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Arlien-Søborg, M. C., Dal, J., Heck, A., Stochholm, K., Husted, E., Feltoft, C. L., . . . Jørgensen, J. O. (2024). Acromegaly management in the nordic countries: a Delphi consensus survey. Clinical Endocrinology
Open this publication in new window or tab >>Acromegaly management in the nordic countries: a Delphi consensus survey
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2024 (English)In: Clinical Endocrinology, ISSN 0300-0664, E-ISSN 1365-2265Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objective: Acromegaly is associated with increased morbidity and mortality if left untreated. The therapeutic options include surgery, medical treatment, and radiotherapy. Several guidelines and recommendations on treatment algorithms and follow-up exist. However, not all recommendations are strictly evidence-based. To evaluate consensus on the treatment and follow-up of patients with acromegaly in the Nordic countries.

Methods: A Delphi process was used to map the landscape of acromegaly management in Denmark, Sweden, Norway, Finland, and Iceland. An expert panel developed 37 statements on the treatment and follow-up of patients with acromegaly. Dedicated endocrinologists (n = 47) from the Nordic countries were invited to rate their extent of agreement with the statements, using a Likert-type scale (1−7). Consensus was defined as ≥80% of panelists rating their agreement as ≥5 or ≤3 on the Likert-type scale.

Results: Consensus was reached in 41% (15/37) of the statements. Panelists agreed that pituitary surgery remains first line treatment. There was general agreement to recommend first-generation somatostatin analog (SSA) treatment after failed surgery and to consider repeat surgery. In addition, there was agreement to recommend combination therapy with first-generation SSA and pegvisomant as second- or third-line treatment. In more than 50% of the statements, consensus was not achieved. Considerable disagreement existed regarding pegvisomant monotherapy, and treatment with pasireotide and dopamine agonists.

Conclusion: This consensus exploration study on the management of patients with acromegaly in the Nordic countries revealed a relatively large degree of disagreement among experts, which mirrors the complexity of the disease and the shortage of evidence-based data.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
acromegaly, Delphi, dopamine agonist, growth hormone, growth hormone receptor antagonist, insulin-like growth factor i, somatostatin
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-226954 (URN)10.1111/cen.15095 (DOI)001244261400001 ()38865284 (PubMedID)2-s2.0-85195918201 (Scopus ID)
Funder
Pfizer AB
Available from: 2024-06-24 Created: 2024-06-24 Last updated: 2024-06-24Bibliographically approved
Bergthorsdottir, R., Esposito, D., Olsson, D. S., Ragnarsson, O., Dahlqvist, P., Bensing, S., . . . Nyberg, F. (2024). Increased risk of hospitalization, intensive care and death due to covid-19 in patients with adrenal insufficiency: a Swedish nationwide study. Journal of Internal Medicine, 295(3), 322-330
Open this publication in new window or tab >>Increased risk of hospitalization, intensive care and death due to covid-19 in patients with adrenal insufficiency: a Swedish nationwide study
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2024 (English)In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 295, no 3, p. 322-330Article in journal (Refereed) Published
Abstract [en]

Background: Patients with adrenal insufficiency (AI) have excess morbidity and mortality related to infectious disorders. Whether patients with AI have increased morbidity and mortality from COVID-19 is unknown.

Methods: In this linked Swedish national register-based cohort study, patients with primary and secondary AI diagnosis were identified and followed from 1 January 2020 to 28 February 2021. They were compared with a control cohort from the general population matched 10:1 for age and sex. The following COVID-19 outcomes were studied: incidence of COVID-19 infection, rates of hospitalization, intensive care admission and death. Hazard ratios (HR) with 95% confidence intervals (95% CI) adjusted for socioeconomic factors and comorbidities were estimated using Cox regression analysis.

Results: We identified 5430 patients with AI and 54,300 matched controls: There were 47.6% women, mean age was 57.1 (standard deviation 18.1) years, and the frequency of COVID-19 infection was similar, but the frequency of hospitalization (2.1% vs. 0.8%), intensive care (0.3% vs. 0.1%) and death (0.8% vs. 0.2%) for COVID-19 was higher in AI patients than matched controls. After adjustment for socioeconomic factors and comorbidities, the HR (95% CI) was increased for hospitalization (1.96, 1.59–2.43), intensive care admission (2.76, 1.49–5.09) and death (2.29, 1.60–3.28).

