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  1. Article: Trends in Incidence of Chronic Heart Failure in Patients With Rheumatoid Arthritis: A Population-Based Study Validating Different Heart Failure Definitions.

    Myasoedova, Elena / Kurmann, Reto D / Achenbach, Sara J / Wright, Kerry / Arment, Courtney A / Dunlay, Shannon M / Davis, John M / Crowson, Cynthia S

    The Journal of rheumatology

    2023  Volume 50, Issue 7, Page(s) 881–888

    Abstract: Objective: To assess trends in the incidence of heart failure (HF) in patients with incident rheumatoid arthritis (RA) from 1980 to 2009 and to compare different HF definitions in RA.: Methods: The study population comprised Olmsted County, Minnesota ...

    Abstract Objective: To assess trends in the incidence of heart failure (HF) in patients with incident rheumatoid arthritis (RA) from 1980 to 2009 and to compare different HF definitions in RA.
    Methods: The study population comprised Olmsted County, Minnesota residents with incident RA (age ≥ 18 yrs, 1987 American College of Rheumatology criteria met in 1980-2009). All subjects were followed until death, migration, or April 30, 2019. Incident HF events were defined as follows: (1) meeting the Framingham criteria for HF, (2) diagnosis of HF (outpatient or inpatient) by a physician, or (3) International Classification of Diseases, 9th revision (ICD-9), or ICD, 10th revision (ICD-10), codes for HF. Patients with HF prior to the RA incidence/index date were excluded. Cox proportional hazards models were used to compare incident HF events by decade, adjusting for age, sex, and cardiovascular risk factors. HF definitions 2 and 3 were compared to the Framingham criteria.
    Results: The study included 905 patients with RA (mean age 55.9 years; 68.6% female; median follow-up 13.4 years). The 10-year cumulative incidence of HF events by any chart-reviewed method in the RA cohort in the 1980s was 11.66% (95% CI 7.86-17.29), in the 1990s it was 12.64% (95% CI 9.31-17.17), and in the 2000s it was 7.67% (95% CI 5.36-10.97). The incidence of HF did not change across the decades of RA incidence using any of the HF definitions. Physician diagnosis of HF and ICD-9/10 code-based definitions of HF performed well compared to the Framingham criteria, showing moderate to high sensitivity and specificity.
    Conclusion: The incidence of HF in patients with incident RA in the 2000s vs the 1980s was not statistically significantly different. Physician diagnosis of HF and ICD-9/10 codes for HF performed well against the Framingham criteria.
    MeSH term(s) Humans ; Female ; Middle Aged ; Adolescent ; Male ; Incidence ; Arthritis, Rheumatoid/diagnosis ; Arthritis, Rheumatoid/epidemiology ; Arthritis, Rheumatoid/complications ; Heart Failure/diagnosis ; Heart Failure/epidemiology ; Heart Failure/etiology ; Chronic Disease ; Minnesota/epidemiology
    Language English
    Publishing date 2023-03-15
    Publishing country Canada
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 194928-7
    ISSN 1499-2752 ; 0315-162X
    ISSN (online) 1499-2752
    ISSN 0315-162X
    DOI 10.3899/jrheum.221170
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  2. Article ; Online: The Incidence and Outcomes of Breast Implants Among 1696 Women over more than 50 Years.

    Peterson, Madeline N / Giblon, Rachel E / Achenbach, Sara J / Davis, John M / TerKonda, Sarvam P / Crowson, Cynthia S

    Aesthetic plastic surgery

    2023  Volume 47, Issue 6, Page(s) 2268–2276

    Abstract: Objective: To investigate the incidence of women with breast implants in 1964-2017 MATERIALS AND METHODS: All women with breast implants in Olmsted County, MN between January 1, 1992 and December 31, 2017 were identified, and a comprehensive review of ... ...

