Anders Palmstrøm Jørgensen

• Stokland, Ann-Elin Meling; Breivik, Lars; Dalen, Ingvild; Steintorsdottir, Sandra Dis; Kildal, Simon & Nermoen, Ingrid [Vis alle 30 forfattere av denne artikkelen] (2026). Risk and outcomes of adrenal crisis in primary adrenal insufficiency: Evidence from a 24‐year nationwide cohort study. Journal of Internal Medicine. ISSN 0954-6820. doi: 10.1111/joim.70153. Fulltekst i vitenarkiv Vis sammendrag

  Background: Adrenal crisis is a life‐threatening emergency. Despite preventive strategies, previous reports suggest increasing incidence and substantial mortality, but robust validated data are limited. Objective: To assess temporal trends in adrenal crisis incidence and identify associated risk factors. Methods: We studied 1040 patients with autoimmune or idiopathic primary adrenal insufficiency enrolled in the Norwegian Addison Registry. Medical records were reviewed for crisis‐related hospitalizations between 2000 and 2023. Overt adrenal crisis was defined by acute clinical deterioration with hemodynamic or biochemical abnormalities, whereas incipient crisis was defined by typical symptoms without objective abnormalities. Results: During a median follow‐up of 15 years, 660 patients (63%) experienced crisis‐related hospitalizations, and 265 (25%) had an overt adrenal crisis after diagnosis. The incidence of overt crises was 3.2 per 100 person‐years and that of incipient crises was 6.9 per 100 person‐years. Admission rates for incipient crises increased significantly over time ( p  < 0.001), whereas overt crisis rates remained stable. Among 1754 admissions, five deaths (0.3%) were attributed to adrenal crisis. Both younger and older age ( p  < 0.001) and type 1 diabetes (incidence rate ratio 2.09, 95% confidence interval 1.45–3.01; p  < 0.001) were associated with increased overt crisis risk. Daily corticosteroid dose was not associated with crisis risk. Prehospital stress dosing was used in about 50% of admissions. Conclusions: Overt adrenal crisis was uncommon and crisis‐related in‐hospital mortality was exceptionally low. Crisis risk was independent of replacement dose but increased in patients with type 1 diabetes. Strengthening education and implementation of prehospital stress dosing may further reduce the burden of adrenal crises.

• Kucuka, Isil; Wolff, Anette Susanne Bøe; Breivik, Lars; Sjøgren, Thea; Bratland, Eirik & Grytaas, Marianne Aardal [Vis alle 22 forfattere av denne artikkelen] (2026). Long-term follow-up of autoimmune polyendocrine syndrome type-1 in Norway. Journal of Clinical Endocrinology and Metabolism (JCEM). ISSN 0021-972X. doi: 10.1210/clinem/dgag060. Fulltekst i vitenarkiv Vis sammendrag

  Context Autoimmune polyendocrine syndrome type-1 (APS-1) is a rare, yet severe multiorgan autoimmune disease caused by mutations in the Autoimmune Regulator (AIRE) gene. Classical APS-1 arises from biallelic recessive AIRE mutations, whereas dominant negative mutations cause a milder, non-classical phenotype with variable clinical presentation. Due to its rarity, long-term, population-based data are limited, underscoring the need for extended follow-up to guide lifelong care and research. Objective To characterize the clinical profiles of APS-1 and explore associations between disease manifestations, autoantibody profiles, and AIRE mutations over an extended follow-up (1996-2025). Patients All known Norwegian patients with APS-1. Methods We analysed longitudinal clinical and laboratory data of 71 APS-1 patients (49 classical, 22 non-classical) from the Norwegian Registry of Organ-specific Autoimmune Diseases. Data included clinical progression, autoantibody and cytokine profiles, and AIRE genotypes. Additionally, we compared age at diagnosis of primary adrenal insufficiency (PAI) in patients with and without (n=999) APS-1. Results In classical APS-1, the most frequent clinical manifestations were chronic mucocutaneous candidiasis, enamel hypoplasia, and PAI, while for non-classical APS-1 vitiligo, hypothyroidism, and PAI were most common. A broad pro-inflammatory cytokine signature was observed in classical APS-1, along with increased levels of the soluble form of the IFN-α/β receptor. Conclusion APS-1 should be considered in patients diagnosed with PAI before age 20, and AIRE sequencing is recommended for diagnostic confirmation. The presence of IFN-ω autoantibodies, a pro-inflammatory cytokine profile, and increased soluble IFN receptor levels further support the role of dysregulated interferon responses in APS-1 pathogenesis.

• Olarescu, Nicoleta Cristina; Jørgensen, Anders Palmstrøm; Atai, Shahriar; Wiedmann, Markus; Dahlberg, Daniel & Bollerslev, Jens [Vis alle 7 forfattere av denne artikkelen] (2025). Pasireotide as first line medical therapy for selected patients with acromegaly. Pituitary. ISSN 1386-341X. 28(3). doi: 10.1007/s11102-025-01514-3. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background and purpose In acromegaly, growth hormone (GH) excess and pituitary tumours are typically managed through transsphenoidal surgery, often in combination with somatostatin receptor ligands (SRLs) given either before or following surgery. Although first-generation SRLs (lanreotide and octreotide) are efficacious in many patients, some exhibit resistance. Methods We present the efficacy of the second-generation SRL, pasireotide, in six patients anticipated to be resistant to first-generation SRLs. The patients had large, hyperintense tumors on T2-weighted MRI and sparse granulation pattern by histology. Results Over three to eight months, pasireotide reduced tumour volume in all patients and improved GH and IGF-1 levels. Visual field defects normalised. Despite hyperglycemia, requiring antidiabetic treatment in two patients, pasireotide proved effective as a first pharmacological therapy. Conclusion This series supports the use of pasireotide for rapid tumour control and GH reduction, in selected patients with complex and large tumours, likely to be resistant to first-generation SRLs. This approach expands the therapeutic options for managing the most challenging cases enhancing the potential for other subsequent treatment modalities.

