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Jesper Krogh Department of Endocrinology & Metabolism, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

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Peter Plomgaard Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark

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Ruth Frikke-Schmidt Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark

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Sten Velschow Fluisense ApS, Lillerød, Denmark

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Jesper Johannesen Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
Department of Pediatrics, Copenhagen University Hospital - Herlev & Gentofte, Copenhagen, Denmark

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Linda Maria Hilsted Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark

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Malene Schrøder Fluisense ApS, Lillerød, Denmark

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Ulla Feldt-Rasmussen Department of Endocrinology & Metabolism, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

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man-hours needed for serial sampling and minimizes the risks of sample loss, wrong timing, misidentification, and contamination. The volumetric DBS technology used in the Fluispotter has previously been tested ex vivo for cortisol assessment by

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Soraya Puglisi Internal Medicine 1, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy

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Paola Perotti Internal Medicine 1, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy

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Mattia Barbot Endocrinology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy

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Paolo Cosio Internal Medicine 1, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy

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Carla Scaroni Endocrinology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy

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

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Pina Lardo Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital University of Rome, Rome, Italy

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Valentina Morelli Endocrinology Unit, Department of Clinical Sciences and Community Health, University of Milan and Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy

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Elisa Polledri Department of Clinical Sciences and Community Health, Laboratory of Toxicology, University of Milan and Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy

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Iacopo Chiodini Endocrinology Unit, Department of Clinical Sciences and Community Health, University of Milan and Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy

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Giuseppe Reimondo Internal Medicine 1, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy

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Anna Pia Internal Medicine 1, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy

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Massimo Terzolo Internal Medicine 1, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy

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mortality ratio between 2.0 and 4.0 ( 2 ). Because of these clinical consequences, CS requires a prompt and definitive resolution since the duration of exposure to cortisol excess is a factor portending a worse prognosis ( 3 ). Surgery is the mainstay of

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Siphiwe N Dlamini SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa

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Zané Lombard Division of Human Genetics, National Health Laboratory Service, and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

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Lisa K Micklesfield SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

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Nigel Crowther Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

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Shane A Norris SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

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Tracy Snyman Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

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Andrew A Crawford Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK

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Brian R Walker BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
Institute of Genetic Medicine to Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK

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Julia H Goedecke SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa

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cortisol leads to Cushing’s syndrome, which exhibits metabolic features similar to metabolic syndrome ( 2 ). Accordingly, previous cross-sectional studies suggest that circulating cortisol concentrations are associated with metabolic syndrome, its

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Sarah Zaheer Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, North Carolina, USA

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Kayla Meyer Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, Massachusetts, USA

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Rebecca Easly Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, Massachusetts, USA

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Omar Bayomy Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA

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Janet Leung Section of Endocrinology, Virginia Mason Medical Center, Seattle, Washington, USA

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Andrew W Koefoed Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, Massachusetts, USA

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Mahyar Heydarpour Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, Massachusetts, USA

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Roy Freeman Harvard Medical School, Boston, Massachusetts, USA
Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

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Gail K Adler Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, Massachusetts, USA
Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
Harvard Medical School, Boston, Massachusetts, USA

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following a bout of intense physical exercise in healthy humans ( 29 , 30 , 31 ). This increase in sclerostin is accompanied by activation of the pituitary–adrenal axis, raising the possibility that acute increases in cortisol due to pituitary

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Milène Tetsi Nomigni INSERM, University of Rouen, Department of Endocrinology, Departments of Endocrinology, Pathology, Department of Pathology, Department of Endocrinology, INSERM, U982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in Biomedicine, Mont‐Saint‐Aignan, France
INSERM, University of Rouen, Department of Endocrinology, Departments of Endocrinology, Pathology, Department of Pathology, Department of Endocrinology, INSERM, U982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in Biomedicine, Mont‐Saint‐Aignan, France

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Sophie Ouzounian INSERM, University of Rouen, Department of Endocrinology, Departments of Endocrinology, Pathology, Department of Pathology, Department of Endocrinology, INSERM, U982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in Biomedicine, Mont‐Saint‐Aignan, France

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Alice Benoit INSERM, University of Rouen, Department of Endocrinology, Departments of Endocrinology, Pathology, Department of Pathology, Department of Endocrinology, INSERM, U982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in Biomedicine, Mont‐Saint‐Aignan, France

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Jacqueline Vadrot INSERM, University of Rouen, Department of Endocrinology, Departments of Endocrinology, Pathology, Department of Pathology, Department of Endocrinology, INSERM, U982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in Biomedicine, Mont‐Saint‐Aignan, France

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Frédérique Tissier INSERM, University of Rouen, Department of Endocrinology, Departments of Endocrinology, Pathology, Department of Pathology, Department of Endocrinology, INSERM, U982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in Biomedicine, Mont‐Saint‐Aignan, France

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Sylvie Renouf INSERM, University of Rouen, Department of Endocrinology, Departments of Endocrinology, Pathology, Department of Pathology, Department of Endocrinology, INSERM, U982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in Biomedicine, Mont‐Saint‐Aignan, France
INSERM, University of Rouen, Department of Endocrinology, Departments of Endocrinology, Pathology, Department of Pathology, Department of Endocrinology, INSERM, U982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in Biomedicine, Mont‐Saint‐Aignan, France

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Hervé Lefebvre INSERM, University of Rouen, Department of Endocrinology, Departments of Endocrinology, Pathology, Department of Pathology, Department of Endocrinology, INSERM, U982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in Biomedicine, Mont‐Saint‐Aignan, France
INSERM, University of Rouen, Department of Endocrinology, Departments of Endocrinology, Pathology, Department of Pathology, Department of Endocrinology, INSERM, U982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in Biomedicine, Mont‐Saint‐Aignan, France
INSERM, University of Rouen, Department of Endocrinology, Departments of Endocrinology, Pathology, Department of Pathology, Department of Endocrinology, INSERM, U982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in Biomedicine, Mont‐Saint‐Aignan, France