    Abstract Objective: To investigate the incidence of women with breast implants in 1964-2017 MATERIALS AND METHODS: All women with breast implants in Olmsted County, MN between January 1, 1992 and December 31, 2017 were identified, and a comprehensive review of individual medical records was performed, adding to a previously identified cohort of women with breast implants in 1964-1991. Incidence rates were calculated and were age- and sex-adjusted to the US white female 2010 population.
    Results: In 1992-2017, 948 women with breast implants were identified, totaling 1696 Olmsted County, MN women with breast implants in 1964-2017. Overall incidence was 63.3 (95% CI 60.2-66.4) per 100,000 women, but incidence varied significantly over time. Women in 1964-1991 were more likely to have implants for cosmetic reasons and more likely to have silicone implants compared to the 1992-2017 cohort. The overall standardized mortality ratio was 1.17 (95% CI 0.99-1.38) in 1964-1991 and 0.94 (95% CI 0.66-1.29) in 1992-2017. In 1992-2017, breast reconstruction patients had a significantly elevated risk of implant rupture and implant removal versus breast augmentation patients.
    Conclusion: The incidence of breast implants among women in Olmsted County, MN has varied drastically over the past five decades, with significant changes in the trends for implant type and reason. The findings of this study may provide further insight regarding how risks associated with implants may vary over time.
    Level of evidence iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
    MeSH term(s) Female ; Humans ; Breast Implants/adverse effects ; Incidence ; Follow-Up Studies ; Reoperation ; Breast Implantation/adverse effects ; Mammaplasty ; Treatment Outcome
    Language English
    Publishing date 2023-08-14
    Publishing country United States
    Document type Review ; Journal Article
    ZDB-ID 532791-x
    ISSN 1432-5241 ; 0364-216X
    ISSN (online) 1432-5241
    ISSN 0364-216X
    DOI 10.1007/s00266-023-03535-4
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  3. Article ; Online: Kidney function in patients with adrenal adenomas: A single-center retrospective cohort study.

    Rahimi, Leili / Kittithaworn, Annop / Gregg Garcia, Raul / Saini, Jasmine / Dogra, Prerna / Atkinson, Elizabeth J / Achenbach, Sara J / Kattah, Andrea / Bancos, Irina

    The Journal of clinical endocrinology and metabolism

    2023  

    Abstract: Objective: Patients with nonfunctioning adrenal adenomas (NFA) and mild autonomous cortisol secretion (MACS) demonstrate an increased risk of chronic kidney disease (CKD), however factors associated with CKD are unknown. We aimed to identify the factors ...

    Abstract Objective: Patients with nonfunctioning adrenal adenomas (NFA) and mild autonomous cortisol secretion (MACS) demonstrate an increased risk of chronic kidney disease (CKD), however factors associated with CKD are unknown. We aimed to identify the factors associated with CKD and assess the impact of adrenalectomy on kidney function in patients with NFA or MACS.
    Design: Single-center cohort study of patients with NFA and MACS, 1999-2020.
    Methods: MACS was diagnosed based on post-dexamethasone cortisol (DST) ≥ 1.8 mcg/dL. Age, sex, dysglycemia, hypertension, therapy with statin, angiotensin converting enzyme inhibitor, or angiotensin II receptor blocker were included in the multivariable analysis. Outcomes included estimated glomerular filtration rate (eGFR) at the time of diagnosis with MACS or NFA and post-adrenalectomy delta eGFR.
    Results: Of 972 patients, 429 (44%) had MACS and 543 (56%) had NFA. At the time of diagnosis, patients with MACS had lower eGFR (median 79.6 vs 83.8 ml/min/1.73m2, p < 0.001) than patients with NFA. In a multivariable analysis, factors associated with lower eGFR were older age, hypertension, and higher DST. In 204 patients (MACS: 155, 76% and NFA: 49, 24%) treated with adrenalectomy, post adrenalectomy eGFR improved in both groups starting at 18 months up to 3.5 years of follow up. Factors associated with increased eGFR were younger age, lower pre-adrenalectomy eGFR and longer follow-up period.
    Conclusion: DST cortisol is an independent risk factor for lower eGFR in patients with adrenal adenomas. Both patients with MACS and NFA demonstrate an increase in eGFR post-adrenalectomy, especially younger patients with lower eGFR pre-adrenalectomy.
    Language English
    Publishing date 2023-12-29
    Publishing country United States
    Document type Journal Article
    ZDB-ID 3029-6
    ISSN 1945-7197 ; 0021-972X
    ISSN (online) 1945-7197
    ISSN 0021-972X
    DOI 10.1210/clinem/dgad765
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  4. Article: Improved Incidence of Cardiovascular Disease in Patients With Incident Rheumatoid Arthritis in the 2000s: A Population-based Cohort Study.