• islam, shahinul; Oftedal, Bergithe Eikeland; Gjerdevik, Miriam; Breivik, Lars Ertesvåg; Røyrvik, Ellen Christine & Lima, Kari [Vis alle 11 forfattere av denne artikkelen] (2025). Immune cell subsets in autoimmune polyendocrine syndrome type I. Scientific Reports. 15. doi: 10.1038/s41598-025-12634-y. Fulltekst i vitenarkiv Vis sammendrag

  Autoimmune Polyendocrine Syndrome Type 1 (APS-I) results from mutations in the Autoimmune Regulator ( AIRE) gene and serves as a valuable model to understand autoimmunity and immune deficiency. Various studies have produced differing results on how AIRE dysfunction affects the balance of immune cell subsets in blood in humans. We conducted high-resolution whole blood immune cell subset analysis using a 36-panel mass cytometry assay in Norwegian APS-I patients ( N  = 18) and compared with age and sex-matched healthy subjects ( N  = 19). Additionally, we provide a comprehensive summary of findings from 28 other studies examining blood immune subset distributions in APS-I patients. Norwegian APS-I patients had significantly reduced numbers of B cells, which was driven by lower levels of the naïve and transitional B cell compartments. We further observed trends indicating reduced frequencies of NK cells, as well as deviations in CD16-expressing cells in several subsets in APS-I patients. Contrary to previous reports, our study did not find differences in regulatory T cell levels between APS-I patients and healthy controls. Several studies in our summary consistently reported lower frequencies of resting naïve B cells in APS-I patients and higher proportions of activated memory B cells in APS-I patients. The composition of other immune cell subsets was more diverse between studies, probably reflecting contributions by other factors like medications, ethnicity, disease complexity, insufficient sample sizes, time of sampling, ages, unique immune profiles and health conditions of the patients and controls. Future research should prioritize investigating antigen-specific responses in blood and tissues to further illuminate this complex area.

• Steintorsdottir, Sandra Dis; Øksnes, Marianne; Jørgensen, Anders Palmstrøm & Husebye, Eystein Sverre (2025). Extended-release Hydrocortisone Formulations - Is There a Clinically Meaningful Benefit? Journal of Clinical Endocrinology and Metabolism (JCEM). ISSN 0021-972X. 110(3), s. e566–e573. doi: 10.1210/clinem/dgae822. Fulltekst i vitenarkiv Vis sammendrag

  Despite best practice replacement therapy with corticosteroids, patients with adrenal insufficiency report diminished quality of life and face increased mortality and morbidity. Conventional formulations of hydrocortisone have short half-lives (about 90 minutes) requiring multiple dosing during the day. Since 2011, extended-release hydrocortisone (ER-HC) formulations have been available enabling once-, sometimes twice-daily dosing. Most studies comparing ER-HC formulations with conventional hydrocortisone therapy report reduction in body weight, blood pressure and glucose levels, and improved quality of life. However, it is still unclear if the reported beneficiary effects are due to differences in cortisol exposure or alterations in pharmacokinetics. Here, we review studies comparing conventional and ER-HC treatment in adrenal insufficiency and discuss whether these novel formulations are safe and offer clinically significant benefits.

• Henriksen, Hans Christian Bordado; Jørgensen, Anders Palmstrøm; Bjørnebekk, Astrid Kristine; Neupane, Sudan Prasad & Havnes, Ingrid Amalia (2024). Clomiphene citrate and optional human chorionic gonadotropin for treating male hypogonadism arising from long-term anabolic-androgenic steroid use—A pilot study. Performance Enhancement & Health. doi: 10.1016/j.peh.2024.100283. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Long-term anabolic-androgenic steroid (AAS) use poses several health risks, including secondary hypogonadism. There is a knowledge gap on treatment targeting the hypothalamic-pituitary-gonadal (HPG) axis among men with anabolic steroid-induced hypogonadism (ASIH). This study aims to gain insights into the potential utility of endocrine therapy to restore endogenous testosterone levels and alleviate ASIH symptoms in AAS dependent men. Methods In this proof-of-concept, single-site, open longitudinal pilot study, AAS dependent men with continuous AAS use and a desire to permanently discontinue use, were given endocrine therapy. The treatment included 25 mg clomiphene citrate (CC) every second day for 16 weeks, transdermal testosterone daily during the first four weeks, and if indicated, human chorionic gonadotropin (hCG) injections for a maximum of eight weeks. Physical exams including blood collection and online questionnaires were completed every four and two weeks, respectively. Results Ten participants, with median age 32 years (interquartile range 30–45), with mean ± standard deviation AAS use of 11 ± 4 years, completed the CC intervention. Seven participants received hCG as part of their treatment protocol. Mild adverse events included headaches, dizziness, and mood swings, and no serious adverse events occurred. During the intervention, there was a decrease in levels of hematocrit, hemoglobin and ALT (alanine aminotransferase), as well as an increase in serum FSH (follicle stimulating hormone), LH (luteinizing hormone) and SHBG (sex hormone binding globulin). Five of ten participants reached a total testosterone level within normal range (9–30 nmol/l). The HPG axis response varied greatly among participants, and was not aligned with the severity of ASIH related withdrawal symptoms. Conclusions The findings from this proof-of-concept study may guide future randomized controlled trials aiming to investigate potential endocrine therapeutic approaches to ASIH.

• Havnes, Ingrid Amalia; Henriksen, Hans Christian Bordado; Johansen, Per Wiik; Bjørnebekk, Astrid Kristine; Neupane, Sudan Prasad & Hisdal, Jonny [Vis alle 11 forfattere av denne artikkelen] (2024). Off-label use of clomiphene citrate to treat anabolic androgenic steroid induced hypogonadism upon cessation among men (CloTASH) – A pilot study protocol. MethodsX. 13. doi: 10.1016/j.mex.2024.102810. Fulltekst i vitenarkiv Vis sammendrag

  Background Non-prescribed anabolic androgenic steroid (AAS) use is associated with AAS-induced hypogonadism (ASIH), and metabolic, cardiovascular, and mental health risks. Symptoms of ASIH (fatigue, depression, anxiety, sexual dysfunction) are hard to endure following cessation, but there is no consensus on whether endocrine treatment should be used to treat ASIH. This proof-of-concept study aims to explore safety of off-label clomiphene citrate therapy, whether the treatment will reduce the symptoms of androgen deficiency, and to study changes in health risks after cessation. Methods In this open-labeled non-randomized off-label hormone intervention pilot study, we shall include males with AAS dependence intending to cease use. The 16-week intervention included clomiphene citrate, transdermal testosterone gel for the first four weeks and optional human chorionic gonadotropin (hCG) from week 4 if low treatment response. Measures of physical and mental health will be examined from ongoing AAS use, during the intervention, and at 6- and 12 months post cessation. Change in self-reported symptoms of hypogonadism and other withdrawal symptoms will be compared with data from a group of men who ended AAS use temporarily without the medical intervention. The study may provide valuable clinical insights and may be used to inform the design of future intervention studies.