Conclusion: Patients with AI have a similar incidence of COVID-19 infection to a matched control population, but a more than twofold increased risk of developing a severe infection or a fatal outcome. They should therefore be prioritized for vaccination, antiviral therapy and other appropriate treatment to mitigate hospitalization and death.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
adrenal insufficiency, COVID-19, death, glucocorticoids, hospitalization, intensive care
National Category
General Practice Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-215852 (URN)10.1111/joim.13731 (DOI)37850585 (PubMedID)2-s2.0-85174246552 (Scopus ID)
Funder
Knut and Alice Wallenberg Foundation, KAW 2020.0299Swedish Research Council, 2021-05045Swedish Research Council, 2021-05450Swedish Research Council, 2019‐01112Swedish Association of Local Authorities and Regions, ALFGBG‐938453Swedish Association of Local Authorities and Regions, ALFGBG‐971130Swedish Association of Local Authorities and Regions, ALFGBG‐960884Swedish Association of Local Authorities and Regions, ALFGBG‐978954Swedish Association of Local Authorities and Regions, ALFGBG‐966066Swedish Research Council Formas, 2020-02828Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2023-10-30 Created: 2023-10-30 Last updated: 2024-05-06Bibliographically approved
Bäcklund, N., Lundstedt, S., Tornevi, A., Wihlbäck, A.-C., Olsson, T., Dahlqvist, P. & Brattsand, G. (2024). Salivary cortisol and cortisone can circumvent confounding effects of oral contraceptives in the short synacthen test. Journal of Clinical Endocrinology and Metabolism, 109(7), 1899-1906
Open this publication in new window or tab >>Salivary cortisol and cortisone can circumvent confounding effects of oral contraceptives in the short synacthen test
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2024 (English)In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 109, no 7, p. 1899-1906Article in journal (Refereed) Published
Abstract [en]

Context: Adrenal insufficiency (AI) is usually diagnosed by low plasma cortisol levels following a short Synacthen test (SST). Most plasma cortisol is bound to corticosteroid-binding globulin, which is increased by estrogen in combined estrogen-progestin oral contraceptives (COCs). Women with AI using COCs are therefore at risk of having an apparently normal plasma cortisol level during SST, which would not adequately reflect AI.

Objective: To test whether salivary cortisol or cortisone during SST is more robust against the COC effect and to calculate the lower reference limits (LRLs) for these to be used as tentative diagnostic cutoffs to exclude AI.

Methods: Forty-one healthy women on COCs and 46 healthy women without exogenous estrogens performed an SST with collection of plasma and salivary samples at 0, 30, and 60 min after Synacthen injection. The groups were compared using regression analysis with age as covariate and the LRLs were calculated parametrically.

Results: SST-stimulated plasma cortisol levels were significantly higher in the COC group versus controls, while mean salivary cortisol and cortisone levels were slightly lower in the COC group. Importantly, COC use did not significantly alter LRLs for salivary cortisol or cortisone. The smallest LRL difference between groups was seen for salivary cortisone.

Conclusion: Salivary cortisol and especially salivary cortisone are considerably less affected by COC use than plasma cortisol during SST. Due to similar LRLs, a common cutoff for salivary cortisol and cortisone during SST can be used to exclude AI in premenopausal women irrespective of COC use.

Place, publisher, year, edition, pages
Oxford University Press, 2024
Keywords
short Synacthen test, salivary cortisol, salivary cortisone, oral contraceptives, adrenal insufficiency, reference limits
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-222629 (URN)10.1210/clinem/dgad763 (DOI)001140071500001 ()38173358 (PubMedID)2-s2.0-85196301347 (Scopus ID)
Funder
Region VästerbottenUmeå University
Available from: 2024-03-22 Created: 2024-03-22 Last updated: 2024-07-02Bibliographically approved
Sævik, Å. B., Ueland, G., Åkerman, A.-K., Methlie, P., Quinkler, M., Jørgensen, A. P., . . . Øksnes, M. (2023). Altered biomarkers for cardiovascular disease and inflammation in autoimmune Addison's disease: a cross-sectional study. European Journal of Endocrinology, 189(4), 438-447
Open this publication in new window or tab >>Altered biomarkers for cardiovascular disease and inflammation in autoimmune Addison's disease: a cross-sectional study
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2023 (English)In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 189, no 4, p. 438-447Article in journal (Refereed) Published
Abstract [en]

Objective: Increased prevalence of cardiovascular disease has been reported in autoimmune Addison's disease (AAD), but pathomechanisms are poorly understood.

