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countries ( 1 ) and the lowest in Japan. Despite the advent of glucocorticoid replacement therapy in the early 1950s, life expectancy remains lower than in the general population ( 2 ), with increased morbidity and impaired quality of life ( 3 , 4
University of Alcalá, Madrid, Spain
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associated glucocorticoid hypersecretion (PA-only). Nevertheless, the studies investigating this aspect are scarce and most of them included a limited number of patients or had been performed in a single center. In addition, the definition of ACS is widely
Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), ISCIII, Spain
Department of Endocrinology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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recognised, however, all stated progressive physical and psychological recovery as soon as glucocorticoid and mineralocorticoid substitution therapy was initiated. Individualisation of the total daily dose and distribution throughout the day was not always
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Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
Medical Research Council London Institute of Medical Sciences, London, UK
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Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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autoimmune destruction of the adrenal cortex, and congenital adrenal hyperplasia (CAH), a group of autosomal recessive inborn disorders caused by enzyme deficiencies in adrenal steroidogenesis ( 2 ). PAI necessitates long-term glucocorticoid replacement, the
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Wellcome–MRC Institute of Metabolic Science, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Addenbrooke’s Hospital, Cambridge, UK
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our analysis if the blood sample was collected after the patient had already received glucocorticoid or mineralocorticoid therapy (e.g. dexamethasone, fludrocortisone, hydrocortisone, methylprednisolone, prednisolone). Following the findings of the
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Department of Medicine, University of Otago, Wellington, New Zealand
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Department of General Surgery, Wellington Regional Hospital, New Zealand
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Department of Medicine, Monash University, Clayton, Victoria, Australia
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context assumes normal cortisol physiology. Any clinical scenario where this is not the case could potentially lead to erroneous conclusions being drawn from the AVS data. Current or historical use of glucocorticoid therapy or intrinsic pituitary or
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National Institute of Endocrinology CI Parhon, Bucharest, Romania
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syndrome, where usually PHEO is preceded by adrenal hyperplasia ( 9 , 28 , 29 , 30 ). The time of follow-up after bilateral adrenalectomy with at least one CSS in order to detect the need for glucocorticoid replacement is not well established. These
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characteristics and laboratory results of the subjects with and without AI are reflected in Table 1 . The aetiologies of AI were due to exogenous glucocorticoid use in 16, primary AI in 2, hypopituitarism in 1, and post-adrenalectomy for adrenal Cushing
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essential to prevent both mortality and morbidity. With physiological replacement of glucocorticoids and mineralocorticoids, PAI has an excellent prognosis ( 3 ). Most studies on PAI have been conducted in European and North American populations ( 4 , 5
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Barts and the London School of Medicine, Centre for Endocrinology, William Harvey Institute, London, UK
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Obesity, Type 2 Diabetes and Immunometabolism Research Group, School of Cardiovascular and Metabolic Medicine & Sciences, Faculty of Life Course Sciences, King’s College London, London, UK
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serum cortisol may not accurately reflect the glucocorticoid status of the patient and may lead to unrecognised adrenal insufficiency. Consequently, the altered binding protein profile and heightened risk of adrenal insufficiency lead to patients on