• Sjøgren, Thea; islam, shahinul; Filippov, Igor; Jebrzycka, Adrianna; Sulen, André & Breivik, Lars Ertesvåg [Vis alle 16 forfattere av denne artikkelen] (2024). Single cell characterization of blood and expanded regulatory T cells in autoimmune polyendocrine syndrome type 1. iScience. 27(4). doi: 10.1016/j.isci.2024.109610. Fulltekst i vitenarkiv Vis sammendrag

  Immune tolerance fails in autoimmune polyendocrine syndrome type 1 (APS-1) because of AIRE mutations. We have used single cell transcriptomics to characterize regulatory T cells (Tregs) sorted directly from blood and from in vitro expanded Tregs in APS-1 patients compared to healthy controls. We revealed only CD52 and LTB (down) and TXNIP (up) as consistently differentially expressed genes in the datasets. There were furthermore no large differences of the TCR-repertoire of expanded Tregs between the cohorts, but unique patients showed a more restricted use of specific clonotypes. We also found that in vitro expanded Tregs from APS-1 patients had similar suppressive capacity as controls in co-culture assays, despite expanding faster and having more exhausted cells. Our results suggest that APS-1 patients do not have intrinsic defects in their Treg functionality, and that their Tregs can be expanded ex vivo for potential therapeutic applications.

• Sævik, Åse Bjorvatn; Ueland, Grethe Åstrøm; Åkerman, Anna-Karin; Methlie, Paal; Quinkler, Marcus & Jørgensen, Anders Palmstrøm [Vis alle 26 forfattere av denne artikkelen] (2023). Altered biomarkers for cardiovascular disease and inflammation in autoimmune Addison's disease - a cross-sectional study. European Journal of Endocrinology (EJE). ISSN 0804-4643. 189(4), s. 438–447. doi: 10.1093/ejendo/lvad136. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Wolff, Anette Susanne Bøe; Hansen, Lena; Grytaas, Marianne Aardal; Oftedal, Bergithe Eikeland; Breivik, Lars Ertesvåg & Zhou, Fan [Vis alle 17 forfattere av denne artikkelen] (2023). Vaccination prevents severe COVID-19 outcome in patients with neutralizing type 1 interferon autoantibodies. iScience. 26(7). doi: 10.1016/j.isci.2023.107084. Fulltekst i vitenarkiv Vis sammendrag

  A hallmark of patients with autoimmune polyendocrine syndrome type 1 (APS-1) is serological neutralizing autoantibodies against type 1 interferons (IFN-I). The presence of these antibodies has been associated with severe course of COVID-19. The aims of this study were to investigate SARS-CoV-2 vaccine tolerability and immune responses in a large cohort of patients with APS-1 (N = 33) and how these vaccinated patients coped with subsequent infections. We report that adult patients with APS-1 were able to mount adequate SARS-CoV-2 spike-specific antibody responses after vaccination and observed no signs of decreased tolerability. Compared with age- and gender-matched healthy controls, patients with APS-1 had considerably lower peak antibody responses resembling elderly persons, but antibody decline was more rapid in the elderly. We demonstrate that vaccination protected patients with APS-1 from severe illness when infected with SARS-CoV-2 virus, overriding the systemic danger of IFN-I autoantibodies observed in previous studies.

• Henriksen, Hans Christian Bordado; Jørgensen, Anders Palmstrøm; Wisløff, Christine & Havnes, Ingrid Amalia (2023). Challenges recruiting men with a desire to cease anabolic-androgenic steroid use to a pilot involving hormone therapy intervention. Drugs: education prevention and policy. ISSN 0968-7637. doi: 10.1080/09687637.2023.2244655. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Long-term use of anabolic-androgenic steroids (AAS) might lead to distressing withdrawal symptoms following cessation. This paper aims to share challenges in recruiting patients to a pilot intervention study with parallel substance use disorder (SUD) treatment and to explore barriers to participation among AAS forum members. Methods Eligible AAS-dependent men were recruited to receive hormone therapy for 16 weeks, and exclusion reasons were registered. Audience engagement from social media advertisements was measured. Information about the study was posted in an AAS online forum, and discussion among forum members was thematically analyzed. Results Twelve of 81 potential participants were included, whereas ten completed the intervention. Participants were excluded due to residency outside the study area, illicit substance use or severe medical conditions. Challenges in recruitment were linked to the COVID-19 pandemic, funding and advertisements on social media. AAS forum members suggested modifications to the intervention, were skeptical to the SUD-patient requirement, feared prosecution or other negative outcomes and/or preferred to seek online advice on self-initiated testosterone replacement therapy or post cycle therapy. Conclusion AAS-related online recommendations among peers, criminalized AAS use setting and obligatory SUD treatment might have affected recruitment. Based on lessons learned, recommendations for future similar studies are presented.

