Julie Sharpless - Academia.edu (original) (raw)

Papers by Julie Sharpless

Carolina Digital Repository (University of North Carolina at Chapel Hill), 2010

Background-Macroprolactin is a large, heterogeneous form of prolactin with limited bioavailabilit... more Background-Macroprolactin is a large, heterogeneous form of prolactin with limited bioavailability. Detection of macroprolactin by different immunoassays varies widely. The objectives of this study were to determine the immunoreactivity of macroprolactin by the Ortho Clinical Diagnostics Vitros ECi prolactin immunoassay, establish the most effective method for interpreting the prolactin concentration after PEG-precipitation, and correlate the clinical features of hyperprolactinemia with the presence of macroprolactin. Methods-PEG-precipitation was performed on 120 hyperprolactinemic specimens. Of these, 31 specimens with a recovery <80% were fractionated by GFC. Four different approaches for identifying true hyperprolactinemia were investigated. Clinical symptoms of hyperprolactinemia were determined by chart review. Results-Macroprolactin was detected by the Vitros ECi prolactin immunoassay. Use of a PEGmodified prolactin reference interval was effective for identifying hyperprolactinemia in the presence of macroprolactin. There was no difference in the prevalence of abnormal menses, galactorrhea, or abnormal MRI between those with and without macroprolactin (p>0.05). Accounting for macroprolactin in patients with hyperprolactinemia reduced the number of idiopathic cases. Conclusions-The Vitros ECi prolactin immunoassay detects macroprolactin. PEG-precipitation is an acceptable surrogate to detect hyperprolactinemia in the presence of macroprolactin when using a prolactin reference interval derived from PEG-precipitated reference sera. Although testing for macroprolactin should not substitute for standard evaluation of hyperprolactinemia, identification of macroprolactin may clarify a diagnosis and direct appropriate therapy.

The Journal of Clinical Endocrinology and Metabolism, May 1, 2002

Diabetologists have long recognized the comorbid diseases of obesity, hypertension, and hyperlipi... more Diabetologists have long recognized the comorbid diseases of obesity, hypertension, and hyperlipidemia in their type 2 diabetic patients, and the necessity of treating these conditions in order to improve outcomes. Cardiovascular disease (CVD) is the number-one cause of death among patients with diabetes, and its prevention is at the forefront of modern diabetes care. The clustering of insulin resistance, obesity, hypertension, and dyslipidemia has been termed “the metabolic syndrome.” As national attention is focused on the emerging epidemic of type 2 diabetes and obesity, more energy is being directed toward earlier detection, improved therapies, and potential prevention. One condition commonly detected in a younger age group and associated with a high risk of progression to diabetes is polycystic ovary syndrome (PCOS). Interestingly, many of the features of the metabolic syndrome, including insulin resistance, obesity, and dyslipidemias, are also present in PCOS. Is PCOS an early...

Clinical Diabetes, 2004

In Brief Care of patients with diabetes should include an assessment of bone health. It is now cl... more In Brief Care of patients with diabetes should include an assessment of bone health. It is now clear that patients with type 1 diabetes have lower bone mineral density (BMD) and higher risk of fractures. Evidence is accumulating that patients with type 2 diabetes who have complications are also at increased risk of certain types of osteoporotic fractures despite having a higher BMD when compared to patients with type 1 diabetes. Therapeutic interventions are key to preventing fractures, both by improving bone density and decreasing the risk for falls.

Pituitary, 2022

To assess long-term quality of life (QoL) in patients with sustained biochemical control of acrom... more To assess long-term quality of life (QoL) in patients with sustained biochemical control of acromegaly, comparing those receiving vs not receiving pharmacotherapy (primary analysis); to assess change in QoL over time (secondary analysis). Cross-sectional study, with a secondary longitudinal component, of 58 patients with biochemically controlled acromegaly. All had participated in studies assessing QoL years previously, after having undergone surgery ± radiotherapy. One cohort received medical therapy [MED (n = 33)]; the other did not [NO-MED (n = 25)]. QoL was assessed by the 36-Item-Short-Form Health Survey (SF-36), Acromegaly Quality of Life Questionnaire (AcroQoL), Gastrointestinal Quality of Life Index (GIQLI), Symptom Questionnaire, and QoL-Assessment of Growth Hormone Deficiency in Adults (QoL-AGHDA). Mean (± SD) duration of biochemical control was 15.0 ± 6.4 years for MED and 20.4 ± 8.2 years for NO-MED (p = 0.007). 58% of subjects scored < 25% of normal on ≥ 1 SF-36 doma...

Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduct... more Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. A 33-year-old male with a history of left testis Leydig cell tumor (LCT), 3-month status after left radical orchiectomy, presented with a rapidly enlarging (0.6 cm to 3.7 cm) right testicular mass. He underwent a right radical orchiectomy, sections interpreted as showing a similar Leydig cell-like oncocytic proliferation, with a differential diagnosis including metachronous bilateral LCT andmetachronous bilateral testicular tumors associated with congenital adrenal hyperplasia (a.k.a. “testicular adrenal rest tumors” (TARTs) and “testicular tumors of the adrenogenital syndrome ” (TTAGS)). Additional workup demonstrated a markedly elevated serum adrenocorticotropic hormone (ACTH) and elevated adrenal precursor steroid levels. He was diagnosed with congenital adrenal hyperplasia, 3

The extension of the average lifeexpectancy of people with dia-betes that has accompanied improve... more The extension of the average lifeexpectancy of people with dia-betes that has accompanied improvements in medical care has increased the significance of osteoporo-sis. In addition to the usual causes of osteoporosis associated with aging, bone health is also compromised by diabetes. There is strong evidence that patients with type 1 diabetes and increasing evi-dence that those with type 2 diabetes have an increased risk of certain types of osteoporotic fractures. Several mecha-nisms have been proposed for diabetes-related osteoporosis. These include both the comorbidities of diabetes and more direct pathophysiological effects of the

Clinical endocrinology, Jan 15, 2018

Exogenous testosterone administration may affect blood clotting, polycythaemia, and may increase ... more Exogenous testosterone administration may affect blood clotting, polycythaemia, and may increase atherosclerosis, though any association with cardiovascular events is unclear. While the literature is inconclusive, some studies have suggested testosterone use may increase short-term risk of cardiovascular events and stroke, and injection testosterone may convey higher risks than other dosage forms. We sought to evaluate the short-term cardiovascular risk of receiving injection testosterone. We conducted a case-crossover analysis comparing injection testosterone exposure in the 7 days prior to an outcome event to referent windows in the past to estimate the acute association of cardiovascular outcomes with the receipt of testosterone injections. We identified adult male testosterone users hospitalized with myocardial infarction (MI), stroke or a composite of MI, stroke or unstable angina in US commercial claims (2000-2013) or Medicare (2007-2010) databases. We identified testosterone ...

Neurosurgery, 2008

OBJECTIVE With the advent of minimally invasive endoscopic pituitary surgery, there has been conc... more OBJECTIVE With the advent of minimally invasive endoscopic pituitary surgery, there has been concern that the technique may be associated with higher rates of complications such as diabetes insipidus (DI) than traditional approaches, particularly early in a center&amp;amp;amp;amp;amp;amp;amp;amp;#39;s experience. We report the incidence and predictors of diabetes insipidus in patients after endoscopic transnasal resection (minimally invasive pituitary surgery) of pituitary lesions. METHODS Data were collected from hospital and clinic records on the first 119 consecutive patients undergoing endoscopic pituitary surgery at our center. RESULTS The rate of postoperative diabetes insipidus is low in patients undergoing minimally invasive pituitary surgery (permanent, 2.7%; transient, 13.6%). Factors associated with development of DI after minimally invasive pituitary surgery include Rathke&amp;amp;amp;amp;amp;amp;amp;amp;#39;s cleft cyst histology, intraoperative cerebrospinal fluid leak, and previous nonendoscopic lesion resection. Elevated serum sodium (&amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;145 mmol/L) within the first 5 days postoperatively has a high sensitivity (87.5%), specificity (83.5%), and negative predictive value (99.5%) for permanent postoperative DI development. CONCLUSION Transitioning from microscopic to endoscopic pituitary surgery can be achieved with a low incidence of DI. An elevated serum sodium level in the first 5 postoperative days using standard monitoring can predict the chance of developing permanent DI. Patients having no elevated serum sodium measurements, defined as &amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;145 mmol/L, in the first 5 days postoperatively will rarely, if ever, develop permanent DI, thereby validating short postoperative inpatient stays with minimal risk of readmission for DI management. Those with a single serum sodium measurement greater than 145 mmol/L have a 15% risk of developing permanent DI.

