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Petar Milovanovic Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Laboratory for Anthropology and Skeletal Biology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

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Björn Busse Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

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osteocyte death also occurs due to hormonal reasons, such as estrogen deficiency or corticosteroid excess ( 38 , 39 , 45 ). Moreover, osteocyte death may be caused by mechanical factors ( 36 , 46 ), but the relationship between mechanical loading and

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Trevor Lewis Physiotherapy Department, Aintree University Hospital NHS Foundation Trust, Liverpool, UK

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Eva Zeisig Department of Surgical and Perioperative Sciences, Umeå Univerisity, Umeå, Sweden

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Jamie E Gaida University of Canberra Research Institute for Sport and Exercise (UCRISE), Canberra, Australian Capital Territory, Australia

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and associated metabolic conditions, such as insulin resistance ( 5 ), diabetes ( 6 ), hypercholesterolaemia ( 7 ), statins ( 8 ), abdominal fat ( 9 ), the sympathetic nervous system ( 10 , 11 ), and corticosteroid use ( 12 ). Glucocorticoids are a

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Angelica Sharma Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK

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Katharine Lazarus Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK

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Deborah Papadopoulou Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK

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Hemanth Prabhudev Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK

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Tricia Tan Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
Department of Clinical Biochemistry, North West London Pathology, London, UK

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Karim Meeran Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK

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Sirazum Choudhury Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
Department of Clinical Biochemistry, North West London Pathology, London, UK

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equivalent to a prednisolone dose of 2–4 mg once daily. This may be because prednisolone has half the affinity for corticosteroid-binding globulin as compared to cortisol, and therefore higher concentrations of unbound prednisolone are present ( 10

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Kamran Iqbal Shire, London, UK

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Kate Halsby pH Associates, Marlow, UK

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Robert D Murray Leeds Centre for Diabetes & Endocrinology, St James’s University Hospital, Leeds, UK

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Paul V Carroll Department of Endocrinology, Guy’s & St. Thomas’ NHS Foundation Trust, London, UK

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Robert Petermann Shire, Vienna, Austria

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information is well recorded and accurate ( 13 , 14 ). Study population The population of interest comprised patients with treated AI defined as an AI-specific Read code and at least one Multilex code for the corticosteroids of interest (i.e. IR HC

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Stephanie E Baldeweg Department of Endocrinology, University College Hospital, London, UK
National Hospital for Neurology and Neurosurgery, London, UK

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Mark Vanderpump Physicians’ Clinic, London, UK

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Will Drake Department of Endocrinology, St Bartholomew’s Hospital, London, UK

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Narendra Reddy Endocrinology/General Medicine, University Hospitals Coventry and Warwickshire NHS Trust, University of Warwick, Coventry, UK

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Andrew Markey The Lister Hospital, London, UK

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Gordon T Plant Department of Endocrinology, University College Hospital, London, UK
National Hospital for Neurology and Neurosurgery, London, UK

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Michael Powell National Hospital for Neurology and Neurosurgery, London, UK

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Saurabh Sinha Royal Hallamshire Hospital, Sheffield, UK

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John Wass Department of Endocrinology, Oxford Centre for Diabetes Endocrinology and Metabolism, The Churchill, Oxford University, Oxford, UK

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the Society for Endocrinology Clinical Committee The Society for Endocrinology, 22 Apex Court, Woodlands, Bradley Stoke, Bristol, UK

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emergencies. Prompt resuscitation and corticosteroid replacement may be lifesaving. MRI scan is the investigation of choice. Urgent discussion with the regional neurosurgical/endocrine team is essential. Surgical intervention should be considered in

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Marcus Quinkler Endocrinology in Charlottenburg, Berlin, Germany

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Bertil Ekman Departments of Endocrinology and Medical and Health Sciences, Linköping University, Linköping, Sweden

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Claudio Marelli Shire International GmbH, Zug, Switzerland

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Sharif Uddin Shire, Lexington, Massachusetts, USA

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Pierre Zelissen Department of Internal Medicine and Endocrinology, University Medical Center Utrecht, Utrecht, the Netherlands

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Robert D Murray Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, UK

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on behalf of the EU-AIR Investigators
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development of corticosteroid side effects between patients ( 7 ). Interestingly, when the endogenous glucocorticoid, cortisol (hydrocortisone), is compared with prednisolone at the isolated human glucocorticoid receptor (GR), the transactivation activity of

