| 11. |
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| 12. |
- Ragnarsson, Oskar, 1971, et al.
(författare)
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Effect of short-term growth hormone and testosterone administration on body composition and glucose homeostasis in men receiving chronic glucocorticoid therapy.
- 2013
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Ingår i: European journal of endocrinology / European Federation of Endocrine Societies. - 1479-683X. ; 168:2, s. 243-51
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Long-term pharmacological glucocorticoid (GC) therapy leads to skeletal muscle atrophy and weakness. The objective of this study was to investigate whether short-term treatment with growth hormone (GH) and testosterone (T) can increase lean mass without major impairment of glucose homeostasis in patients on GC therapy. DESIGN, MATERIALS AND METHODS: This was a prospective, open-label, randomized, crossover study. Twelve men (age 74±6 years) on chronic GC treatment participated. The effects of two weeks treatment with GH, testosterone and the combination of both, on lean body mass (LBM), appendicular skeletal muscle mass (ASMM), extracellular water (ECW), body cell mass (BCM) and plasma glucose concentrations were investigated. RESULTS: LBM increased significantly after GH (Δ1.7±1.4 kg; P=0.007) and GH+T (Δ2.4±1.1 kg; P=0.003), but not T alone. ASMM increased after all three treatment periods; by 1.0±0.8 kg after GH (P=0.005), 1.7±0.4 kg after GH+T (P=0.002) and 0.8±1.0 kg after T (P=0.018). The increase in ASMM was larger with combined treatment than either GH or T alone (P<0.05). ECW increased significantly after GH+T by 1.5±2.6 L (P=0.038) but not after GH or T alone. BCM increased slightly after single and combined treatments but the changes were not significant. Fasting glucose increased significantly after GH (Δ0.4±0.4 mmol/L, P=0.006) while both fasting (Δ0.2±0.3 mmol/L, P=0.045) and post glucose-load (Δ1.8±2.3 mmol/L, P=0.023) plasma glucose concentrations increased after GH+T. CONCLUSIONS: GH and T induce favourable and additive body compositional changes in men on chronic, low-dose GC treatment. In the doses used, combination therapy increases fasting and postprandial glucose concentration.
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| 13. |
- Ragnarsson, Oskar, 1971, et al.
(författare)
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Glucocorticoid replacement therapy is independently associated with reduced bone mineral density in women with hypopituitarism.
- 2012
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Ingår i: Clinical endocrinology. - : Wiley. - 1365-2265 .- 0300-0664. ; 76:2, s. 246-252
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Patients with hypopituitarism have adverse cardiovascular morbidity and reduced bone mineral density (BMD). The objective of this study was to analyze the effects of glucocorticoid (GC) replacement on cardiovascular risk factors and BMD in patients with hypopituitarism. Design, patients and methods: This was a cross-sectional study on 365 patients with hypopituitarism. Two-hundred and four patients (56%) were ACTH insufficient (ACTHins), receiving a mean ± SD hydrocortisone equivalent (HCeq) dose of 20.5 ± 5.8 mg/day. The difference in BMD and cardiovascular risk profile between ACTH sufficient (ACTHsuff) and ACTHins patients, before commencement of GH replacement, was analyzed by multiple linear and logistic regression. Results: ACTHins was independently associated with lower fasting glucose but not other cardiovascular risk factors. The mean HCeq dose per kg body weight was 15% higher in ACTHins women than in ACTHins men (P = 0.009). In women, ACTHins was independently associated with decreased BMD at the lumbar spine (P = 0.002) and femoral neck (P = 0.006) and the presence of osteopenia (P = 0.004). BMD was not different between ACTHins and ACTHsuff men. Conclusion: The current average HCeq dose of approximately 20 mg per day is not associated with an adverse metabolic profile, as compared with ACTHsuff hypopituitary patients. GC replacement in ACTHins women is independently associated with reduced BMD and higher prevalence of osteopenia.