Clinica Chimica Acta, 2010

BackgroundMacroprolactin is a large, heterogeneous form of prolactin with limited bioavailability... more BackgroundMacroprolactin is a large, heterogeneous form of prolactin with limited bioavailability. Detection of macroprolactin by different immunoassays varies widely. The objectives of this study were to determine the immunoreactivity of macroprolactin by the Ortho Clinical Diagnostics Vitros® ECi prolactin immunoassay, establish the most effective method for interpreting the prolactin concentration after PEG-precipitation, and correlate the clinical features of hyperprolactinemia with

... Lancet 1990;336: 11411144. 14. Abel-Gadir A, Mowafi RS, Alnaser HMI, Alrashid AH, Alonezi OM... more ... Lancet 1990;336: 11411144. 14. Abel-Gadir A, Mowafi RS, Alnaser HMI, Alrashid AH, Alonezi OM, Shaw RW. ... 82. Ehrmann DA, Liljenquist DR, Kasza K, Azziz R, Legro RS, Mahmoud NG, for the PCOS/Troglitazone Study Group. ...

Case Reports in Pathology, 2015

A 33-year-old male with a history of left testis Leydig cell tumor (LCT), 3-month status after le... more A 33-year-old male with a history of left testis Leydig cell tumor (LCT), 3-month status after left radical orchiectomy, presented with a rapidly enlarging (0.6 cm to 3.7 cm) right testicular mass. He underwent a right radical orchiectomy, sections interpreted as showing a similar Leydig cell-like oncocytic proliferation, with a differential diagnosis including metachronous bilateral LCT and metachronous bilateral testicular tumors associated with congenital adrenal hyperplasia (a.k.a. “testicular adrenal rest tumors” (TARTs) and “testicular tumors of the adrenogenital syndrome” (TTAGS)). Additional workup demonstrated a markedly elevated serum adrenocorticotropic hormone (ACTH) and elevated adrenal precursor steroid levels. He was diagnosed with congenital adrenal hyperplasia, 3β-hydroxysteroid dehydrogenase deficiency (3BHSD) type, and started on treatment. Metachronous bilateral testicular masses in adults should prompt consideration of adult presentation of CAH. Since all untrea...

Journal of the American Dietetic Association

LEARNING OBJECTIVE: To determine whether institution of hormonal replacement therapy is associate... more LEARNING OBJECTIVE: To determine whether institution of hormonal replacement therapy is associated with alterations in weight.A common perception among postmenopausal women (PMW) is that hormonal replacement therapy (HRT) causes weight gain. Healthy PMW aged 45-55 years (n=9) arid 70-80 years (n=7) were enrolled. Subjects were studied at baseline, after 1 month of estrogen (estraderm 50 mcg) followed by a further month of estrogen at the same dose with progesterone (100 mg per vagina bid) for the final 7 days. Food and activity questionnaires, anthropometric measures, and indirect calorimetry were performed at each visit. Fat mass was estimated by bioimpedance and by skinfold measurements. These parameters were compared across the 3 visits using paired t-test. Serum estradiol level increased from 22.1±1 pg/ml to 80.4±11 pg/ml, while progesterone increased from 0.6 ng/ml to 11.9±2 ng/ml after replacement. No significant change in weight across the 3 visits was observed in the group a...

JAMA Internal Medicine

Increases in testosterone use and mixed reports of adverse events have raised concerns about the ... more Increases in testosterone use and mixed reports of adverse events have raised concerns about the cardiovascular safety of testosterone. Testosterone is available in several delivery mechanisms with varying pharmacokinetics; injections cause spikes in testosterone levels, and transdermal patches and gels cause more subtle but sustained increases. The comparative cardiovascular safety of gels, injections, and patches has not been studied. To determine the comparative cardiovascular safety of testosterone injections, patches, and gels. A retrospective cohort study was conducted using administrative claims from a commercially insured (January 1, 2000, to December 31, 2012) and Medicare (January 1, 2007, to December 31, 2010) population in the United States and general practitioner records from the United Kingdom (January 1, 2000, to June 30, 2012). Participants included 13 men (aged ≥18 years) who initiated use of testosterone patches, gels, or 14 injections following 180 days with no t...