Design: Cross-sectional study.Methods: We compared serum levels of 177 cardiovascular and inflammatory biomarkers in 43 patients with AAD at >18-h glucocorticoid withdrawal and 43 matched controls, overall and stratified for sex. Biomarker levels were correlated with the frequency of adrenal crises and quality of life (QoL) by AddiQoL-30. Finally, we investigated changes in biomarker levels following 250 µg tetracosactide injection in patients without residual adrenocortical function (RAF) to explore glucocorticoid-independent effects of high ACTH.

Results: Nineteen biomarkers significantly differed between patients with AAD and controls; all but 1 (ST1A1) were higher in AAD. Eight biomarkers were significantly higher in female patients compared with controls (IL6, MCP1, GAL9, SPON2, DR4, RAGE, TNFRSF9, and PGF), but none differed between male patients and controls. Levels of RAGE correlated with the frequency of adrenal crises (r = 0.415, P = .006) and AddiQoL-30 scores (r = -0.347, P = .028) but not after correction for multiple testing. PDL2 and leptin significantly declined 60 min after injection of ACTH in AAD without RAF (-0.15 normalized protein expression [NPX], P = .0001, and -0.25 NPX, P = .0003, respectively).

Conclusions: We show that cardiovascular and inflammatory biomarkers are altered in AAD compared with controls, particularly in women. RAGE might be a marker of disease severity in AAD, associated with more adrenal crises and reduced QoL. High ACTH reduced PDL2 and leptin levels in a glucocorticoid-independent manner but the overall effect on biomarker profiles was small.

Place, publisher, year, edition, pages
Oxford University Press, 2023
Keywords
autoimmunity, primary adrenal insufficiency, cardiovascular disease, proteomics, biomarkers
National Category
Endocrinology and Diabetes Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-217965 (URN)10.1093/ejendo/lvad136 (DOI)001086414300001 ()37807083 (PubMedID)2-s2.0-85180101346 (Scopus ID)
Funder
The Research Council of Norway, 288022Novo Nordisk Foundation, NNF18OC0034130Stockholm County CouncilKarolinska Institute
Available from: 2023-12-14 Created: 2023-12-14 Last updated: 2023-12-28Bibliographically approved
Imamovic, M., Bäcklund, N., Lundstedt, S., Brattsand, G., Aardal, E., Olsson, T. & Dahlqvist, P. (2023). Confounding effects of liquorice, hydrocortisone, and blood contamination on salivary cortisol but not cortisone. Endocrine Connections, 12(1), Article ID e220324.
Open this publication in new window or tab >>Confounding effects of liquorice, hydrocortisone, and blood contamination on salivary cortisol but not cortisone
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2023 (English)In: Endocrine Connections, E-ISSN 2049-3614, Vol. 12, no 1, article id e220324Article in journal (Refereed) Published
Abstract [en]

Objective: To determine the effects of liquorice consumption, topical hydrocortisone, and blood contamination on salivary cortisol and cortisone concentrations.

Design and methods: Thirty healthy volunteers were randomized to a low, medium, or high dose of liquorice. Late-night saliva samples were collected using a Salivette® collection device at baseline, during 1 week of daily liquorice consumption, and during 4 weeks' washout. Saliva sampling was also performed before and after the application of topical hydrocortisone on the skin. Furthermore, in a subgroup (n  = 16), saliva and venous blood were collected from each individual and mixed to achieve graded blood contamination in saliva. Salivary cortisol and cortisone were analyzed with liquid chromatography-tandem mass spectrometry.