• Åkerman, Anna-Karin; Sævik, Åse Bjorvatn; Thorsby, Per Medbøe; Methlie, Paal; Quinkler, Marcus & Jørgensen, Anders Palmstrøm [Vis alle 26 forfattere av denne artikkelen] (2023). Plasma-Metanephrines in Patients with Autoimmune Addison’s Disease with and without Residual Adrenocortical Function. Journal of Clinical Medicine. 12:3602(10), s. 1–10. doi: 10.3390/jcm12103602. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: Residual adrenocortical function, RAF, has recently been demonstrated in one-third of patients with autoimmune Addison's disease (AAD). Here, we set out to explore any influence of RAF on the levels of plasma metanephrines and any changes following stimulation with cosyntropin. Methods: We included 50 patients with verified RAF and 20 patients without RAF who served as controls upon cosyntropin stimulation testing. The patients had abstained from glucocorticoid and fludrocortisone replacement > 18 and 24 h, respectively, prior to morning blood sampling. The samples were obtained before and 30 and 60 min after cosyntropin stimulation and analyzed for serum cortisol, plasma metanephrine (MN), and normetanephrine (NMN) by liquid-chromatography tandem-mass pectrometry (LC-MS/MS). Results: Among the 70 patients with AAD, MN was detectable in 33%, 25%, and 26% at baseline, 30 min, and 60 min after cosyntropin stimulation, respectively. Patients with RAF were more likely to have detectable MN at baseline (p = 0.035) and at the time of 60 min (p = 0.048) compared to patients without RAF. There was a positive correlation between detectable MN and the level of cortisol at all time points (p = 0.02, p = 0.04, p < 0.001). No difference was noted for NMN levels, which remained within the normal reference ranges. Conclusion: Even very small amounts of endogenous cortisol production affect MN levels in patients with AAD.

• Aranda-Guillén, Maribel; Røyrvik, Ellen Christine; Fletcher-Sandersjöö, Sara; Artaza, Haydee; Botusan, Ileana Ruxandra & Grytaas, Marianne A. [Vis alle 18 forfattere av denne artikkelen] (2023). A polygenic risk score to help discriminate primary adrenal insufficiency of different etiologies. Journal of Internal Medicine. ISSN 0954-6820. 294(1), s. 96–109. doi: 10.1111/joim.13649. Fulltekst i vitenarkiv Vis sammendrag

  Background Autoimmune Addison's disease (AAD) is the most common cause of primary adrenal insufficiency (PAI). Despite its exceptionally high heritability, tools to estimate disease susceptibility in individual patients are lacking. We hypothesized that polygenic risk score (PRS) for AAD could help investigate PAI pathogenesis in pediatric patients. Methods We here constructed and evaluated a PRS for AAD in 1223 seropositive cases and 4097 controls. To test its clinical utility, we reevaluated 18 pediatric patients, whose whole genome we also sequenced. We next explored the individual PRS in more than 120 seronegative patients with idiopathic PAI. Results The genetic susceptibility to AAD—quantified using PRS—was on average 1.5 standard deviations (SD) higher in patients compared with healthy controls (p < 2e − 16), and 1.2 SD higher in the young patients compared with the old (p = 3e − 4). Using the novel PRS, we searched for pediatric patients with strikingly low AAD susceptibility and identified cases of monogenic PAI, previously misdiagnosed as AAD. By stratifying seronegative adult patients by autoimmune comorbidities and disease duration we could delineate subgroups of PRS suggesting various disease etiologies. Conclusions The PRS performed well for case-control differentiation and susceptibility estimation in individual patients. Remarkably, a PRS for AAD holds promise as a means to detect disease etiologies other than autoimmunity.

• Kolnes, Anders Jensen; Øystese, Kristin Astrid Berland; Sjöstedt, Evelina; Olarescu, Nicoleta Cristina; Heck, Ansgar & Pahnke, Jens [Vis alle 12 forfattere av denne artikkelen] (2023). TGFBR3L is associated with gonadotropin production in non-functioning gonadotroph pituitary neuroendocrine tumours. Pituitary. ISSN 1386-341X. 26, s. 227–236. doi: 10.1007/s11102-023-01310-x. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Transforming growth factor-beta receptor 3-like (TGFBR3L) is a pituitary enriched membrane protein selectively detected in gonadotroph cells. TGFBR3L is named after transforming growth factor-beta receptor 3 (TGFBR3), an inhibin A co-receptor in mice, due to sequence identity to the C-terminal region. We aimed to characterize TGFBR3L detection in a well-characterized, prospectively collected cohort of non-functioning pituitary neuroendocrine tumours (NF-PitNETs) and correlate it to clinical data. Methods 144 patients operated for clinically NF-PitNETs were included. Clinical, radiological and biochemical data were recorded. Immunohistochemical (IHC) staining for FSHβ and LHβ was scored using the immunoreactive score (IRS), TGFBR3L and TGFBR3 were scored by the percentage of positive stained cells. Results TGFBR3L staining was selectively present in 52% of gonadotroph tumours. TGFBR3L was associated to IRS of LHβ (median 2 [IQR 0–3] in TGFBR3L negative and median 6 [IQR 3–9] in TGFBR3L positive tumours, p < 0.001), but not to the IRS of FSHβ (p = 0.32). The presence of TGFBR3L was negatively associated with plasma gonadotropin concentrations in males (P-FSH median 5.5 IU/L [IQR 2.9–9.6] and median 3.0 [IQR 1.8–5.6] in TGFBR3L negative and positive tumours respectively, p = 0.008) and P-LH (median 2.8 IU/L [IQR 1.9–3.7] and median 1.8 [IQR 1.1-3.0] in TGFBR3L negative and positive tumours respectively, p = 0.03). TGFBR3 stained positive in 22% (n = 25) of gonadotroph tumours with no correlation to TGFBR3L. Conclusion TGFBR3L was selectively detected in half (52%) of gonadotroph NF-PitNETs. The association to LHβ staining and plasma gonadotropins suggests that TGFBR3L may be involved in hormone production in gonadotroph NF-PitNETs.

