30 results on '"Henrik Falhammar"'
Search Results
2. Corticosteroid-binding globulin (CBG): spatiotemporal distribution of cortisol in sepsis
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Jessica H. Lee, Emily J. Meyer, Marne A. Nenke, Henrik Falhammar, and David J. Torpy
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Endocrinology ,Endocrinology, Diabetes and Metabolism - Published
- 2023
3. Incidence, patterns, risk factors and clinical outcomes of intravenous acyclovir induced nephrotoxicity
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Abdullah M, Al-Alawi, Juhaina Salim, Al-Maqbali, Maria, Al-Adawi, Anan, Al-Jabri, and Henrik, Falhammar
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Pharmacology ,Pharmaceutical Science - Abstract
Acyclovir is approved to treat herpes simplex virus (HSV) type 1, type 2 and varicella-zoster virus. It is mainly eliminated via the kidneys, for which drug crystals accumulation might lead to nephrotoxicity. This study aimed to determine the incidence, risk factors, preventive measures, and clinical outcomes of acyclovir induced-nephrotoxicity.This is a retrospective cohort study of patients12 years of age at Sultan Qaboos University Hospital (SQUH) receiving IV acyclovir therapy between January 2016 and December 2020.Out of 191 included patients, 40 (20.1%) developed acyclovir induced-nephrotoxicity. Age (per year older: OR 1.04, 95 %CI 1.01-1.07), total duration of treatment (per day OR1.19, 95 %CI 1.06-1.33), and concomitant use of vancomycin (OR 5.96, 95 %CI 1.87-19.01) were significant independent risk factors for acyclovir induced-nephrotoxicity development. Nine patients (4.5%) died during the same hospitalization, including those three patients who required renal replacement therapy (1.5%).Frequent monitoring of kidney function for older patients with concurrent use of vancomycin and IV hydration is essential to prevent IV acyclovir induced-nephrotoxicity. Antimicrobial stewardship is a crucial method to reduce the duration of treatment with IV acyclovir as appropriate.
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- 2022
4. Adrenal myelolipomas
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Jan, Calissendorff, Carl Christofer, Juhlin, Anders, Sundin, Irina, Bancos, and Henrik, Falhammar
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Male ,Adrenal Hyperplasia, Congenital ,Endocrinology, Diabetes and Metabolism ,Adrenal Gland Neoplasms ,Middle Aged ,Prognosis ,Article ,Endocrinology ,Adrenocorticotropic Hormone ,Myelolipoma ,Proto-Oncogene Proteins ,Mutation ,Internal Medicine ,Humans ,Female ,Tomography, X-Ray Computed ,Aged - Abstract
Adrenal myelolipomas are benign, lipomatous tumours with elements of myeloid cells, most of which present as adrenal incidentalomas and comprise 3·3-6·5% of all adrenal masses. Adrenal myelolipomas are usually unilateral (in 95% of cases), variable in size, most often found during midlife, and affect both sexes almost equally. On imaging, adrenal myelolipomas show pathognomonic imaging features consistent with the presence of macroscopic fat. Large adrenal myelolipomas can cause symptoms of mass effect, and can occasionally be complicated by haemorrhage. In the event of a concomitant adrenal cortical adenoma or hyperplasia, adrenal hormone excess might be detected in patients with adrenal myelolipoma. Patients with congenital adrenal hyperplasia exhibit a higher prevalence of adrenal myelolipomas than other patient groups, and are at risk of developing large and bilateral lesions. This Review discusses the pathogenesis, clinical presentation, and management of adrenal myelolipomas.
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- 2021
5. Congenital adrenal hyperplasia in the Nordic countries – a potential base for long-term outcome studies
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Anna Nordenström and Henrik Falhammar
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Oncology ,Health Policy ,Internal Medicine - Published
- 2023
6. Age-dependent and sex-dependent disparity in mortality in patients with adrenal incidentalomas and autonomous cortisol secretion : an international, retrospective, cohort study
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Timo Deutschbein, Giuseppe Reimondo, Guido Di Dalmazi, Irina Bancos, Jekaterina Patrova, Dimitra Argyro Vassiliadi, Anja Barač Nekić, Miguel Debono, Pina Lardo, Filippo Ceccato, Luigi Petramala, Alessandro Prete, Iacopo Chiodini, Miomira Ivović, Kalliopi Pazaitou-Panayiotou, Krystallenia I Alexandraki, Felicia Alexandra Hanzu, Paola Loli, Serkan Yener, Katharina Langton, Ariadni Spyroglou, Tomaz Kocjan, Sabina Zacharieva, Nuria Valdés, Urszula Ambroziak, Mari Suzuki, Mario Detomas, Soraya Puglisi, Lorenzo Tucci, Danae Anastasia Delivanis, Dimitris Margaritopoulos, Tina Dusek, Roberta Maggio, Carla Scaroni, Antonio Concistrè, Cristina Lucia Ronchi, Barbara Altieri, Cristina Mosconi, Aristidis Diamantopoulos, Nicole Marie Iñiguez-Ariza, Valentina Vicennati, Anna Pia, Matthias Kroiss, Gregory Kaltsas, Alexandra Chrisoulidou, Ljiljana V Marina, Valentina Morelli, Wiebke Arlt, Claudio Letizia, Marco Boscaro, Antonio Stigliano, Darko Kastelan, Stylianos Tsagarakis, Shobana Athimulam, Uberto Pagotto, Uwe Maeder, Henrik Falhammar, John Newell-Price, Massimo Terzolo, and Martin Fassnacht
