer and mortality. Methods Pertinent acromegaly-related variables were collected from 739 patients diagnosed since 1990. Data are presented across three decades (1990-1999, 2000-2009, and 2010-2021) based on the year of diagnosis or treatment initiation. Results Adenoma size and insulin-like growth factor I (IGF-I) levels at diagnosis did not differ significantly between study periods. The risk of being diagnosed with diabetes, heart disease, sleep apnea, joint disease, and osteoporosis increased from the 1990s to the later decades, while the mortality risk declined to nearly half. The risk of cancer did not significantly change. Treatment changed toward the use of more medical therapy, and fewer patients underwent repeat surgeries or pituitary irradiation. A statistically significant increase in the proportion of patients achieving IGF-I normalization within 3-5 years was observed over time (69%, 83%, and 88%). The proportion of patients with three or more deficient pituitary hormones decreased significantly over time. Conclusion Modern medical treatment regimens of acromegaly as well as increased awareness and improved diagnostics for its comorbidities have led to better disease control, fewer patients with severe hypopituitarism, and declining mortality in the Danish cohort of acromegaly patients. The risk of cancer did not increase over the study period.
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Affiliation(s)
- Christian Rosendal
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | | | | | | | - Claus Larsen Feltoft
- Department of Medicine, Copenhagen University Hospital, Herlev, Denmark
- Department of Endocrinology, Gentofte Hospital, Herlev, Denmark
| | - Marianne Klose
- Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Andreassen
- Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Niels Henrik Bruun
- Research Data and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | | | - Jakob Dal
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Aalborg, Denmark
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Okutan S, Jørgensen NT, Pedersen LE, Borresen SW, Hilsted L, Hansen LF, Feldt-Rasmussen U, Klose M. Determination of cortisol cut-off limits and steroid dynamics in the ACTH stimulation test: a comparative analysis using Roche Elecsys Cortisol II immunoassay and LC-MS/MS. Endocrine 2024:10.1007/s12020-024-03752-0. [PMID: 38460071 DOI: 10.1007/s12020-024-03752-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 02/12/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE Measurement of cortisol concentrations is method dependent. The study aimed to establish assay-specific cut-off limits for cortisol after adrenocorticotropic hormone (ACTH) stimulation, comparing Roche Elecsys Cortisol II immunoassay to liquid chromatography-mass spectrometry (LC-MS/MS), and to assess the impact of patient characteristics, estrogen containing oral contraceptives as well as relation to other adrenocortical steroid hormone dynamics. METHODS One hundred healthy participants underwent a 250 μg ACTH-test, with plasma samples analyzed using ElecsysCortI, ElecsysCortII, and LC-MS/MS. Cortisone, corticosterone, 17-OH-progesterone, dehydroepiandrosterone sulfate (DHEAS), androstenedione, and testosterone were additionally analyzed with LC-MS/MS. Cut-off limit for a normal cortisol response to the ACTH-test was defined as: 2.5th percentile-1.96 × SE. RESULTS ElecsysCort II measured cortisol concentrations 21% (95% CI: 19-22%) lower than ElecsysCort I. Cut-off limits for cortisol 30 and 60 min after ACTH were 426 and 485 nmol/L (ElecsysCort II) and 411 and 470 nmol/L (LC-MS/MS). Cut-offs were unaffected by gender, or body-composition. The ACTH-test resulted in significantly increased adrenocortical steroid hormones, except for decreased cortisone concentrations (both sexes), and decreased testosterone in men (1.9 nmol/L, 95% CI: 1.3-2.5). Testosterone was increased in women (0.07 nmol/L, 95% CI: 0.02-0.13). CONCLUSION ElecsysCort II has high analytical performance and yields significantly lower cortisol concentrations than prior polyclonal immunoassays. This clinically relevant difference underscores the necessity for revised cut-off limits for improved diagnostic precision. Suggested 30-minute cortisol cutoff limits are 411 nmol/L (LC-MS/MS) and 426 nmol/L (ElecsysCort II). Adrenocortical steroids increased upon ACTH stimulation, except for cortisone in both sexes and testosterone in men, both of which decreased.
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Affiliation(s)
- Sema Okutan
- Department of Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Nanna Thurmann Jørgensen
- Department of Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Lars Engers Pedersen
- Department of Clinical Biochemistry, Næstved, Slagelse and Ringsted Hospitals, Slagelse, Denmark
| | - Stina Willemoes Borresen
- Department of Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Linda Hilsted
- Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lennart Friis Hansen
- Department of Clinical Biochemistry, Næstved, Slagelse and Ringsted Hospitals, Slagelse, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Marianne Klose
- Department of Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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Slott C, Langer SW, Møller S, Krogh J, Klose M, Hansen CP, Kjaer A, Holmager P, Garbyal RS, Knigge U, Andreassen M. Outlook for 615 Small Intestinal Neuroendocrine Tumor Patients: Recurrence Risk after Surgery and Disease-Specific Survival in Advanced Disease. Cancers (Basel) 2024; 16:204. [PMID: 38201631 PMCID: PMC10778333 DOI: 10.3390/cancers16010204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/08/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Small intestinal neuroendocrine tumors (siNET) are one of the most common neuroendocrine neoplasms. Radical surgery is the only curative treatment. METHOD We utilized a single-center study including consecutive patients diagnosed from 2000 to 2020 and followed them until death or the end of study. Disease-specific survival and recurrence-free survival (RFS) were investigated by Cox regression analyses with the inclusion of prognostic factors. Aims/primary outcomes: We identified three groups: (1) disease specific-survival in the total cohort (group1), (2) RFS and disease-specific survival after intended radical surgery (group2), (3) disease specific-survival in patients with unresectable disease or residual tumor after primary resection (group3). RESULTS In total, 615 patients, with a mean age (SD) 65 ± 11 years were included. Median (IQR) Ki-67 index was 4 (2-7)%. Median disease-specific survival in group1 was 130 months. Median RFS in group2 was 138 months with 5- and 10-year RFS rates of 72% and 59% with age, plasma chromogranin A (p-CgA) and Ki-67 index as prognostic factors. The ten year disease-specific survival rate in group2 was 86%. The median disease-specific survival in group3 was 85 months with age, Ki-67 index, p-CgA and primary tumor resection as prognostic factors. When proliferation was expressed by WHO grade, no difference was observed between G1 vs. G2 for any of the primary outcomes. CONCLUSIONS Recurrence rates remained high 5-10 years after surgery (group2) supporting long-term follow-up. Median disease-specific survival in patient with unresectable disease (group3) was 7 years, with a favorable impact of primary tumor resection. Our data does not support the current grading system since no significant prognostic information was detected in G1 vs. G2 tumors.
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Affiliation(s)
- Cecilie Slott
- ENETS Center of Excellence, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.S.); (S.W.L.); (S.M.); (J.K.); (M.K.); (C.P.H.); (A.K.); (P.H.); (R.S.G.); (U.K.)
- Department of Endocrinology and Metabolism, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Seppo W. Langer
- ENETS Center of Excellence, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.S.); (S.W.L.); (S.M.); (J.K.); (M.K.); (C.P.H.); (A.K.); (P.H.); (R.S.G.); (U.K.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Oncology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Stine Møller
- ENETS Center of Excellence, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.S.); (S.W.L.); (S.M.); (J.K.); (M.K.); (C.P.H.); (A.K.); (P.H.); (R.S.G.); (U.K.)
- Department of Endocrinology and Metabolism, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Jesper Krogh
- ENETS Center of Excellence, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.S.); (S.W.L.); (S.M.); (J.K.); (M.K.); (C.P.H.); (A.K.); (P.H.); (R.S.G.); (U.K.)
- Department of Endocrinology and Metabolism, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Marianne Klose
- ENETS Center of Excellence, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.S.); (S.W.L.); (S.M.); (J.K.); (M.K.); (C.P.H.); (A.K.); (P.H.); (R.S.G.); (U.K.)
- Department of Endocrinology and Metabolism, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Carsten Palnæs Hansen
- ENETS Center of Excellence, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.S.); (S.W.L.); (S.M.); (J.K.); (M.K.); (C.P.H.); (A.K.); (P.H.); (R.S.G.); (U.K.)
- Department of Surgery and Transplantation, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Andreas Kjaer
- ENETS Center of Excellence, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.S.); (S.W.L.); (S.M.); (J.K.); (M.K.); (C.P.H.); (A.K.); (P.H.); (R.S.G.); (U.K.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine & Cluster for Molecular Imaging, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Pernille Holmager
- ENETS Center of Excellence, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.S.); (S.W.L.); (S.M.); (J.K.); (M.K.); (C.P.H.); (A.K.); (P.H.); (R.S.G.); (U.K.)
- Department of Endocrinology and Metabolism, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Rajendra Singh Garbyal
- ENETS Center of Excellence, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.S.); (S.W.L.); (S.M.); (J.K.); (M.K.); (C.P.H.); (A.K.); (P.H.); (R.S.G.); (U.K.)
- Department of Pathology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Ulrich Knigge
- ENETS Center of Excellence, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.S.); (S.W.L.); (S.M.); (J.K.); (M.K.); (C.P.H.); (A.K.); (P.H.); (R.S.G.); (U.K.)
- Department of Endocrinology and Metabolism, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Surgery and Transplantation, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Mikkel Andreassen
- ENETS Center of Excellence, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.S.); (S.W.L.); (S.M.); (J.K.); (M.K.); (C.P.H.); (A.K.); (P.H.); (R.S.G.); (U.K.)
- Department of Endocrinology and Metabolism, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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Møller S, Langer SW, Slott C, Krogh J, Hansen CP, Kjaer A, Holmager P, Klose M, Garbyal RS, Knigge U, Andreassen M. Recurrence-Free Survival and Disease-Specific Survival in Patients with Pancreatic Neuroendocrine Neoplasms: A Single-Center Retrospective Study of 413 Patients. Cancers (Basel) 2023; 16:100. [PMID: 38201527 PMCID: PMC10777990 DOI: 10.3390/cancers16010100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION The prognosis and impact of different prognostic factors in pancreatic neuroendocrine neoplasms (pNEN) remain controversial. AIM To investigate prognostic factors for recurrence-free survival and disease-specific survival in patients with pNEN, divided into three groups: patients undergoing surveillance (tumor size < 2 cm, group 1), patients followed after curative-intended surgery (group 2), and patients with unresectable disease or residual tumors after resection (group 3). METHOD A single-center retrospective study including consecutive patients over a 20-year period. Multivariate Cox regression analyses were performed to identify risk factors. RESULTS 413 patients were included, with a mean (SD) age of 62 ± 14 years. In group 1 (n = 51), median (IQR) follow-up was 29 (21-34) months, and tumor size was 1.0 (0.8-1.4) cm. One progressed and had a tumor resection. In group 2 (n = 165), follow-up 59 (31-102) months, median tumor size 2 (1.2-3.4) cm, median Ki-67 index 5 (3-10)%, the 5-year recurrence rate was 21%. Tumor size (p < 0.001), Ki-67 index (p = 0.02), and location in the pancreatic head (p < 0.001) were independent risk factors. In group 3 (n = 197), follow-up 19 (6-46) months, median tumor size 4.2 (2.6-7.0) cm, Ki-67 index 17 (9-64)%, the median disease-specific survival was 22 (6-75) months-99 in NET G1; 54 in NET G2; 14 in NET G3; and 6 months in neuroendocrine carcinomas (NEC). Age (p = 0.029), plasma chromogranin A (p = 0.014), and proliferation, expressed by grade (p = 0.001) and Ki-67 index (p < 0.001), were risk factors. CONCLUSION Growth in pNET < 2 cm requiring surgery was observed in 1/51. Tumor size, Ki-67 index, and location in the head were prognostic factors for disease recurrence, while age, plasma chromogranin A, and proliferation predicted mortality in patients with unresectable disease or residual tumors after resection.
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Affiliation(s)
- Stine Møller
- ENETS Center of Excellence, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (S.M.); (S.W.L.); (C.S.); (J.K.); (C.P.H.); (A.K.); (P.H.); (M.K.); (R.S.G.); (U.K.)
- Department of Endocrinology and Metabolism 7562, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Seppo W. Langer
- ENETS Center of Excellence, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (S.M.); (S.W.L.); (C.S.); (J.K.); (C.P.H.); (A.K.); (P.H.); (M.K.); (R.S.G.); (U.K.)
- Department of Oncology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 1172 Copenhagen, Denmark
| | - Cecilie Slott
- ENETS Center of Excellence, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (S.M.); (S.W.L.); (C.S.); (J.K.); (C.P.H.); (A.K.); (P.H.); (M.K.); (R.S.G.); (U.K.)
- Department of Endocrinology and Metabolism 7562, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Jesper Krogh
- ENETS Center of Excellence, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (S.M.); (S.W.L.); (C.S.); (J.K.); (C.P.H.); (A.K.); (P.H.); (M.K.); (R.S.G.); (U.K.)
- Department of Endocrinology and Metabolism 7562, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 1172 Copenhagen, Denmark
| | - Carsten Palnæs Hansen
- ENETS Center of Excellence, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (S.M.); (S.W.L.); (C.S.); (J.K.); (C.P.H.); (A.K.); (P.H.); (M.K.); (R.S.G.); (U.K.)
- Department of Surgery and Transplantation, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Andreas Kjaer
- ENETS Center of Excellence, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (S.M.); (S.W.L.); (C.S.); (J.K.); (C.P.H.); (A.K.); (P.H.); (M.K.); (R.S.G.); (U.K.)
- Department of Clinical Physiology and Nuclear Medicine & Cluster for Molecular Imaging, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, 1172 Copenhagen, Denmark
| | - Pernille Holmager
- ENETS Center of Excellence, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (S.M.); (S.W.L.); (C.S.); (J.K.); (C.P.H.); (A.K.); (P.H.); (M.K.); (R.S.G.); (U.K.)
- Department of Endocrinology and Metabolism 7562, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Marianne Klose
- ENETS Center of Excellence, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (S.M.); (S.W.L.); (C.S.); (J.K.); (C.P.H.); (A.K.); (P.H.); (M.K.); (R.S.G.); (U.K.)
- Department of Endocrinology and Metabolism 7562, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Rajendra Singh Garbyal
- ENETS Center of Excellence, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (S.M.); (S.W.L.); (C.S.); (J.K.); (C.P.H.); (A.K.); (P.H.); (M.K.); (R.S.G.); (U.K.)
- Department of Pathology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Ulrich Knigge
- ENETS Center of Excellence, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (S.M.); (S.W.L.); (C.S.); (J.K.); (C.P.H.); (A.K.); (P.H.); (M.K.); (R.S.G.); (U.K.)
- Department of Endocrinology and Metabolism 7562, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Surgery and Transplantation, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Mikkel Andreassen
- ENETS Center of Excellence, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (S.M.); (S.W.L.); (C.S.); (J.K.); (C.P.H.); (A.K.); (P.H.); (M.K.); (R.S.G.); (U.K.)
- Department of Endocrinology and Metabolism 7562, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 1172 Copenhagen, Denmark
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Feldt-Rasmussen U, Effraimidis G, Bliddal S, Klose M. Consequences of undertreatment of hypothyroidism. Endocrine 2023:10.1007/s12020-023-03460-1. [PMID: 37556077 DOI: 10.1007/s12020-023-03460-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 07/15/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE To provide an overview of consequences of undertreatment with levothyroxine (LT4) in the common non-communicable disease, hypothyroidism. METHODS Narrative review of the literature. RESULTS Hypothyroidism is globally very prevalent at all age groups and represents a non-communicable disease in which the risks and consequences are preventable. In children and adolescents, the most devastating consequences of undertreatment are poor growth and development. Lack of early treatment in congenital hypothyroidism can lead to permanent damage of brain function. In young to middle-aged adults, consequences are often overlooked, and treatment delayed by many years. The resulting consequences are also at this age group compromised brain and physical functioning but less severe and partly reversible with treatment. The undertreated condition often results in a higher risk of several secondary devastating diseases such as increased cardiovascular disease burden, obesity, hypertension, poor physical capacity, poor quality of life. In young women of fertile age the consequences of undertreatment with LT4 are subnormal fertility, recurrent pregnancy loss, preeclampsia, compromised fetal growth and neurocognitive development. There is a further risk of 30-50% of developing postpartum thyroiditis. In the elderly population care must be given to avoid confusing a slightly high serum TSH as result of physiological age adaptation with a requirement for LT4 treatment in a truly hypothyroid patient. CONCLUSION Undertreatment of the preventable non-communicable disease hypothyroidism requires more focus both from caretakers in the healthcare system, but also from the global political systems in order to prevent the personally devastating and socioeconomically challenging consequences.