Results: Significant increases in salivary cortisol concentrations were observed during medium- (+49%) and high-dose (+97%) liquorice intake, which returned to baseline 4 days after liquorice withdrawal. Topical hydrocortisone on fingers holding the collection swab increased salivary cortisol concentrations >1000-fold with concomitant pronounced elevation of the cortisol:cortisone ratio. Salivary cortisol increased significantly after contamination with blood ≥0.5%. Visual examination could safely detect these samples. Salivary cortisone concentrations were unaffected by liquorice consumption and blood contamination, and only marginally affected by topical hydrocortisone.

Conclusion: Liquorice, topical hydrocortisone, and blood contamination may all cause elevated salivary cortisol concentrations. Improved sampling instructions and visual examination of the sample may minimize these risks. Salivary cortisone is essentially unaffected by the different preanalytical confounders and may be used as a first-line screening test for Cushing's syndrome.

Place, publisher, year, edition, pages
Bioscientifica, 2023
Keywords
Cushing’s syndrome, salivary cortisol, salivary cortisone, liquorice, sample contamination
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-208130 (URN)10.1530/ec-22-0324 (DOI)000971893300001 ()36383173 (PubMedID)2-s2.0-85151875249 (Scopus ID)
Funder
Region Västerbotten
Available from: 2023-05-10 Created: 2023-05-10 Last updated: 2024-03-26Bibliographically approved
Robèrt, J., Tsatsaris, E., Berinder, K., Bonelli, L., Burman, P., Dahlqvist, P., . . . Edén Engström, B. (2023). Establishing a valid cohort of patients with acromegaly by combining the national patient register with the Swedish pituitary register. Journal of Endocrinological Investigation
Open this publication in new window or tab >>Establishing a valid cohort of patients with acromegaly by combining the national patient register with the Swedish pituitary register
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2023 (English)In: Journal of Endocrinological Investigation, ISSN 0391-4097, E-ISSN 1720-8386Article in journal (Refereed) Epub ahead of print
Abstract [en]

Purpose: The aim of this study was to establish a valid national cohort of patients diagnosed with acromegaly by combining data from the general National Patient Register (NPR) and the disease-specific Swedish Pituitary Register (SPR).

Methods: Patients ≥ 18 years of age at diagnosis of acromegaly reported from 1991 to 2018 who were registered in the NPR and/or SPR were included. The diagnosis of acromegaly was considered correct for patients identified in both registers or confirmed through chart review. Medical records were reviewed in two of Sweden´s six health care regions if the patient was reported only in the NPR. An algorithm for the NPR, with criteria requiring multiple diagnosis registrations and tumour and/or surgery codes, was constructed to reduce the number of patients to review in the remaining four regions.

Results: A total of 1866 patients were identified. Among these, 938 were reported in both registers. After application of the algorithm and chart review, the diagnosis was confirmed for 83 of the 906 patients found only in the NPR. Among 22 patients only registered in the SPR, a review of medical records confirmed acromegaly in 13. This resulted in a total of 1034 cases with acromegaly during the study period. The incidence rate of acromegaly in Sweden 1991–2018 was calculated to 4.0/million/year in the entire population and 5.1/million/year among subjects ≥ 18 years of age.

Conclusion: The combination of the SPR and NPR established a valid cohort of patients diagnosed with acromegaly and increased the estimated incidence in Sweden.

Place, publisher, year, edition, pages
Springer, 2023
Keywords
Acromegaly, ICD codes, Incidence, Patient register
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-215868 (URN)10.1007/s40618-023-02217-x (DOI)37851314 (PubMedID)2-s2.0-85174407981 (Scopus ID)
Funder
Region UppsalaRegion ÖstergötlandPfizer AB
Available from: 2023-11-01 Created: 2023-11-01 Last updated: 2023-11-01
Simander, G., Dahlqvist, P., Oja, L., Eriksson, P. O., Lindvall, P. & Koskinen, L.-O. D. (2023). Intrasellar pressure is related to endocrine disturbances in patients with pituitary tumors. World Neurosurgery, 175, e344-e351
Open this publication in new window or tab >>Intrasellar pressure is related to endocrine disturbances in patients with pituitary tumors
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2023 (English)In: World Neurosurgery, ISSN 1878-8750, E-ISSN 1878-8769, Vol. 175, p. e344-e351Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to investigate the association between intraoperative intrasellar pressure (ISP) and pre- and postoperative endocrine disturbances with focus on hyperprolactinemia and hypopituitarism in patients with pituitary tumors.