• Stokland, Ann-Elin Meling; Ueland, Grethe Åstrøm; Lima, Kari; Grønning, Kaja; Finnes, Trine Elisabeth & Svendsen, Margrethe [Vis alle 22 forfattere av denne artikkelen] (2022). Autoimmune Thyroid Disorders in Autoimmune Addison Disease. Journal of Clinical Endocrinology and Metabolism (JCEM). ISSN 0021-972X. 107(6), s. e2331–e2338. doi: 10.1210/clinem/dgac089. Fulltekst i vitenarkiv Vis sammendrag

  Context: Autoimmune thyroid disease is the most common endocrine co-morbidity in autoimmune Addison's disease (AAD), but detailed investigations of prevalence and clinical course is lacking. Objective: Provide comprehensive epidemiological and clinical data on autoimmune thyroid disorders in AAD. Design and patients: A nationwide registry-based study including 442 patients with AAD and autoimmune thyroid disease, identified through the Norwegian National Registry of Autoimmune Diseases. Results: Of 912 registered AAD patients, 442 (48%) were diagnosed with autoimmune thyroid disease. Three hundred and eighty (42%) had autoimmune hypothyroidism. Of the 302 with available thyroid function tests at time for diagnosis, 20% had overt hypothyroidism, 73% had subclinical hypothyroidism and 7% had thyroid levels in the normal range. Negative thyroid peroxidase antibodies was found in 32%. Ninety-eight percent were treated with levothyroxine, 5% with combination therapy with liothyronine or thyroid extracts, and 1% were observed without treatment. Seventy-eight patients (9%) were diagnosed with Graves' disease (GD), of whom 16 (21%) were diagnosed with autoimmune hypothyroidism either before onset or after remission of GD. At the end of follow-up 33% had normal thyroid hormone levels without antithyroid-drugs or levothyroxine treatment. The remaining had either active disease (5%), had undergone ablative treatment (41%), or had developed autoimmune hypothyroidism (21%). Conclusion: The true prevalence of hypothyroidism in AAD is lower than reported in current literature. Careful consideration of the indication to start thyroxin therapy is warranted. Long-term remission rates in GD patients with AAD are comparable to recent reports on long-term follow-up of patients without AAD.

• Sjöstedt, Evelina; Kolnes, Anders Jensen; Olarescu, Nicoleta Cristina; Mitsios, Nicholas; Hikmet, Feria & Sivertsson, Åsa [Vis alle 11 forfattere av denne artikkelen] (2021). Tgfbr3l—an uncharacterised pituitary specific membrane protein detected in the gonadotroph cells in non-neoplastic and tumour tissue. Cancers. 13:114(1), s. 1–15. doi: 10.3390/CANCERS13010114. Fulltekst i vitenarkiv Vis sammendrag

  Here, we report the investigation of transforming growth factor beta-receptor 3 like (TGFBR3L), an uncharacterised pituitary specific membrane protein, in non-neoplastic anterior pituitary gland and pituitary neuroendocrine tumours. A polyclonal antibody produced within the Human Protein Atlas project (HPA074356) was used for TGFBR3L staining and combined with SF1 and FSH for a 3-plex fluorescent protocol, providing more details about the cell lineage specificity of TGFBR3L expression. A cohort of 230 pituitary neuroendocrine tumours were analysed. In a subgroup of previously characterised gonadotroph tumours, correlation with expression of FSH/LH, E-cadherin, oestrogen (ER) and somatostatin receptors (SSTR) was explored. TGFBR3L showed membranous immunolabeling and was found to be gonadotroph cell lineage-specific, verified by co-expression with SF1 and FSH/LH staining in both tumour and non-neoplastic anterior pituitary tissues. TGFBR3L immunoreactivity was observed in gonadotroph tumours only and demonstrated intra-tumour heterogeneity with a perivascular location. TGFBR3L immunostaining correlated positively to both FSH (R = 0.290) and LH (R = 0.390) immunostaining, and SSTR3 (R = 0.315). TGFBR3L correlated inversely to membranous E-cadherin staining (R = −0.351) and oestrogen receptor β mRNA (R = −0.274). In conclusion, TGFBR3L is a novel pituitary gland specific protein, located in the membrane of gonadotroph cells in non-neoplastic anterior pituitary gland and in a subset of gonadotroph pituitary tumours.

• Eriksson, Daniel; Røyrvik, Ellen Christine; Aranda-Guillen, Maribel; Berger, Amund Holte; Landegren, Nils & Alvarez, Haydee Maribel Artaza [Vis alle 30 forfattere av denne artikkelen] (2021). GWAS for autoimmune Addison's disease identifies multiple risk loci and highlights AIRE in disease susceptibility. Nature Communications. 12:959(1), s. 1–14. doi: 10.1038/s41467-021-21015-8. Fulltekst i vitenarkiv Vis sammendrag

  Autoimmune Addison’s disease (AAD) is characterized by the autoimmune destruction of the adrenal cortex. Low prevalence and complex inheritance have long hindered successful genetic studies. We here report the first genome-wide association study on AAD, which identifies nine independent risk loci (P < 5 × 10−8). In addition to loci implicated in lymphocyte function and development shared with other autoimmune diseases such as HLA, BACH2, PTPN22 and CTLA4, we associate two protein-coding alterations in Autoimmune Regulator (AIRE) with AAD. The strongest, p.R471C (rs74203920, OR = 3.4 (2.7–4.3), P = 9.0 × 10−25) introduces an additional cysteine residue in the zinc-finger motif of the second PHD domain of the AIRE protein. This unbiased elucidation of the genetic contribution to development of AAD points to the importance of central immunological tolerance, and explains 35–41% of heritability (h2).

• Shukur, Hasanain Hamid; Hussain-Alkhateeb, Laith; Farholt, Stense; Nørregaard, Ole; Jørgensen, Anders Palmstrøm & Hoybye, Charlotte (2021). Effects of Growth Hormone Treatment on Sleep-Related Parameters in Adults with Prader-Willi Syndrome. Journal of Clinical Endocrinology and Metabolism (JCEM). ISSN 0021-972X. 106(9), s. E3634–E3643. doi: 10.1210/clinem/dgab300. Fulltekst i vitenarkiv
• Jørgensen, Anders Palmstrøm (2021). Endocrine Workup for Primary Aldosteronism Should Include Adrenal Venous Sampling in Young Patients. Journal of Clinical Endocrinology and Metabolism (JCEM). ISSN 0021-972X. 106(7), s. e2828–e2829. doi: 10.1210/clinem/dgab142. Fulltekst i vitenarkiv
• Kolnes, Anders Jensen; Øystese, Kristin Astrid; Dahlberg, Daniel; Berg-Johnsen, Jon; Niehusmann, Pitt & Pahnke, Jens [Vis alle 8 forfattere av denne artikkelen] (2020). Cut-off values for sufficient cortisol response to low dose Short Synacthen Test after surgery for non-functioning pituitary adenoma. Acta Neurochirurgica. ISSN 0001-6268. 162(4), s. 845–852. doi: 10.1007/s00701-019-04068-z. Fulltekst i vitenarkiv Vis sammendrag