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Sophie Christin-Maitre INSERM, University of Rouen, Department of Endocrinology, Departments of Endocrinology, Pathology, Department of Pathology, Department of Endocrinology, INSERM, U982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in Biomedicine, Mont‐Saint‐Aignan, France
INSERM, University of Rouen, Department of Endocrinology, Departments of Endocrinology, Pathology, Department of Pathology, Department of Endocrinology, INSERM, U982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in Biomedicine, Mont‐Saint‐Aignan, France

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Estelle Louiset INSERM, University of Rouen, Department of Endocrinology, Departments of Endocrinology, Pathology, Department of Pathology, Department of Endocrinology, INSERM, U982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in Biomedicine, Mont‐Saint‐Aignan, France
INSERM, University of Rouen, Department of Endocrinology, Departments of Endocrinology, Pathology, Department of Pathology, Department of Endocrinology, INSERM, U982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in Biomedicine, Mont‐Saint‐Aignan, France

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androgen and cortisol oversecretion is highly suggestive of adrenocortical carcinoma (12) . In very few cases, androgen-secreting adrenal lesions have been identified as bilateral macronodular hyperplasia (13, 14) , adenoma (15) , primary pigmented

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Boni Xiang Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China

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Ran Tao Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China

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Xinhua Liu Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China

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Xiaoming Zhu Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China

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Min He Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China

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Zengyi Ma Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China

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Yehong Yang Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China

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Zhaoyun Zhang Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China

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Yiming Li Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China

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Zhenwei Yao Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China

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Yongfei Wang Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China

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Hongying Ye Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China

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impairment was relieved after a pituitary implant of 198 Au ( 6 ). Primary cortisol deficiency was reported concomitant with high TSH and low FT3. After cortisone administration, TSH returned to normal. However, serum cortisol and TSH showed no significant

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Nishchil Patel Department of Endocrinology, University Hospital Plymouth, UK

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Kagabo Hirwa Department of Endocrinology, University Hospital Plymouth, UK

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Gemma Gardner Department of Endocrinology, University Hospital Plymouth, UK

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Kirsten Pearce Department of Endocrinology, University Hospital Plymouth, UK

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Jinny Jeffery Department of Endocrinology, University Hospital Plymouth, UK

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Fizzah Iqbal Department of Endocrinology, University Hospital Plymouth, UK

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Daniel Flanagan Department of Endocrinology, University Hospital Plymouth, UK

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-stimulated 09:00 h cortisol was accepted if the cortisol was significantly low (<100 nmol/L). Individuals were asked to withhold their morning dose of hydrocortisone until after the assessment. No other glucocorticoids were being taken at the time of the test

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Henryk F Urbanski Division of Neuroscience, Oregon National Primate Research Center, Beaverton, Oregon, USA
Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Beaverton, Oregon, USA
Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon, USA
Department of Physiology & Pharmacology, Oregon Health & Science University, Portland, Oregon, USA

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Kevin Mueller Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Beaverton, Oregon, USA

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Cynthia L Bethea Division of Neuroscience, Oregon National Primate Research Center, Beaverton, Oregon, USA
Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Beaverton, Oregon, USA
Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA

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. Blood samples were collected from each animal under ketamine HCl sedation (10 mg/kg body weight, intramuscular), at Month −1 and again at Month 24; the serum was stored frozen at −20°C and subsequently assayed for leptin, cortisol and DHEAS. Note

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Jonneke J Hollanders Department of Pediatric Endocrinology, VU University Medical Center, Amsterdam, The Netherlands

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Bibian van der Voorn Department of Pediatric Endocrinology, VU University Medical Center, Amsterdam, The Netherlands

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Noera Kieviet Department of Pediatrics, Psychiatry Obstetrics Pediatrics Expert Center, OLVG West, Amsterdam, The Netherlands

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Koert M Dolman Department of Pediatrics, Psychiatry Obstetrics Pediatrics Expert Center, OLVG West, Amsterdam, The Netherlands

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Yolanda B de Rijke Department of Clinical Chemistry, Erasmus MC, University Medical Center, Rotterdam, The Netherlands

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Erica L T van den Akker Department of Pediatric Endocrinology, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands

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Joost Rotteveel Department of Pediatric Endocrinology, VU University Medical Center, Amsterdam, The Netherlands

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Adriaan Honig Department of Pediatrics, Psychiatry Obstetrics Pediatrics Expert Center, OLVG West, Amsterdam, The Netherlands
Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands

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Martijn J J Finken Department of Pediatric Endocrinology, VU University Medical Center, Amsterdam, The Netherlands

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estriol) and precursor GCs, since the adrenocortical enzymes are not fully matured yet ( 5 ). Subsequently, during the last 6–8 weeks of pregnancy, the more matured fetal adrenal produces increasing amounts of cortisol and cortisone under the control of

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Anne-Sophie C A M Koning Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands

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Philippe C Habets Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands

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Marit Bogaards Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands

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Jan Kroon Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands

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Hanneke M van Santen Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
Department of Pediatric Neuro-Oncology, Prinses Máxima Centrum, Utrecht, The Netherlands

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Judith M de Bont Department of Pediatric Neuro-Oncology, Prinses Máxima Centrum, Utrecht, The Netherlands

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Onno C Meijer Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands

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naturally produced glucocorticoid hormone cortisol. Cortisol also acts via the mineralocorticoid receptor (MR) in many tissues including the brain ( 6 ), but synthetic glucocorticoids have a clear preference for GR over MR ( 7 ). Both receptor types are

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