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Sex Characteristics ,hypertension ,Endocrinology, Diabetes and Metabolism ,Sexual Behavior ,dexamethasone ,Article ,retrospective studies ,Endocrinology ,female ,cohort studies ,male ,middle aged ,adrenal gland neoplasms ,Internal Medicine ,adenoma ,hydrocortisone ,humans - Abstract
Background\ud \ud The association between cortisol secretion and mortality in patients with adrenal incidentalomas is controversial. We aimed to assess all-cause mortality, prevalence of comorbidities, and occurrence of cardiovascular events in uniformly stratified patients with adrenal incidentalomas and cortisol autonomy (defined as non-suppressible serum cortisol on dexamethasone suppression testing).\ud \ud \ud \ud Methods\ud \ud We conducted an international, retrospective, cohort study (NAPACA Outcome) at 30 centres in 16 countries. Eligible patients were aged 18 years or older with an adrenal incidentaloma (diameter ≥1 cm) detected between Jan 1, 1996, and Dec 31, 2015, and availability of a 1 mg dexamethasone suppression test result from the time of the initial diagnosis. Patients with clinically apparent hormone excess, active malignancy, or follow-up of less than 36 months were excluded. Patients were stratified according to the 0800–0900 h serum cortisol values after an overnight 1 mg dexamethasone suppression test; less than 50 nmol/L was classed as non-functioning adenoma, 50–138 nmol/L as possible autonomous cortisol secretion, and greater than 138 nmol/L as autonomous cortisol secretion. The primary endpoint was all-cause mortality. Secondary endpoints were the prevalence of cardiometabolic comorbidities, cardiovascular events, and cause-specific mortality. The primary and secondary endpoints were assessed in all study participants.\ud \ud \ud \ud Findings\ud \ud Of 4374 potentially eligible patients, 3656 (2089 [57·1%] with non-functioning adenoma, 1320 [36·1%] with possible autonomous cortisol secretion, and 247 [6·8%] with autonomous cortisol secretion) were included in the study cohort for mortality analysis (2350 [64·3%] women and 1306 [35·7%] men; median age 61 years [IQR 53–68]; median follow-up 7·0 years [IQR 4·7–10·2]). During follow-up, 352 (9·6%) patients died. All-cause mortality (adjusted for age, sex, comorbidities, and previous cardiovascular events) was significantly increased in patients with possible autonomous cortisol secretion (HR 1·52, 95% CI 1·19–1·94) and autonomous cortisol secretion (1·77, 1·20–2·62) compared with patients with non-functioning adenoma. In women younger than 65 years, autonomous cortisol secretion was associated with higher all-cause mortality than non-functioning adenoma (HR 4·39, 95% CI 1·93–9·96), although this was not observed in men. Cardiometabolic comorbidities were significantly less frequent with non-functioning adenoma than with possible autonomous cortisol secretion and autonomous cortisol secretion (hypertension occurred in 1186 [58·6%] of 2024 patients with non-functioning adenoma, 944 [74·0%] of 1275 with possible autonomous cortisol secretion, and 179 [75·2%] of 238 with autonomous cortisol secretion; dyslipidaemia occurred in 724 [36·2%] of 1999 patients, 547 [43·8%] of 1250, and 123 [51·9%] of 237; and any diabetes occurred in 365 [18·2%] of 2002, 288 [23·0%] of 1250, and 62 [26·7%] of 232; all p values
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- 2022
7. Adrenal crises in older patients
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Ruth L Rushworth, Henrik Falhammar, and David J. Torpy
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Pediatrics ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Population ,030209 endocrinology & metabolism ,Global Health ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Age groups ,Older patients ,Risk Factors ,Adrenal Glands ,Internal Medicine ,medicine ,Global health ,Adrenal insufficiency ,Humans ,In patient ,030212 general & internal medicine ,education ,Aged ,education.field_of_study ,business.industry ,Incidence ,Incidence (epidemiology) ,Adrenal crisis ,medicine.disease ,Hospitalization ,medicine.symptom ,business ,Adrenal Insufficiency - Abstract
Adrenal crises are severe manifestations of adrenal insufficiency that result in hospital admission and incur a risk of cardiovascular events, acute renal injury, and death. Evidence from population-based studies indicate that adults older than 60 years have the highest adrenal insufficiency incidence, contribute to the highest number of adrenal crises, and have the highest age-specific incidence of adrenal crisis, which doubles between the age groups of 60-69 years and 80 years or older. Older patients might be more susceptible to adrenal crises because of a higher prevalence of comorbidities and a consequently higher risk of acute illness. This susceptibility might be compounded by shortfalls in the implementation of prevention strategies for adrenal crisis, because of individual and social factors that increase with age. Although little research has focused on adrenal crisis prevention in older patients, it seems logical that a timely diagnosis of adrenal insufficiency and the use of consensus driven adrenal crisis prevention and attenuation strategies might reduce adrenal crises in patients older than 60 years old.