    Myasoedova, Elena / Davis, John M / Roger, Veronique L / Achenbach, Sara J / Crowson, Cynthia S

    The Journal of rheumatology

    2021  Volume 48, Issue 9, Page(s) 1379–1387

    Abstract: Objective: To assess trends in incidence of cardiovascular disease (CVD) and mortality following incident CVD events in patients with rheumatoid arthritis (RA) onset in 1980-2009 vs non-RA subjects.: Methods: We studied Olmsted County, Minnesota ... ...

    Abstract Objective: To assess trends in incidence of cardiovascular disease (CVD) and mortality following incident CVD events in patients with rheumatoid arthritis (RA) onset in 1980-2009 vs non-RA subjects.
    Methods: We studied Olmsted County, Minnesota residents with incident RA (aged > 18 yrs, 1987 American College of Rheumatology criteria met in 1980-2009) and non-RA subjects from the same source population with similar age, sex, and calendar year of index. All subjects were followed until death, migration, or December 31, 2016. Incident CVD events included myocardial infarction and stroke. Patients with CVD before RA incidence/index date were excluded. Cox models were used to compare incident CVD events by decade, adjusting for age, sex, and CVD risk factors.
    Results: The study included 905 patients with RA and 904 non-RA subjects. Cumulative incidence of any CVD event was lower in patients with incident RA in the 2000s vs the 1980s. The HR for any incident CVD in the 2000s vs 1980s was 0.53 (95% CI 0.31-0.93). The strength of association attenuated after adjustment for anti-rheumatic medication use (HR 0.64, 95% CI 0.34-1.22). Patients with RA in the 2000s had no excess in CVD over non-RA subjects (HR 0.71, 95% CI 0.42-1.19). Risk of death after a CVD event was somewhat lower in patients with RA after the 1980s with an HR of 0.54 (95% CI 0.33-0.90) in the 1990s vs 1980s and 0.68 (95% CI 0.33-1.41) in the 2000s vs 1980s.
    Conclusion: The incidence of major CVD events in RA has declined in recent decades. The gap in CVD occurrence between patients with RA and the general population is closing. Mortality after CVD events in RA may be improving.
    MeSH term(s) Antirheumatic Agents/therapeutic use ; Arthritis, Rheumatoid/drug therapy ; Arthritis, Rheumatoid/epidemiology ; Cardiovascular Diseases/drug therapy ; Cardiovascular Diseases/epidemiology ; Cohort Studies ; Humans ; Incidence
    Chemical Substances Antirheumatic Agents
    Language English
    Publishing date 2021-02-15
    Publishing country Canada
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 194928-7
    ISSN 1499-2752 ; 0315-162X
    ISSN (online) 1499-2752
    ISSN 0315-162X
    DOI 10.3899/jrheum.200842
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  5. Article ; Online: Incidence, Risk Factors, and Mortality of Clinical and Subclinical Rheumatoid Arthritis-Associated Interstitial Lung Disease: A Population-Based Cohort.

    Samhouri, Bilal F / Vassallo, Robert / Achenbach, Sara J / Kronzer, Vanessa L / Davis, John M / Myasoedova, Elena / Crowson, Cynthia S

    Arthritis care & research

    2022  Volume 74, Issue 12, Page(s) 2042–2049

    Abstract: Objective: To identify the incidence, risk factors, and outcomes of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) and to assess time trends in the incidence and mortality in RA-ILD.: Methods: We included adult residents of ... ...