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Affiliation(s)
- Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
- Institute of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark.
| | - Grigoris Effraimidis
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Endocrinology and Metabolic Diseases, Larissa University Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Sofie Bliddal
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marianne Klose
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Said M, Krogh J, Feldt-Rasmussen U, Rasmussen ÅK, Kristensen TS, Rossing CM, Johannesen HH, Oturai P, Holmager P, Kjaer A, Klose M, Langer S, Knigge U, Andreassen M. Imaging surveillance in multiple endocrine neoplasia type 1: Ten years of experience with somatostatin receptor positron emission tomography. J Neuroendocrinol 2023; 35:e13322. [PMID: 37564005 DOI: 10.1111/jne.13322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 06/23/2023] [Accepted: 06/29/2023] [Indexed: 08/12/2023]
Abstract
Guidelines for multiple endocrine neoplasia type 1 (MEN1) recommend intensive imaging surveillance without specifying a superior regimen, including the role of somatostatin receptor imaging (SRI) with positron emission tomography (PET). The primary outcomes were to: (1) Assess change in treatment of duodenal-pancreatic neuroendocrine neoplasms (DP-NENs), bronchopulmonary NENs, and thymic tumors attributed to use of SRI PET/computed tomography (CT) and (2) estimate radiation from imaging and risk of cancer death attributed to imaging radiation. This was a retrospective single center study, including all MEN1 patients, who had had at least one SRI PET/CT. A total of 60 patients, median age 42 (range 21-54) years, median follow-up 6 (range 1-10) years were included. Of 470 cross sectional scans (MRI, CT, SRI PET/CT), 209 were SRI PET/CT. The additional information from SRI PET had implications in 1/14 surgical interventions and 2/12 medical interventions. The estimated median radiation dose per patient was 104 (range 51-468) mSv of which PET contributed with 13 (range 5-55) mSv and CT with 91 mSv (range 46-413 mSv), corresponding to an estimated increased median risk of cancer death of 0.5% during 6 years follow-up. SRI PET had a significant impact on 3/26 decisions to intervene in 60 MEN1 patients followed for a median of 6 years with SRI PET/CT as the most frequently used modality. The surveillance program showed a high radiation dose. Multi-modality imaging strategies designed to minimize radiation exposure should be considered. Based on our findings, SRI-PET combined with CT cannot be recommended for routine surveillance in MEN1 patients.
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Affiliation(s)
- Maha Said
- Department of Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen N, Denmark
| | - Jesper Krogh
- Department of Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen N, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen N, Denmark
| | - Åse Krogh Rasmussen
- Department of Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen N, Denmark
| | | | - Caroline Maria Rossing
- Department of Genomic Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen N, Denmark
| | - Helle Hjorth Johannesen
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen N, Denmark
| | - Peter Oturai
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen N, Denmark
| | - Pernille Holmager
- Department of Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen N, Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen N, Denmark
| | - Marianne Klose
- Department of Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen N, Denmark
| | - Seppo Langer
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen N, Denmark
| | - Ulrich Knigge
- Department of Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen N, Denmark
- Department of surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen N, Denmark
| | - Mikkel Andreassen
- Department of Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen N, Denmark
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8
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Torp NMU, Pedersen IB, Carlé A, Karmisholt JS, Ebbehøj E, Grove-Laugesen D, Brix TH, Bonnema SJ, Schrijvers BF, Nygaard B, Sigurd LB, Feldt-Rasmussen U, Klose M, Rasmussen ÅK, Andersen S, Andersen SL. Hyperthyroidism in pregnancy: design and methodology of a Danish multicenter study. Thyroid Res 2023; 16:11. [PMID: 37041614 PMCID: PMC10088206 DOI: 10.1186/s13044-023-00154-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/19/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Graves' disease (GD) is the main cause of hyperthyroidism in women of the fertile age. In pregnant women, the disease should be carefully managed and controlled to prevent maternal and fetal complications. Observational studies provide evidence of the adverse effects of untreated hyperthyroidism in pregnancy and have in more recent years substantiated a risk of teratogenic side effects with the use of antithyroid drugs (ATDs). These findings have challenged the clinical recommendations regarding the choice of treatment when patients become pregnant. To extend observational findings and support future clinical practice, a systematic collection of detailed clinical data in and around pregnancy is needed. METHODS With the aim of collecting clinical and biochemical data, a Danish multicenter study entitled 'Pregnancy Investigations on Thyroid Disease' (PRETHYR) was initiated in 2021. We here describe the design and methodology of the first study part of PRETHYR. This part focuses on maternal hyperthyroidism and recruits female patients in Denmark with a past or present diagnosis of GD, who become pregnant, as well as women who are treated with ATDs in the pregnancy, irrespective of the underlying etiology. The women are included during clinical management from endocrine hospital departments in Denmark, and study participation includes patient questionnaires in pregnancy and postpartum as well as review of medical records from the mother and the child. RESULTS Data collection was initiated on November 1, 2021 and covered all five Danish Regions from March 1, 2022. Consecutive study inclusion will continue, and we here report the first status of inclusion. As of November 1, 2022, a total of 62 women have been included in median pregnancy week 19 (interquartile range (IQR): 10-27) with a median maternal age of 31.4 years (IQR: 28.5-35.1). At inclusion, 26 women (41.9%) reported current use of thyroid medication; ATDs (n = 14), Levothyroxine (n = 12). CONCLUSION This report describes a newly established systematic and nationwide collection of detailed clinical data on pregnant women with hyperthyroidism and their offspring. Considering the course and relatively low prevalence of GD in pregnant women, such nationwide design is essential to establish a sufficiently large cohort.
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Affiliation(s)
- Nanna Maria Uldall Torp
- Department of Clinical Biochemistry, Aalborg University Hospital, Hobrovej 18-22, Aalborg, 9000, Denmark.
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Inge Bülow Pedersen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Allan Carlé
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Jesper Scott Karmisholt
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Eva Ebbehøj
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Diana Grove-Laugesen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Heiberg Brix
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Steen Joop Bonnema
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bieke F Schrijvers
- Department of Endocrinology, Zealand University Hospital Køge, Køge, Denmark
| | - Birte Nygaard
- Department of Endocrinology, Copenhagen University Hospital Herlev-Gentofte, Herlev, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Lena Bjergved Sigurd
- Department of Endocrinology, Copenhagen University Hospital Herlev-Gentofte, Herlev, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
- Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Marianne Klose
- Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Åse Krogh Rasmussen
- Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Stig Andersen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Deparment of Geriatrics, Aalborg University Hospital, Aalborg, Denmark
| | - Stine Linding Andersen
- Department of Clinical Biochemistry, Aalborg University Hospital, Hobrovej 18-22, Aalborg, 9000, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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9
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Jørgensen NT, Erichsen TM, Jørgensen MB, Idorn T, Feldt-Rasmussen B, Holst JJ, Feldt-Rasmussen U, Klose M. Glucose metabolism, gut-brain hormones, and acromegaly treatment: an explorative single centre descriptive analysis. Pituitary 2023; 26:152-163. [PMID: 36609655 DOI: 10.1007/s11102-022-01297-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE Active acromegaly is associated with impaired glucose metabolism, which improves upon treatment. Treatment options include surgery, medical therapy with somatostatin analogues (SSA) and Pegvisomant (PEG), and irradiation. The objective of the study was to describe the differential effect of various treatment regimens on the secretion of glucose, insulin, glucagon, glucagon-like peptide-1 (GLP-1), and glucose-dependent insulinotropic polypeptide (GIP) in patients with acromegaly. METHODS 23 surgically treated, non-diabetic patients with acromegaly and 12 healthy controls underwent an oral glucose tolerance test (OGTT) and subsequently isoglycaemic intravenous glucose infusion on a separate day. Baseline hormone concentrations, time-to-peak and area under the curve (AUC) on the OGTT-day and incretin effect were compared according to treatment regimens. RESULTS The patients treated with SSA (N = 15) had impaired GIP-response (AUC, P = 0.001), and numerical impairment of all other hormone responses (P > 0.3). Patients co-treated with PEG (SSA + PEG, N = 4) had increased secretion of insulin and glucagon compared to patients only treated with SSA (SSA ÷ PEG, N = 11) (insulinAUC mean ± SEM, SSA + PEG 49 ± 8.3 nmol/l*min vs SSA ÷ PEG 25 ± 3.4, P = 0.007; glucagonAUC, SSA + PEG 823 ± 194 pmol/l*min vs SSA ÷ PEG 332 ± 69, P = 0.009). GIP secretion remained significantly impaired, whereas GLP-1 secretion was numerically increased with PEG (SSA + PEG 3088 ± 366 pmol/l*min vs SSA ÷ PEG 2401 ± 239, P = 0.3). No difference was found in patients treated with/without radiotherapy nor substituted or not with hydrocortisone. CONCLUSION SSA impaired the insulin, glucagon, and incretin hormone secretions. Co-treatment with PEG seemed to counteract the somatostatinergic inhibition of the glucagon and insulin response to OGTT. We speculate that PEG may exert its action through GH-receptors on pancreatic δ-cells. Clinical trial registration NCT02005978.
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Affiliation(s)
- Nanna Thurmann Jørgensen
- Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Trine Møller Erichsen
- Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Buus Jørgensen
- Department of Nephrology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas Idorn
- Department of Nephrology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Bo Feldt-Rasmussen
- Department of Nephrology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens J Holst
- Department of Biomedical Sciences, and NNF Centre for Basic Metabolic Research Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Klose
- Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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10
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Dal J, Rosendal C, Karmisholt J, Feldt-Rasmussen U, Andersen MS, Klose M, Feltoft C, Heck A, Nielsen EH, Jørgensen JOL. Sex difference in patients with controlled acromegaly-A multicentre survey. Clin Endocrinol (Oxf) 2023; 98:74-81. [PMID: 35474467 PMCID: PMC10083986 DOI: 10.1111/cen.14750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/03/2022] [Accepted: 04/08/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Active acromegaly is subject to sex differences in growth hormone (GH) and Insulin like growth factor 1 (IGF-I) patterns as well as clinical features but whether this also pertains to controlled disease is unclear. DESIGN In a cross-sectional, multi-centre study, 84 patients with acromegaly (F = 43, M = 41), who were considered controlled after surgery alone (n = 23) or during continued somatostatin receptor ligand (SRL) treatment (n = 61), were examined. METHODS Serum concentrations of GH, insulin, glucose and free fatty acid (FFA) were measured during an oral glucose tolerance test (OGTT) together with baseline serum IGF-I and completion of two HR-Qol questionnaires (acromegaly quality of life questionnaire [AcroQol] and Patient-assessed Acromegaly Symptom Questionnaire [PASQ]). RESULTS The mean age at the time of the study was 57 (±1.1) years and the majority of females (were postmenopausal. Females had significantly higher fasting GH but comparable IGF-I standard deviation scores (SDS). Using fasting GH < 1.0 µg/L as cut off, disease control was less prevalent in females (F: 56% vs. M: 83%, p = .007) whereas a comparable figure was observed using IGF-I SDS < 2 (F:79% vs. M:76%, p = .71). Compared with males, female patients showed impaired AcroQol physical score (p = .05), higher fasting FFA (p = .03) and insulin concentrations during the OGTT (p = .04). CONCLUSION In patients with acromegaly considered controlled, postmenopausal females exhibited higher GH levels than males despite comparable IGF-I levels, which also translated into impaired metabolic health and well-being. Our findings point to the relevance of including GH measurements in the assessment of disease control and suggest that disease-specific sex differences prevail after treatment.
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Affiliation(s)
- Jakob Dal
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Centre North Jutland, Aalborg, Denmark
| | - Christian Rosendal
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Jesper Karmisholt
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Endocrinology and Metabolism, National University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | | | - Marianne Klose
- Department of Endocrinology and Metabolism, National University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Claus Feltoft
- Department of Endocrinology, Herlev University Hospital, Herlev, Denmark
| | - Ansgar Heck
- Section of Specialized Endocrinology, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Eigil H Nielsen
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Jens O L Jørgensen
- Department of Endocrinology, Aarhus University Hospital, Aarhus C, Denmark
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11
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Pickering L, Main KM, Feldt-Rasmussen U, Sehested A, Mathiasen R, Klose M, Ibsen R, Kjellberg J, Jennum P. Survival and long-term socioeconomic consequences of childhood and adolescent onset of brain tumours. Dev Med Child Neurol 2022. [PMID: 36451275 DOI: 10.1111/dmcn.15467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 10/20/2022] [Accepted: 10/22/2022] [Indexed: 12/05/2022]
Abstract
AIM To evaluate survival distributions, long-term socioeconomic consequences, and health care costs in patients with childhood and adolescent onset of brain tumours in a Danish nationwide prospective cohort study. METHOD A search of national registries identified 2283 patients (1198 males, 1085 females; mean age 9 years 6 months [SD 5 years 7 months]) diagnosed with a brain tumour between 1980 and 2015 and aged no older than 18 years at diagnosis. These were compared with sex-, age-, and residency-matched comparison individuals. Patients with malignant tumours were compared with those with benign tumours. Survival distributions were estimated by the Kaplan-Meier method and hazard ratio by the Cox proportional hazard model. Socioeconomic data at age 20 and 30 years were assessed. RESULTS The probability of mortality was highest during the first year after tumour diagnosis. In young adulthood, the patients were generally less likely to be married, had lower grade-point averages, educational levels, and income, were less likely to be in employment, and had higher health care costs than comparison individuals. Patients with malignant tumours had worse outcomes with respect to education, employment, and health care costs than those with benign tumours. INTERPRETATION A diagnosis of brain tumour in childhood and adolescence adversely affects survival and has negative long-term socioeconomic consequences, especially in patients with malignant tumours. These patients require continuous social support.
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Affiliation(s)
- Line Pickering
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, University of Copenhagen, Glostrup, Denmark
| | - Katharina M Main
- Department of Growth and Reproduction and EDMaRC, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Clinical Medicine, University of Copenhagen, Denmark.,Department of Medical Endocrinology and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Astrid Sehested
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - René Mathiasen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Klose
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Jakob Kjellberg
- VIVE - The Danish Center for Social Science Research, Copenhagen, Denmark
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, University of Copenhagen, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark
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12
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Danielsen E, Hansen JF, Klose M, Worm D. [Hyperpigmentation reveals Addison's disease in a pregnant woman]. Ugeskr Laeger 2022; 184:V07220434. [PMID: 36458598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
A 31-year-old woman was admitted to the local department of endocrinology for control of known anti-TPO positive hypothyroidism during pregnancy. The clinician noticed a remarkable hyperpigmentation. Primary adrenal insufficiency was diagnosed and treatment with cortico- and mineralosteroids commenced. Diagnosis of primary adrenal insufficiency during pregnancy is challenging as many symptoms overlap with normal symptoms of pregnancy. The usual diagnostic criteria cannot be used due to the altered hormone concentrations during pregnancy.
