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Janko Sattler Adrenal Steroid Group, ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia
Department of Rheumatology and Clinical Immunology, Charité-University Medicine, Berlin, Germany

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Jinwen Tu Adrenal Steroid Group, ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia
Bone Research Program, ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia
Concord Clinical School, The University of Sydney, Sydney, Australia

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Shihani Stoner Bone Research Program, ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia

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Jingbao Li Bone Research Program, ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia
Key Laboratory for Space Bioscience and Biotechnology, Institute of Special Environmental Biophysics, School of Life Sciences, Northwestern Polytechnical University, Shaanxi, China

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Frank Buttgereit Department of Rheumatology and Clinical Immunology, Charité-University Medicine, Berlin, Germany

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Markus J Seibel Bone Research Program, ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia
Concord Clinical School, The University of Sydney, Sydney, Australia
Department of Endocrinology & Metabolism, Concord Hospital, Sydney, Australia

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Hong Zhou Bone Research Program, ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia
Concord Clinical School, The University of Sydney, Sydney, Australia

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Mark S Cooper Adrenal Steroid Group, ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia
Concord Clinical School, The University of Sydney, Sydney, Australia
Department of Endocrinology & Metabolism, Concord Hospital, Sydney, Australia

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Background Acute inflammation is typically associated with an activation of the hypothalamo-pituitary-adrenal (HPA) axis, which results in an increase in the level of glucocorticoids within the circulation ( 1 ). In situations where this

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Filippo Ceccato Department of Medicine DIMED, University of Padova, Padova, Italy
Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy
Department of Neuroscience DNS, University of Padova, Padova, Italy

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Elisa Selmin Department of Medicine DIMED, University of Padova, Padova, Italy

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Giorgia Antonelli Department of Medicine DIMED, University of Padova, Padova, Italy
Laboratory Medicine, University-Hospital of Padova, Padova, Italy

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Mattia Barbot Department of Medicine DIMED, University of Padova, Padova, Italy
Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy
Department of Neuroscience DNS, University of Padova, Padova, Italy

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Andrea Daniele Department of Medicine DIMED, University of Padova, Padova, Italy

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Marco Boscaro Department of Medicine DIMED, University of Padova, Padova, Italy

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Mario Plebani Department of Medicine DIMED, University of Padova, Padova, Italy
Laboratory Medicine, University-Hospital of Padova, Padova, Italy

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Carla Scaroni Department of Medicine DIMED, University of Padova, Padova, Italy
Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy

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only confirm central AI in patients with very low morning basal serum F levels (≤83 nmol/L, 3 µg/dL), whereas only high serum F levels (≥415 nmol/L) can confirm a normal hypothalamic–pituitary–adrenal (HPA) axis ( 2 ). A confirmatory dynamic test is

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Lisa Arnetz Departments of Endocrinology, Molecular Medicine and Surgery, Metabolism and Diabetes
Departments of Endocrinology, Molecular Medicine and Surgery, Metabolism and Diabetes

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Neda Rajamand Ekberg Departments of Endocrinology, Molecular Medicine and Surgery, Metabolism and Diabetes
Departments of Endocrinology, Molecular Medicine and Surgery, Metabolism and Diabetes

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Kerstin Brismar Departments of Endocrinology, Molecular Medicine and Surgery, Metabolism and Diabetes
Departments of Endocrinology, Molecular Medicine and Surgery, Metabolism and Diabetes

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Michael Alvarsson Departments of Endocrinology, Molecular Medicine and Surgery, Metabolism and Diabetes
Departments of Endocrinology, Molecular Medicine and Surgery, Metabolism and Diabetes

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–pituitary–adrenal (HPA) axis, studies have shown discrepant results, reporting both increased and decreased activation (2) . Cortisol has effects opposite to those of insulin on glucose metabolism, decreasing glucose uptake and increasing gluconeogenesis (1, 2, 3

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Britt J van Keulen Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
Department of Pediatrics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Reproduction & Development Research Institute, de Boelelaan, Amsterdam, The Netherlands

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Michelle Romijn Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
Department of Pediatrics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Reproduction & Development Research Institute, de Boelelaan, Amsterdam, The Netherlands

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Bibian van der Voorn Department of Pediatric Endocrinology, Sophia Kinderziekenhuis, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

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Marita de Waard Emma Children’s Hospital, Amsterdam University Medical Centers, locations AMC and VUmc, Amsterdam, The Netherlands

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Michaela F Hartmann Steroid Research and Mass Spectrometry Unit, Laboratory for Translational Hormone Analytics, Pediatric Endocrinology & Diabetology, Center of Child and Adolescent Medicine, Justus-Liebig-University, Giessen, Germany

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Johannes B van Goudoever Emma Children’s Hospital, Amsterdam University Medical Centers, locations AMC and VUmc, Amsterdam, The Netherlands