    Abstract Objective: To identify the incidence, risk factors, and outcomes of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) and to assess time trends in the incidence and mortality in RA-ILD.
    Methods: We included adult residents of Olmsted County, Minnesota with incident RA between 1999 and 2014. Subjects were followed until death, emigration, or April 30, 2019. ILD was defined as the presence of a radiologist-defined pattern consistent with ILD on chest computed tomography (CT). When chest CT was absent, the combination of chest radiograph abnormalities compatible with ILD and restrictive pattern on pulmonary function testing was considered consistent with ILD. Potential risk factors included age, sex, smoking, obesity, seropositivity, extraarticular manifestations (EAMs), and medications. For survival analysis, we matched RA-ILD patients to RA-non-ILD comparators. The frequency and mortality from clinician-diagnosed RA-ILD from 1999 to 2014 was compared against a cohort from 1955 to 1994.
    Results: During the 1999-2014 time period, 645 individuals (70% women) had incident RA, were a median age of 55.3 years, and 53% never smoked. Twenty-two patients had ILD before RA, and 51 (67% women) developed ILD during follow-up. The 20-year cumulative incidence of RA-ILD was 15.3%. Ever-smoking (hazard ratio [HR] 1.92), age at RA onset (HR 1.89 per 10-year increase), and severe EAMs (HR 2.29) were associated with incident RA-ILD. The RA-ILD cases had higher mortality than their matched RA comparators (HR 2.42). Incidence of RA-ILD was non-significantly lower from 1999 to 2014 than from 1955 to1994, but mortality was improved.
    Conclusions: RA-ILD occurs in nearly 1 in 6 patients with RA within 20 years and is associated with shorter survival. Lack of significant change in RA-ILD incidence over 6 decades deserves further investigation.
    MeSH term(s) Adult ; Humans ; Female ; Middle Aged ; Male ; Incidence ; Lung Diseases, Interstitial/diagnostic imaging ; Lung Diseases, Interstitial/epidemiology ; Arthritis, Rheumatoid/diagnosis ; Arthritis, Rheumatoid/diagnostic imaging ; Risk Factors ; Proportional Hazards Models
    Language English
    Publishing date 2022-08-10
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 645059-3
    ISSN 2151-4658 ; 0893-7524 ; 2151-464X
    ISSN (online) 2151-4658
    ISSN 0893-7524 ; 2151-464X
    DOI 10.1002/acr.24856
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  6. Article ; Online: Frailty in Patients With Mild Autonomous Cortisol Secretion is Higher Than in Patients with Nonfunctioning Adrenal Tumors.

    Singh, Sumitabh / Atkinson, Elizabeth J / Achenbach, Sara J / LeBrasseur, Nathan / Bancos, Irina

    The Journal of clinical endocrinology and metabolism

    2020  Volume 105, Issue 9

    Abstract: Context: Mild autonomous cortisol secretion (MACS) affects up to 50% of patients with adrenal adenomas. Frailty is a syndrome characterized by the loss of physiological reserves and an increase in vulnerability, and it serves as a marker of declining ... ...

    Abstract Context: Mild autonomous cortisol secretion (MACS) affects up to 50% of patients with adrenal adenomas. Frailty is a syndrome characterized by the loss of physiological reserves and an increase in vulnerability, and it serves as a marker of declining health.
    Objective: To compare frailty in patients with MACS versus patients with nonfunctioning adrenal tumors (NFAT).
    Design: Retrospective study, 2003-2018.
    Setting: Referral center.
    Patients: Patients >20 years of age with adrenal adenoma and MACS (1 mg overnight dexamethasone suppression (DST) of 1.9-5 µg/dL) and NFAT (DST <1.9 µg/dL).
    Main outcome measure: Frailty index (range 0-1), calculated using a 47-variable deficit model.
    Results: Patients with MACS (n = 168) demonstrated a higher age-, sex-, and body mass index-adjusted prevalence of hypertension (71% vs 60%), cardiac arrhythmias (50% vs 40%), and chronic kidney disease (25% vs 17%), but a lower prevalence of asthma (5% vs 14%) than patients with NFAT (n = 275). Patients with MACS reported more symptoms of weakness (21% vs 11%), falls (7% vs 2%), and sleep difficulty (26% vs 15%) as compared with NFAT. Age-, sex- and BMI-adjusted frailty index was higher in patients with MACS vs patients with NFAT (0.17 vs 0.15; P = 0.009). Using a frailty index cutoff of 0.25, 24% of patients with MACS were frail, versus 18% of patients with NFAT (P = 0.028).
    Conclusion: Patients with MACS exhibit a greater burden of comorbid conditions, adverse symptoms, and frailty than patients with NFAT. Future prospective studies are needed to further characterize frailty, examine its responsiveness to adrenalectomy, and assess its influence on health outcomes in patients with MACS.
    MeSH term(s) Activities of Daily Living ; Adrenal Gland Neoplasms/epidemiology ; Adrenal Gland Neoplasms/metabolism ; Adrenal Gland Neoplasms/pathology ; Adrenocortical Adenoma/epidemiology ; Adrenocortical Adenoma/metabolism ; Adrenocortical Adenoma/pathology ; Adult ; Aged ; Aged, 80 and over ; Comorbidity ; Female ; Frailty/epidemiology ; Frailty/metabolism ; Humans ; Hydrocortisone/metabolism ; Male ; Middle Aged ; Retrospective Studies ; Young Adult
    Chemical Substances Hydrocortisone (WI4X0X7BPJ)
    Language English
    Publishing date 2020-07-23
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 3029-6
    ISSN 1945-7197 ; 0021-972X
    ISSN (online) 1945-7197
    ISSN 0021-972X
    DOI 10.1210/clinem/dgaa410
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  7. Article: Validating the Fracture Risk Assessment Tool Score in a US Population-Based Study of Patients With Rheumatoid Arthritis.