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Affiliation(s)
- Elisabeth Danielsen
- Endokrinologisk Ambulatorium, Medicinsk Afdeling, Københavns Universitetshospital - Amager Hospital
| | - Juliana Frohnert Hansen
- Endokrinologisk Ambulatorium, Medicinsk Afdeling, Københavns Universitetshospital - Amager Hospital
| | - Marianne Klose
- Afdeling for Hormon- og Stofskiftesygdomme, Københavns Universitetshospital - Rigshospitalet
| | - Dorte Worm
- Endokrinologisk Ambulatorium, Medicinsk Afdeling, Københavns Universitetshospital - Amager Hospital
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13
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Klose M, Huynh K, Krogsgaard K, Drejer J, Pharm D, Byberg S, Madsbad S, Magkos F, Researcher S, Aharaz A, Edsberg B, Tfelt J, Astrup A, Feldt-Rasmussen U. ODP350 Safety and Efficacy of Tesomet over 48 Weeks of Treatment: Results From a 24-Week Phase 2, Randomized, Double-Blind Study With 24 Week Open-Label Extension in Adults With Hypothalamic Obesity. J Endocr Soc 2022. [DOI: 10.1210/jendso/bvac150.1059] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract
Objective
To assess the safety and efficacy of Tesomet (tesofensine plus metoprolol) in adults with hypothalamic obesity, a rare disease with no approved therapy.
Research Design and Methods
Twenty-one adults with hypothalamic obesity (16 females, 5 males) were randomized to Tesomet (0.5 mg tesofensine/50 mg metoprolol) (n=14) or placebo (n=8) during a 24-week double-blind period. On completion of the double-blind period, 17 (81%) subjects (11 Tesomet; 6 placebo) entered in to a 24-week open-label extension period and were treated with Tesomet. The primary endpoint was safety while secondary endpoints included measures of body weight, waist circumference, and body composition. Trial NCT03845075.
Results
The most common adverse events following the 24-week double-blind period and the 24-week open-label extension period were sleep disorder, dizziness, dry mouth, and headache; the majority of these adverse events were mild to moderate in severity. No significant nor clinically meaningful changes in heart rate or blood pressure were observed during the study. On completion of the double-blind period mean change in body weight (kg) was -7.84 for the Tesomet group versus -0.34 kg for the placebo group (P=0. 03). At the end of the open-label extension period mean change in body weight (kg) from baseline was -6.34 for the Tesomet-Tesomet group and -6. 03 for the placebo-Tesomet group. On completion of the double-blind period mean change in waist circumference (cm) was -7. 09 cm for the Tesomet group versus -1.16 for the placebo group (P=NS). At the end of the open-label extension period mean change in waist circumference (cm) from baseline was -5.73 for the Tesomet-Tesomet group and -3. 04 for the placebo-Tesomet group. On completion of the double-blind period mean change in fat mass (kg) was -5.28 for the Tesomet group versus -1.11 for the placebo group (P=NS). At the end of the open-label extension period mean change in fat mass (kg) from baseline was -4.84 for the Tesomet-Tesomet group and -3.85 for the placebo-Tesomet group. On completion of the double-blind period mean change in lean tissue mass (kg) was -2.76 for the Tesomet group versus 0.36 for the placebo group (P<0. 01). At the end of the open-label extension period mean change in lean mass (kg) from baseline was -1.64 for the Tesomet-Tesomet group and -2.22 for the placebo-Tesomet group.
Discussion
Tesomet was generally well tolerated after 48 weeks treatment and resulted in clinically meaningful improvements in body weight and body composition measures in adults with hypothalamic obesity. In contrast to previous studies of tesofensine monotherapy in general obesity, no significant nor clinically meaningful changes in cardiovascular measures were observed during the study.
Conclusion
Tesomet is a promising new experimental treatment for hypothalamic obesity. A randomized, placebo controlled, multi-center, dose-finding, Phase 2b study has now been initiated.
Presentation: No date and time listed
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14
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Borresen SW, Klose M, Glintborg D, Watt T, Andersen MS, Feldt-Rasmussen U. Approach to the Patient With Glucocorticoid-induced Adrenal Insufficiency. J Clin Endocrinol Metab 2022; 107:2065-2076. [PMID: 35302603 DOI: 10.1210/clinem/dgac151] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Indexed: 11/19/2022]
Abstract
Glucocorticoid-induced adrenal insufficiency is caused by exogenous glucocorticoid suppression of the hypothalamic-pituitary-adrenal axis and is the most prevalent form of adrenal insufficiency. The condition is important to diagnose given the risk of life-threatening adrenal crisis and impact on patients' quality of life. The diagnosis is made with a stimulation test such as the ACTH test. Until now, testing for glucocorticoid-induced adrenal insufficiency has often been based on clinical suspicion rather than routinely but accumulating evidence indicates that a significant number of cases will remain unrecognized. During ongoing oral glucocorticoid treatment or initially after withdrawal, ~50% of patients have adrenal insufficiency, but, outside clinical studies, ≤ 1% of patients have adrenal testing recorded. More than 70% of cases are identified during acute hospital admission, where the diagnosis can easily be missed because symptoms of adrenal insufficiency are nonspecific and overlap those of the underlying and intercurrent conditions. Treatment of severe glucocorticoid-induced adrenal insufficiency should follow the principles for treatment of central adrenal insufficiency. The clinical implications and thus indication to treat mild-moderate adrenal deficiency after glucocorticoid withdrawal has not been established. Also, the indication of adding stress dosages of glucocorticoid during ongoing glucocorticoid treatment remains unclear. In patients with established glucocorticoid-induced adrenal insufficiency, high rates of poor confidence in self-management and delayed glucocorticoid administration in the acute setting with an imminent adrenal crisis call for improved awareness and education of clinicians and patients. This article reviews different facets of glucocorticoid-induced adrenal insufficiency and discusses approaches to the condition in common clinical situations.
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Affiliation(s)
- Stina Willemoes Borresen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Marianne Klose
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, DK-5000 Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark
| | - Torquil Watt
- Department of Endocrinology and Internal Medicine, Herlev and Gentofte Hospital, DK-2730 Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark
| | - Marianne Skovsager Andersen
- Department of Endocrinology, Odense University Hospital, DK-5000 Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark
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15
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Huynh K, Klose M, Krogsgaard K, Drejer J, Byberg S, Madsbad S, Magkos F, Aharaz A, Edsberg B, Tfelt-Hansen J, Astrup AV, Feldt-Rasmussen U. Randomized controlled trial of Tesomet for weight loss in hypothalamic obesity. Eur J Endocrinol 2022; 186:687-700. [PMID: 35294397 PMCID: PMC9175551 DOI: 10.1530/eje-21-0972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/16/2022] [Indexed: 11/21/2022]
Abstract
CONTEXT Hypothalamic injury often leads to rapid, intractable weight gain causing hypothalamic obesity, which is associated with increased risk of cardiovascular and metabolic morbidity and mortality. There are no approved or effective pharmacological treatments for hypothalamic obesity, and conventional lifestyle management remains ineffective. OBJECTIVE To investigate the safety and efficacy of Tesomet (0.5 mg tesofensine/50 mg metoprolol) in adults with hypothalamic obesity. METHODS Twenty-one adults with hypothalamic obesity (16 females) were randomized to Tesomet (0.5 mg/50 mg) or placebo for 24 weeks. Patients also received diet/lifestyle counselling. The primary endpoint was safety; secondary endpoints included measures of body weight, appetite scores, quality of life, and metabolic profile. RESULTS Eighteen patients completed 24 weeks. Consent withdrawal, eligibility, and serious adverse events (SAE) unrelated to treatment resulted in dropouts. One patient experienced a Tesomet-related SAE of exacerbated pre-existing anxiety leading to treatment discontinuation. Tesomet-related adverse events were otherwise mostly mild and included sleep disturbances (Tesomet 50%, placebo 13%), dry mouth (Tesomet 43%, placebo 0%), and headache (Tesomet 36%, placebo 0%). No significant differences in heart rate or blood pressure were observed between groups. Compared to placebo, Tesomet resulted in additional mean (95% CI) weight change of -6.3% ((-11.3; -1.3); P = 0.017), increased the number of patients achieving ≥5% weight loss (Tesomet 8/13, placebo 1/8; P = 0.046), and tended to augment the reduction in waist circumference by 5.7 cm ((-0.1; 11.5); P = 0.054). CONCLUSION Tesomet was welltolerated, did not affect heart rate or blood pressure, and resulted in significant reductions in body weight compared to placebo in adults with hypothalamic obesity.
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Affiliation(s)
- Kim Huynh
- Department of Medical Endocrinology and Metabolism PE 2131/2, Copenhagen University Hospital (Rigshospitalet), Copenhagen Ø, Denmark
| | - Marianne Klose
- Department of Medical Endocrinology and Metabolism PE 2131/2, Copenhagen University Hospital (Rigshospitalet), Copenhagen Ø, Denmark
| | | | | | - Sarah Byberg
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - Sten Madsbad
- Department of Endocrinology, Hvidovre University Hospital, University of Copenhagen, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen, Copenhagen N, Denmark
| | - Faidon Magkos
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Frederiksberg C, Denmark
| | | | | | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital (Rigshospitalet), Copenhagen Ø, Denmark
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Arne Vernon Astrup
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Frederiksberg C, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism PE 2131/2, Copenhagen University Hospital (Rigshospitalet), Copenhagen Ø, Denmark
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen, Copenhagen N, Denmark
- Correspondence should be addressed to U Feldt-Rasmussen;
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Sivapalan P, Borresen SW, Eklöf J, Klose M, Holm FS, Feldt-Rasmussen U, Rossing M, Jørgensen NR, Marvig RL, Saeed MI, Wilcke T, Seersholm N, Mathioudakis AG, Vestbo J, Jensen JUS. Adrenal suppression in patients with chronic obstructive pulmonary disease treated with glucocorticoids: Role of specific glucocorticoid receptor polymorphisms. PLoS One 2022; 17:e0262898. [PMID: 35120172 PMCID: PMC8815987 DOI: 10.1371/journal.pone.0262898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 01/07/2022] [Indexed: 11/18/2022] Open
Abstract
Background Single-nucleotide polymorphisms (SNPs) of the glucocorticoid receptor (GR) gene NR3C1 have been associated with an altered sensitivity to glucocorticoids, and thus may alter the therapeutic effects of glucocorticoids. We investigated the prevalence of adrenal suppression after treatment with glucocorticoids and evaluated whether GR SNPs were associated with altered risks of adrenal suppression and metabolic disorders in patients with chronic obstructive pulmonary disease (COPD). Methods In an observational prospective cohort study, we recruited 78 patients with severe COPD receiving 5 days glucocorticoid treatment for an exacerbation of COPD. In total, 55% of these patients were also receiving regular inhaled corticosteroids (ICS). Adrenal function was evaluated with a corticotropin test 30 days after the exacerbation. Patients were genotyped for Bcl1, N363S, ER22/23EK, and 9β SNPs. Results The prevalence of adrenal suppression (corticotropin-stimulated plasma-cortisol ≤ 420 nmol/L) 30 days after glucocorticoid treatment was 4/78 (5%). There was no difference between carriers and non-carriers of the polymorphisms (Bcl1, 9β, ER22/23K, and N363S) in corticotropin stimulated plasma-cortisol concentrations. In the haplotype analyses, we included the 50 patients who had a high-sensitivity (76%), a low-sensitivity (4%), or a wild-type (20%) GR haplotype. There was no difference in the frequency of adrenal suppression or metabolic disorders between the two stratified groups: (a) high-sensitivity (Bcl1 and/or N363S) haplotypes vs. (b) low-sensitivity (9β and/or ER22/23K) plus wild-type haplotypes (p > 0.05). Carriers of the high-sensitivity GR gene haplotype exhibited a steeper decline in stimulated P-cortisol with increased ICS dose (slope, –1.35 vs. 0.94; p = 0.17), compared to the group with low-sensitivity or wild-type haplotypes, respectively. Conclusions In total, 5% of patients exhibited insufficient adrenal function. The Bcl1 and N363S polymorphisms did not seem to increase the risk of glucocorticoid suppression or metabolic disorders in adults treated with glucocorticoids for COPD exacerbations.
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Affiliation(s)
- Pradeesh Sivapalan
- Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Internal Medicine, Zealand Hospital, University of Copenhagen, Roskilde, Denmark
- * E-mail:
| | - Stina Willemoes Borresen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital
| | - Josefin Eklöf
- Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Marianne Klose
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital
| | - Freja S. Holm
- Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital
- Institute for Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maria Rossing
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niklas R. Jørgensen
- Institute for Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Rasmus L. Marvig
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mohamad Isam Saeed
- Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Torgny Wilcke
- Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Niels Seersholm
- Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Alexander G. Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Jens-Ulrik Stæhr Jensen
- Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Institute for Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Pickering L, Main KM, Feldt‐Rasmussen U, Klose M, Sehested A, Mathiasen R, Jennum P. Brain tumours in children and adolescents may affect the circadian rhythm and quality of life. Acta Paediatr 2021; 110:3376-3386. [PMID: 34432900 DOI: 10.1111/apa.16080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/15/2021] [Accepted: 08/24/2021] [Indexed: 12/22/2022]
Abstract
AIM Children with brain and cervical medulla tumours may experience circadian abnormalities and poor health. We aimed to examine their circadian rhythm, fatigue and quality of life (QoL). METHODS Children with a brain or cervical medulla tumour were recruited from the Paediatric Department, Rigshospitalet, Copenhagen, Denmark, between 2016 and 2020. They were grouped by tumour location involving the circadian regulatory system, defined as diencephalon, pineal gland, brain stem and cervical medulla, or other areas. Saliva melatonin and cortisol concentrations were measured. Sleep diaries and actigraphy assessed sleep-wake patterns. The Pediatric Quality of Life Inventory, Multidimensional Fatigue Scale and Generic Core Scale measured fatigue and QoL. RESULTS We included 68 children (62% males) with a median age (25th-75th percentiles) of 12.2 (7.7-16.3) years. Children with tumours involving the circadian regulatory system typically had a lower melatonin peak (p=0.06) and experienced significantly more fatigue and poorer QoL. Low melatonin profiles were observed in 31% and 4% had a phase-shifted daytime peak, compared with 14% and 0%, respectively, in children with tumours located elsewhere. Children with low melatonin profiles had significantly lower inter-daily stability than those with normal profiles. CONCLUSION Tumours involving the circadian regulatory system adversely affected circadian function, fatigue and QoL.
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Affiliation(s)
- Line Pickering
- Danish Center for Sleep Medicine Department of Clinical Neurophysiology, Rigshospitalet University of Copenhagen Glostrup Denmark
| | - Katharina M. Main
- Department of Growth and Reproduction and EDMaRC, Rigshospitalet University of Copenhagen Copenhagen Denmark
- Department of Clinical Medicine Copenhagen University Copenhagen Denmark
| | - Ulla Feldt‐Rasmussen
- Department of Clinical Medicine Copenhagen University Copenhagen Denmark
- Department of Medical Endocrinology and Metabolism, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Marianne Klose
- Department of Medical Endocrinology and Metabolism, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Astrid Sehested
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - René Mathiasen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Poul Jennum
- Danish Center for Sleep Medicine Department of Clinical Neurophysiology, Rigshospitalet University of Copenhagen Glostrup Denmark
- Department of Clinical Medicine Copenhagen University Copenhagen Denmark
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Pickering L, Main KM, Sehested A, Mathiasen R, Feldt-Rasmussen U, Klose M, Kotagal S, Jennum PJ. Brain tumours result in sleep disorders in children and adolescents. Sleep Med 2021; 88:13-21. [PMID: 34715527 DOI: 10.1016/j.sleep.2021.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Sleep disturbances are frequently reported in children with brain tumours. The objective of our cross-sectional study was to systematically examine sleep in these children. We hypothesised that children with tumours involving the sleep-wake-regulatory areas have an altered sleep-wake-regulation. METHODS Sixty-one patients aged 0-18 years and with a diagnosis of a primary brain or cervical medullary tumour were included. They were categorised based upon tumour location into two groups - those affecting the sleep-wake regulatory regions, i.e. brain stem, basal forebrain, hypothalamus, thalamus, and posterior fossa compressing the brain stem and those that did not. Sleep history, questionnaire surveys, polysomnography, and multiple sleep latency test were used, as indicated clinically. Surveys included Pediatric Daytime Sleepiness Scale, Children's Sleep Habits Questionnaire, Strengths and Difficulties Questionnaire, and Pediatric Quality of Life Inventory, Multidimensional Fatigue Scale and Generic Core Scale. RESULTS Patients with tumours involving the sleep-wake regulatory areas were sleepier/more fatigued (p = 0.03). Sleep apnoea was observed in 86% of all the patients and comorbid narcolepsy in 8%, without group differences (p ≥ 0.12). Patients with tumours involving the sleep-wake-regulatory areas had more emotional problems (p = 0.04), were more affected by mental health problems (p < 0.001), and had poorer quality of life (p ≤ 0.03). CONCLUSIONS Many children with brain tumours suffer from disturbed sleep, poor mental health, and low quality of life. We recommend that systematic sleep evaluation is included in their routine care along with psychological and social support.
