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Carolina Inda Instituto de Investigación en Biomedicina de Buenos Aires (IBioBA)-CONICET-Partner Institute of the Max Planck Society, Buenos Aires, Argentina
DFBMC, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina

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Natalia G Armando Instituto de Investigación en Biomedicina de Buenos Aires (IBioBA)-CONICET-Partner Institute of the Max Planck Society, Buenos Aires, Argentina

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Paula A dos Santos Claro Instituto de Investigación en Biomedicina de Buenos Aires (IBioBA)-CONICET-Partner Institute of the Max Planck Society, Buenos Aires, Argentina

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Susana Silberstein Instituto de Investigación en Biomedicina de Buenos Aires (IBioBA)-CONICET-Partner Institute of the Max Planck Society, Buenos Aires, Argentina
DFBMC, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina

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are essential to the stress response driving both basal and stress-induced hypothalamic–pituitary–adrenal axis (HPA) activation. Besides the hypothalamus, CRH is widely distributed in extrahypothalamic circuits of the brain where it functions as a

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C E Higham Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK

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A Olsson-Brown The Clatterbridge Cancer Centre, Bebbington, Wirral, UK
The University of Liverpool, Brownlow Hill, Liverpool, UK

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

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T Cooksley Department of Acute Medicine, UHSM and Christie Hospital NHS Foundation Trust, Manchester, UK

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J Larkin Skin Unit, Royal Marsden Hospital, London, UK

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P Lorigan Department of Medical Oncology, Christie Hospital NHS Foundation Trust, Manchester, UK

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D Morganstein Department of Endocrinology, Chelsea and Westminster Hospital, London, UK

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P J Trainer Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK

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the Society for Endocrinology Clinical Committee The Society for Endocrinology, Starling House, 1600 Bristol Parkway North, Bristol, UK

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should be re-evaluated once stable to confirm diagnosis and at intermittent intervals to assess for HPA axis recovery. Immunotherapy can be continued once patient clinically stable on appropriate endocrine replacement therapy. Declaration

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Filippo Ceccato Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Padova, Italy

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Elisa Selmin Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Padova, Italy

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Chiara Sabbadin Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Padova, Italy

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Miriam Dalla Costa Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Padova, Italy

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

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

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Mattia Barbot Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Padova, Italy

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Corrado Betterle Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Padova, Italy

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Marco Boscaro Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Padova, Italy

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

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). The most common cause of acquired and persistent SAI in adults is a result of a pituitary tumor: its mass effect or pituitary-directed treatments (surgery/radiotherapy) may impair hypothalamic–pituitary–adrenal (HPA) axis function ( 3 , 4

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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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, such as that which a shy or fearful child might experience, influences the expression of CRH in both the amygdala and the hypothalamic–pituitary–adrenal (HPA) axis in rats ( 41 , 42 ). Conclusion Glucocorticoids are not just related to stress

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Alexander Tacey Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
Department of Medicine-Western Health, Australian Institute for Musculoskeletal Science (AIMSS), Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia

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Lewan Parker Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia

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Bu B Yeap Medical School, University of Western Australia, and Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia

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John Joseph PathWest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

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Ee M Lim PathWest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

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Andrew Garnham Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia

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David L Hare University of Melbourne and the Department of Cardiology, Austin Health, Melbourne, Victoria, Australia

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Tara Brennan-Speranza Department of Physiology and Bosch Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia

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Itamar Levinger Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
Department of Medicine-Western Health, Australian Institute for Musculoskeletal Science (AIMSS), Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia

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Introduction Glucocorticoids (GC) are a naturally occurring catabolic steroid, produced by the hypothalamic–pituitary–adrenal (HPA) axis and regulated by neuroendocrine and immune responses ( 1 , 2 ). Synthetic forms of GC, such as

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Giovanni Tulipano Unit of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy

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inhibitor compound C or by dominant negative AMPK. The overexpression of constitutively active AMPK mimicked the effect of AICAR. These data suggest that AMPK directly mediates the effects of starvation and subsequent energy depletion on the HPA axis

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Carlo Cinque Fondazione Ethoikos, Radicondoli, Italy
Department of Physiology and Pharmacology V. Erspamer, Sapienza University of Rome, Rome, Italy

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Manuela Zinni Department of Physiology and Pharmacology V. Erspamer, Sapienza University of Rome, Rome, Italy

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Anna Rita Zuena Department of Physiology and Pharmacology V. Erspamer, Sapienza University of Rome, Rome, Italy

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Chiara Giuli Fondazione Ethoikos, Radicondoli, Italy

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Sebastiano G Alemà Department of Physiology and Pharmacology V. Erspamer, Sapienza University of Rome, Rome, Italy

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Assia Catalani Department of Physiology and Pharmacology V. Erspamer, Sapienza University of Rome, Rome, Italy

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Paola Casolini Department of Physiology and Pharmacology V. Erspamer, Sapienza University of Rome, Rome, Italy

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Roberto Cozzolino Fondazione Ethoikos, Radicondoli, Italy

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handling and restraint of the animals, with a consequent activation of the hypothalamic–pituitary–adrenal (HPA) axis that quickly leads to secretion of glucocorticoids ( 7 ). For some experimental designs, faecal sampling may be a valid non