    Mousa, Jehan / Peterson, Madeline N / Crowson, Cynthia S / Achenbach, Sara J / Atkinson, Elizabeth J / Amin, Shreyasee / Khosla, Sundeep / Davis, John M / Myasoedova, Elena

    The Journal of rheumatology

    2023  Volume 50, Issue 10, Page(s) 1279–1286

    Abstract: Objective: The World Health Organization fracture risk assessment tool (FRAX) algorithm for risk prediction of major osteoporotic and hip fractures accounts for several risk factors, including rheumatoid arthritis (RA), since individuals with RA have an ...

    Abstract Objective: The World Health Organization fracture risk assessment tool (FRAX) algorithm for risk prediction of major osteoporotic and hip fractures accounts for several risk factors, including rheumatoid arthritis (RA), since individuals with RA have an excess burden of fractures. FRAX has not been validated in population-based RA cohorts in the US. We aimed to determine the accuracy of FRAX predictions for individuals with RA in the US.
    Methods: This retrospective population-based cohort study included residents of Olmsted County, Minnesota, who were followed until death, migration, or last medical record review. Each patient with RA (1987 American College of Rheumatology criteria met in 1980-2007, age 40-89 years) was matched 1:1 on age and sex to an individual without RA from the same underlying population. Ten-year predictions for major osteoporotic and hip fractures were estimated using the FRAX tool. Fractures were ascertained through follow-up, truncated at 10 years. Standardized incidence ratios (SIRs) and 95% CI were calculated to compare observed and predicted fractures.
    Results: The study included 662 patients with RA and 658 non-RA comparators (66.8% vs 66.9% female and a mean age of 60.6 vs 60.5 years, respectively). Among patients with RA, 76 major osteoporotic fractures and 21 hip fractures were observed during follow-up (median follow-up: 9.0 years) compared to 67.0 predicted major osteoporotic fractures (SIR 1.13, 95% CI 0.91-1.42) and 23.3 predicted hip fractures (SIR 0.90, 95% CI 0.59-1.38). The observed and predicted major osteoporotic and hip fracture risks were similar for patients with RA and non-RA comparators.
    Conclusion: The FRAX tool is an accurate method for estimating major osteoporotic and hip fracture risk in patients with RA.
    MeSH term(s) Humans ; Female ; Middle Aged ; Adult ; Aged ; Aged, 80 and over ; Male ; Osteoporotic Fractures/epidemiology ; Osteoporotic Fractures/etiology ; Cohort Studies ; Retrospective Studies ; Bone Density ; Risk Assessment/methods ; Arthritis, Rheumatoid/complications ; Arthritis, Rheumatoid/epidemiology ; Risk Factors ; Hip Fractures/epidemiology ; Hip Fractures/etiology
    Language English
    Publishing date 2023-07-01
    Publishing country Canada
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 194928-7
    ISSN 1499-2752 ; 0315-162X
    ISSN (online) 1499-2752
    ISSN 0315-162X
    DOI 10.3899/jrheum.2022-1293
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  8. Article ; Online: Risk of dementia and psychiatric or sleep disorders after diagnosis of adrenal adenomas: a population-based cohort study.

    Li, Dingfeng / Singh, Sumitabh / Zhang, Catherine D / Kaur, Ravinder Jeet / Ebbehoj, Andreas / Atkinson, Elizabeth J / Achenbach, Sara J / Stricker, Nikki H / Mielke, Michelle M / Rocca, Walter / Bancos, Irina

    European journal of endocrinology

    2023  Volume 189, Issue 4, Page(s) 429–437

    Abstract: Objective: Adrenal adenomas are commonly encountered in clinical practice. To date, population-based data on their impact on cognition, mental health, and sleep are lacking. We aimed to study possible associations between adrenal adenomas and dementia, ... ...

