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Cheryl M Isherwood Section of Chronobiology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom

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M Denise Robertson Section of Metabolic Medicine, Food and Macronutrients, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom

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Debra J Skene Section of Chronobiology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom

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Jonathan D Johnston Section of Chronobiology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom

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obesity, type 2 diabetes mellitus (T2D) and circadian rhythmicity have been reviewed elsewhere ( 12 ). In one notable study, mice made obese by a high-fat diet exhibit reduced amplitude of circadian rhythms ( 17 ), although these effects may be due to diet

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Patricia Arroyo Tardio University Hospital Basel, Basel, Switzerland

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Gabriela Baldini University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland

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Eleonora Seelig University Hospital Basel, Basel, Switzerland
University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland

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Introduction The hypothalamopituitary–adrenal (HPA) axis tightly regulates cortisol secretion ( 1 ). Cortisol is secreted in a circadian rhythm with a brisk increase upon awakening and a nadir around midnight ( 1 ). Food is an external factor

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Mohammed S Albreiki Department of Biochemistry and Physiology, Centre for Chronobiology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK

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Benita Middleton Department of Biochemistry and Physiology, Centre for Chronobiology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK

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Shelagh M Hampton Department of Biochemistry and Physiology, Centre for Chronobiology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK

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Introduction Artificial light exposure at night has become commonplace throughout the developed world ( 1 , 2 ). Light has been linked to various complex mechanisms such as the synchronisation of the circadian system ( 3 ). Circadian rhythms

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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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suspected CS was confirmed by the lack of cortisol suppression after 1 mg dexamethasone (10 µg/dL, n.v. <1.8) and the absence of a cortisol circadian rhythm (midnight serum cortisol, MserC, 12 µg/dL; n.v. <7.5). Which clinical features are the

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Lang Qin Division of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China

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Xiaoming Zhu Division of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China

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Xiaoxia Liu Division of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China

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Meifang Zeng Division of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China

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Ran Tao Division of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China

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Yan Zhuang Division of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China

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Yiting Zhou Division of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China

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Zhaoyun Zhang Division of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
Shanghai Pituitary Tumor Center, Shanghai, China

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Yehong Yang Division of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China

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Yiming Li Division of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China

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Yongfei Wang Division of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
Shanghai Pituitary Tumor Center, Shanghai, China

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Hongying Ye Division of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China

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The 24-h UFC excretion, the overnight 1 mg dexamethasone suppression test (DST) and cortisol secretion circadian rhythm were used as the first-line screen tests to identify patients with CS after exclusion of exogenous glucocorticoids exposure

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Ditte Sofie Dahl Sørensen Department of Endocrinology and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

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Jesper Krogh Department of Endocrinology and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

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Åse Krogh Rasmussen Department of Endocrinology and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

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Mikkel Andreassen Department of Endocrinology and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

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profiles in adult patients with 21-hydroxylase deficiency have shown a substantial circadian rhythm highly influenced by glucocorticoid replacement ( 6 ). Most recent clinical guideline from the US Endocrine Society suggests levels of androstenedione and 17

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L M Mongioì Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy

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R A Condorelli Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy

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S La Vignera Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy

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A E Calogero Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy

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 months ( 11 ). At the end of the 3 months, dual-release hydrocortisone mimicked the physiological circadian rhythm of cortisol secretion, confirming the results these authors had previously published in a phase 1 study ( 9 ). Moreover, the authors also

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Ramjan Sanas Mohamed Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK

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Biyaser Abuelgasim Imperial College School of Medicine, Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK

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Sally Barker Imperial College School of Medicine, Department of Biochemistry, 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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Niamh M Martin Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK

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

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Emma L Williams Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK

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Sarah Darch Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK

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Whitlock Matthew Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK

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Tricia Tan Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK

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Florian Wernig Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK

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circadian rhythm of cortisol secretion whereby, in the evening, cortisol secretion is higher in CS patients than in normal subjects ( 4 ). Therefore, assessment of LNSC, without the impracticality of hospitalisation and disruption of a normal routine, would

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Kuang Hung Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

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Bo-Ching Lee Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

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Po-Ting Chen Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

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Kao-Lang Liu Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

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Chin-Chen Chang Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Department and Graduate Institute of Forensic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan

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Vin-Cent Wu Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

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Yen-Hung Lin Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

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appearance, unilateral abnormality, and bilateral abnormalities. AVS All AVS procedures were performed by an interventional radiologist with 15 years of experience and in the morning to avoid bias resulting from the circadian rhythms of aldosterone

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Dafydd Aled Rees Cardiff University, Cardiff, United Kingdom

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Deborah P Merke National Institutes of Health Clinical Center and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, USA

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Wiebke Arlt MRC LMS, London, United Kingdom

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Aude Brac De La Perriere Hospices Civils de Lyon - GHE - Endocrinologie, Bron, France

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Angelica Linden Hirschberg Karolinska Institute, Solna, Sweden

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Anders Juul Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

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John Newell-Price The University of Sheffield, Sheffield, United Kingdom

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Alessandro Prete University of Birmingham, Birmingham, United Kingdom

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Nicole Reisch Endokrinologie, Nephrologie und weitere Sektionen - Medizinische Klinik und Poliklinik IV - Campus Innenstadt, München, Germany

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Nike M Stikkelbroeck Radboud University Nijmegen, Nijmegen, Netherlands

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Philippe A Touraine University Hospitals Pitié Salpêtrière - Charles Foix, Paris, France

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Alex Lewis Neurocrine Biosciences Inc, London, United Kingdom

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John Porter Neurocrine Biosciences Inc, London, United Kingdom

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Helen Coope Neurocrine Biosciences Inc, London, United Kingdom

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Richard J Ross The University of Sheffield, Sheffield, United Kingdom

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taking the dose on waking in the morning. MRHC has delayed release and sustained absorption was called Chronocort during development and has been shown to mimic the normal circadian rhythm of cortisol ( 13 , 14 ). MRHC is taken twice daily, at bedtime

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