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Stefan A Wudy Steroid Research and Mass Spectrometry Unit, Laboratory for Translational Hormone Analytics, Pediatric Endocrinology & Diabetology, Center of Child and Adolescent Medicine, Justus-Liebig-University, Giessen, Germany

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Joost Rotteveel Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands

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Martijn J J Finken Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
Department of Pediatrics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Reproduction & Development Research Institute, de Boelelaan, Amsterdam, The Netherlands

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) handicaps and had lower scores on tests of neurodevelopment than their female counterparts ( 5 , 6 ). Integrity of the hypothalamic–pituitary–adrenal (HPA) axis is crucial during critical illnesses. Among preterm infants, the HPA axis seems to be

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Dan Liang Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

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Han Chen Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

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Li-Yong Zhong Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

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–pituitary–adrenal axis (HPA): basal cortisol level <3 μg/dL indicated impaired HPA function while the basal cortisol level >15 μg/dL excluded it. If basal cortisol levels ranged from 3 to 15 μg/dL, the circadian rhythm of adrenocorticotropic hormone and cortisol (08

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Eva Novoa Department of Otorhinolaryngology, Clinic of Endocrinology, Head and Neck Surgery

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Marcel Gärtner Department of Otorhinolaryngology, Clinic of Endocrinology, Head and Neck Surgery

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Christoph Henzen Department of Otorhinolaryngology, Clinic of Endocrinology, Head and Neck Surgery

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route of administration, the varied systemic side effects of oral or intravenous glucocorticoids should be minimized, in particular the suppression of the hypothalamic–pituitary–adrenal (HPA) axis or the inhibition of osteoblast function. Even after

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Kunzhe Lin Department of Neurosurgery, Affiliated Fuzhou First Hospital of Fujian Medical University, Fuzhou, China
Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China

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Lingling Lu Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China

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Zhijie Pei Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China

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Shuwen Mu Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China

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Shaokuan Huang Department of Neurosurgery, Guiqian International General Hospital, Guiyang, China

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Shousen Wang Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
Department of Neurosurgery, 900th Hospital, Fuzhou, China

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postoperatively. Preoperative routine examination of the hypothalamus–pituitary–adrenal (HPA) axis and hypothalamus–pituitary–thyroid (HPT) axis functions was performed to determine the low function and the need for oral glucocorticoid and thyroxine replacement

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Carla Scaroni Dipartimento di Medicina, U.O.C. Endocrinologia, Università di Padova, Padova, Italy

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Nora M Albiger Dipartimento di Medicina, U.O.C. Endocrinologia, Università di Padova, Padova, Italy

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Serena Palmieri Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy

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Davide Iacuaniello Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Napoli, Italy

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Chiara Graziadio Department of Experimental Medicine, University La Sapienza, Rome, Italy

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Luca Damiani Department of Medical Sciences, Endocrinology and Internal Medicine Section, University of Ferrara, Ferrara, Italy

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Marialuisa Zilio Dipartimento di Medicina, U.O.C. Endocrinologia, Università di Padova, Padova, Italy

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Antonio Stigliano Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University La Sapienza, Rome, Italy

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Annamaria Colao Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Napoli, Italy

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Rosario Pivonello Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Napoli, Italy

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the Altogether to Beat Cushing’s Syndrome (ABC) study group
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Introduction Physiological activation of the hypothalamic-pituitary-adrenal (HPA) axis can be found in several situations, such as major surgery, severe illness, intensive physical exercise, and prolonged fasting leading to improve the ability

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Morten Winkler Møller Department of Neurosurgery, Odense University Hospital, Odense C, Denmark
Clinical Institute, University of Southern Denmark, Odense C, Denmark

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Marianne Skovsager Andersen Clinical Institute, University of Southern Denmark, Odense C, Denmark
Department of Endocrinology, Odense University Hospital, Odense C, Denmark

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Christian Bonde Pedersen Department of Neurosurgery, Odense University Hospital, Odense C, Denmark
Clinical Institute, University of Southern Denmark, Odense C, Denmark

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Bjarne Winther Kristensen Clinical Institute, University of Southern Denmark, Odense C, Denmark
Department of Pathology, Odense University Hospital, Odense C, Denmark

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Frantz Rom Poulsen Department of Neurosurgery, Odense University Hospital, Odense C, Denmark
Clinical Institute, University of Southern Denmark, Odense C, Denmark

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–pituitary–adrenal (HPA) axis (s-ACTH, s-cortisol and Synacthen test). Deficiency in either axis was defined as biochemical data outside reference values for the specific hormone or if patients were already on substitution therapy. Intact function was defined as hormone

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Gavin P Vinson School of Biological and Chemical Sciences, Queen Mary University of London, London E1 4NS, UK

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Caroline H Brennan School of Biological and Chemical Sciences, Queen Mary University of London, London E1 4NS, UK

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also in protection against it. The hypophyseal–pituitary–adrenal axis in the brain and addiction In relation to addiction, far more attention has been paid to hypophyseal–pituitary–adrenal (HPA) components in the brain than to the systemic (i.e. blood

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