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Affiliation(s)
- Line Pickering
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, University of Copenhagen, Valdemar Hansens Vej 17, DK-2600, Glostrup, Denmark.
| | - Katharina M Main
- Department of Growth and Reproduction and EDMaRC, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark.
| | - Astrid Sehested
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - René Mathiasen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Ulla Feldt-Rasmussen
- Department of Clinical Medicine, Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark; Department of Medical Endocrinology and Metabolism, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Marianne Klose
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Suresh Kotagal
- Department of Neurology and the Center for Sleep Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Poul J Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, University of Copenhagen, Valdemar Hansens Vej 17, DK-2600, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark.
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Holmager P, Langer SW, Federspiel B, Willemoe GL, Garbyal RS, Melchior L, Klose M, Kjaer A, Hansen CP, Andreassen M, Knigge U. Increase of Ki-67 index and influence on mortality in patients with neuroendocrine neoplasms. J Neuroendocrinol 2021; 33:e13018. [PMID: 34414612 DOI: 10.1111/jne.13018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/15/2021] [Accepted: 07/23/2021] [Indexed: 12/11/2022]
Abstract
An increase in the Ki-67 index in neuroendocrine neoplasms over time in relation to prognosis has scarcely been investigated. We aimed to assess whether the Ki-67 index changed over time and also whether a change influenced prognosis. Second, we investigated the difference in the Ki-67 index between primary tumour and metastases. From 1 January 1995 to 31 December 2019, 108 consecutive patients with gastroenteropancreatic tumours were included. Patients were followed with regard to an increase in the Ki-67 index and all-cause mortality. Ki-67 determination of the primary tumour at diagnosis and at the time of radiological progression, including developed metastases, was performed. A significant increase in the Ki-67 index was defined as a doubling of the value at disease progression compared to the value at diagnosis. In addition, in 14 patients, the Ki-67 index of the primary tumour and present metastases at the time of diagnosis was investigated. At diagnosis, there were no differences in the Ki-67 index between primary tumours and metastases (P = .41). Sixty-five patients had a doubling of the Ki-67 index. The median Ki-67 index at the time of progression 17% (1%-90%) vs 5% (1%-60%) at the time of diagnosis (P = .006). A doubling of the Ki-67 index was independently associated with all-cause mortality (hazard ratio = 2.7 [1.3-6.3], P = 0.02), after adjustment for relevant co-variables including the Ki-67 index at baseline. Doubling of the Ki-67 index at the time of disease progression was associated with a significantly higher risk of all-cause mortality. We recommend that a Ki-67 index is obtained whenever disease progression is recorded by demonstrated progression because it may have impact on the choice of treatment.
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Affiliation(s)
- Pernille Holmager
- ENETS Neuroendocrine Tumor Centre of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Seppo W Langer
- ENETS Neuroendocrine Tumor Centre of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Federspiel
- ENETS Neuroendocrine Tumor Centre of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Gro Linno Willemoe
- ENETS Neuroendocrine Tumor Centre of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Rajendra Singh Garbyal
- ENETS Neuroendocrine Tumor Centre of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Linea Melchior
- ENETS Neuroendocrine Tumor Centre of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Klose
- ENETS Neuroendocrine Tumor Centre of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Andreas Kjaer
- ENETS Neuroendocrine Tumor Centre of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Carsten Palnaes Hansen
- ENETS Neuroendocrine Tumor Centre of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Andreassen
- ENETS Neuroendocrine Tumor Centre of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ulrich Knigge
- ENETS Neuroendocrine Tumor Centre of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Staby I, Krogh J, Klose M, Baekdal J, Feldt-Rasmussen U, Poulsgaard L, Springborg JB, Andreassen M. Pituitary function after transsphenoidal surgery including measurement of basal morning cortisol as predictor of adrenal insufficiency. Endocr Connect 2021; 10:750-757. [PMID: 34137733 PMCID: PMC8346196 DOI: 10.1530/ec-21-0155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/16/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Patients with pituitary adenomas undergoing transsphenoidal surgery require pre- and post-surgery examination of pituitary hormones. There is currently no consensus on how to evaluate the adrenal axis post-surgery. The aims of this study were to investigate factors that may predict postoperative adrenal insufficiency (AI) and to investigate the overall effect of transsphenoidal surgery on pituitary function. METHODS One hundred and forty-three consecutive patients who had undergone transsphenoidal surgery for pituitary adenomas were included. Data on tumour size, pituitary function pre-surgery, plasma basal cortisol measured within 48 h post-surgery and pituitary function 6 months post-surgery were collected. Patients with AI prior to surgery, perioperative glucocorticoid treatment, Cushing's disease and no re-evaluation after 1 month were excluded (n = 93) in the basal cortisol analysis. RESULTS Low plasma basal cortisol post-surgery, tumour size and previous pituitary surgery were predictors of AI (all P < 0.05). A basal cortisol cut-off concentration of 300 nmol/L predicted AI 6 months post-surgery with sensitivity and negative predictive value of 100%, specificity of 81% and positive predictive value of 25%. New gonadal, thyroid and adrenal axis insufficiencies accounted for 2, 10 and 10%, respectively. The corresponding recovery rates were 17, 7 and 24%, respectively. CONCLUSION Transsphenoidal surgery had an overall beneficial effect on pituitary endocrine function. Low basal plasma cortisol measured within 48 h after surgery, tumour size and previous surgery were identified as risk factors for AI. Measurement of basal cortisol post-surgery may help to identify patients at risk of developing AI.
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Affiliation(s)
- Ida Staby
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jesper Krogh
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marianne Klose
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jonas Baekdal
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Lars Poulsgaard
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Mikkel Andreassen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark
- Correspondence should be addressed to M Andreassen:
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Laenkholm IT, Langer SW, Andreassen M, Holmager P, Kjaer A, Klose M, Federspiel BH, Hansen CP, Knigge U. A short report of 50 patients with gastroenteropancreatic mixed neuroendocrine-non-neuroendocrine neoplasms (MiNEN). Acta Oncol 2021; 60:808-812. [PMID: 33779475 DOI: 10.1080/0284186x.2021.1903077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Isak T. Laenkholm
- ENETS Neuroendocrine Tumor Centre of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Seppo W. Langer
- ENETS Neuroendocrine Tumor Centre of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Andreassen
- ENETS Neuroendocrine Tumor Centre of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Pernille Holmager
- ENETS Neuroendocrine Tumor Centre of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Andreas Kjaer
- ENETS Neuroendocrine Tumor Centre of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Klose
- ENETS Neuroendocrine Tumor Centre of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Birgitte H. Federspiel
- ENETS Neuroendocrine Tumor Centre of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Carsten P. Hansen
- ENETS Neuroendocrine Tumor Centre of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ulrich Knigge
- ENETS Neuroendocrine Tumor Centre of Excellence, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Feldt-Rasmussen U, Effraimidis G, Klose M. The hypothalamus-pituitary-thyroid (HPT)-axis and its role in physiology and pathophysiology of other hypothalamus-pituitary functions. Mol Cell Endocrinol 2021; 525:111173. [PMID: 33549603 DOI: 10.1016/j.mce.2021.111173] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 12/16/2022]
Abstract
The hypothalamus-pituitary-thyroid axis is one of several hormone regulatory systems from the hypothalamus to the pituitary and ultimately to the peripheral target organs. The hypothalamus and the pituitary gland are in close anatomical proximity at the base of the brain and extended through the pituitary stalk to the sella turcica. The pituitary stalk allows passage of stimulatory and inhibitory hormones and other signal molecules. The target organs are placed in the periphery and function through stimulation/inhibition by the circulating pituitary hormones. The several hypothalamus-pituitary-target organ axis systems interact in very sophisticated and complicated ways and for many of them the interactive and integrated mechanisms are still not quite clear. The diagnosis of central hypothyroidism is complicated by itself but challenged further by concomitant affection of other hypothalamus-pituitary-hormone axes, the dysfunction of which influences the diagnosis of central hypothyroidism. Treatment of both the central hypothyroidism and the other hypothalamus-pituitary axes also influence the function of the others by complex mechanisms involving both central and peripheral mechanisms. Clinicians managing patients with neuroendocrine disorders should become aware of the strong integrative influence from each hypothalamus-pituitary-hormone axis on the physiology and pathophysiology of central hypothyroidism. As an aid in this direction the present review summarizes and highlights the importance of the hypothalamus-pituitary-thyroid axis, pitfalls in diagnosing central hypothyroidism, diagnosing/testing central hypothyroidism in relation to panhypopituitarism, pointing at interactions of the thyroid function with other pituitary hormones, as well as local hypothalamic neurotransmitters and gut-brain hormones. Furthermore, the treatment effect of each axis on the regulation of the others is described. Finally, these complicating aspects require stringent diagnostic testing, particularly in clinical settings with lower or at least altered à priori likelihood of hypopituitarism than in former obvious clinical patient presentations.
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Affiliation(s)
- Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Denmark.
| | - Grigoris Effraimidis
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Marianne Klose
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Denmark
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Holmager P, Willemoe GL, Nielsen K, Grøndahl V, Klose M, Andreassen M, Langer SW, Hansen CP, Kjær A, Federspiel BH, Knigge U. Neuroendocrine neoplasms of the appendix: Characterization of 335 patients referred to the Copenhagen NET Center of Excellence. Eur J Surg Oncol 2021; 47:1357-1363. [PMID: 33589240 DOI: 10.1016/j.ejso.2021.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/13/2021] [Accepted: 02/03/2021] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Neuroendocrine neoplasms (NEN) of the appendix are often incidentally discovered after appendectomy. Appropriate management is debated. The purpose was to characterize a cohort of 335 appendix NEN and evaluate the risk of recurrence. METHODS Retrospective collection of data from 335 patients referred to the Neuroendocrine Tumor Center at Rigshospitalet 2000-2019. Appendix goblet cell carcinoids and mixed neuroendocrine non-neuroendocrine neoplasms were excluded. Patients were followed until December 31st, 2019. No patients were lost to follow-up. RESULTS Sixty-three percent of the patients were female. The median (range) age at diagnosis was 34 (9-92) years. Median follow-up was 66 (1-250) months. Median tumor size was 7 (1-45) mm with 10 (3%) tumors >20 mm. In 18 specimens (5%) resection margins were positive. Mesoappendiceal invasion was found in 113 (35%). Sixty-three (19%) patients underwent right-sided completion hemicolectomy (RHC) after appendectomy according to ENETS guidelines. Among these, 11 (17%) had lymph node metastases in the resected tissue. Further, one patient who underwent initial RHC due to colonic adenocarcinoma had lymph node metastases. All lymph node metastases were detected in patients with serotonin positive tumors. No patients with glucagon positive tumors (n = 85) had lymph node metastases. Mesoappendiceal invasion >3 mm and positive resection margins were associated with presence of lymph node metastases. No recurrences were recorded. CONCLUSION Following ENETS guidelines may lead to overtreatment of patients with respect to completion RHC. The risk of over- and undertreatment needs to be further evaluated.
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Affiliation(s)
- Pernille Holmager
- ENETS Neuroendocrine Tumor Centre of Excellence, Rigshospitalet, Copenhagen University Hospital, Denmark; Dept. of Endocrinology, Rigshospitalet, Copenhagen University Hospital, Denmark.
| | - Gro Linno Willemoe
- ENETS Neuroendocrine Tumor Centre of Excellence, Rigshospitalet, Copenhagen University Hospital, Denmark; Dept. of Pathology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Kirstine Nielsen
- ENETS Neuroendocrine Tumor Centre of Excellence, Rigshospitalet, Copenhagen University Hospital, Denmark; Dept. of Surgery, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Veronica Grøndahl
- ENETS Neuroendocrine Tumor Centre of Excellence, Rigshospitalet, Copenhagen University Hospital, Denmark; Dept. of Surgery, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Marianne Klose
- ENETS Neuroendocrine Tumor Centre of Excellence, Rigshospitalet, Copenhagen University Hospital, Denmark; Dept. of Endocrinology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Mikkel Andreassen
- ENETS Neuroendocrine Tumor Centre of Excellence, Rigshospitalet, Copenhagen University Hospital, Denmark; Dept. of Endocrinology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Seppo W Langer
- ENETS Neuroendocrine Tumor Centre of Excellence, Rigshospitalet, Copenhagen University Hospital, Denmark; Dept. of Oncology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Carsten Palnæs Hansen
- ENETS Neuroendocrine Tumor Centre of Excellence, Rigshospitalet, Copenhagen University Hospital, Denmark; Dept. of Surgery, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Andreas Kjær
- ENETS Neuroendocrine Tumor Centre of Excellence, Rigshospitalet, Copenhagen University Hospital, Denmark; Dept. of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Birgitte H Federspiel
- ENETS Neuroendocrine Tumor Centre of Excellence, Rigshospitalet, Copenhagen University Hospital, Denmark; Dept. of Pathology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Ulrich Knigge
- ENETS Neuroendocrine Tumor Centre of Excellence, Rigshospitalet, Copenhagen University Hospital, Denmark; Dept. of Endocrinology, Rigshospitalet, Copenhagen University Hospital, Denmark; Dept. of Surgery, Rigshospitalet, Copenhagen University Hospital, Denmark
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Boesen VB, Borresen SW, Christoffersen T, Klose M, Watt T, Feldt-Rasmussen U. The effect of dual-release versus conventional hydrocortisone on fatigue, measured by ecological momentary assessments. Endocrine 2021; 71:467-475. [PMID: 33063273 DOI: 10.1007/s12020-020-02507-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/23/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Replicating the physiological cortisol secretion is key in the treatment of glucocorticoid insufficient individuals and optimization may enhance quality of life. The study investigates fatigue measured by ecological momentary assessments in patients treated with conventional hydrocortisone compared with once-daily dual-release hydrocortisone (Plenadren). METHODS A 21-week open-label switch pilot trial included 30 patients with adrenal insufficiency due to hypopituitarism. Fatigue was assessed four times daily for 20 days using a momentary item version of the Multidimensional Fatigue Inventory on patients' usual hydrocortisone regimen. Participants switched treatment to an identical daily dose of Plenadren for 16 weeks where fatigue assessments were repeated. Change in fatigue and diurnal variation of fatigue was analyzed using mixed models for repeated measurements. RESULTS In four out of five fatigue subscales fatigue was significantly reduced 0.7-1.1 points (scales ranging from 4 to 20), when treated with Plenadren compared with conventional hydrocortisone, corresponding to small effect sizes below the scale-specific minimal important changes. However, 33% of the participants completing the study (9/27) experienced reductions in fatigue above the minimal important change. On Plenadren, we found larger between-person variances and smaller within-person variances. Finally, we identified diurnal fatigue curves for both treatments. CONCLUSIONS The Plenadren-related reduction in fatigue was significant but not necessarily of clinical importance when looking at a group level. However, there was a large interindividual variation in treatment effect, why patients with a large benefit in quality of life should be identified. Future RCTs should be powered to detect the effect magnitudes identified here.