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- 2020
8. Trends in Hospital Admissions for Adrenal Insufficiency in Adolescents and Young Adults in the 21st Century
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Georgina L. Chrisp, Maria Quartararo, David J. Torpy, Henrik Falhammar, and R. Louise Rushworth
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History ,Polymers and Plastics ,Endocrinology, Diabetes and Metabolism ,Business and International Management ,Industrial and Manufacturing Engineering - Abstract
BackgroundVery little is known about the epidemiology of adrenal crises (AC) and adrenal insufficiency (AI) in adolescents and young adults.MethodsData on all admissions to Australian hospitals between 2000/1 to 2019/20 for a principal diagnosis of AI (including AC) in 10-24 year olds were extracted from a national repository. Age and sex-specific rates and age-adjusted rates were compared.FindingsOver the study, there were 3386 admissions for a principal diagnosis of AI; 24.0% (n=812) were for an AC and 50·7% (n=1718) were for secondary AI. Age-adjusted AI admissions increased from 31·70/million in 2000/1 to 54·68/million in 2019/20 (pInterpretationAC/AI admissions increased over the first two decades of this century in the emerging adult population, particularly among females who also experienced a marked increase in AC admission rates, most evident in the second decade. Although uncertain, possible explanations include: dose of glucocorticoid replacement; non-adherence to therapy; psychosocial factors; and difficulty in transition to adult services. Admissions for SAI also increased, while rates of PAI and CAH remained constant.
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- 2022
9. Antipsychotics and severe hyponatremia: A Swedish population–based case–control study
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Henrik Falhammar, Jakob Skov, Jan Calissendorff, Jonatan D. Lindh, Buster Mannheimer, and David Nathanson
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Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Logistic regression ,Inappropriate ADH Syndrome ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Swedish population ,Internal Medicine ,medicine ,Humans ,Registries ,030212 general & internal medicine ,Antipsychotic ,Aged ,Aged, 80 and over ,Sweden ,Risperidone ,business.industry ,Case-control study ,nutritional and metabolic diseases ,Middle Aged ,medicine.disease ,Hospitalization ,Logistic Models ,Case-Control Studies ,Concomitant ,Multivariate Analysis ,Female ,Aripiprazole ,Hyponatremia ,business ,Antipsychotic Agents ,medicine.drug - Abstract
Background Antipsychotics have been claimed to cause hyponatremia. The risk associated with individual antipsychotics, or groups (first-generation [FGAs] or second-generation [SGAs] antipsychotics), is not well-documented. The objective of this study was to investigate the association between antipsychotics and hospitalization due to hyponatremia. Methods The general Swedish population was the base of this register–based case–control study. Comparisons were made between patients hospitalized with a principal diagnosis of hyponatremia (n = 14,359) and matched controls (n = 57,383). Multivariable logistic regression adjusting for concomitant drugs, medical conditions, previous hospitalizations and socioeconomic factors was performed to investigate the association between hyponatremia and antipsychotic use. In addition newly initiated (≤90 days) or ongoing use was analysed separately. Results Compared to controls, the adjusted OR (95%CI) for hospitalization due to hyponatremia was for any antipsychotic 1.67(1.5–1.86). Individuals on FGA were more likely to experience severe hyponatremia (2.12[1.83–2.46]) than those on any SGA (1.32[1.15–1.51]). No increased risks, neither as newly initiated nor ongoing therapy, were found for risperidone (0.86[0.56–1.31] and 0.83[0.67–1.02]) and aripiprazole (1.16[0.30–4.46] and 0.62[0.27–1.34]), respectively. Conclusions There was an association between antipsychotic therapy and hospitalization due to hyponatremia. The association was stronger for FGAs than SGAs. Risperidone was not associated with an increased risk.
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- 2019
10. Corrigendum to: Tramadol- and codeine-induced severe hyponatremia: A Swedish population-based case-control study. Eur J Intern Med. 2019 Nov;69:20-24
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Buster Mannheimer, Henrik Falhammar, David Nathanson, Jakob Skov, Jonatan D. Lindh, and Jan Calissendorff
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Pediatrics ,medicine.medical_specialty ,business.industry ,Codeine ,MEDLINE ,Case-control study ,medicine.disease ,Swedish population ,Internal Medicine ,medicine ,Tramadol ,Hyponatremia ,business ,medicine.drug - Published
- 2021
11. Corrigendum to: Antipsychotics and severe hyponatremia: A Swedish population-based case-control study. Eur J Intern Med. 2019 Feb;60:71-77
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David Nathanson, Henrik Falhammar, Jonatan D. Lindh, Jakob Skov, Jan Calissendorff, and Buster Mannheimer
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Pediatrics ,medicine.medical_specialty ,Swedish population ,business.industry ,Published Erratum ,Internal Medicine ,Case-control study ,medicine ,MEDLINE ,business ,Hyponatremia ,medicine.disease - Published
- 2021
12. Corrigendum to: Associations of proton pump inhibitors and hospitalization due to hyponatremia: A population–based case–control study. Eur J Intern Med. 2019 Jan;59:65-69
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Jakob Skov, David Nathanson, Jonatan D. Lindh, Buster Mannheimer, Henrik Falhammar, and Jan Calissendorff
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Pediatrics ,medicine.medical_specialty ,business.industry ,Internal Medicine ,medicine ,MEDLINE ,Case-control study ,Population based ,Hyponatremia ,medicine.disease ,business - Published
- 2021
13. The Spectrum From Classic to Non-Classic 11β-Hydroxylase Deficiency
