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ABSTRACT: Differentiation between the two major subgroups of primary aldosteronism, bilateral hyperplasia and aldosterone producing adenoma is essential since therapy in the former is medical and in the latter surgical. The aim of the present study was to evaluate the clinical utility of adrenocortical scintigraphy in the management of primary aldosteronism.
[131I] norcholesterol (NP-59) scintigraphy with dexamethasone suppression for subclassification and lateralization of primary aldosteronism was evaluated in 49 patients with long-term follow-up after diagnosis and treatment.
Thirty-three patients with the diagnosis of aldosterone producing adenoma were operated with adrenalectomy. Preoperative scintigraphy showed lateralized isotope uptake in 27/33 patients while 6 showed no uptake. Twenty-two were cured and three significantly improved. Thus, in 25/33 (76%), scintigraphy showed the correct side as the patients benefited of surgery. Two patients did not improve. Fourteen patients with a probable diagnosis of bilateral hyperplasia had normal scintigraphies.
In the present retrospective study we found limited sensitivity of NP-59 scintigraphy. However, when a lateralized scintigraphic uptake is achieved it has a high accuracy. Scintigraphy may be used as an adjunct in cases where adrenal venous sampling is inconclusive.
Scandinavian journal of surgery: SJS: official organ for the Finnish Surgical Society and the Scandinavian Surgical Society 02/2008; 97(3):248-53. · 1.03 Impact Factor
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O Törring
Lakartidningen 11/2001; 98(42):4552-3.
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O Törring
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ABSTRACT: The increasing number of fractures due to osteoporosis continues to put economical and practical burdens on the national health service. Despite the fact that knowledge of the disease and its consequences has increased tremendously and new, effective drugs have been developed only a minority of the patients are diagnosed and appropriately treated. Resources should be made available to improve methods of measuring bone mineral density as well as establishing outpatient osteoporosis clinics at all hospitals in the country. Age ought not to be a limiting factor to initiate treatment or prevention of fractures. The present situation for the osteoporosis patient, the clinical syndromes with special reference to age-related and secondary osteoporosis, their causes, diagnosis and treatment are briefly reviewed.
Lakartidningen 08/2001; 98(28-29):3220-4.
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ABSTRACT: The patients' views and costs of three different forms of treatment for Graves' hyperthyroidism were investigated. The study comprises 174 patients with Graves' hyperthyroidism who were stratified into two age groups: 20 to 34 years and 35 to 55 years. The younger group was randomly assigned to treatment with antithyroid drug plus thyroxine for 18 months or subtotal thyroidectomy, and in the older group iodine-131 was added as a third alternative. The patients' views of their therapy were based on a questionnaire formulated to identify possible differences between the three treatment forms. The costs were assessed by analyzing the official hospital reimbursement system for both outpatient and inpatient costs for a period of 2 years from the day of randomization. The results show that no significant differences in opinion were found between the five treatment groups with regard to any of the questions. Furthermore, only 10% of the patients expressed slight and 3% major hesitation to recommend the treatment form received to a friend with similar disease. Twenty percent of the patients with endocrine ophthalmopathy reported the eye problems to be much more troublesome and 14% somewhat more troublesome than the thyroid problems. The cost proportion between the medical and surgical treatment in the young group was 1:2.5 (1 = 1126 United States dollars [USD]) before and 1:1.3 (1 = 2284 USD) after inclusion of the relapse costs. The proportion between the medical, surgical, and iodine-131 treatment in the older group was 1:2.5:1.6 (1 = 1164 USD) before and 1:1.6:1.4 (1 = 1972 USD) after inclusion of the relapse costs.
Thyroid 09/1998; 8(8):653-9. · 4.79 Impact Factor
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ABSTRACT: During recent years parathyroid hormone-related protein (PTHrP) research has been focused on the physiological functions of different fragments of the PTHrP molecule. Here we demonstrate that PTHrP (1-37) induced cyclic adenosine monophosphate (cAMP) response in primary human osteoblast-like cells, which were well characterized by the presence of alkaline phosphatase activity and osteocalcin production after stimulation with 1,25-dihydroxyvitamin D3. However, there was no cAMP response to PTHrP (58-77). Furthermore, the response to PTHrP (1-37) was dose dependent, with a significant increase at 1 nM. The presence of PTHrP (1-37)-induced cAMP response in human osteoblast-like cells implies that aminoterminal PTHrP fragments may exert important functions in the bone.
Calcified Tissue International 03/1998; 62(3):250-4. · 2.38 Impact Factor
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Lakartidningen 10/1996; 93(36):3050-2.