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Affiliation(s)
- Victor Brun Boesen
- Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Stina Willemoes Borresen
- Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Thea Christoffersen
- Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Marianne Klose
- Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Torquil Watt
- Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Internal Medicine, Copenhagen University Hospital Herlev Gentofte, Gentofte, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Marina D, Mathiesen ER, Klose M, Pedersen BW, Ringholm L. Co-existence of starvation ketoacidosis and hyperthyroidism in early pregnancy: a case report. Acta Diabetol 2020; 57:1267-1270. [PMID: 32607650 DOI: 10.1007/s00592-020-01560-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/17/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Djordje Marina
- Department of Endocrinology PE7562, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Elisabeth R Mathiesen
- Department of Endocrinology PE7562, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
- Center for Pregnant Women with Diabetes, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Marianne Klose
- Department of Endocrinology PE7562, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Berit Woetmann Pedersen
- Center for Pregnant Women with Diabetes, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
- Department of Obstretics, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Lene Ringholm
- Department of Endocrinology PE7562, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
- Center for Pregnant Women with Diabetes, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
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26
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Dal J, Nielsen EH, Klose M, Feldt-Rasmussen U, Andersen M, Vang S, Korbonits M, Jørgensen JOL. Phenotypic and genotypic features of a large kindred with a germline AIP variant. Clin Endocrinol (Oxf) 2020; 93:146-153. [PMID: 32324286 DOI: 10.1111/cen.14207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 11/30/2022]
Abstract
CONTEXT Acromegaly is usually a sporadic disease, but familial cases occur. Mutations in the aryl hydrocarbon receptor-interacting protein (AIP) gene are associated with familial pituitary adenoma predisposition. However, the pathogenicity of some AIP variants remains unclear and additional unknown genes may be involved. OBJECTIVE To explore the phenotype and genotype of a large kindred carrying the p.R304Q AIP variant. METHODS The family comprised 52 family members at risk of carrying the p.R304Q AIP variant including a case with gigantism and one with acromegaly and several family members with acromegalic features. Nine family members (three trios) underwent exome sequencing to identify putative pathogenic variants. RESULTS We identified 31 p.R304Q carriers, and based on two cases with somatotropinomas, the disease penetrance was 6%. We observed physical signs of acromegaly in several family members, which were independent of AIP status. Serum insulin-like growth factor-I (IGF-I) levels in all family members were above the mean for age and sex (IGF-I SDS: +0.6 [CI95% +0.4-0.9], P < .01). Exome analysis identified two candidate genes: PDE11A, known to be associated with the development of adrenal tumours, and ALG14. Ten asymptomatic p.R304Q family members (age >50 years) were screened for the PDE11A and ALG14 variant; both variants were present in five of ten persons. CONCLUSIONS This large family adds new information on the p.R304Q AIP variant, and data suggest two new candidate genes could be associated with growth hormone excess.
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Affiliation(s)
- Jakob Dal
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetic Center Northjutland, Aalborg, Denmark
| | - Eigil H Nielsen
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Marianne Klose
- Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marianne Andersen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Søren Vang
- Department of Molecular Medicine, Aarhus University Hospital, Denmark
| | - Márta Korbonits
- Centre for Endocrinology, Barts and the London School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Jens Otto L Jørgensen
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Aarhus C, Denmark
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Borresen SW, Klose M, Baslund B, Locht H, Thorgrimsen TB, Jensen B, Sørensen SS, Valentin A, Hansen A, Hetland ML, Nørregaard J, Rossing M, Feldt-Rasmussen U. MON-179 Association Between Long-Term Prednisolone Induced Adrenal Insufficiency and Polymorphisms in the Glucocorticoid Receptor Gene. J Endocr Soc 2020. [PMCID: PMC7209044 DOI: 10.1210/jendso/bvaa046.585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE: Several biomarkers for glucocorticoid (GC) sensitivity have been proposed relevant for the inter-individual variation seen in treatment response and side effects to GC treatment. Four single nucleotide polymorphisms (SNPs) of the GC receptor (GR) gene have been associated with increased (Bcl1 and N363S) or decreased (9β and ER23/23EK) GC sensitivity. We investigated the influence of these proposed biomarkers for GC sensitivity on GC-induced adrenal insufficiency. SUBJECTS AND METHODS: We included 239 patients receiving long-term prednisolone treatment for rheumatoid arthritis (RA), polymyalgia rheumatica (PMR) / giant cell arteritis (GCA), or after renal transplantation (RTx). Four GR gene SNPs (Bcl1 rs41423247; 9β rs6198; N363S rs56149945; ER22/23EK rs6189 + rs6190) were sequenced by Sanger sequencing. Adrenal function was evaluated by a 250 µg corticotropin stimulation test. To compare allele frequencies with background population, two control groups were generated from two regional whole-genome databases. We downscaled each genome dataset to 239 individuals/group to balance statistical analysis. RESULTS: In total 239 patients were genotyped and 178 of these (RA n=103, PMR/GCA n=47, RTx n=28) treated with a median current dose of 5 mg prednisolone/day (interquartile range 5-7 mg) and a median treatment duration of 48 months (interquartile range 22-111 months) completed the corticotropin test. Seventy-three (41%, CI95%: 34-48%) patients had an insufficient response to the corticotropin test. Neither the risk of adrenal insufficiency, unstimulated nor stimulated P-cortisol levels were directly associated with any of the GR SNPs. However, for both insensitive SNPs 9β and ER23/23EK the effect of current prednisolone dose on stimulated P-cortisol was smaller (higher dose did not suppress the cortisol level as much) in carriers vs. non-carriers (p=0.035 and p=0.0075). The same sensitivity-associated tendency was seen for the N363S, but not the Bcl1 SNP. The Bcl1 SNP occurred more frequently in our cohort compared with control groups (63% vs. 40%, p<0.0001). The same trend was seen for the other sensitive but less frequent SNP N363S. The 9β SNP also occurred more frequently in our cohort (18% vs. 13%, p=0.029), but depending on regional sub cohorts in one control group. CONCLUSION: The GR SNPs did not directly associate to the risk of adrenal insufficiency, unstimulated nor stimulated cortisol levels, respectively. However, the effect of prednisolone dose on stimulated cortisol depended on the GR SNPs: Cortisol was less suppressed with higher current prednisolone dose in patients carrying the insensitive SNPs. The substantially higher frequency of the Bcl1 SNP is remarkable even with modest n=239. It questions whether there is an association between carrying the sensitive GR SNPs and inability to taper GC treatment ending up in this cohort of long-term treated patients.
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Affiliation(s)
- Stina Willemoes Borresen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Klose
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bo Baslund
- Center of Rheumatology and Joint Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henning Locht
- Center of Rheumatology and Joint Diseases, Copenhagen University Hospital, Frederiksberg and Bispebjerg Hospital, Frederiksberg, Denmark
| | - Toke Bjørk Thorgrimsen
- Center of Rheumatology and Joint Diseases, Copenhagen University Hospital, Frederiksberg and Bispebjerg Hospital, Frederiksberg, Denmark
| | - Bente Jensen
- Center of Rheumatology and Joint Diseases, Copenhagen University Hospital, Frederiksberg and Bispebjerg Hospital, Frederiksberg, Denmark
| | - Søren Schwartz Sørensen
- Department of Nephrology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Amalie Valentin
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Annette Hansen
- Center of Rheumatology and Joint Diseases, Copenhagen University Hospital, Herlev and Gentofte Hospital, Gentofte, Denmark
| | - Merete Lund Hetland
- Center of Rheumatology and Joint Diseases, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Jesper Nørregaard
- Center of Rheumatology and Joint Diseases, Copenhagen University Hospital, Nordsjællands Hospital Hillerød, Hillerød, Denmark
| | - Maria Rossing
- Centre for Genome Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Andreassen M, Ilett E, Wiese D, Slater EP, Klose M, Hansen CP, Gercke N, Langer SW, Kjaer A, Maurer E, Federspiel B, Kann PH, Bartsch DK, Knigge U. Surgical Management, Preoperative Tumor Localization, and Histopathology of 80 Patients Operated on for Insulinoma. J Clin Endocrinol Metab 2019; 104:6129-6138. [PMID: 31369096 DOI: 10.1210/jc.2019-01204] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 07/26/2019] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Diagnosis and pathological classification of insulinomas are challenging. AIM To characterize localization of tumors, surgery outcomes, and histopathology in patients with insulinoma. METHODS Patients with surgically resected sporadic insulinoma were included. RESULTS Eighty patients were included. Seven had a malignant tumor. A total of 312 diagnostic examinations were performed: endoscopic ultrasonography (EUS; n = 59; sensitivity, 70%), MRI (n = 33; sensitivity, 58%), CT (n = 55; sensitivity, 47%), transabdominal ultrasonography (US; n = 45; sensitivity, 40%), somatostatin receptor imaging (n = 17; sensitivity, 29%), 18F-fluorodeoxyglucose positron emission tomography/CT (n = 1; negative), percutaneous transhepatic venous sampling (n = 10; sensitivity, 90%), arterial stimulation venous sampling (n = 20; sensitivity, 65%), and intraoperative US (n = 72; sensitivity, 89%). Fourteen tumors could not be visualized. Invasive methods were used in 7 of these 14 patients and localized the tumor in all cases. Median tumor size was 15 mm (range, 7 to 80 mm). Tumors with malignant vs benign behavior showed less staining for insulin (3 of 7 vs 66 of 73; P = 0.015) and for proinsulin (3 of 6 vs 58 of 59; P < 0.001). Staining for glucagon was seen in 2 of 6 malignant tumors and in no benign tumors (P < 0.001). Forty-three insulinomas stained negative for somatostatin receptor subtype 2a. CONCLUSION Localization of insulinomas requires many different diagnostic procedures. Most tumors can be localized by conventional imaging, including EUS. For nonvisible tumors, invasive methods may be a useful diagnostic tool. Malignant tumors showed reduced staining for insulin and proinsulin and increased staining for glucagon.
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Affiliation(s)
- Mikkel Andreassen
- Department of Endocrinology Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- European Neuroendocrine Tumor Society Center of Excellence, Rigshospitalet, Copenhagen, Denmark
| | - Emma Ilett
- Department of Endocrinology Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- European Neuroendocrine Tumor Society Center of Excellence, Rigshospitalet, Copenhagen, Denmark
| | - Dominik Wiese
- European Neuroendocrine Tumor Society, Philipps University, Marburg, Germany
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University, Marburg, Germany
| | - Emily P Slater
- European Neuroendocrine Tumor Society, Philipps University, Marburg, Germany
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University, Marburg, Germany
| | - Marianne Klose
- Department of Endocrinology Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- European Neuroendocrine Tumor Society Center of Excellence, Rigshospitalet, Copenhagen, Denmark
| | - Carsten Palnæs Hansen
- European Neuroendocrine Tumor Society Center of Excellence, Rigshospitalet, Copenhagen, Denmark
- Department of Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Norman Gercke
- European Neuroendocrine Tumor Society, Philipps University, Marburg, Germany
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University, Marburg, Germany
| | - Seppo W Langer
- European Neuroendocrine Tumor Society Center of Excellence, Rigshospitalet, Copenhagen, Denmark
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Kjaer
- European Neuroendocrine Tumor Society Center of Excellence, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Physiology, Nuclear Medicine, & PET and Cluster for Molecular Imaging, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth Maurer
- European Neuroendocrine Tumor Society, Philipps University, Marburg, Germany
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University, Marburg, Germany
| | - Birgitte Federspiel
- European Neuroendocrine Tumor Society Center of Excellence, Rigshospitalet, Copenhagen, Denmark
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter H Kann
- European Neuroendocrine Tumor Society, Philipps University, Marburg, Germany
- Department of Gastroenterology and Division of Endocrinology, Philipps University, Marburg, Germany
| | - Detlef K Bartsch
- European Neuroendocrine Tumor Society, Philipps University, Marburg, Germany
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University, Marburg, Germany
| | - Ulrich Knigge
- Department of Endocrinology Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- European Neuroendocrine Tumor Society Center of Excellence, Rigshospitalet, Copenhagen, Denmark
- Department of Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Benvenga S, Klose M, Vita R, Feldt-Rasmussen U. Less known aspects of central hypothyroidism: Part 1 - Acquired etiologies. J Clin Transl Endocrinol 2018; 14:25-33. [PMID: 30416972 PMCID: PMC6205405 DOI: 10.1016/j.jcte.2018.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 12/24/2022] Open
Abstract
Central hypothyroidism (CH) is a rare cause of hypothyroidism. CH is frequently overlooked, as its clinical picture is subtle and includes non-specific symptoms; furthermore, if measurement of TSH alone is used to screen for thyroid function, TSH concentrations can be normal or even above the upper normal reference limit. Indeed, certain patients are at risk of developing CH, such as those with a pituitary adenoma or hypophysitis, those who have been treated for a childhood malignancy, have suffered a head trauma, sub-arachnoid hemorrhage or meningitis, and those who are on drugs capable to reduce TSH secretion.
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Key Words
- ADH, antidiuretic hormone
- AT/RT, atypical teratoid/rhabdoid tumor
- CH, central hypothyroidism
- CNS, central nervous system
- CPI, conformal primary-site irradiation
- CRI, cranial irradiation
- Central hypothyroidism
- Congenital hypothyroidism
- DDMS, Dyke-Davidoff-Masson syndrome
- FSH, follicle-stimulating hormone
- FT3, free triiodothyronine
- FT4, free thyroxine
- GCT, germ cell tumor
- GH, growth hormone
- Hypopituitarism
- IGF-1, insulin growth factor-1
- LH, luteinizing hormone
- MB, medulloblastoma
- PD-1, programmed cell death-1 receptor
- PNET, primitive neuroectodermal tumor
- PRL, prolactin
- SAH, subarachnoid hemorrhage
- TBI, traumatic brain injury
- TRH, TSH-releasing hormone
- TSH, thyrotropin
- Thyrotropin deficiency
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Affiliation(s)
- Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- Master Program on Childhood, Adolescent and Women’s Endocrine Health, University of Messina, Messina, Italy
- Interdepartmental Program of Molecular & Clinical Endocrinology, and Women’s Endocrine Health, University Hospital Policlinico G. Martino, Messina, Italy
| | - Marianne Klose
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, National University Hospital, Copenhagen University, Copenhagen, Denmark
| | - Roberto Vita
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, National University Hospital, Copenhagen University, Copenhagen, Denmark
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30
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Feldt-Rasmussen U, Klose M, Benvenga S. Interactions between hypothalamic pituitary thyroid axis and other pituitary dysfunctions. Endocrine 2018; 62:519-527. [PMID: 30191443 DOI: 10.1007/s12020-018-1738-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 08/23/2018] [Indexed: 12/16/2022]
Abstract
Central hypothyroidism is defined as low circulating free thyroxine (free T4) with inappropriately low circulating thyrotropin (TSH), in context of a hypothalamic pituitary pathology. Rare cases of idiopathic central hypothyroidism caused by a functional defect may occur, and the condition is often overlooked due to difficulty in achieving the correct diagnosis, sparse symptomatology of the condition and a high risk of misinterpretion of the biochemical changes in central hypothyroidism. Central hypothyroidism is mainly seen in patients with hypothalamic-pituitary pathology due to one of many possible aetiologies, where other hormone deficiencies often co-exist, and both the presence of other deficiencies and their replacement have a strong influence on the measurement of the thyroid-related hormones and thereby interpretation of the thyroid function variables in relation to the clinical impact of thyroid hormone substitution therapy. Conversely, lack of thyroid hormone has a similar strong influence on the interpretation of other pituitary hormone axes, as well as their replacement. Undertreating patients with central hypothyroidism may have serious metabolic consequences with a potentially increased risk of cardiovascular morbidity. The present review thus aims at describing central hypothyroidism, by an overview of interactions of hypothyroidism with other pituitary hormones, diagnosing/testing for central hypothyroidism, and focusing on consequences of undertreatment. Finally, it is mentioned how to deal with new diagnostic settings with lower a priori likelihood of hypopituitarism, particularly in view of the importance of stringent diagnostic testing in order to avoid overdiagnosing central hypothyroidism.