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Seyit Ahmet Uçaktürk, Serap Turan, Mehmet Nuri Ozbek, Goncagül Haklar, Henrik Falhammar, Tulay Guran, Atilla Cayir, Emregul Isik, Ali Yaman, Melek Yildiz, Gönül Çatlı, Karl-Heinz Storbeck, Tugba Baris, Ahmet Anık, Firdevs Bas, Hasan Önal, Fatma Dursun, Huseyin Demirbilek, Edip Unal, Cengiz Kara, Zehra Yavas Abali, Tugba Cetin, Muammer Buyukinan, Feyza Darendeliler, Abdullah Bereket, and Mehmet Keskin
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Pediatrics ,medicine.medical_specialty ,business.industry ,Hydroxylase deficiency ,Final height ,Ethics committee ,medicine.disease ,Informed consent ,Cohort ,Adrenal insufficiency ,Medicine ,Congenital adrenal hyperplasia ,Differential diagnosis ,business - Abstract
Background: Given the rarity of 11β-hydroxylase deficiency (11βOHD), there is a paucity of the data about the differences in clinical and biochemical characteristics of classic (C-11βOHD) and non-classic 11βOHD (NC-11βOHD).Objective: To characterize a multicenter pediatric cohort with 11βOHD. Method: The clinical and biochemical characteristics were retrieved. CYP11B1 gene sequencing was performed. Seventeen plasma steroids were quantified by liquid chromatography-mass spectrometry and compared to that of controls. Results: 102 patients (C-11βOHD; n=92, NC-11βOHD; n=10) from 76 families (46,XX; n=53) had biallelic CYP11B1 mutations (novel 9 out of 30). Five 46,XX patients (10%) were raised as males. Nineteen patients (19%) had initially been misdiagnosed with 21-hydroxylase deficiency. Female final height was 152 cm (-1.85SDS) and male 160.4 cm (-2.56SDS). None of the NC-11βOHD girls had ambiguous genitalia (C-11βOHD 100%) and none of the NC-11βOHD patients were hypertensive (C-11βOHD 50%). Compared to NC-11βOHD, C-11βOHD patients were diagnosed earlier (1.33 vs. 6.9 years, p 2.2
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- 2020
14. Corrigendum to 'Differences in associations of antiepileptic drugs and hospitalization due to hyponatremia: A population–based case–control study' [Seizure: Eur. J. Epilepsy 59 (2018) 28–33]
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Shermineh Farmand, Buster Mannheimer, Jan Calissendorff, David Nathanson, Henrik Falhammar, Jakob Skov, and Jonatan D. Lindh
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Pediatrics ,medicine.medical_specialty ,business.industry ,MEDLINE ,Case-control study ,General Medicine ,Population based ,medicine.disease ,Epilepsy ,Neurology ,medicine ,Neurology (clinical) ,Hyponatremia ,business - Published
- 2021
15. Multiple cutaneous lesions and pulmonary cysts
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Henrik Falhammar and Sudharsan Venkatesan
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Lung Diseases ,medicine.medical_specialty ,Cysts ,business.industry ,Internal Medicine ,MEDLINE ,Humans ,Medicine ,business ,Dermatology ,Skin - Published
- 2020
16. Corrigendum to 'Differences in Associations of Antidepressants and Hospitalization Due to Hyponatremia' AmJMed, 131(01);56-63
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Shermineh Farmand, David Nathanson, Jan Calissendorff, Henrik Falhammar, Jakob Skov, Buster Mannheimer, and Jonatan D. Lindh
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,MEDLINE ,General Medicine ,Hyponatremia ,medicine.disease ,business - Published
- 2021
17. Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency Presenting as Adrenal Incidentaloma: A Systematic Review and Meta-Analysis
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Henrik Falhammar and David J. Torpy
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congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,endocrine system diseases ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Population ,030209 endocrinology & metabolism ,Adrenocorticotropic hormone ,urologic and male genital diseases ,Gastroenterology ,03 medical and health sciences ,Basal (phylogenetics) ,0302 clinical medicine ,Endocrinology ,Congenital adrenal hyperplasia due to 21-hydroxylase deficiency ,Internal medicine ,Medicine ,Adrenocortical carcinoma ,Congenital adrenal hyperplasia ,education ,Genetic testing ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Adrenalectomy ,nutritional and metabolic diseases ,General Medicine ,medicine.disease ,female genital diseases and pregnancy complications ,030220 oncology & carcinogenesis ,business - Abstract
Objective: Adrenal incidentalomas (AIs) may be due to congenital adrenal hyperplasia (CAH) due to homozygous CYP21A2 mutations, or perhaps from heterozygous carrier status. It is unclear if genetic or biochemical testing of CYP21A2 status in AI is justified, despite its potential for avoiding adrenal crises in those referred for adrenalectomy. Methods: We systematically searched PubMed/MEDLINE for articles published up to October 19, 2015 containing all terms associated with adrenal tumors and CAH. Meta-analyses were used to estimate the CAH or carrier prevalence in AI and assess clinical factors that may guide testing. Results: Thirty-six publications were included. Of AI patients biochemically screened for CAH, 58/990 (5.9%) were diagnosed with CAH. Genetic screening of all AIs revealed only 2/252 (0.8%) with clear CAH. The carrier prevalence was 10.2% (36/352). The rate of 0.8% (8/1,000) genetically confirmed CAH is higher than the 1/15,000 affected by classic CAH or 1/1,000 by nonclassic CAH in the Caucasian population. The rate of heterozygous CYP21A2 mutation frequency is similar to those in reported in population studies. Levels of both basal and stimulated 17-hydroxyprogesterone positively correlated with AI diameter. Although bilateral incidentalomata were frequent in CAH, their presence did not predict CYP21A2 status. Conclusion: The presence of an AI does not increase the probability of detection of CAH or CYP21A2 carrier status to the extent routine genetic testing is justified. Screening with 17-hydroxyprogesterone levels appears to lack specificity in the setting of an AI. CYP21A2 mutation analysis is probably the only reliable method for CAH diagnosis in AIs. Abbreviations: ACC = adrenocortical carcinoma ACTH = adrenocorticotropic hormone AI = adrenal incidentaloma CAH = congenital adrenal hyperplasia NCAH = nonclassic congenital adrenal hyperplasia 17OHP = 17-hydroxyprogesterone SV = simple virilizing