  Objective The aim was to study the prevalence of secondary adrenal insufficiency before and after surgery for non-functioning pituitary adenomas, as well as determine risk factors for developing secondary adrenal insufficiency. A secondary aim was to determine adequate p-cortisol response to a 1-μg Short Synacthen Test after surgery. Design Longitudinal cohort study. Methods One hundred seventeen patients (52/65 females/males, age 59 years) undergoing primary surgery for clinically non-functioning pituitary adenomas were included. P-cortisol was measured in morning blood samples. Three months after surgery, a Short Synacthen Test was performed. Results All tumours were macroadenomas (mean size 26.9 mm, range 13–61 mm). The surgical indications were visual impairment (93), tumour growth (16), pituitary apoplexy (6) and headache (2). Before surgery, 17% of the patients had secondary adrenal insufficiency (SAI), decreasing to 15% 3 months postoperatively. Risk of SAI was increased in patients operated for pituitary apoplexy (p < 0.001), while age, sex, tumour size and complication rate were not different from the remaining cohort. Three months after surgery, all patients with baseline p-cortisol ≥ 172 nmol/l (6.2 μg/dl) and peak p-cortisol during Short Synacthen Test ≥ 320 nmol/l (11.6 μg/dl) tapered cortisone unproblematically. In patients with intact hypothalamic-pituitary-adrenal axis, p-cortisol peaked < 500 nmol/l (18.1 μg/dl) during Short Synacthen Test in 48% of patient. Conclusion Pituitary surgery is safe and transsphenoidal surgery rarely causes new SAI. Relying solely on morning p-cortisol for diagnosing secondary adrenal insufficiency gives false positives and the Short Synacthen Test remains useful. A peak p-cortisol ≥ 320 during (11.6 μg/dl) Short Synacthen Test indicates a sufficient response, while < 309 nmol/l (11.2 μg/dl) indicates secondary adrenal insufficiency.

• Kolnes, Anders Jensen; Øystese, Kristin Astrid; Olarescu, Nicoleta Cristina; Ringstad, Geir Andre; Berg-Johnsen, Jon & Casar-Borota, Olivera [Vis alle 8 forfattere av denne artikkelen] (2020). FSH Levels Are Related to E-cadherin Expression and Subcellular Location in Nonfunctioning Pituitary Tumors. Journal of Clinical Endocrinology and Metabolism (JCEM). ISSN 0021-972X. 105(8), s. 1–8. doi: 10.1210/clinem/dgaa281. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Context Gonadotroph pituitary neuroendocrine tumors (PitNETs) can express follicle-stimulating hormone (FSH) and luteinizing hormone (LH) or be hormone negative, but they rarely secrete hormones. During tumor development, epithelial cells develop a mesenchymal phenotype. This process is characterized by decreased membranous E-cadherin and translocation of E-cadherin to the nucleus. Estrogen receptors (ERs) regulate both E-cadherin and FSH expression and secretion. Whether the hormone status of patients with gonadotroph PitNETs is regulated by epithelial-to-mesenchymal transition (EMT) and ERs is unknown. Objectives To study the effect of EMT on hormone expression in gonadotroph nonfunctioning (NF)-PitNETs. Design Molecular and clinical analyses of 105 gonadotroph PitNETs. Immunohistochemical studies and real-time quantitative polymerase chain reaction were performed for FSH, LH, E-cadherin, and ERα. Further analyses included blood samples, clinical data, and radiological images. Setting All patients were operated on in the same tertiary referral center. Results NF-PitNET with high FSH expression had decreased immunohistochemical staining for membranous E-cadherin (P &amp;lt; .0001) and increased staining for nuclear E-cadherin (P &amp;lt; .0001). Furthermore, high FSH expression was associated with increased ERα staining (P = .0002) and ERα mRNA (P = .0039). Circulating levels of plasma-FSH (P-FSH) correlated with FSH staining in gonadotroph NF-PitNET (P = .0025). Tumor size and invasiveness was not related to FSH staining, E-cadherin, or ERα. LH expression was not associated with E-cadherin or ERα. Conclusion In gonadotroph PitNETs, FSH staining is related to E-cadherin, ERα expression, and circulating levels of P-FSH. There was no association between FSH staining and invasiveness. The clinical significance of these findings will be investigated in ongoing prospective studies.

• Sævik, Åse Bjorvatn; Åkerman, Anna-Karin; Methlie, Paal; Quinkler, Marcus; Jørgensen, Anders Palmstrøm & Høybye, Charlotte [Vis alle 26 forfattere av denne artikkelen] (2020). Residual Corticosteroid Production in Autoimmune Addison Disease. Journal of Clinical Endocrinology and Metabolism (JCEM). ISSN 0021-972X. 105(7), s. 2430–2441. doi: 10.1210/clinem/dgaa256. Fulltekst i vitenarkiv Vis sammendrag

  Design: Two-staged, cross-sectional clinical study in 17 centers (Norway, Sweden, and Germany). Residual glucocorticoid (GC) production was defined as quantifiable serum cortisol and 11-deoxycortisol and residual mineralocorticoid (MC) production as quantifiable serum aldosterone and corticosterone after > 18 hours of medication fasting. Corticosteroids were analyzed by liquid chromatography–tandem mass spectrometry. Clinical variables included frequency of adrenal crises and quality of life. Peak cortisol response was evaluated by a standard 250 µg cosyntropin test. Results: Fifty-eight (30.2%) of 192 patients had residual GC production, more common in men (n = 33; P < 0.002) and in shorter disease duration (median 6 [0-44] vs 13 [0-53] years; P < 0.001). Residual MC production was found in 26 (13.5%) patients and associated with shorter disease duration (median 5.5 [0.5-26.0] vs 13 [0-53] years; P < 0.004), lower fludrocortisone replacement dosage (median 0.075 [0.050-0.120] vs 0.100 [0.028-0.300] mg; P < 0.005), and higher plasma renin concentration (median 179 [22-915] vs 47.5 [0.6-658.0] mU/L; P < 0.001). There was no significant association between residual production and frequency of adrenal crises or quality of life. None had a normal cosyntropin response, but peak cortisol strongly correlated with unstimulated cortisol (r = 0.989; P < 0.001) and plasma adrenocorticotropic hormone (ACTH; r = –0.487; P < 0.001). Conclusion: In established AAD, one-third of the patients still produce GCs even decades after diagnosis. Residual production is more common in men and in patients with shorter disease duration but is not associated with adrenal crises or quality of life. (J Clin Endocrinol Metab 105: 1–12, 2020) Key words: Adrenal failure; adrenal steroids; Autoimmune Addison disease; cortisol; primary adrenal insufficiency; residual function