Methods: The study is a consecutive, retrospective study with ISP collected prospectively. One hundred patients operated with transsphenoidal surgery due to a pituitary tumor, who had their ISP measured intraoperatively, were included. Data on patient endocrine status preoperatively and from 3-month postoperative follow-up were collected from medical records.

Results: The risk of preoperative hyperprolactinemia in patients with nonprolactinoma pituitary tumors increased with ISP (unit odds ratio 1.067, n = 70) (P = 0.041). Preoperative hyperprolactinemia was normalized at 3 months after surgery. Mean ISP was higher in patients with preoperative thyroid-stimulating hormone (TSH) deficiency (25.3 ± 9.2 mmHg, n = 37) than in patients with intact thyroid axis (21.6 ± 7.2 mmHg, n = 50) (P = 0.041). No significant difference in ISP was found between patients with and without adrenocorticotropic hormone(ACTH) deficiency. No association was found between ISP and postoperative hypopituitarism at 3 months after surgery.

Conclusions: In patients with pituitary tumors, preoperative hypothyroidism and hyperprolactinemia may be associated with higher ISP. This is in line with the theory of pituitary stalk compression, suggested to be mediated by an elevated ISP. ISP does not predict the risk of postoperative hypopituitarism 3 months after surgical treatment.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Hyperprolactinemia, Hypopituitarism, Intrasellar pressure, Pituitary adenoma
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-206954 (URN)10.1016/j.wneu.2023.03.085 (DOI)36966914 (PubMedID)2-s2.0-85152366491 (Scopus ID)
Funder
Umeå UniversityRegion Västerbotten
Available from: 2023-04-26 Created: 2023-04-26 Last updated: 2023-07-13Bibliographically approved
Himonakos, C., Burman, P., Borg, H., Dahlqvist, P., Engström, B. E., Ekman, B., . . . Berinder, K. (2023). Long-term follow-up of 84 patients with giant prolactinomas: a swedish nationwide study. Journal of Clinical Endocrinology and Metabolism, 108(12), e1506-e1514
Open this publication in new window or tab >>Long-term follow-up of 84 patients with giant prolactinomas: a swedish nationwide study
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2023 (English)In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 108, no 12, p. e1506-e1514Article in journal (Refereed) Published
Abstract [en]

Purpose: To describe the clinical presentation and treatment outcomes in a nationwide cohort of patients with giant prolactinomas.

Methods: Register-based study of patients with giant prolactinomas [serum prolactin (PRL) > 1000 & mu;g/L, tumor diameter & GE;40 mm] identified in the Swedish Pituitary Register 1991-2018.

Results: Eighty-four patients [mean age 47 (SD & PLUSMN;16) years, 89% men] were included in the study. At diagnosis, the median PRL was 6305 & mu;g/L (range 1450-253 000), the median tumor diameter was 47 mm (range 40-85), 84% of the patients had hypogonadotropic hypogonadism, and 71% visual field defects. All patients were treated with a dopamine agonist (DA) at some point. Twenty-three (27%) received 1 or more additional therapies, including surgery (n = 19), radiotherapy (n = 6), other medical treatments (n = 4), and chemotherapy (n = 2). Ki-67 was & GE;10% in 4/14 tumors. At the last follow-up [median 9 years (interquartile range (IQR) 4-15)], the median PRL was 12 & mu;g/L (IQR 4-126), and the median tumor diameter was 22 mm (IQR 3-40). Normalized PRL was achieved in 55%, significant tumor reduction in 69%, and combined response (normalized PRL and significant tumor reduction) in 43%. In the primary DA-treated patients (n = 79), the reduction in PRL or tumor size after the first year predicted the combined response at the last follow-up (P < .001 and P = .012, respectively).

Conclusion: DAs effectively reduced PRL and tumor size, but approximately 1 patient out of 4 needed multimodal treatment. Our results suggest that the response to DA after 1 year is useful for identifying patients who need more careful monitoring and, in some cases, additional treatment.