    Abstract Objective: Adrenal adenomas are commonly encountered in clinical practice. To date, population-based data on their impact on cognition, mental health, and sleep are lacking. We aimed to study possible associations between adrenal adenomas and dementia, psychiatric or sleep disorders.
    Design: Population-based cohort study, Olmsted County, MN, 1995-2017.
    Methods: Patients with adrenal adenoma and absent overt hormone excess were age- and sex-matched 1:1 to a referent person without adrenal adenoma. Outcomes were baseline and incident diagnoses of dementia, psychiatric or sleep disorders, assessed using ICD codes.
    Results: Of 1004 patients with adrenal adenomas, 582 (58%) were women, and median age at diagnosis was 63 years. At baseline, and after adjusting for age, sex, education, BMI, and tobacco use, patients with adenoma had higher odds of depression (adjusted odds ratio, aOR: 1.3, 95% CI, 1.1-1.6), anxiety (aOR: 1.4, 95% CI, 1.1-1.8), and substance abuse (aOR: 2.4, 95% CI, 1.7-3.4) compared to referents. During a median follow-up of 6.8 years, and after adjusting for age, sex, socioeconomic status, BMI, tobacco, and substance abuse, patients demonstrated a higher risk of psychiatric and sleep disorders [adjusted hazard ratio (95% CI)]: depression [1.7 (1.3-2.2)], anxiety [1.4, CI (1.1-1.7)], insomnia [1.4 (1.0-1.9)], sleep-related breathing disorders [1.5 (1.1-1.9)], hypersomnias [2.1 (1.0-4.2)], parasomnias [2.1 (1.0-4.2)], and sleep-related movement disorders [1.5 (1.0-2.1)], but not dementia.
    Conclusions: Patients with adenomas demonstrate a higher incidence of psychiatric and sleep disorders, possibly due to the underlying subtle increase in cortisol secretion.
    MeSH term(s) Humans ; Female ; Middle Aged ; Male ; Cohort Studies ; Sleep Wake Disorders/epidemiology ; Adrenocortical Adenoma ; Substance-Related Disorders ; Adenoma/diagnosis ; Adenoma/epidemiology ; Dementia/epidemiology
    Language English
    Publishing date 2023-10-06
    Publishing country England
    Document type Journal Article
    ZDB-ID 1183856-5
    ISSN 1479-683X ; 0804-4643
    ISSN (online) 1479-683X
    ISSN 0804-4643
    DOI 10.1093/ejendo/lvad135
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  9. Article ; Online: Determinants of muscle function and health-related quality of life in patients with endogenous hypercortisolism: a cross-sectional study.

    Li, Dingfeng / Zhang, Catherine D / Saini, Jasmine / Singh, Sumitabh / Nathani, Rohit / Thangamuthu, Karthik / Suresh, Malavika / Atkinson, Elizabeth J / Achenbach, Sara J / Van Gompel, Jamie / Young, William F / Bancos, Irina

    European journal of endocrinology

    2023  Volume 188, Issue 7, Page(s) 603–612

    Abstract: Objective: Prospective data on determinants of muscle strength impairment and quality of life in patients with various subtypes and severity of endogenous hypercortisolism are lacking.: Design: Single-center cross-sectional study, 2019 to 2022.: ... ...