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- 2016
18. Diabetes during pregnancy and birthweight trends among Aboriginal and non-Aboriginal people in the Northern Territory of Australia over 30 years
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Federica Barzi, Jacqueline Boyle, Vanya Webster, Elizabeth L M Barr, Gurmeet Singh, Jonathan E. Shaw, Louise J. Maple-Brown, Henrik Falhammar, Matthew J.L. Hare, Roland Dyck, and Steven Guthridge
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Pregnancy ,business.industry ,lcsh:Public aspects of medicine ,Health Policy ,Public Health, Environmental and Occupational Health ,Ethnic group ,Obstetrics and Gynecology ,lcsh:RA1-1270 ,Retrospective cohort study ,medicine.disease ,Logistic regression ,Gestational diabetes ,Psychiatry and Mental health ,Infectious Diseases ,Diabetes mellitus ,Pediatrics, Perinatology and Child Health ,Internal Medicine ,medicine ,Gestation ,Geriatrics and Gerontology ,Northern territory ,business ,Research Paper ,Demography - Abstract
Background: Early-life risk factors, including maternal hyperglycaemia and birthweight, are thought to contribute to the high burden of cardiometabolic disease experienced by Indigenous populations. We examined rates of pre-existing diabetes in pregnancy, gestational diabetes mellitus (GDM) and extremes of birthweight over three decades in the Northern Territory (NT) of Australia. Methods: We performed a retrospective cohort analysis of the NT Perinatal Data Collection from 1987 to 2016, including all births >20 weeks gestation, stratified by maternal Aboriginal identification. Key outcomes were annual rates of pre-existing diabetes, GDM, small-for-gestational-age, large-for-gestational-age, low birthweight (4000 g). Logistic regression was used to assess trends and interactions. Findings: 109 349 babies were born to 64 877 mothers, 36% of whom identified as Aboriginal ethnicity. Among Aboriginal women, rates of GDM and pre-existing diabetes, respectively, were 3 · 4% and 0 · 6% in 1987 and rose to 13% and 5 · 7% in 2016 (both trends p
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- 2020
19. 036 Top End Pulmonary Hypertension Study
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Douglas L. Forrester, Nadarajah Kangaharan, Asanga Abeyaratne, Sam Joseph, Henrik Falhammar, Gregory M. Scalia, P. Naing, P. Lee, E. Costello, G. Strange, Maddison Hall, and David Playford
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Internal medicine ,Cardiology ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease ,Pulmonary hypertension - Published
- 2020
20. Congenital adrenal hyperplasia and risk for psychiatric disorders in girls and women born between 1915 and 2010: A total population study
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Agneta Nordenskjöld, Paul Lichtenstein, Mikael Landén, Anna Nordenström, Angelica Lindén Hirschberg, Henrik Falhammar, Agnieszka Butwicka, Louise Frisén, and Hedvig Engberg
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Adult ,Male ,Chronic condition ,medicine.medical_specialty ,Adolescent ,Genotype ,medicine.drug_class ,Endocrinology, Diabetes and Metabolism ,Population ,Adjustment disorders ,Emotional Adjustment ,Cohort Studies ,Young Adult ,Endocrinology ,medicine ,Humans ,Congenital adrenal hyperplasia ,Registries ,Child ,Psychiatry ,Biological Psychiatry ,Depression (differential diagnoses) ,Aged ,Aged, 80 and over ,Psychiatric Status Rating Scales ,Sweden ,Adrenal Hyperplasia, Congenital ,Endocrine and Autonomic Systems ,business.industry ,Mental Disorders ,Infant ,Middle Aged ,Androgen ,medicine.disease ,Alcoholism ,Psychiatry and Mental health ,In utero ,Child, Preschool ,Anxiety ,Female ,Steroid 21-Hydroxylase ,medicine.symptom ,business ,Stress, Psychological ,Cohort study - Abstract
Congenital adrenal hyperplasia (CAH) is a chronic condition and individuals are exposed to elevated androgen levels in utero as a result of the endogenous cortisol deficiency. Prenatal androgen exposure has been suggested to influence mental health, but population based studies on psychiatric morbidity among girls and women with CAH are lacking. Therefore, we performed a cohort study based on Swedish nationwide registers linked with the national CAH register. Girls and women with CAH due to 21-hydroxylase deficiency (n = 335) born between January 1915 and January 2010 were compared with aged-matched female (n = 33500) and male controls (n = 33500). Analyses were stratified by phenotype [salt wasting (SW), simple virilizing (SV), and non-classical type (NC)] and by CYP21A2 genotype subgroups (null, I2splice, I172N, and P30L). Results are presented as estimated risks (OR, 95%CI) of psychiatric disorders among girls and women with CAH compared with age-matched controls. Any psychiatric diagnoses were more common in CAH females compared with female and male population controls [1.9 (1.4–2.5), and 2.2 (1.7–2.9)]. In particular, the risk of alcohol misuse was increased compared with female and male population controls [2.8 (1.7–4.7) and 2.1 (1.2–3.5)], and appeared most common among the girls and women with the most severe null genotype [6.7 (2.6–17.8)]. The risk of stress and adjustment disorders was doubled compared with female population controls [2.1 (1.3–3.6)]. Girls and women with CAH have an increased risk of psychiatric disorders in general and substance use disorders in particular compared with unexposed females, with the highest risk among those with the most severe genotype. Prenatal androgen exposure and deficient endogenous cortisol and/or adrenaline production may provide explanations for these findings, but other factors related to CAH cannot be excluded.