Place, publisher, year, edition, pages
Endocrine Society, 2023
Keywords
giant prolactinomas, dopamine agonists, dopamine agonist resistance, long-term follow-up, Ki-67
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-217966 (URN)10.1210/clinem/dgad393 (DOI)001024276000001 ()37403202 (PubMedID)2-s2.0-85178498966 (Scopus ID)
Funder
Region VärmlandKarolinska Institute
Available from: 2023-12-14 Created: 2023-12-14 Last updated: 2023-12-15Bibliographically approved
Ragnarsson, O., Dahlqvist, P., Muth, A., Calissendorff, J. & Olsson, T. (2023). Mineralocorticoid receptor antagonists for primary aldosteronism - appropriate or not? [Letter to the editor]. European Journal of Endocrinology, 188(3), L1-L2
Open this publication in new window or tab >>Mineralocorticoid receptor antagonists for primary aldosteronism - appropriate or not?
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2023 (English)In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 188, no 3, p. L1-L2Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
Oxford University Press, 2023
Keywords
adrenal vein sampling, adrenalectomy, mineralocorticoid receptor antagonist, primary aldosteronism
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-206025 (URN)10.1093/ejendo/lvad020 (DOI)000953971500002 ()36757798 (PubMedID)2-s2.0-85150396850 (Scopus ID)
Available from: 2023-03-28 Created: 2023-03-28 Last updated: 2023-09-05Bibliographically approved
Al-Shamkhi, N., Berinder, K., Borg, H., Burman, P., Dahlqvist, P., Höybye, C., . . . Engström, B. E. (2023). Pituitary function before and after surgery for nonfunctioning pituitary adenomas-data from the Swedish pituitary register. European Journal of Endocrinology, 189(2), 217-224
Open this publication in new window or tab >>Pituitary function before and after surgery for nonfunctioning pituitary adenomas-data from the Swedish pituitary register
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2023 (English)In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 189, no 2, p. 217-224Article in journal (Refereed) Published
Abstract [en]

Objective: Data on pre- and postoperative pituitary function in nonfunctioning pituitary adenomas (NFPA) are not consistent. We aimed to investigate pituitary function before and up to 5 years after transsphenoidal surgery with emphasis on the hypothalamic-pituitary-adrenal axis (HPA).

Design and methods: Data from the Swedish Pituitary Register was used to analyze anterior pituitary function in 838 patients with NFPA diagnosed between 1991 and 2014. Patients who were reoperated or had received radiotherapy were excluded.

Results: Preoperative ACTH, TSH, LH/FSH, and GH deficiencies were reported in 31% (236/755), 39% (300/769), 51% (378/742), and 28% (170/604) of the patients, respectively. Preoperative median tumor volume was 5.0 (2.4-9.0) cm(3). Among patients with preoperative, 1 year and 5 years postoperative data on the HPA axis (n = 428), 125 (29%) were ACTH-deficient preoperatively. One year postoperatively, 26% (32/125) of them had recovered ACTH function while 23% (70/303) patients had developed new ACTH deficiency. Thus, 1 year postoperatively, 163 (38%) patients were ACTH-deficient (P < .001 vs. preoperatively). No further increase was seen 5 years postoperatively (36%, P = .096). At 1 year postoperatively, recoveries in the TSH and LH/FSH axes were reported in 14% (33/241) and 15% (46/310), respectively, and new deficiencies in 22% (88/403) and 29% (83/288), respectively.

Conclusions: Adrenocorticotrophic hormone deficiency increased significantly at 1 year postoperatively. Even though not significant, some patients recovered from or developed new deficiency between 1 and 5 years postoperatively. This pattern was seen in all axes. Our study emphasizes that continuous individual evaluations are needed during longer follow-up of patients operated for NFPA.

Place, publisher, year, edition, pages
Oxford University Press, 2023
Keywords
pituitary adenoma, transsphenoidal surgery, pituitary insufficiency, HPA axis, pituitary register
National Category
Endocrinology and Diabetes Surgery
Identifiers
urn:nbn:se:umu:diva-217873 (URN)10.1093/ejendo/lvad104 (DOI)001046486000001 ()37551511 (PubMedID)2-s2.0-85180571840 (Scopus ID)
Funder
Region Örebro County
Available from: 2023-12-13 Created: 2023-12-13 Last updated: 2024-01-04Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-6471-9503

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