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ABSTRACT: To analyze the benefits and risks of three common treatments, we randomly assigned 179 patients with Graves' hyperthyroidism as follows: 60 patients, 20-34 yr of age (young adults), received antithyroid drugs for 18 months (medical) or subtotal thyroidectomy (surgical), and 119 patients, 35-55 yr of age (old adults), received medical, surgical, or radioiodine (iodine-131) treatment. The follow-up time was at least 48 months. Antithyroid drugs, surgery, or iodine-131 treatment normalized the mean serum hormone levels within 6 weeks. The risk of relapse was highest in the medically treated young and old adults (42% vs. 34%), followed by that in those treated with iodine-131 (21%) and that in the surgically treated young and old adults (3% vs 8%), respectively. Elevated TSH receptor antibodies at the end of medical therapy or increasing TSH receptor antibodies values after medical or surgical treatment increased the probability of relapse. Development or worsening of ophthalmopathy was not associated with relapse per se. Ninety percent of the subjects in all groups were satisfied with the treatment they received. No significant difference in sick-leave due to Graves' or other diseases was seen during the first 2 yr after initiation of therapy. The increased risk of ophthalmopathy in patients with high serum T3 levels, especially when treated with iodine-131, and the relatively high frequency of relapse after treatment with antithyroid drugs are important factors to consider when selecting therapy for Graves' disease.
Journal of Clinical Endocrinology & Metabolism 09/1996; 81(8):2986-93. · 6.50 Impact Factor
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ABSTRACT: Lithium is known to interfere with normal calcium homeostasis, but the long-term effects and possible clinical significance are uncertain. Thus, we measured indices of parathyroid function including intact parathyroid hormone (PTH) and ionized and total calcium levels in 26 patients treated for manic-depressive psychosis with lithium for 10 years or longer (mean +/- SD duration, 15 +/- 6 years). Increased ionized calcium levels were found in 11 patients and increased PTH concentrations in five patients. Altogether, 54% of the patients (14 of 26) had ionized calcium and/or PTH levels above the laboratory reference range. The PTH/ionized calcium relationship of the lithium-treated patients was compared with that of a group of normal subjects (n = 23) and with those of three different groups of patients with abnormal parathyroid function (chronic hypoparathyroidism, n = 21; primary hyperparathyroidism [HPT], n = 50; and tertiary HPT, n = 21). Lithium-treated patients had significantly higher ionized calcium levels (P < .0001) but not significantly higher PTH concentrations (P = .08) than the normal subjects. In comparison to the normal controls, lithium-treated patients had a right-sided shift in their PTH/ionized calcium relationship that was in the same direction but less prominent than in primary or tertiary HPT. Dual-energy x-ray absorptiometry disclosed similar bone mineral densities (BMDs) of lithium-treated patients and age-, sex-, and body mass-matched normal controls in the whole body, lumbar spine, and femoral neck (Z scores: +1.20, +1.22, and +1.02, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Metabolism 12/1994; 43(12):1563-7. · 2.66 Impact Factor
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ABSTRACT: In the first part of this study, we examined TSH receptor (TSHR) and thyroid hormone receptor (T3R beta) messenger ribonucleic acid (mRNA) levels in normal, hyperplastic, and neoplastic human thyroid tissue. Tumor specimens from patients with different thyroid carcinomas and thyroid adenomas, and tissues from patients with Graves' disease and from normal thyroid glands were analyzed by solution hybridization and Northern blot using complementary RNA probes. In the second part of the study, mRNA analysis of T3R was extended to include the expression levels of each of the four T3R isoforms alpha 1, alpha 2, beta 1, and beta 2. In neoplastic thyroid tissue such as papillary and follicular carcinomas, the expression of both TSHR and T3R beta mRNA per microgram total RNA was significantly lower than that in normal thyroid tissue. The decrease in T3R beta mRNA was shown to represent a specific and significant decrease in T3R beta 2 mRNA levels in particular, but also in the expression levels of T3R beta 1 mRNA. No differences were found in the expression levels of T3R alpha 1 or -alpha 2 mRNA. Furthermore, no differences in TSHR or T3R mRNA levels were found in thyroid tissue from patients with Graves' disease compared to normal thyroid tissue. It is concluded that the reduction of TSHR and T3R mRNA in specific neoplastic thyroid tissues might be associated with the differentiation state of these tumors and that the decrease in T3R mRNA levels is due to a specific decrease in the expression levels of the T3R beta gene.
Journal of Clinical Endocrinology & Metabolism 09/1994; 79(2):384-9. · 6.50 Impact Factor
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ABSTRACT: Secondary hyperparathyroidism has been suggested as a cause of itching in chronic renal failure. The aim of the present study was to evaluate the possible role of parathyroid hormone (PTH) in pruritus affecting patients undergoing maintenance haemodialysis. In agreement with our previous findings, patients with pruritus had significantly (P less than 0.01) higher serum levels of PTH fragment 53-68 (m-PTH53-68) than patients without pruritus, 47.7 +/- 40.0 and 23.4 +/- 17.1 micrograms l-1 respectively. Serum concentrations of other substances including calcium, phosphate and magnesium did not differ between the two groups of patients. Intradermal injections of human PTH1-34 and PTH44-68 failed to evoke any acute or delayed cutaneous reactions in either patients or controls. Immunohistochemical investigations of skin biopsies from uraemic patients using several different antibodies against PTH were negative. Thus, the present results do not support PTH as a peripheral mediator of uraemic itching.
Journal of Internal Medicine 07/1989; 225(6):411-5. · 5.48 Impact Factor