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Affiliation(s)
- Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, National University Hospital, Copenhagen University, Copenhagen, Denmark.
| | - Marianne Klose
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, National University Hospital, Copenhagen University, Copenhagen, Denmark
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- Master Program on Childhood, Adolescent and Women's Endocrine Health, University of Messina, Messina, Italy
- Interdepartmental Program of Molecular and Clinical Endocrinology, and Women's Endocrine Health, University hospital Policlinico G. Martino, Messina, Italy
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31
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Feldt-Rasmussen U, Borresen SW, Klose M. [Not Available]. Ugeskr Laeger 2018; 180:V70013. [PMID: 30518462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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32
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Benvenga S, Klose M, Vita R, Feldt-Rasmussen U. Less known aspects of central hypothyroidism: Part 2 - Congenital etiologies. J Clin Transl Endocrinol 2018; 14:5-11. [PMID: 30294553 PMCID: PMC6171088 DOI: 10.1016/j.jcte.2018.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/12/2018] [Accepted: 09/25/2018] [Indexed: 12/27/2022]
Abstract
Central hypothyroidism (CH) occurs approximately in 1:50,000, and therefore is expected to be one thousand times rarer compared with primary hypothyroidism. Despite its rarity in the general population, it is much more common in certain disorders, in which it is frequently associated with other pituitary hormone deficiencies. The aim of this paper is to provide an updated review on the frequency of congenital CH, which is <1:50,000, and on its etiology, disregarding CH caused by other genetic defects, such as mutations of transcription factors involved in pituitary organogenesis or mutations of the genes encoding TRH or TRH receptor.
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Key Words
- ACTH, adrenocorticotropin hormone
- ALGS, arteriohepatic dysplasia
- CH, central hypothyroidism
- Central hypothyroidism
- Congenital hypothyroidism
- DWS, Dandy-Walker syndrome
- FT3, free triiodothyronine
- FT4, free thyroxine
- GH, growth hormone
- HCG, human chorionic gonadotropin
- Hypopituitarism
- IGDF1, immunogobulin superfamily member 1
- PC1/3, proprotein convertase 1/3
- PWS, Prader-Willi syndrome
- ROHHAD, rapid-onset obesity with hypoventilation, hypothalamic dysfunction and autonomic dysregulation
- SCD, sickle cell anemia
- SMMCIS, solitary median maxillary central incisor syndrome
- SOD, septo-optic dysplasia
- SWS, Sturge-Weber syndrome
- TRH, TSH-releasing hormone
- TSH, thyrotropin
- TT3, total triiodothyronine
- TT4, total thyroxine
- Thyrotropin deficiency
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Affiliation(s)
- Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,Master Program on Childhood, Adolescent and Women's Endocrine Health, University of Messina, Messina, Italy.,Interdepartmental Program of Molecular & Clinical Endocrinology, and Women's Endocrine Health, University Hospital Policlinico G. Martino, Messina, Italy
| | - Marianne Klose
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, National University Hospital, Copenhagen University, Copenhagen, Denmark
| | - Roberto Vita
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, National University Hospital, Copenhagen University, Copenhagen, Denmark
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Boesen VB, Christoffersen T, Watt T, Borresen SW, Klose M, Feldt-Rasmussen U. PlenadrEMA: effect of dual-release versus conventional hydrocortisone on fatigue, measured by ecological momentary assessments: a study protocol for an open-label switch pilot study. BMJ Open 2018; 8:e019487. [PMID: 29362269 PMCID: PMC5786125 DOI: 10.1136/bmjopen-2017-019487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/15/2023] Open
Abstract
INTRODUCTION Patients with adrenal insufficiency have impaired health-related quality of life (QoL). The dual-release hydrocortisone preparation, Plenadren, has been developed to mimic the physiological cortisol release more closely than conventional hydrocortisone treatment. Plenadren has been shown to improve QoL, in particular fatigue, in patients with primary adrenal insufficiency. However, the effect has not been investigated in patients with secondary adrenal insufficiency; furthermore, no study has taken the diurnal variation of fatigue into account. To assess diurnal variations, it is necessary to use repeated daily measurements, such as ecological momentary assessments (EMAs). This study aims to evaluate EMAs of fatigue as outcome in future large-scale randomised clinical trials. METHODS AND ANALYSIS The PlenadrEMA trial is an investigator-initiated open-label switch pilot trial of the effect of Plenadren versus conventional hydrocortisone on fatigue in patients with secondary adrenal insufficiency. The trial will include 30 participants. After 5 weeks on their usual hydrocortisone treatment, patients will be shifted to Plenadren for 16 weeks. Fatigue will be assessed using momentary versions of the Multidimensional Fatigue Inventory (MFI-20). Items will be administered to participants via a smartphone application four times daily during 20 days. Assessments will be performed before treatment shift and repeated after 12.5 weeks on Plenadren. The study will identify the best suited outcome for future randomised clinical trials, and in addition, estimate the variability and difference in fatigue between the two treatments to perform power calculations. ETHICS AND DISSEMINATION The trial will be conducted in accordance with the Declaration of Helsinki and has been approved by the Regional Scientific Ethical Committee in Copenhagen (ID: H-1-2014-073). All patients will receive written and verbal information about the trial and will give informed consent before enrolment. Findings will be published in peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER EudraCT201400203932.
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Affiliation(s)
- Victor Brun Boesen
- Department of Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Thea Christoffersen
- Department of Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Torquil Watt
- Department of Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Internal Medicine, Copenhagen University Hospital Herlev Gentofte, Denmark
| | | | - Marianne Klose
- Department of Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Abstract
Traumatic brain injury (TBI) is a major public health problem with potentially debilitating consequences for the individual. Hypopituitarism after TBI has received increasing attention over the past decade; development of the condition as a consequence of TBI was previously hardly mentioned in textbooks on the subject. Hypopituitarism has been reported in more than 25% of patients with TBI and is now thought to be one of the most important causes of treatable morbidity in TBI survivors. However, most clinicians dealing with neuroendocrine diseases and TBI generally do not see such a high incidence of hypopituitarism. This disproportion is not clearly explained, but recent data indicate that diagnostic testing, which is designed for high-risk populations and not for a cohort of patients with, for example, de novo isolated growth hormone deficiency (the predominant finding in TBI), might have overestimated the true risk and disease burden of hypopituitarism. In this Opinion article, we discuss current recommendations for post-traumatic hypopituitarism in light of recent evidence.
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Affiliation(s)
- Marianne Klose
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, National University Hospital, Copenhagen University, Blegdamsvej 9, Copenhagen DK-2100, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, National University Hospital, Copenhagen University, Blegdamsvej 9, Copenhagen DK-2100, Denmark
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Dal J, Klose M, Heck A, Andersen M, Kistorp C, Nielsen EH, Bollerslev J, Feldt-Rasmussen U, Jørgensen JOL. Targeting either GH or IGF-I during somatostatin analogue treatment in patients with acromegaly: a randomized multicentre study. Eur J Endocrinol 2018; 178:65-74. [PMID: 28993415 DOI: 10.1530/eje-17-0546] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/14/2017] [Accepted: 10/04/2017] [Indexed: 11/08/2022]
Abstract
CONTEXT Discordant GH and IGF-I values are frequent in acromegaly. The clinical significance and its dependence on treatment modality and of glucose-suppressed GH (GHnadir) measurements remain uncertain. OBJECTIVE To evaluate the effects of targeting either IGF-I or GH during somatostatin analogue (SA) treatment. PATIENTS AND METHODS 84 patients with controlled acromegaly after surgery (n = 23) or SA (n = 61) underwent a GH profile including an OGTT, at baseline and after 12 months. SA patients were randomized to monitoring according to either IGF-I (n = 33) or GHnadir (n = 28). SA dose escalation was allowed at baseline and 6 months. MAIN OUTCOME MEASURES GHnadir and IGF-I at baseline and 12 months, and disease-specific Quality of Life (QoL). RESULTS IGF-I and fasting GH levels were comparable between the surgery and the SA group, whereas GHnadir (µg/L) was lower in the surgery group (GHnadir 0.7 ± 0.1 vs 0.3 ± 0.1, P < 0.01). SA dose increase was performed in 20 patients in the GH group and in 8 patients in the IGF-I group (P = 0.02), which increased the number of concordantly controlled patients (P = 0.01). QoL was only mildly affected at baseline in all groups and did not changed consistently during the study. CONCLUSION (1) Discordant values in terms of high GH levels are prevalent in SA patients and more so if applying glucose-suppressed GHnadir; (2) targeting discordant levels of either GH or IGF-I translates into SA dose increase and improved biochemical control; (3) even though QoL was not improved in this study, we suggest biochemical assessment of disease activity to include glucose-suppressed GHnadir also in SA patients.
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Affiliation(s)
- Jakob Dal
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Marianne Klose
- Department of Endocrinology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ansgar Heck
- Section of Specialized Endocrinology, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marianne Andersen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | | | - Eigil H Nielsen
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Jens Bollerslev
- Section of Specialized Endocrinology, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ulla Feldt-Rasmussen
- Department of Endocrinology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jens O L Jørgensen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
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Joustra SD, Gu C, Rohling JHT, Pickering L, Klose M, Hu K, Scheer FA, Feldt-Rasmussen U, Jennum PJ, Pereira AM, Biermasz NR, Meijer JH. Decrease in scale invariance of activity fluctuations with aging and in patients with suprasellar tumors. Chronobiol Int 2017; 35:368-377. [PMID: 29182371 PMCID: PMC5862770 DOI: 10.1080/07420528.2017.1407779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Motor activity in healthy young humans displays intrinsic fluctuations that are scale-invariant over a wide range of time scales (from minutes to hours). Human postmortem and animal lesion studies showed that the intact function of the suprachiasmatic nucleus (SCN) is required to maintain such scale-invariant patterns. We therefore hypothesized that scale invariance is degraded in patients treated for suprasellar tumors that compress the SCN. To test the hypothesis, we investigated 68 patients with nonfunctioning pituitary macroadenoma and 22 patients with craniopharyngioma, as well as 72 age-matched healthy controls (age range 21.0–70.6 years). Spontaneous wrist locomotor activity was measured for 7 days with actigraphy, and detrended fluctuation analysis was applied to assess correlations over a range of time scales from minutes to 24 h. For all the subjects, complex scale-invariant correlations were only present for time scales smaller than 1.5 h, and became more random at time scales 1.5–10 h. Patients with suprasellar tumors showed a larger decrease in correlations at 1.5–10 h as compared to healthy controls. Within healthy subject, gender and age >33 year were associated with attenuated scale invariance. Conversely, activity patterns at time scales between 10 and 24 h were significantly more regular than all other time scales, and this was mostly associated with age. In conclusion, scale invariance is degraded in healthy subjects at the ages of >33 year as characterized by attenuation of correlations at time scales 1.5–10 h. In addition, scale invariance was more degraded in patients with suprasellar tumors as compared to healthy subjects.
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Affiliation(s)
- S D Joustra
- a Center for Endocrine Tumors Leiden, Department of Medicine, Division of Endocrinology , Leiden University Medical Center , Leiden , The Netherlands
| | - C Gu
- b Department of Molecular Cell Biology , Laboratory for Neurophysiology, Leiden University Medical Center , Leiden , The Netherlands.,c Business School , University of Shanghai for Science and Technology , Shanghai , China
| | - J H T Rohling
- b Department of Molecular Cell Biology , Laboratory for Neurophysiology, Leiden University Medical Center , Leiden , The Netherlands
| | - L Pickering
- d Department of Medical Endocrinology , Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark.,e Danish Center for Sleep Medicine , Neurophysiologic Clinic, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - M Klose
- d Department of Medical Endocrinology , Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - K Hu
- f Division of Sleep and Circadian Disorders , Brigham and Women's Hospital , Boston , MA , USA.,g Division of Sleep Medicine , Harvard Medical School , Boston , MA , USA
| | - F A Scheer
- f Division of Sleep and Circadian Disorders , Brigham and Women's Hospital , Boston , MA , USA.,g Division of Sleep Medicine , Harvard Medical School , Boston , MA , USA
| | - U Feldt-Rasmussen
- d Department of Medical Endocrinology , Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - P J Jennum
- e Danish Center for Sleep Medicine , Neurophysiologic Clinic, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - A M Pereira
- a Center for Endocrine Tumors Leiden, Department of Medicine, Division of Endocrinology , Leiden University Medical Center , Leiden , The Netherlands
| | - N R Biermasz
- a Center for Endocrine Tumors Leiden, Department of Medicine, Division of Endocrinology , Leiden University Medical Center , Leiden , The Netherlands
| | - J H Meijer
- b Department of Molecular Cell Biology , Laboratory for Neurophysiology, Leiden University Medical Center , Leiden , The Netherlands
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Borresen SW, Klose M, Baslund B, Rasmussen ÅK, Hilsted L, Friis-Hansen L, Locht H, Hansen A, Hetland ML, Lydolph MC, Feldt-Rasmussen U. Adrenal insufficiency is seen in more than one-third of patients during ongoing low-dose prednisolone treatment for rheumatoid arthritis. Eur J Endocrinol 2017; 177:287-295. [PMID: 28877961 DOI: 10.1530/eje-17-0251] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 03/27/2017] [Revised: 06/16/2017] [Accepted: 07/04/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Patients receiving long-term glucocorticoid treatment are at risk of developing adrenal insufficiency during treatment. We investigated the prevalence of prednisolone-induced adrenal insufficiency in the particular clinical situation where patients receive ongoing low-dose (5 mg/day) prednisolone treatment, a dose by itself too low to cover glucocorticoid needs during stress. DESIGN AND METHODS Cross-sectional study in 42 patients with rheumatoid arthritis (29 women, aged 36-86 years) treated with 5 mg prednisolone/day, who had received prednisolone for ≥6 months (median: 66, range: 6-444 months). Adrenal function was evaluated by a 250 μg Synacthen test performed after mean 48.7 h prednisolone pause. Local assay-specific cut-off for normal adrenal function was P-cortisol ≥420 nmol/L 30 min after Synacthen injection. RESULTS Overall, 20 of the 42 patients (48%, 95% CI: 33-62%) had an insufficient adrenal response to the Synacthen test. Including only patients who had not received concomitant treatment with any other glucocorticoid formulas within the last 3 months, 13 of 33 patients (39%, 95% CI: 25-56%) had an insufficient response. Adrenocorticotrophic hormone (ACTH) concentrations were generally low and anti-adrenal antibodies were negative indicating secondary adrenal insufficiency as the most likely diagnosis. There was no correlation between duration of treatment and 30 min P-cortisol (P = 0.62). Adrenal function did not depend on sex or seropositivity of rheumatoid arthritis. CONCLUSION We demonstrate a high prevalence of adrenal insufficiency during ongoing low-dose prednisolone treatment. The results urge to increase focus on the condition to ensure identification and correct management of insufficient patients during stress and withdrawal. Strategies for adrenal function evaluation during ongoing low-dose glucocorticoid treatment need to be established.