    Abstract Objective: Prospective data on determinants of muscle strength impairment and quality of life in patients with various subtypes and severity of endogenous hypercortisolism are lacking.
    Design: Single-center cross-sectional study, 2019 to 2022.
    Methods: Patients with Cushing syndrome (CS) and mild autonomous cortisol secretion (MACS) were assessed with clinical and biochemical severity scores, muscle function (nondominant hand grip strength and sit-to-stand test), and quality of life (Short Form-36 [SF36] and CushingQoL). Referent subjects were recruited from the local population undergoing abdominal imaging for reasons other than suspected adrenal disorder.
    Results: Of 164 patients, 81 (49%) had MACS, 14 (9%) had adrenal CS, 60 (37%) had pituitary CS, and 9 (5%) had ectopic CS. Median age was 53 years (interquartile range: 42-63 years), and 126 (77%) were women. The SF36 mental component score was similarly low in patients with MACS vs CS, but physical component score was lower in CS when compared to MACS (mean of 34.0 vs 40.5, P = .001). Compared to MACS, patients with CS had lower scores on the standardized CushingQoL (mean of 47.1 vs 34.2, P < .001). Compared to referent subjects, patients with MACS demonstrated reduced muscle strength, similar to patients with CS (mean sit to stand Z-score of -0.47 vs -0.54, P = .822). Clinical severity (r = -0.22, P = .004) but not biochemical severity was associated with sit-to-stand test performance.
    Conclusions: Both patients with overt CS and MACS demonstrate reduced muscle strength and low quality of life. The clinical severity score utilized is associated with both physical and psychosocial components of CushingQoL and with the physical component of SF36.
    MeSH term(s) Humans ; Female ; Middle Aged ; Male ; Cushing Syndrome/complications ; Cross-Sectional Studies ; Quality of Life ; Prospective Studies ; Hand Strength ; Muscular Diseases ; Muscles ; Hydrocortisone
    Chemical Substances Hydrocortisone (WI4X0X7BPJ)
    Language English
    Publishing date 2023-06-14
    Publishing country England
    Document type Journal Article
    ZDB-ID 1183856-5
    ISSN 1479-683X ; 0804-4643
    ISSN (online) 1479-683X
    ISSN 0804-4643
    DOI 10.1093/ejendo/lvad069
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  10. Article ; Online: Glucocorticoid withdrawal syndrome following surgical remission of endogenous hypercortisolism: a longitudinal observational study.

    Zhang, Catherine D / Li, Dingfeng / Singh, Sumitabh / Suresh, Malavika / Thangamuthu, Karthik / Nathani, Rohit / Achenbach, Sara J / Atkinson, Elizabeth J / Van Gompel, Jamie J / Young, William F / Bancos, Irina

    European journal of endocrinology

    2023  Volume 188, Issue 7, Page(s) 592–602

    Abstract: Objective: Glucocorticoid withdrawal syndrome (GWS) is a scarcely studied phenomenon that complicates the recovery following surgical remission of hypercortisolism. We aimed to characterize the presence and trajectory of glucocorticoid withdrawal ... ...

    Abstract Objective: Glucocorticoid withdrawal syndrome (GWS) is a scarcely studied phenomenon that complicates the recovery following surgical remission of hypercortisolism. We aimed to characterize the presence and trajectory of glucocorticoid withdrawal symptoms in the postoperative period and to determine presurgical predictors of GWS severity.
    Design: Longitudinal observational study.
    Methods: Glucocorticoid withdrawal symptoms were prospectively evaluated weekly for the first 12 weeks following surgical remission of hypercortisolism. Quality of life (CushingQoL and Short-Form-36) and muscle function (hand grip strength and sit-to-stand test) were assessed at the baseline and at 12 weeks after surgery.
    Results: Prevalent symptoms were myalgias and arthralgias (50%), fatigue (45%), weakness (34%), sleep disturbance (29%), and mood changes (19%). Most symptoms persisted, while myalgias, arthralgias, and weakness worsened during weeks 5-12 postoperatively. At 12 weeks after surgery, normative hand grip strength was weaker than at baseline (mean Z-score delta -0.37, P = .009), while normative sit-to-stand test performance improved (mean Z-score delta 0.50, P = .013). Short-Form-36 Physical Component Summary score worsened (mean delta -2.6, P = .015), but CushingQoL score improved (mean delta 7.8, P < .001) at 12 weeks compared to baseline. Cushing syndrome (CS) clinical severity was predictive of postoperative GWS symptomology.
    Conclusion: Glucocorticoid withdrawal symptoms are prevalent and persistent following surgical remission of hypercortisolism with baseline CS clinical severity predictive of postoperative GWS symptom burden. Differential changes observed in muscle function and quality of life in the early postoperative period may reflect the competing influences of GWS and recovery from hypercortisolism.
    MeSH term(s) Humans ; Cushing Syndrome/surgery ; Glucocorticoids/therapeutic use ; Quality of Life ; Hand Strength ; Muscular Diseases ; Substance Withdrawal Syndrome
    Chemical Substances Glucocorticoids
    Language English
    Publishing date 2023-06-30
    Publishing country England
    Document type Observational Study ; Journal Article
    ZDB-ID 1183856-5
    ISSN 1479-683X ; 0804-4643
    ISSN (online) 1479-683X
    ISSN 0804-4643
    DOI 10.1093/ejendo/lvad073
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