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- 2015
21. Clinical Outcomes in Adrenal Incidentaloma: Experience From one Center
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Hans Wahrenberg, Henrik Falhammar, Jekaterina Patrova, and Iwona Jarocka
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Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Adrenal Gland Neoplasms ,Metastasis ,Tertiary Care Centers ,Pheochromocytoma ,Cushing syndrome ,Endocrinology ,Outcome Assessment, Health Care ,medicine ,Humans ,Adrenocortical carcinoma ,Congenital adrenal hyperplasia ,Adrenal incidentaloma ,Aged ,Subclinical infection ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Hyperaldosteronism ,Surgery ,Female ,Radiology ,business ,Follow-Up Studies - Abstract
To investigate the outcome in patients with adrenal incidentaloma (AI).A retrospective evaluation of 637 patients with AI referred to a tertiary center over 8 years. Radiologic and hormonal evaluations were performed at baseline. Follow-up imaging was carried out if necessary, and hormonal evaluation was performed at 24 months according to national guidelines.The mean age was 62.7 ± 11.6 years, and the mean AI size was 25.3 ± 17.0 mm at presentation. Hormonal evaluation revealed that 85.4% of all tumors were nonfunctioning adenomas, 4.1% subclinical Cushing syndrome (SCS), 1.4% pheochromocytoma, 1.4% primary hyperaldosteronism, 0.8% Cushing syndrome, 0.6% adrenocortical carcinoma, 0.3% congenital adrenal hyperplasia, 2.2% metastasis to adrenals, and 3.8% other lesions of benign origin. Bilateral tumors were found in 11%, and compared to unilateral tumors, SCS was more prevalent. Only 2 cases were reclassified during follow-up, both as SCS, but neither had had a dexamethasone suppression test performed at initial work-up. In patients diagnosed with an adrenal metastasis, 92.9% were deceased within 2 years. Excluding those with malignant tumors, 12.9% of patients died during the study period of up to 11 years due to other causes than adrenal.Most AIs were benign, but a small fraction of tumors were functional and malignant. The prognosis of patients with adrenal metastasis was extremely poor, but otherwise, the mortality rate was similar to that for the general population. Follow-up of AIs4 cm with an initial nonfunctional profile and benign radiologic appearance appears unwarranted, but screening for congenital adrenal hyperplasia should be considered.
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- 2015
22. Adrenal insufficiency due to bilateral adrenal metastases – A systematic review and meta-analysis
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Philippa H. Tallis, Henrik Falhammar, R. Louise Rushworth, and David J. Torpy
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0301 basic medicine ,medicine.medical_specialty ,Hyperkalemia ,Gastroenterology ,Article ,03 medical and health sciences ,Basal (phylogenetics) ,0302 clinical medicine ,Breast cancer ,Internal medicine ,medicine ,Adrenal insufficiency ,lcsh:Social sciences (General) ,lcsh:Science (General) ,Lung cancer ,Multidisciplinary ,business.industry ,medicine.disease ,Lymphoma ,030104 developmental biology ,Oncology ,Meta-analysis ,lcsh:H1-99 ,medicine.symptom ,Hyponatremia ,business ,030217 neurology & neurosurgery ,lcsh:Q1-390 - Abstract
Objective Bilateral adrenal metastases may cause adrenal insufficiency (AI) but it is unclear if screening for AI in patients with bilateral adrenal metastases is justified, despite the potential for adrenal crises. Method A search using PubMed/Medline, ScienceDirect and Cochrane Reviews was performed to collect all original research articles and all case reports from the past 50 years that describe AI in bilateral adrenal metastases. Results Twenty studies were included with 6 original research articles, 13 case reports and one case series. The quality was generally poor. The prevalence of AI was 3–8%. Of all cases of AI (n = 25) the mean pooled baseline cortisol was 318 ± 237 nmol/L and stimulated 423 ± 238 nmol/L. Hypotension was present in 69%, hyponatremia in 9% and hyperkalemia in 100%. Lung cancer was the cause in 35%, colorectal 20%, breast cancer 15% and lymphoma 10%. The size of the adrenal metastases was 5.5 ± 2.8 cm (left) and 5.5 ± 3.1 cm (right), respectively. There was no correlation between basal cortisol, stimulated cortisol concentration or ACTH with the size of adrenal metastases. The median time to death was 5.0 months (IQR 0.6–6.5). However, two cases were alive after 12–24 months. Conclusion The prevalence of AI in patients with bilateral adrenal metastases was low. Prognosis was very poor. Due to the low prevalence of AI, screening is likely only indicated in patients with symptoms and signs suggestive of hypocortisolism.