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Affiliation(s)
- Stina Willemoes Borresen
- Department of Medical Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Klose
- Department of Medical Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bo Baslund
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center of Rheumatology and Joint Diseases
| | - Åse Krogh Rasmussen
- Department of Medical Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Linda Hilsted
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lennart Friis-Hansen
- Department of Clinical Biochemistry, Copenhagen University Hospital, Nordsjællands Hospital, Hillerød, Denmark
| | - Henning Locht
- Center of Rheumatology and Joint Diseases, Copenhagen University Hospital, Frederiksberg Hospital, Frederiksberg, Denmark
| | - Annette Hansen
- Center of Rheumatology and Joint Diseases, Copenhagen University Hospital, Gentofte Hospital, Gentofte, Denmark
| | - Merete Lund Hetland
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center of Rheumatology and Joint Diseases, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | | | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Astradsson A, Munck af Rosenschöld P, Feldt-Rasmussen U, Poulsgaard L, Wiencke AK, Ohlhues L, Engelholm SA, Broholm H, Hansen Møller E, Klose M, Roed H, Juhler M. Visual outcome, endocrine function and tumor control after fractionated stereotactic radiation therapy of craniopharyngiomas in adults: findings in a prospective cohort. Acta Oncol 2017; 56:415-421. [PMID: 28084862 DOI: 10.1080/0284186x.2016.1270466] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The purpose of this study was to examine visual outcome, endocrine function and tumor control in a prospective cohort of craniopharyngioma patients, treated with fractionated stereotactic radiation therapy (FSRT). MATERIAL AND METHODS Sixteen adult patients with craniopharyngiomas were eligible for analysis. They were treated with linear accelerator-based FSRT during 1999-2015. In all cases, diagnosis was confirmed by histological analysis. The prescription dose to the tumor was 54 Gy (median, range 48-54) in 1.8 or 2.0 Gy per fraction, and the maximum radiation dose to the optic nerves and chiasm was 54.2 Gy (median, range 48.6-60.0) for the cohort. Serial ophthalmological and endocrine evaluations and magnetic resonance imaging (MRI) scans were performed at regular intervals. Median follow-up was 3.3 years (range 1.1-14.1), 3.7 years (range 0.8-15.2), and 3.6 years (range 0.7-13.1) for visual outcome, endocrine function, and tumor control, respectively. RESULTS Visual acuity impairment was present in 10 patients (62.5%) and visual field defects were present in 12 patients (75%) before FSRT. One patient developed radiation-induced optic neuropathy at seven years after FSRT. Thirteen of 16 patients (81.3%) had pituitary deficiency before FSRT, and did not develop further pituitary deficiency after FSRT. Mean tumor volume pre-FSRT was 2.72 cm3 (range 0.20-9.90) and post-FSRT 1.2 cm3 (range 0.00-13.10). Tumor control rate was 81.3% at two, five, and 10 years after FSRT. CONCLUSIONS FSRT was relatively safe in this prospective cohort of craniopharyngiomas, with only one case of radiation-induced optic neuropathy and no case of new endocrinopathy. Tumor control rate was acceptable.
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Affiliation(s)
- Arnar Astradsson
- Department of Neurorehabilitation, Traumatic Brain Injury Unit, Rigshospitalet, Hvidovre, Denmark
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Lars Poulsgaard
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | | | - Lars Ohlhues
- Department of Radiation Oncology, Finsen Center, Rigshospitalet, Copenhagen, Denmark
| | - Svend Aage Engelholm
- Department of Radiation Oncology, Finsen Center, Rigshospitalet, Copenhagen, Denmark
| | - Helle Broholm
- Department of Neuropathology, Rigshospitalet, Copenhagen, Denmark
| | - Emil Hansen Møller
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
- Department of Medical Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Klose
- Department of Medical Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Roed
- Department of Radiation Oncology, Finsen Center, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Juhler
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
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Klose M, Naberukhin YI. Vibrationally and Diffusionally Spectroscopical Investigations of the Structure of Water. Z PHYS CHEM 2017. [DOI: 10.1515/zpch-1985-266132] [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: 11/15/2022]
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Kabisch G, Klose M. Temperature Dependence of the XH Band Profiles in Hydrogen Bonded Liquids. A Comparative Raman Study of HDO, CD3OH and N-methylformamide. Z PHYS CHEM 2017. [DOI: 10.1515/zpch-1985-26685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Hypothyroidism is characterized by hypometabolism, and may be seen as a part of secondary failure due to pituitary insufficiency or tertiary due to hypothalamic disease. Secondary and tertiary failures are also referred to as central hypothyroidism. Whereas overt primary hypothyroidism has a well-known affection on the heart and cardiovascular system, and may result in cardiac failure, cardiovascular affection is less well recognized in central hypothyroidism. Studies on central hypothyroidism and cardiovascular outcome are few and given the rarity of the diseases often small. Further, there are several limitations given vast difficulties in diagnosing the condition correctly biochemically, and difficulties monitoring the treatment because normal thyroid-pituitary feedback interrelationships are disrupted. The present review summarizes available studies of central adult hypothyroidism and its possible influence on the cardiovascular system, describe differences from primary thyroid failure and seek evidence for performing guidelines for clinical management of this particular thyroid and hypothalamo-pituitary disorder.
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Affiliation(s)
- Ulla Feldt-Rasmussen
- Department of Medical Endocrinology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
| | - Marianne Klose
- Department of Medical Endocrinology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
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Klett H, Klose M, Kowar S, Bronsert P, Küsters S, Werner M, Christoph P, Busch H, Boerries M. Biomarker detection in pancreatic ductal adenocarcinoma. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61629-5] [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: 11/30/2022]
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Rasmussen MH, Janukonyté J, Klose M, Marina D, Tanvig M, Nielsen LF, Höybye C, Andersen M, Feldt-Rasmussen U, Christiansen JS. Reversible Albumin-Binding GH Possesses a Potential Once-Weekly Treatment Profile in Adult Growth Hormone Deficiency. J Clin Endocrinol Metab 2016; 101:988-98. [PMID: 26727076 PMCID: PMC4803179 DOI: 10.1210/jc.2015-1991] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT NNC0195-0092 is a reversible, albumin-binding GH derivative, developed for once-weekly administration. OBJECTIVES The objective of the study was to evaluate safety, local tolerability, pharmacodynamics, and pharmacokinetics of multiple, once-weekly doses of NNC0195-0092, compared with daily GH. DESIGN AND SETTING This was a phase 1, randomized, open-label, active-controlled, multiple-dose, dose-escalation trial. PATIENTS Thirty-four GH-treated adult subjects (male, n = 25) with GH deficiency participated in the study. INTERVENTIONS AND MAIN OUTCOME MEASURES Subjects were sequentially assigned into four cohorts of eight subjects, randomized within each cohort (3:1) to once-weekly NNC0195-0092 (n = 6) for 4 weeks (0.02, 0.04, 0.08, and 0.12 mg/kg) or daily injections of Norditropin NordiFlex (n = 2) for 4 weeks with a dose replicating the pretrial dose of somatropin. A safety assessment was performed prior to initiating treatment at the next dose level of NNC0195-0092. Daily GH treatment was discontinued 14 days before the trial start. Blood samples were drawn for assessment of safety, pharmacokinetics, pharmacodynamics (IGF-1 and IGF-binding protein-3) profiles, and immunogenicity studies. RESULTS Numbers of adverse events were similar at the dose levels of 0.02, 0.04, and 0.08 mg/kg NNC0195-0092 vs daily injections of Norditropin NordiFlex, whereas the number of adverse events was greater at the highest dose level of NNC0195-0092 (0.12 mg/kg). NNC0195-0092 (area under the curve[0-168h]) and peak plasma concentration) increased in a dose-dependent manner, and a dose-dependent increase in IGF-1 levels was observed. IGF-1 profiles were elevated for at least 1 week, and for the 0.02-mg/kg and 0.04-mg/kg NNC0195-0092 doses, the observed IGF-1 levels were similar to the levels for the active control group. CONCLUSION Four once-weekly doses of NNC0195-0092 (dose range 0.02-0.12 mg/kg) administered to adult patients with GH deficiency were well tolerated, and IGF-1 profiles were consistent with a once-weekly treatment profile. No clinically significant safety and tolerability signals causally related to NNC0195-0092 were identified, nor were any immunogenicity concerns revealed.
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Affiliation(s)
- Michael Højby Rasmussen
- Department of Global Development (M.H.R., L.F.N.), Novo Nordisk, DK-2860 Søborg Denmark; Medical Department of Diabetes and Endocrinology, Aarhus University Hospital (J.J., J.S.C.), DK-8000 C Aarhus, Denmark; Department of Endocrinology, Rigshospitalet, (M.K., D.M., U.F.-R.), University of Copenhagen, DK-2100 Copenhagen, Denmark; Department of Endocrinology, Odense University Hospital (M.T., M.A.), DK-5000 Odense, Denmark; and Department of Endocrinology, Karolinska University Hospital (C.H.), SE-171 76 Stockholm, Sweden
| | - Jurgita Janukonyté
- Department of Global Development (M.H.R., L.F.N.), Novo Nordisk, DK-2860 Søborg Denmark; Medical Department of Diabetes and Endocrinology, Aarhus University Hospital (J.J., J.S.C.), DK-8000 C Aarhus, Denmark; Department of Endocrinology, Rigshospitalet, (M.K., D.M., U.F.-R.), University of Copenhagen, DK-2100 Copenhagen, Denmark; Department of Endocrinology, Odense University Hospital (M.T., M.A.), DK-5000 Odense, Denmark; and Department of Endocrinology, Karolinska University Hospital (C.H.), SE-171 76 Stockholm, Sweden
| | - Marianne Klose
- Department of Global Development (M.H.R., L.F.N.), Novo Nordisk, DK-2860 Søborg Denmark; Medical Department of Diabetes and Endocrinology, Aarhus University Hospital (J.J., J.S.C.), DK-8000 C Aarhus, Denmark; Department of Endocrinology, Rigshospitalet, (M.K., D.M., U.F.-R.), University of Copenhagen, DK-2100 Copenhagen, Denmark; Department of Endocrinology, Odense University Hospital (M.T., M.A.), DK-5000 Odense, Denmark; and Department of Endocrinology, Karolinska University Hospital (C.H.), SE-171 76 Stockholm, Sweden
| | - Djordje Marina
- Department of Global Development (M.H.R., L.F.N.), Novo Nordisk, DK-2860 Søborg Denmark; Medical Department of Diabetes and Endocrinology, Aarhus University Hospital (J.J., J.S.C.), DK-8000 C Aarhus, Denmark; Department of Endocrinology, Rigshospitalet, (M.K., D.M., U.F.-R.), University of Copenhagen, DK-2100 Copenhagen, Denmark; Department of Endocrinology, Odense University Hospital (M.T., M.A.), DK-5000 Odense, Denmark; and Department of Endocrinology, Karolinska University Hospital (C.H.), SE-171 76 Stockholm, Sweden
| | - Mette Tanvig
- Department of Global Development (M.H.R., L.F.N.), Novo Nordisk, DK-2860 Søborg Denmark; Medical Department of Diabetes and Endocrinology, Aarhus University Hospital (J.J., J.S.C.), DK-8000 C Aarhus, Denmark; Department of Endocrinology, Rigshospitalet, (M.K., D.M., U.F.-R.), University of Copenhagen, DK-2100 Copenhagen, Denmark; Department of Endocrinology, Odense University Hospital (M.T., M.A.), DK-5000 Odense, Denmark; and Department of Endocrinology, Karolinska University Hospital (C.H.), SE-171 76 Stockholm, Sweden
| | - Lene F Nielsen
- Department of Global Development (M.H.R., L.F.N.), Novo Nordisk, DK-2860 Søborg Denmark; Medical Department of Diabetes and Endocrinology, Aarhus University Hospital (J.J., J.S.C.), DK-8000 C Aarhus, Denmark; Department of Endocrinology, Rigshospitalet, (M.K., D.M., U.F.-R.), University of Copenhagen, DK-2100 Copenhagen, Denmark; Department of Endocrinology, Odense University Hospital (M.T., M.A.), DK-5000 Odense, Denmark; and Department of Endocrinology, Karolinska University Hospital (C.H.), SE-171 76 Stockholm, Sweden
| | - Charlotte Höybye
- Department of Global Development (M.H.R., L.F.N.), Novo Nordisk, DK-2860 Søborg Denmark; Medical Department of Diabetes and Endocrinology, Aarhus University Hospital (J.J., J.S.C.), DK-8000 C Aarhus, Denmark; Department of Endocrinology, Rigshospitalet, (M.K., D.M., U.F.-R.), University of Copenhagen, DK-2100 Copenhagen, Denmark; Department of Endocrinology, Odense University Hospital (M.T., M.A.), DK-5000 Odense, Denmark; and Department of Endocrinology, Karolinska University Hospital (C.H.), SE-171 76 Stockholm, Sweden
| | - Marianne Andersen
- Department of Global Development (M.H.R., L.F.N.), Novo Nordisk, DK-2860 Søborg Denmark; Medical Department of Diabetes and Endocrinology, Aarhus University Hospital (J.J., J.S.C.), DK-8000 C Aarhus, Denmark; Department of Endocrinology, Rigshospitalet, (M.K., D.M., U.F.-R.), University of Copenhagen, DK-2100 Copenhagen, Denmark; Department of Endocrinology, Odense University Hospital (M.T., M.A.), DK-5000 Odense, Denmark; and Department of Endocrinology, Karolinska University Hospital (C.H.), SE-171 76 Stockholm, Sweden
| | - Ulla Feldt-Rasmussen
- Department of Global Development (M.H.R., L.F.N.), Novo Nordisk, DK-2860 Søborg Denmark; Medical Department of Diabetes and Endocrinology, Aarhus University Hospital (J.J., J.S.C.), DK-8000 C Aarhus, Denmark; Department of Endocrinology, Rigshospitalet, (M.K., D.M., U.F.-R.), University of Copenhagen, DK-2100 Copenhagen, Denmark; Department of Endocrinology, Odense University Hospital (M.T., M.A.), DK-5000 Odense, Denmark; and Department of Endocrinology, Karolinska University Hospital (C.H.), SE-171 76 Stockholm, Sweden
| | - Jens Sandahl Christiansen
- Department of Global Development (M.H.R., L.F.N.), Novo Nordisk, DK-2860 Søborg Denmark; Medical Department of Diabetes and Endocrinology, Aarhus University Hospital (J.J., J.S.C.), DK-8000 C Aarhus, Denmark; Department of Endocrinology, Rigshospitalet, (M.K., D.M., U.F.-R.), University of Copenhagen, DK-2100 Copenhagen, Denmark; Department of Endocrinology, Odense University Hospital (M.T., M.A.), DK-5000 Odense, Denmark; and Department of Endocrinology, Karolinska University Hospital (C.H.), SE-171 76 Stockholm, Sweden
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Marina D, Burman P, Klose M, Casar-Borota O, Luque RM, Castaño JP, Feldt-Rasmussen U. Truncated somatostatin receptor 5 may modulate therapy response to somatostatin analogues--Observations in two patients with acromegaly and severe headache. Growth Horm IGF Res 2015; 25:262-267. [PMID: 26188991 DOI: 10.1016/j.ghir.2015.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 02/25/2015] [Revised: 06/10/2015] [Accepted: 07/08/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Somatotropinomas have unique "fingerprints" of somatostatin receptor (sst) expression, which are targets in treatment of acromegaly with somatostatin analogues (SSAs). However, a significant expression of sst is not always related to the biochemical response to SSAs. Headache is a common complaint in acromegaly and considered a clinical marker of disease activity. SSAs are reported to have an own analgesic effect, but the sst involved are unknown. PATIENTS AND METHODS We investigated sst expression in two acromegalic patients with severe headache and no biochemical effects of octreotide, but a good response to pasireotide. We searched the literature for determinants of biochemical and analgesic effects of SSAs in somatotropinomas. RESULTS Case 1 had no biochemical or analgesic effects of octreotide, a semi-selective SSA, but a rapid and significant effect of pasireotide, a pan-SSA. Case 2 demonstrated discordance between analgesic and biochemical effects of octreotide, in that headache disappeared, but without biochemical improvement. In contrast, pasireotide normalized insulin-like growth factor 1. Both adenomas were sparsely granulated and had strong membranous expressions of sst2a in 50-75% and sst5 in 75-100% of tumor cells. The truncated sst5 variant TMD4 (sst5TMD4) showed expression in 20-57% of tumor cells. CONCLUSIONS A poor biochemical response to octreotide may be associated with tumor expression of a truncated sst5 variant, despite abundant sst2a expression, suggesting an influence from variant sst5 on common sst signaling pathways. Furthermore, unrelated analgesic and biochemical effects of SSAs supported a complex pathogenesis of acromegaly-associated headache. Finally, assessment of truncated sst5 in addition to full length sst could be important for a choice of postoperative SSA treatment in somatotropinomas.