• Tazmini, Kiarash; Meling, Torstein Ragnar; Skattør, Thor Håkon; Jørstad, Øystein Kalsnes & Jørgensen, Anders Palmstrøm (2017). A woman in her 50s with chronic fatigue syndrome, sepsis and hyponatraemia. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 137(5), s. 372–377. doi: 10.4045/tidsskr.16.0896. Fulltekst i vitenarkiv
• Sævik, Åse Bjorvatn; Åkerman, Anna Karin; Grønning, Kaja; Nermoen, Ingrid; Valland, Susanna Fonneland & Finnes, Trine Elisabeth [Vis alle 22 forfattere av denne artikkelen] (2017). Clues for early detection of autoimmune Addison's disease - myths and realities. Journal of Internal Medicine. ISSN 0954-6820. 283(2), s. 190–199. doi: 10.1111/joim.12699. Fulltekst i vitenarkiv Vis sammendrag

  BACKGROUND: Early detection of autoimmune Addison's disease (AAD) is important as delay in diagnosis may result in a life-threatening adrenal crisis and death. The classical clinical picture of untreated AAD is well-described, but methodical investigations are scarce. OBJECTIVE: Perform a retrospective audit of patient records with the aim of identifying biochemical markers for early diagnosis of AAD. MATERIAL AND METHODS: A multicentre retrospective study including 272 patients diagnosed with AAD at hospitals in Norway and Sweden during 1978-2016. Scrutiny of medical records provided patient data and laboratory values. RESULTS: Low sodium occurred in 207 of 247 (84%), but only one-third had elevated potassium. Other common nonendocrine tests were largely normal. TSH was elevated in 79 of 153 patients, and hypoglycaemia was found in 10%. Thirty-three per cent were diagnosed subsequent to adrenal crisis, in whom electrolyte disturbances were significantly more pronounced (P < 0.001). Serum cortisol was consistently decreased (median 62 nmol L(-1) [1-668]) and significantly lower in individuals with adrenal crisis (38 nmol L(-1) [2-442]) than in those without (81 nmol L(-1) [1-668], P < 0.001). CONCLUSION: The most consistent biochemical finding of untreated AAD was low sodium independent of the degree of glucocorticoid deficiency. Half of the patients had elevated TSH levels. Only a minority presented with marked hyperkalaemia or other nonhormonal abnormalities. Thus, unexplained low sodium and/or elevated TSH should prompt consideration of an undiagnosed AAD, and on clinical suspicion bring about assay of cortisol and ACTH. Presence of 21-hydroxylase autoantibodies confirms autoimmune aetiology. Anticipating additional abnormalities in routine blood tests may delay diagnosis.

• Bruserud, Øyvind; Oftedal, Bergithe Eikeland; Landegren, Nils; Erichsen, Martina Moter; Bratland, Eirik & Lima, Kari [Vis alle 21 forfattere av denne artikkelen] (2016). A longitudinal follow-up of autoimmune polyendocrine syndrome type 1. Journal of Clinical Endocrinology and Metabolism (JCEM). ISSN 0021-972X. 101(8), s. 2975–2983. doi: 10.1210/jc.2016-1821. Fulltekst i vitenarkiv Vis sammendrag

  Context: Autoimmune polyendocrine syndrome type 1 (APS1) is a childhood-onset monogenic disease defined by the presence of two of the three major components: hypoparathyroidism, primary adrenocortical insufficiency, and chronic mucocutaneous candidiasis (CMC). Information on longitudinal follow-up of APS1 is sparse. Objective: To describe the phenotypes of APS1 and correlate the clinical features with autoantibody profiles and autoimmune regulator (AIRE) mutations during extended follow-up (1996–2016). Patients: All known Norwegian patients with APS1. Results: Fifty-two patients from 34 families were identified. The majority presented with one of the major disease components during childhood. Enamel hypoplasia, hypoparathyroidism, and CMC were the most frequent components. With age, most patients presented three to five disease manifestations, although some had milder phenotypes diagnosed in adulthood. Fifteen of the patients died during follow-up (median age at death, 34 years) or were deceased siblings with a high probability of undisclosed APS1. All except three had interferon-ω) autoantibodies, and all had organ-specific autoantibodies. The most common AIRE mutation was c.967_979del13, found in homozygosity in 15 patients. A mild phenotype was associated with the splice mutation c.879+1G>A. Primary adrenocortical insufficiency and type 1 diabetes were associated with protective human leucocyte antigen genotypes. Conclusions: Multiple presumable autoimmune manifestations, in particular hypoparathyroidism, CMC, and enamel hypoplasia, should prompt further diagnostic workup using autoantibody analyses (eg, interferon-ω) and AIRE sequencing to reveal APS1, even in adults. Treatment is complicated, and mortality is high. Structured follow-up should be performed in a specialized center.