- Published
- 2019
23. Epidemiology of Pulmonary Hypertension at the Top End of Australia
- Author
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David Playford, Henrik Falhammar, Sanjay Joseph, Ellie Costelloe, Pyi Naing, Geoff Strange, Nadarajah Kangaharan, and Asanga Abeyaratne
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Epidemiology ,medicine ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease ,Intensive care medicine ,Pulmonary hypertension - Published
- 2019
24. IGF2BP2 and IGF2 genetic effects in diabetes and diabetic nephropathy
- Author
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Kerstin Brismar, Eva Horova, Henrik Falhammar, Martin Prázný, Norhashimah Abu Seman, Anna Möllsten, Harvest F. Gu, and Tianwei Gu
- Subjects
Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Single-nucleotide polymorphism ,Type 2 diabetes ,Kidney ,Polymorphism, Single Nucleotide ,Cohort Studies ,Diabetic nephropathy ,Mice ,Endocrinology ,Insulin-Like Growth Factor II ,Internal medicine ,Diabetes mellitus ,Internal Medicine ,medicine ,Animals ,Humans ,Diabetic Nephropathies ,Gene ,Genetic Association Studies ,Czech Republic ,Sweden ,Sex Characteristics ,Type 1 diabetes ,biology ,business.industry ,RNA-Binding Proteins ,Type 2 Diabetes Mellitus ,medicine.disease ,Mice, Mutant Strains ,United States ,Diabetes Mellitus, Type 1 ,Diabetes Mellitus, Type 2 ,Gene Expression Regulation ,Insulin-like growth factor 2 ,biology.protein ,Female ,business - Abstract
The IGF2BP2 gene is located on chromosome 3q27.2 within a region linked to type 1 diabetes (T1D), type 2 diabetes (T2D) and diabetic nephropathy (DN). Its protein functionally binds to 5'-UTR of the imprinting IGF2 gene. The present study aims to evaluate the IGF2BP2-IGF2 genetic effects in diabetes and DN.Three cohorts including T1D with and without DN (n=1139) of European descents from the GoKinD study, Swedish T1D with and without DN (n=303) and Czech control subjects without diabetes, T1D, T2D with and without DN (n=1418) were enrolled in TaqMan genotyping experiments for IGF2BP2 rs4402960 and IGF2 rs10770125. Igf2bp2 gene expression in kidney tissues of db/db and control mice at the ages of 5 and 26 weeks was examined with real time RT-PCR and Western blot.An association of IGF2BP2 rs4402960 with T2D in the Czech population was replicated. This IGF2BP2 polymorphism (P=0.037, OR=0.69 95% CI 0.49-0.98) was found to be associated with DN in male not in female patients with T1D selected from the GoKinD study. In the analyses of combined the GoKinD, Czech and Swedish populations, the association between IGF2BP2 polymorphism and DN in male patients with T1D was still significant (P=0.030, OR=0.73, 95% CI 0.54-0.97). IGF2 rs10770125 was also associated with DN in male T1D patients of the GoKinD population (P=0.038, OR=0.67 95% CI 0.46-0.98). There might be a genetic interaction between IGF2BP2 and IGF2 (P=0.05). The Igf2bp2 gene expression levels were increased in the kidneys of db/db mice compared to controls at the age of 5weeks but not at 26 weeks.The present study has replicated the association of IGF2BP2 rs4402960 with T2D in the Czech population and provided data suggesting that IGF2BP2 may have genetic interaction with IGF2 with a protective effect against DN in male patients with T1D.