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Affiliation(s)
- Djordje Marina
- Department of Medical Endocrinology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Pia Burman
- Department of Endocrinology, Skånes University Hospital, Malmö, Sweden
| | - Marianne Klose
- Department of Medical Endocrinology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Olivera Casar-Borota
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Raúl M Luque
- Department of Cell Biology, Physiology and Immunology, University of Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofia, 14014 Córdoba, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), 14014 Córdoba, Spain
| | - Justo P Castaño
- Department of Cell Biology, Physiology and Immunology, University of Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofia, 14014 Córdoba, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), 14014 Córdoba, Spain
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Borresen S, Klose M, Rasmussen A, Feldt-Rasmussen U. Adrenal Insufficiency Caused by Locally Applied Glucocorticoids-Myth or Fact? Curr Med Chem 2015; 22:2801-9. [DOI: 10.2174/0929867322666150716113003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 06/24/2015] [Accepted: 07/11/2015] [Indexed: 11/22/2022]
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Marina D, Klose M, Nordenbo A, Liebach A, Feldt-Rasmussen U. Early endocrine alterations reflect prolonged stress and relate to 1-year functional outcome in patients with severe brain injury. Eur J Endocrinol 2015; 172:813-22. [PMID: 25825347 DOI: 10.1530/eje-14-1152] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 03/30/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Severe brain injury may increase the risk of developing acute and chronic hypopituitarism. Pituitary hormone alterations developed in the early recovery phase after brain injury may have implications for long-term functional recovery. The objective of the present study was to assess the pattern and prevalence of pituitary hormone alterations 3 months after a severe brain injury with relation to functional outcome at a 1-year follow-up. DESIGN Prospective study at a tertiary university referral centre. METHODS A total of 163 patients admitted to neurorehabilitation after severe traumatic brain injury (TBI, n=111) or non-TBI (n=52) were included. The main outcome measures were endocrine alterations 3.3 months (median) after the brain injury and their relationship to the functioning and ability of the patients at a 1-year follow-up, as measured by the Functional Independence Measure and the Glasgow Outcome Scale-Extended. RESULTS Three months after the injury, elevated stress hormones (i.e. 30 min stimulated cortisol, prolactin and/or IGF1) and/or suppressed gonadal or thyroid hormones were recorded in 68 and 32% of the patients respectively. At 1 year after the injury, lower functioning level (Functional Independence Measure) and lower capability of performing normal life activities (Glasgow Outcome Scale-Extended) were related to both the elevated stress hormones (P≤0.01) and the reduced gonadal and/or thyroid hormones (P≤0.01) measured at 3 months. CONCLUSION The present study suggests that brain injury-related endocrine alterations that mimic secondary hypogonadism and hypothyroidism and that occur with elevated stress hormones most probably reflect a prolonged stress response 2-5 months after severe brain injury, rather than pituitary insufficiency per se. These endocrine alterations thus seem to reflect a more severe disease state and relate to 1-year functional outcome.
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Affiliation(s)
- Djordje Marina
- Department of Medical Endocrinology PE2131Rigshospital, Copenhagen University Hospital, Copenhagen, DenmarkTraumatic Brain Injury UnitDepartment of Neurorehabilitation, Glostrup Hospital, Copenhagen University Hospital, Glostrup, Denmark
| | - Marianne Klose
- Department of Medical Endocrinology PE2131Rigshospital, Copenhagen University Hospital, Copenhagen, DenmarkTraumatic Brain Injury UnitDepartment of Neurorehabilitation, Glostrup Hospital, Copenhagen University Hospital, Glostrup, Denmark
| | - Annette Nordenbo
- Department of Medical Endocrinology PE2131Rigshospital, Copenhagen University Hospital, Copenhagen, DenmarkTraumatic Brain Injury UnitDepartment of Neurorehabilitation, Glostrup Hospital, Copenhagen University Hospital, Glostrup, Denmark
| | - Annette Liebach
- Department of Medical Endocrinology PE2131Rigshospital, Copenhagen University Hospital, Copenhagen, DenmarkTraumatic Brain Injury UnitDepartment of Neurorehabilitation, Glostrup Hospital, Copenhagen University Hospital, Glostrup, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology PE2131Rigshospital, Copenhagen University Hospital, Copenhagen, DenmarkTraumatic Brain Injury UnitDepartment of Neurorehabilitation, Glostrup Hospital, Copenhagen University Hospital, Glostrup, Denmark
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Klose M, Stochholm K, Janukonyté J, Christensen LL, Cohen AS, Wagner A, Laurberg P, Christiansen JS, Andersen M, Feldt-Rasmussen U. Patient reported outcome in posttraumatic pituitary deficiency: results from The Danish National Study on posttraumatic hypopituitarism. Eur J Endocrinol 2015; 172:753-62. [PMID: 25766045 DOI: 10.1530/eje-14-1069] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 03/12/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Posttraumatic pituitary hormone deficiency is often suggested. The impact of these predominantly mild and often irreproducible deficiencies on outcome is less clear. The aim of the present study was to describe patient reported outcome in a national a priori unselected cohort of patients with traumatic brain injury (TBI) in relation to deficiencies identified upon pituitary assessment. DESIGN AND METHODS We conducted a nationwide population-based cohort study. Participants were Danish patients with a head trauma diagnosis recorded in the Danish Board of Health diagnostic code registry; 439 patients (and 124 healthy controls) underwent assessment of anterior pituitary function 2.5 years (median) after TBI. Questionnaires on health-related quality of life (QoL) (SF36, EuroQoL-5D, QoL assessment of GH deficiency in adults) and fatigue (MFI-20) were completed in parallel to pituitary assessment. RESULTS Patients with TBI had significant detriments in QoL. Impairment (mainly physical scales) related to pituitary deficiency, although only partially confirmed after adjustment for demographic differences. Hypogonadotropic hypogonadism related to several QoL scores. Increasing impairments were observed with declining total testosterone concentrations (men), but not free testosterone concentrations or any other hormone concentrations. Total testosterone was not independently related to impaired QoL and fatigue, after adjustment for demographics, and treatment with antidiabetics, opioids, antidepressants, and anticonvulsants. CONCLUSIONS Only a very limited relationship between pituitary hormone deficiencies and QoL/fatigue was demonstrated. Due to the dominating influence of concurrent comorbidities, pituitary deficiencies were not independently related to QoL/fatigue. Causality is still to be shown, and whether substitution therapy could be of additional relevance in selected patients needs to be proven.
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Affiliation(s)
- Marianne Klose
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Kirstine Stochholm
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Jurgita Janukonyté
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Louise Lehman Christensen
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Arieh S Cohen
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Aase Wagner
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Peter Laurberg
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Jens Sandahl Christiansen
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Marianne Andersen
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
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Abstract
OBJECTIVE To assess the influence of craniopharyngioma or consequent surgery on melatonin secretion, and the association with fatigue, sleepiness, sleep pattern and sleep quality. DESIGN Cross-sectional study. METHODS A total of 15 craniopharyngioma patients were individually matched to healthy controls. In this study, 24-h salivary melatonin and cortisol were measured. Sleep-wake patterns were characterised by actigraphy and sleep diaries recorded for 2 weeks. Sleepiness, fatigue, sleep quality and general health were assessed by Multidimensional Fatigue Inventory, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Short-Form 36. RESULTS Patients had increased mental fatigue, daytime dysfunction, sleep latency and lower general health (all, P≤0.05), and they tended to have increased daytime sleepiness, general fatigue and impaired sleep quality compared with controls. The degree of hypothalamic injury was associated with an increased BMI and lower mental health (P=0.01). High BMI was associated with increased daytime sleepiness, daytime dysfunction, mental fatigue and lower mental health (all, P≤0.01). Low midnight melatonin was associated with reduced sleep time and efficiency (P≤0.03) and a tendency for increased sleepiness, impaired sleep quality and physical health. Midnight melatonin remained independently related to sleep time after adjustment for cortisol. Three different patterns of melatonin profiles were observed; normal (n=6), absent midnight peak (n=6) and phase-shifted peak (n=2). Only patients with absent midnight peak had impaired sleep quality, increased daytime sleepiness and general and mental fatigue. CONCLUSION Craniopharyngioma patients present with changes in circadian pattern and daytime symptoms, which may be due to the influence of the craniopharyngioma or its treatment on the hypothalamic circadian and sleep regulatory nuclei.
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Affiliation(s)
- Line Pickering
- Department of EndocrinologyCopenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen East, DenmarkDanish Center for Sleep MedicineDepartment of Clinical BiochemistryCopenhagen University Hospital, Glostrup Hospital, Ndr. Ringvej 57, DK-2600 Glostrup, DenmarkDepartment of NeurosurgeryCopenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen East, Denmark
| | - Poul Jennum
- Department of EndocrinologyCopenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen East, DenmarkDanish Center for Sleep MedicineDepartment of Clinical BiochemistryCopenhagen University Hospital, Glostrup Hospital, Ndr. Ringvej 57, DK-2600 Glostrup, DenmarkDepartment of NeurosurgeryCopenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen East, Denmark
| | - Steen Gammeltoft
- Department of EndocrinologyCopenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen East, DenmarkDanish Center for Sleep MedicineDepartment of Clinical BiochemistryCopenhagen University Hospital, Glostrup Hospital, Ndr. Ringvej 57, DK-2600 Glostrup, DenmarkDepartment of NeurosurgeryCopenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen East, Denmark
| | - Lars Poulsgaard
- Department of EndocrinologyCopenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen East, DenmarkDanish Center for Sleep MedicineDepartment of Clinical BiochemistryCopenhagen University Hospital, Glostrup Hospital, Ndr. Ringvej 57, DK-2600 Glostrup, DenmarkDepartment of NeurosurgeryCopenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen East, Denmark
| | - Ulla Feldt-Rasmussen
- Department of EndocrinologyCopenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen East, DenmarkDanish Center for Sleep MedicineDepartment of Clinical BiochemistryCopenhagen University Hospital, Glostrup Hospital, Ndr. Ringvej 57, DK-2600 Glostrup, DenmarkDepartment of NeurosurgeryCopenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen East, Denmark
| | - Marianne Klose
- Department of EndocrinologyCopenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen East, DenmarkDanish Center for Sleep MedicineDepartment of Clinical BiochemistryCopenhagen University Hospital, Glostrup Hospital, Ndr. Ringvej 57, DK-2600 Glostrup, DenmarkDepartment of NeurosurgeryCopenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen East, Denmark
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Klose M, Stochholm K, Janukonyté J, Lehman Christensen L, Frystyk J, Andersen M, Laurberg P, Christiansen JS, Feldt-Rasmussen U. Prevalence of posttraumatic growth hormone deficiency is highly dependent on the diagnostic set-up: results from The Danish National Study on Posttraumatic Hypopituitarism. J Clin Endocrinol Metab 2014; 99:101-10. [PMID: 24243629 DOI: 10.1210/jc.2013-2397] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Recent international guidelines suggest pituitary screening in patients with moderate and severe traumatic brain injury (TBI). Predominantly isolated GH deficiency (GHD) was reported in the literature, raising the question of potential methodological bias. OBJECTIVE Our objective was to assess the prevalence of GHD in patients admitted in 2008 with TBI, with concurrent assessment of methodological bias. DESIGN AND SETTING We conducted a nationwide population-based cohort study at tertiary referral university hospitals. PARTICIPANTS Participants were Danish patients with a head trauma diagnosis from the Danish Board of Health diagnostic code registry; 439 patients and 124 healthy controls underwent dynamic assessment of GH secretion 2.5 years (median) after TBI. MAIN OUTCOME We evaluated the prevalence of GHD given use of 1) local versus guideline cutoffs, 2) insulin tolerance test (ITT), pyridostigmine (PD)-GHRH or GHRH-arginine (arg) test, 3) single versus repeated testing, and 4) GH assessment by assays with different isoform specificities. RESULTS The prevalence of GHD was lower by local than by guideline cutoffs (12% vs 19% [PD-GHRH/GHRH-arg, P<.001]; 4.5% vs 5% [ITT, P=.9]), and by ITT than by PD-GHRH/GHRH-arg (P=.006 [local cutoffs]; P<.001 [guideline cutoffs]). Only 1% of patients had GHD according to 2 tests. GH assessment by the Immulite or iSYS assay caused no significant diagnostic differences. CONCLUSIONS The study confirmed a high risk of bias in the management of pituitary testing of patients with TBI and stresses the importance of a proper control group and stringent GH testing including confirmatory testing in cohorts with low a priori likelihood of GHD such as in TBI. Our results question the evidence for newly introduced recommendations for routine pituitary assessment in TBI.
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Affiliation(s)
- Marianne Klose
- Department of Medical Endocrinology (M.K., U.F.-R.), Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; Department of Internal Medicine and Endocrinology (K.S., J.J., J.F., J.S.C.), Aarhus University Hospital, DK-8000 Aarhus, Denmark; Department of Medical Endocrinology (L.L.C., M.A.), Odense University Hospital, DK-5000 Odense, Denmark; and Department of Medical Endocrinology (P.L.), Aalborg University Hospital, DK-9100 Aalborg, Denmark
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Dinsen S, Baslund B, Klose M, Rasmussen AK, Friis-Hansen L, Hilsted L, Feldt-Rasmussen U. Why glucocorticoid withdrawal may sometimes be as dangerous as the treatment itself. Eur J Intern Med 2013; 24:714-20. [PMID: 23806261 DOI: 10.1016/j.ejim.2013.05.014] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 05/20/2013] [Accepted: 05/24/2013] [Indexed: 10/26/2022]
Abstract
Glucocorticoid therapy is widely used, but withdrawal from glucocorticoids comes with a potential life-threatening risk of adrenal insufficiency. Recent case reports document that adrenal crisis after glucocorticoid withdrawal remains a serious problem in clinical practice. Partly due to difficulties in inter-study comparison the true prevalence of glucocorticoid-induced adrenal insufficiency is unknown, but it might be somewhere between 46 and 100% 24h after glucocorticoid withdrawal, 26-49% after approximately one week, and some patients show prolonged suppression lasting months to years. Adrenal insufficiency might therefore be underdiagnosed in clinical practice. Clinical data do not permit accurate estimates of a lower limit of glucocorticoid dose and duration of treatment, where adrenal insufficiency will not occur. Due to individual variation, neither the glucocorticoid dose nor the duration of treatment can be used reliably to predict adrenal function after glucocorticoid withdrawal. Also the recovery rate of the adrenal glands shows individual variation, which may be why there is currently insufficient evidence to prove the efficacy and safety of different withdrawal regimens. Whether a patient with an insufficient response to an adrenal stimulating test develops clinically significant adrenal insufficiency depends on the presence of stress and resulting glucocorticoid demand and it is thus totally unpredictable and can change relative fast. Adrenal insufficiency should therefore always be taken seriously. Individual variation in hypothalamic-pituitary-adrenal axis function might be due to differences in glucocorticoid sensitivity and might be genetic. Further awareness of the potential side effect of withdrawal of glucocorticoid and further research are urgently needed.
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Affiliation(s)
- Stina Dinsen
- Department of Medical Endocrinology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
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