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Marloes L P Langelaan Clinical Laboratory, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
Department of Clinical Chemistry and Haematology, Zuyderland Medical Centre, Heerlen, The Netherlands

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Jérôme M H Kisters Department of Internal Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands

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Mirjam M Oosterwerff Department of Internal Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands

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Arjen-Kars Boer Clinical Laboratory, Catharina Hospital Eindhoven, Eindhoven, The Netherlands

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.14712/23362936.2016.2 ) 10.14712/23362936.2016.2 26995200 18 Clow A Hucklebridge F Stalder T Evans P Thorn L. The cortisol awakening response: more than a measure of HPA axis function. Neuroscience and Biobehavioral Reviews 2010 35 97 – 103 . ( https://doi.org/10

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Rachel K Rowe Phoenix Veterans Affairs Health Care System, Phoenix, Arizona, USA
BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, Arizona, USA
Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, Arizona, USA

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Benjamin M Rumney BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, Arizona, USA
Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, Arizona, USA
Department of Biology and Biochemistry, University of Bath, UK

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Hazel G May BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, Arizona, USA
Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, Arizona, USA
Department of Biology and Biochemistry, University of Bath, UK

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Paska Permana Phoenix Veterans Affairs Health Care System, Phoenix, Arizona, USA

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P David Adelson BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, Arizona, USA
Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, Arizona, USA
School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona, USA

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S Mitchell Harman Phoenix Veterans Affairs Health Care System, Phoenix, Arizona, USA

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Jonathan Lifshitz Phoenix Veterans Affairs Health Care System, Phoenix, Arizona, USA
BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, Arizona, USA
Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, Arizona, USA

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Theresa C Thomas Phoenix Veterans Affairs Health Care System, Phoenix, Arizona, USA
BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, Arizona, USA
Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, Arizona, USA

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. Dexamethasone treatment At 56 DPI, rats were administered a subcutaneous dose of 0.1mg/kg dexamethasone (DEX) (Dexamethasone Injectable sc-362917Rx, Santa Cruz Biotechnology) at approximately 06:00h to investigate effectiveness of HPA axis negative feedback

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Veronica Kieffer
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Kate Davies University Hospitals of Leicester NHS Trust, Great Ormond Street Hospital for Children NHS Trust, Central Manchester University Hospitals NHS Foundation Trust, NHS Grampian, Portsmouth Hospitals NHS Trust, Salford Royal Hospitals Foundation Trust, Heart of England NHS Foundation Trust, The London Clinic, Department of Diabetes and Endocrinology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK

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Christine Gibson University Hospitals of Leicester NHS Trust, Great Ormond Street Hospital for Children NHS Trust, Central Manchester University Hospitals NHS Foundation Trust, NHS Grampian, Portsmouth Hospitals NHS Trust, Salford Royal Hospitals Foundation Trust, Heart of England NHS Foundation Trust, The London Clinic, Department of Diabetes and Endocrinology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK

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Morag Middleton University Hospitals of Leicester NHS Trust, Great Ormond Street Hospital for Children NHS Trust, Central Manchester University Hospitals NHS Foundation Trust, NHS Grampian, Portsmouth Hospitals NHS Trust, Salford Royal Hospitals Foundation Trust, Heart of England NHS Foundation Trust, The London Clinic, Department of Diabetes and Endocrinology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK

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Jean Munday University Hospitals of Leicester NHS Trust, Great Ormond Street Hospital for Children NHS Trust, Central Manchester University Hospitals NHS Foundation Trust, NHS Grampian, Portsmouth Hospitals NHS Trust, Salford Royal Hospitals Foundation Trust, Heart of England NHS Foundation Trust, The London Clinic, Department of Diabetes and Endocrinology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK

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Shashana Shalet University Hospitals of Leicester NHS Trust, Great Ormond Street Hospital for Children NHS Trust, Central Manchester University Hospitals NHS Foundation Trust, NHS Grampian, Portsmouth Hospitals NHS Trust, Salford Royal Hospitals Foundation Trust, Heart of England NHS Foundation Trust, The London Clinic, Department of Diabetes and Endocrinology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK

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Lisa Shepherd University Hospitals of Leicester NHS Trust, Great Ormond Street Hospital for Children NHS Trust, Central Manchester University Hospitals NHS Foundation Trust, NHS Grampian, Portsmouth Hospitals NHS Trust, Salford Royal Hospitals Foundation Trust, Heart of England NHS Foundation Trust, The London Clinic, Department of Diabetes and Endocrinology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK

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Phillip Yeoh University Hospitals of Leicester NHS Trust, Great Ormond Street Hospital for Children NHS Trust, Central Manchester University Hospitals NHS Foundation Trust, NHS Grampian, Portsmouth Hospitals NHS Trust, Salford Royal Hospitals Foundation Trust, Heart of England NHS Foundation Trust, The London Clinic, Department of Diabetes and Endocrinology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK

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• Understands the pathophysiology of the normal hypothalamic-pituitary-adrenal (HPA) axis and recognises deviation from the norm • Is able to identify abnormal test results and escalate appropriately a,b,c • Can understand false-positive and -negative

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