- Published
- 2012
25. Pleural Lipomatosis Masquerading as Pleural Mass With Effusion
- Author
-
Subash S. Heraganahally, Henrik Falhammar, and Sumit Mehra
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Lipomatosis ,Critical Care and Intensive Care Medicine ,Pleural Mass ,medicine.disease ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Effusion ,medicine ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Published
- 2017
26. Pattern of Dyslipidaemia in Subjects with Coronary Artery Disease: A Study Comparing Indigenous and non-Indigenous Australians
- Author
-
Henrik Falhammar and Keith Tiong
- Subjects
Coronary artery disease ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,medicine.disease ,business ,Cardiology and Cardiovascular Medicine ,Indigenous - Published
- 2012
27. GP4-3: Epigenetic analyses of the insulin-like growth factor binding protein 1 gene in diabetes and diabetic nephropathy
- Author
-
Kerstin Brismar, T. Gu, T.J. Ekström, A. Hilding, Harvest F. Gu, Claes-Göran Östenson, L.K. Sjöholm, and Henrik Falhammar
- Subjects
medicine.medical_specialty ,business.industry ,Endocrinology, Diabetes and Metabolism ,medicine.disease ,Diabetic nephropathy ,Endocrinology ,Insulin-Like Growth Factor Binding Protein 1 Gene ,Internal medicine ,Diabetes mellitus ,Cancer research ,medicine ,Epigenetics ,business - Published
- 2014
28. Voice Characteristics Related to Increased Levels of Androgens in Women with Congenital Adrenal Hyperplasia (CAH)
- Author
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Ulrika Nygren, Henrik Falhammar, Agneta Nordenskjöld, Kerstin Hagenfeldt, Maria Sö Dersten, and Marja Thorén
- Subjects
Range (music) ,medicine.medical_specialty ,Aldosterone ,business.industry ,Urology ,Audiology ,medicine.disease ,Voice assessment ,chemistry.chemical_compound ,Endocrinology ,Late diagnosis ,chemistry ,Treatment compliance ,Internal medicine ,Pediatrics, Perinatology and Child Health ,medicine ,Congenital adrenal hyperplasia ,Patient group ,business ,Timbre - Abstract
Purpose Congenital adrenal hyperplasia (CAH) is an autosomal recessive inherited disorder resulting in a lack of cortisol and aldosterone as well as an overproduction of androgens. Raised levels of androgens leads to increased mass in the laryngeal tissues thus may lower the fundamental frequency (F0) in females. Material and Methods We investigated voice characteristics in thirty-eight women with CAH and 24 control women between 18-63 years using acoustic analysis, subjective self-ratings using visual analogue scales of voice symptoms and perceptual analysis regarding dark voice timbre and pitch. Recordings were made of a standard reading passage in a sound treated booth. Acoustic analyses were made of the patient´s fundamental frequency and of min and max F0 in the habitual speech range phonetogram. This was evaluated in relation to mutation and treatment compliance. Results Women with CAH regarded the voice to be a problem in daily life more often than controls. The patient group had statistically significant lower mean fundamental frequency (MF0), as well as lower min and max F0 measured from the speech range profiles as compared to the controls. The perceptual analysis showed that the patients had significantly darker voice timbre and lower pitch than the controls. This was associated with lower treatment compliance but not to the mutation. Conclusions The patients’ voices are affected by androgens due to late diagnosis or undertreatment with cortisol. The results suggest the need for information that voice problems may occur and that referral for voice assessment may be needed.
- Published
- 2008
29. HD3-2 Screening and follow-up for gestational diabetes in the Torres strait Islands
- Author
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Marissa Arnot, Ashim Sinha, Dianne Bond, Bronwyn Davis, Deirdre Frost, Henrik Falhammar, Alexandra Raulli, and Edna Sambo
- Subjects
Gestational diabetes ,medicine.medical_specialty ,Endocrinology ,Torres strait ,business.industry ,Obstetrics ,Endocrinology, Diabetes and Metabolism ,Diabetes mellitus ,Internal Medicine ,medicine ,General Medicine ,medicine.disease ,business - Published
- 2008
30. Gender Role Behaviour, Sexuality and Sexual Function in Women With Congenital Adrenal Hyperplasia
- Author
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Peo Jansson, Gundela Holmdahl, Kerstin Hagenfeldt, Louise Frisén, Anna Nordenström, Agneta Nordenskjöld, Henrik Falhammar, Helena L. Filipsson, and Marja Thorén
- Subjects
Gynecology ,medicine.medical_specialty ,medicine.diagnostic_test ,Obstetrics ,business.industry ,Urology ,Virilization ,Physical examination ,Disease ,medicine.disease ,Quality of life ,Rating scale ,Pediatrics, Perinatology and Child Health ,Genotype ,medicine ,Congenital adrenal hyperplasia ,medicine.symptom ,business ,Sexual function - Abstract
Purpose Females with congenital adrenal hyperplasia (CAH) are exposed to androgens during fetal development resulting in virilization of external genitalia. Gender-atypical behavior has been described in young girls with CAH. Little is known about what effect the disease has on their lives. Material and Methods Sixty-two Swedish women with CAH and age-matched controls completed a 120-item questionnaire, McCoy sexual rating scale and a validated quality of life instrument (PGWB). Surgical outcome was evaluated by clinical examination. The patients were divided into four genotype groups. Results Cases held more male-dominant occupations (30%) compared to controls (13%) (P=0.04), especially women with null mutations. They also reported a greater interest in rough sports (74%) compared to controls (50%) (P=0.007). Eight women with CAH (14%) reported a prime interest in motor vehicles, compared to none of the controls (P=0.002). Non-heterosexual orientation was reported by 19% of women with CAH (P=0.005), 50% of those with null mutations (P=0.0001). The patients in the null genotype group scored lower for sexual function and satisfaction and had more surgical complications. Conclusions Women with CAH display an increased gender-atypical behavior that is correlated to the genotype. This speaks in favor of dose dependent effects of prenatal androgens on the development of higher brain functions. The impact of the disease on upbringing and interpersonal relationships did not correlate with disease severity. Our data also shows that the null genotype group was considerably more affected than the other groups and should be regarded as a subgroup with special needs.
- Published
- 2010
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