Metabolism

Postmenopausal women (PMW) commonly believe that hormone replacement (HR) leads to weight gain, a... more Postmenopausal women (PMW) commonly believe that hormone replacement (HR) leads to weight gain, and fear of weight gain and/or an actual increase in weight is one of the principle reasons evoked for the discontinuation of HR. However, the potential effects of physiologic HR on body composition have yet to be separated from the effects of lifestyle or aging. Therefore, we examined the effect of short-term hormone replacement and age on alterations in weight, body composition, and energy balance. A prospective study of 28 healthy PMW aged 45 to 55 years (younger PMW, studies completed n = 18) and 70 to 80 years (older PMW, studies completed n = 15) was conducted. The last menstrual period was more than 12 months previously. The women had a body mass index (BMI) less than 30 kg/m(2) and were taking no medication. Subjects were studied at baseline, after 1 month of transdermal estrogen (Estraderm, 50 microg/day) administration (E2), followed by a further month of transdermal estrogen wi...

The Journal of Clinical Endocrinology and Metabolism

Context: New formulations, increased marketing, and wider recognition of declining testosterone l... more Context: New formulations, increased marketing, and wider recognition of declining testosterone levels in older age may have contributed to wider testosterone testing and supplementation in many countries. Objective: To describe testosterone testing and testosterone treatment in men in the United Kingdom (UK) and US. Design: Retrospective incident user cohort. Setting: Commercial and Medicare insurance claims from the US, and general practitioner healthcare records from the UK for the years 2000-2011. Participants: We identified 410,019 US men and 6,858 UK men who initiated a testosterone formulation, as well as 1,114,329 US men and 66,140 UK men UK with a new testosterone laboratory measurement. Main outcome measures: Initiation of any injected testosterone, implanted testosterone pellets, or prescribed transdermal or oral testosterone formulation. Results: Testosterone testing and supplementation have increased, pronouncedly in the US. Increased testing in the UK has identified mo...

Clinical endocrinology, 1999

Leptin is a hormone which is secreted by adipocytes and appears to influence the reproductive axi... more Leptin is a hormone which is secreted by adipocytes and appears to influence the reproductive axis. Previous studies have demonstrated higher leptin levels in relation to body fat mass in women compared to men, higher levels in normally cycling compared to postmenopausal women, and a decrease in leptin levels with increased age. The purpose of this study was to determine whether oestrogen replacement with or without progesterone increases serum leptin levels in postmenopausal women, independently of changes in body fat, and to determine if ageing affects leptin levels at baseline or in response to hormone replacement. Twenty-one healthy postmenopausal women on no hormone replacement were studied at baseline, after 1 month of oestrogen (E2: estraderm 50 microg/day) and after a further month of oestrogen and 7 days of progesterone (P: progesterone 100 mg per vagina bid) designed to achieve physiological hormone levels. Subjects included 11 younger (45-55 years) and 10 older (70-80 yea...

The Journal of clinical endocrinology and metabolism, 1999

Pituitary secretion of LH is increased after menopause, but it is not known whether changes in LH... more Pituitary secretion of LH is increased after menopause, but it is not known whether changes in LH clearance also contribute to elevated serum levels. To determine whether the disappearance of endogenous LH is decreased in postmenopausal women (PMW), compared with normal cycling women, GnRH receptor blockade was used to inhibit endogenous secretion of LH and the glycoprotein free alpha-subunit (FAS), and the decline of serum levels was monitored. The NAL-GLU GnRH antagonist ([Ac-D-2Nal1,D-4ClPhe2, D-3Pal3,Arg5,D-4-p-methoxybenzoyl-2-aminobutyric acid6,D-Ala10]GnRH) was administered s.c., at doses of 5, 15, 50, and 150 microg/kg, to 15 euthyroid PMW in 21 studies. Blood was sampled every 10 min, for 4 h before and 8 h after a single sc injection of the GnRH antagonist, followed by hourly samples, ending at 20 h after injection. Results of the maximally suppressive doses (50 and 150 microg/kg) were compared with those of 24 normal cycling women in the early follicular phase and late fo...