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Greta B Raglan Department of Psychology, American University, Washington, District of Columbia, USA

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Louis A Schmidt Department of Psychology, Neuroscience & Behavior, McMaster University, Hamilton, Ontario, Canada

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Jay Schulkin Department of Research, American College of Obstetricians and Gynecologists, Washington, District of Columbia, USA
Department of Neuroscience, Georgetown University, Washington, District of Columbia, USA

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as a possible intervention for mental illness including depression. Although further study is necessary, it appears that corticosteroid synthesis inhibitors (CSIs) may show some efficacy in treating individuals with intractable depression ( 23

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Martijn J J Finken Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

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Aleid J G Wirix Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

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Ines A von Rosenstiel-Jadoul Department of Pediatrics, Rijnstate Hospital, Arnhem, The Netherlands

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Bibian van der Voorn Department of Pediatric Endocrinology and Obesity Center CGG, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands

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Mai J M Chinapaw Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

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

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Joana E Kist-van Holthe Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

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Stefan A Wudy Steroid Research and Mass Spectrometry Unit, Laboratory for Translational Hormone Analytics, Department of 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 UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

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, raised blood pressure, insulin resistance, and dyslipidemia ( 7 , 10 ). There is controversy as to whether increased HPA axis activity is a cause or a consequence of childhood obesity. It has been demonstrated that the rise in serum corticosteroids

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Bliss Anderson Department of Endocrinology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK

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Daniel L Morganstein Department of Endocrinology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK

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practice is to reserve high dose corticosteroids for those presenting with adrenal crisis or with significant pituitary enlargement. Other patients can be commenced directly on replacement doses of corticosteroids (e.g. hydrocortisone 20 mg daily in divided

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Hanna F Nowotny Medizinische Klinik IV, Department of Endocrinology, Klinikum der Universität München, Munich, Germany

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Jillian Bryce Office for Rare Conditions, University of Glasgow, Glasgow, UK

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Salma R Ali Office for Rare Conditions, University of Glasgow, Glasgow, UK

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Roberta Giordano Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy

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Federico Baronio Pediatric Unit, Department Hospital of Woman and Child, Endo-ERN Centre IT11, IRCSS AOU S.Orsola-Malpighi University Hospital, Bologna, Italy

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Irina Chifu Division of Endocrinology and Diabetology, Department of Internal Medicine I, University Hospital of Wuerzburg, University of Wuerzburg, Wuerzburg, Germany

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Lea Tschaidse Medizinische Klinik IV, Department of Endocrinology, Klinikum der Universität München, Munich, Germany

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Martine Cools Department of Paediatric Endocrinology, Ghent University Hospital, University of Ghent, Ghent, Belgium

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Erica LT van den Akker Department of Pediatrics, Division of Pediatric Endocrinology, Erasmus MC - Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands

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Henrik Falhammar Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden

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Natasha M Appelman-Dijkstra Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands

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Luca Persani Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan Italy

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Guglielmo Beccuti Department of Clinical and Biological Sciences, University of Turin, Turin, Italy

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Ian L Ross Division of Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa

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Simona Grozinsky-Glasberg Neuroendocrine Tumor Unit, ENETS Center of Excellence, Department of Endocrinology and Metabolism, Hadassah Medical Organisation and Faculty of Medicine, the Hebrew University, Jerusalem, Israel

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Alberto M Pereira Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands

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Eystein S Husebye Department of Clinical Science and KG Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway
Department of Medicine, Haukeland University Hospital, Bergen, Norway
Department of Medicine, Karolinska Institutet, Stockholm, Sweden

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Stefanie Hahner Division of Endocrinology and Diabetology, Department of Internal Medicine I, University Hospital of Wuerzburg, University of Wuerzburg, Wuerzburg, Germany

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S Faisal Ahmed Office for Rare Conditions, University of Glasgow, Glasgow, UK
Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
Developmental Endocrinology Research Group, University of Glasgow, Glasgow, United Kingdom

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Nicole Reisch Medizinische Klinik IV, Department of Endocrinology, Klinikum der Universität München, Munich, Germany

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stress-related cortisol rise by the interference of antibodies directed against those viral antigens with the host’s natural secretion of corticosteroids ( 8 ). Recent studies in patients with SARS-CoV-2 infections confirmed significantly impaired

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