• Ueland, Thor; Olarescu, Nicoleta Cristina; Jørgensen, Anders Palmstrøm; Otterdal, Kari; Aukrust, Pål & Godang, Kristin [Vis alle 8 forfattere av denne artikkelen] (2015). Increased serum and bone matrix levels of the secreted Wnt antagonist DKK-1 in patients with growth hormone deficiency in response to growth hormone treatment. Journal of Clinical Endocrinology and Metabolism (JCEM). ISSN 0021-972X. 100(2), s. 736–743. doi: 10.1210/jc.2014-2912. Fulltekst i vitenarkiv
• Olarescu, Nicoleta Cristina; Jørgensen, Anders Palmstrøm; Godang, Kristin; Jurik, Anne Grethe; Frøslie, Kathrine Frey & Bollerslev, Jens (2014). Dual-energy X-ray absorptiometry is a valid method to estimate visceral adipose tissue in adult patients with Prader-Willi syndrome during treatment with growth hormone. Journal of Clinical Endocrinology and Metabolism (JCEM). ISSN 0021-972X. 99(9), s. E1727–E1731. doi: 10.1210/jc.2014-2059. Fulltekst i vitenarkiv
• Jørgensen, Anders Palmstrøm; Ueland, Thor; Sode-Carlsen, Rasmus; Schreiner, Thomas; Rabben, Kai Fr. & Farholt, Stense [Vis alle 9 forfattere av denne artikkelen] (2014). Glucose homeostasis in adults with Prader-Willi syndrome during treatment with growth hormone: Results from a 12-month prospective study. Growth Hormone & IGF Research. ISSN 1096-6374. 24(1), s. 16–21. doi: 10.1016/j.ghir.2013.11.002. Fulltekst i vitenarkiv
• Jørgensen, Anders Palmstrøm; Ueland, Thor; Sode-Carlsen, Rasmus; Schreiner, Thomas; Rabben, Kai Fr. & Farholt, S. [Vis alle 9 forfattere av denne artikkelen] (2013). Two Years of Growth Hormone Treatment in Adults With Prader-Willi Syndrome Do Not Improve the Low BMD. Journal of Clinical Endocrinology and Metabolism (JCEM). ISSN 0021-972X. 98(4), s. E753–E760. doi: 10.1210/jc.2012-3378. Fulltekst i vitenarkiv
• Ueland, Thor; Lekva, Tove; Otterdal, Kari; Dahl, Tuva Børresdatter; Olarescu, Nicoleta Cristina & Jørgensen, Anders Palmstrøm [Vis alle 10 forfattere av denne artikkelen] (2011). Increased serum and bone matrix levels of transforming growth factor beta 1 in patients with GH deficiency in response to GH treatment. European Journal of Endocrinology (EJE). ISSN 0804-4643. 165(3), s. 393–400. doi: 10.1530/EJE-11-0442. Fulltekst i vitenarkiv
• Jørgensen, Anders Palmstrøm; Fougner, Kristian J; Ueland, Thor; Gudmundsen, Ola; Burman, Pia & Schreiner, Thomas [Vis alle 7 forfattere av denne artikkelen] (2011). Favorable long-term effects of growth hormone replacement therapy on quality of life, bone metabolism, body composition and lipid levels in patients with adult-onset growth hormone deficiency. Growth Hormone & IGF Research. ISSN 1096-6374. 21(2), s. 69–75. doi: 10.1016/j.ghir.2011.01.001. Fulltekst i vitenarkiv
• Ueland, Thor; Jørgensen, Anders Palmstrøm; Godang, Kristin; Fougner, Kristian J; Aukrust, Pål & Burman, Pia [Vis alle 7 forfattere av denne artikkelen] (2011). Interleukin 1 receptor antagonist is associated with changes in body composition during physiological GH substitution in patients with adult-onset growth hormone deficiency. Clinical Endocrinology. ISSN 0300-0664. 74(1), s. 60–66. doi: 10.1111/j.1365-2265.2010.03884.x. Fulltekst i vitenarkiv
• Bollerslev, Jens; Hallén, Jostein; Fougner, Kristian J; Jørgensen, Anders Palmstrøm; Kristo, Cybele & Fagertun, Hans [Vis alle 9 forfattere av denne artikkelen] (2005). Low-dose GH improves exercise capacity in adults with GH deficiency : effects of a 22-month placebo-controlled, crossover trial. European Journal of Endocrinology (EJE). ISSN 0804-4643. 153(3), s. 379–387. Fulltekst i vitenarkiv Vis sammendrag

  Fifty-five patients with adult-onset GH deficiency (mean age, 49 years) were enrolled in a placebo-controlled, crossover study to investigate the effects of GH therapy on exercise capacity, body composition, and quality of life (QOL). GH and placebo were administered for 9 months each, separated by a 4-month washout period. GH therapy was individually dosed to obtain an IGF-I concentration within the normal range for age and sex. The final mean daily dose of GH was 1.2 IU/day for men and 1.8 IU/day for women. Mean IGF-I concentration at baseline was higher in men than in women (95+/-33 vs 68+/-41 microg/l respectively; P < 0.04) and increased to a similar level on GH therapy. Body fat mass was reduced by 1.9+/-2.9 kg and lean body mass was increased by 1.8+/-2.8 kg (P = 0.0001 for each) with GH treatment. Total and low-density cholesterol levels decreased. Absolute maximal oxygen uptake increased by 6% (P = 0.01), relative to body weight by 9% (P = 0.004), and there was a trend toward increased endurance performance by 7% (P = 0.07). There were no significant effects on QOL. In conclusion, treatment with a low, physiologic dose of GH produced positive effects on body composition and lipids and improved exercise capacity, likely to be of clinical relevance. No changes in QOL were seen, possibly because of a good QOL at baseline.

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• Børøsund, Elin; Abelsen, Kari Irene; Jørgensen, Anders Palmstrøm; Schie, Line Cecilie Krabbe & Seljelid, Berit (2026). Patient Experiences with the Digital Communication Tool InvolveMe in Outpatient Management of Pituitary Adenomas. Fulltekst i vitenarkiv
• Jørgensen, Anders Palmstrøm & Bollerslev, Jens (2012). BONE Growth hormone replacement-implications for bone health. Nature Reviews Endocrinology. ISSN 1759-5029. 8(6), s. 325–326. doi: 10.1038/nrendo.2012.50. Fulltekst i vitenarkiv
• Jørgensen, Anders Palmstrøm; Ueland, Thor; Sode-Carlsen, Rasmus; Schreiner, Thomas; Rabben, Kai Fr. & Farholt, Stense [Vis alle 9 forfattere av denne artikkelen] (2010). Growth Hormone Treatment in Adults with Prader-Willi Syndrome Increases Bone Formative Markers, but Not Bone Resorption and Bone Mass: Results from a 12 Months Placebo-Controlled Study. Endocrine reviews. ISSN 0163-769X. 31(3). Fulltekst i vitenarkiv

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