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| 14. |
- Ragnarsson, Oskar, 1971
(författare)
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Glucocorticoids - outcome in patients with glucocorticoid deficiency and Cushing's syndrome
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Glucocorticoids (GCs) are steroid hormones that have a major impact on human metabolism and are essential for life. Chronic GC overexposure, called Cushing’s syndrome, is characterized by central obesity, muscle atrophy, osteoporosis, hypertension, impaired glucose tolerance and neurocognitive impairment. Cushing’s syndrome can be caused by increased endogenous GC production or arise due to pharmacological GC treatment. This thesis is based on four studies, including four different patient populations, aimed at investigating outcomes in patients with Cushing’s syndrome and patients receiving current standard GC replacement therapy for adrenal insufficiency. In a large study of patients with hypopituitarism it was demonstrated that GC replacement therapy was independently associated with reduced bone mineral density in women with adrenal insufficiency receiving an average daily hydrocortisone dose of approximately 20 mg. In another study of adult patients, treated for Cushing’s disease during childhood, final adult height was compromised in the majority of the patients and the prevalence of hypertension was high. In a study of patients in long-term remission after successful treatment for Cushing’s syndrome, numerous domains of cognitive function were impaired at long-term follow-up in comparison to healthy individuals. Finally it was demonstrated that short-term treatment with growth hormone and testosterone increases skeletal muscle mass in men on chronic low dose GC treatment. In conclusion, this thesis demonstrates that long-term GC exposure has various long-term adverse health related consequences for patients receiving GC replacement therapy and in patients in long-term remission from Cushing’s syndrome. Furthermore, anabolic treatment with growth hormone and testosterone has the potential to improve GC induced muscle wasting.
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| 15. |
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| 16. |
- Ragnarsson, Oskar, 1971, et al.
(författare)
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Neurodegenerative and inflammatory biomarkers in cerebrospinal fluid in patients with Cushing's syndrome in remission.
- 2013
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Ingår i: European journal of endocrinology / European Federation of Endocrine Societies. - 1479-683X. ; 169:2, s. 211-5
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Tidskriftsartikel (refereegranskat)abstract
- Patients with Cushing's syndrome (CS) in long-term remission have impaired cognitive function. Cerebrospinal fluid (CSF) biomarkers are important diagnostic tools in the work-up of patients with cognitive impairment. The aim of this study was to analyze neurodegenerative and inflammatory biomarkers in the CSF of patients with CS in remission.
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| 17. |
- Ragnarsson, Oskar, 1971, et al.
(författare)
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The relationship between glucocorticoid replacement and quality of life in 2737 hypopituitary patients.
- 2014
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Ingår i: European journal of endocrinology / European Federation of Endocrine Societies. - 1479-683X .- 0804-4643. ; 171:5, s. 571-9
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Tidskriftsartikel (refereegranskat)abstract
- Quality of life (QoL) is impaired in hypopituitary patients and patients with primary adrenal insufficiency. The aim of this study was to analyse the impact of glucocorticoid (GC) replacement on QoL. The main hypothesis was that ACTH-insufficient patients experience a dose-dependent deterioration in QoL.
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| 18. |
- Tjörnstrand, Axel, et al.
(författare)
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The incidence rate of pituitary adenomas in western Sweden for the period 2001-2011
- 2014
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Ingår i: European Journal of Endocrinology. - 0804-4643 .- 1479-683X. ; 171:4, s. 519-526
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Tidskriftsartikel (refereegranskat)abstract
- © 2014 European Society of Endocrinology. Objective: The number of studies on the incidence of pituitary adenomas (PAs) is limited. The aim of this study was to evaluate the standardised incidence rate (SIR) of PAs in western Sweden.Design, subjects and methods: Data from adult patients diagnosed with PAs in 2001-2011, living in the Vä stra Götaland County, were collected from the Swedish Pituitary Registry (SPR). In addition, medical records on all patients diagnosed with PAs at the six hospitals in the region were reviewed. In total, 592 patients were included in the study.Age-SIR, given as rate/100 000 inhabitants (95% CI), was calculated using the WHO 2000 standard population as a reference.Results: The total SIRfor PAswas 3.9/100 000 (3.6-4.3); 3.3/100 000 (2.9-3.7) formen and 4.7/100 000 (4.1-5.3) forwomen. Inmen, SIR increasedwith age, while inwomen SIR peaked at 25-34 years, mainly due to prolactinomas. Non-functioning PA (NFPA)was the most common PA (54%, 1.8/100 000 (1.6-2.0)) followed by prolactinomas (32%, 1.6/100 000 (1.3-1.9)), acromegaly (9%, 0.35/100 000 (0.25-0.45)), Cushing'sdisease (4%, 0.18/100 000 (0.11-0.25)) andTSH-producingPA(0.7%, 0.03/100 000 (0.00-0.05)). The proportion of macroadenomas for NFPA was 82%, prolactinomas 37%, GH-producing PA 77%, ACTH-producing PA 28% and TSH-producing PA 100%. The lifetime risk for PAs was 0.27% (0.24-0.31) in men and 0.29% (0.26-0.33) in women.Conclusion: This study provides a reliable estimate on the overall incidence of PAs and confirms an increased incidence of PAs compared with studies conducted in the pre-magnetic resonance imaging era. The lower proportion of prolactinomas compared with previous studies is probably explained by the different criteria used.
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