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R A M Quax Departments of Internal Medicine, Immunology, St John's Hospital, Department of Medicine, Department of Ophthalmology, Academic Unit of Ophthalmology, Department of Oral Medicine, University Hospital, Department of Ophthalmology, Department of Rheumatology, Erasmus MC, University Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands

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J A M van Laar Departments of Internal Medicine, Immunology, St John's Hospital, Department of Medicine, Department of Ophthalmology, Academic Unit of Ophthalmology, Department of Oral Medicine, University Hospital, Department of Ophthalmology, Department of Rheumatology, Erasmus MC, University Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands

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R van Heerebeek Departments of Internal Medicine, Immunology, St John's Hospital, Department of Medicine, Department of Ophthalmology, Academic Unit of Ophthalmology, Department of Oral Medicine, University Hospital, Department of Ophthalmology, Department of Rheumatology, Erasmus MC, University Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands

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K Greiner Departments of Internal Medicine, Immunology, St John's Hospital, Department of Medicine, Department of Ophthalmology, Academic Unit of Ophthalmology, Department of Oral Medicine, University Hospital, Department of Ophthalmology, Department of Rheumatology, Erasmus MC, University Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands

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E Ben-Chetrit Departments of Internal Medicine, Immunology, St John's Hospital, Department of Medicine, Department of Ophthalmology, Academic Unit of Ophthalmology, Department of Oral Medicine, University Hospital, Department of Ophthalmology, Department of Rheumatology, Erasmus MC, University Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands

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M Stanford Departments of Internal Medicine, Immunology, St John's Hospital, Department of Medicine, Department of Ophthalmology, Academic Unit of Ophthalmology, Department of Oral Medicine, University Hospital, Department of Ophthalmology, Department of Rheumatology, Erasmus MC, University Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands

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G R Wallace Departments of Internal Medicine, Immunology, St John's Hospital, Department of Medicine, Department of Ophthalmology, Academic Unit of Ophthalmology, Department of Oral Medicine, University Hospital, Department of Ophthalmology, Department of Rheumatology, Erasmus MC, University Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands

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F Fortune Departments of Internal Medicine, Immunology, St John's Hospital, Department of Medicine, Department of Ophthalmology, Academic Unit of Ophthalmology, Department of Oral Medicine, University Hospital, Department of Ophthalmology, Department of Rheumatology, Erasmus MC, University Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands

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M Ghabra Departments of Internal Medicine, Immunology, St John's Hospital, Department of Medicine, Department of Ophthalmology, Academic Unit of Ophthalmology, Department of Oral Medicine, University Hospital, Department of Ophthalmology, Department of Rheumatology, Erasmus MC, University Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands

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M Soylu Departments of Internal Medicine, Immunology, St John's Hospital, Department of Medicine, Department of Ophthalmology, Academic Unit of Ophthalmology, Department of Oral Medicine, University Hospital, Department of Ophthalmology, Department of Rheumatology, Erasmus MC, University Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands

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J M W Hazes Departments of Internal Medicine, Immunology, St John's Hospital, Department of Medicine, Department of Ophthalmology, Academic Unit of Ophthalmology, Department of Oral Medicine, University Hospital, Department of Ophthalmology, Department of Rheumatology, Erasmus MC, University Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands

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S W J Lamberts Departments of Internal Medicine, Immunology, St John's Hospital, Department of Medicine, Department of Ophthalmology, Academic Unit of Ophthalmology, Department of Oral Medicine, University Hospital, Department of Ophthalmology, Department of Rheumatology, Erasmus MC, University Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands

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J H Kappen Departments of Internal Medicine, Immunology, St John's Hospital, Department of Medicine, Department of Ophthalmology, Academic Unit of Ophthalmology, Department of Oral Medicine, University Hospital, Department of Ophthalmology, Department of Rheumatology, Erasmus MC, University Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands

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P M van Hagen Departments of Internal Medicine, Immunology, St John's Hospital, Department of Medicine, Department of Ophthalmology, Academic Unit of Ophthalmology, Department of Oral Medicine, University Hospital, Department of Ophthalmology, Department of Rheumatology, Erasmus MC, University Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands

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J W Koper Departments of Internal Medicine, Immunology, St John's Hospital, Department of Medicine, Department of Ophthalmology, Academic Unit of Ophthalmology, Department of Oral Medicine, University Hospital, Department of Ophthalmology, Department of Rheumatology, Erasmus MC, University Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands

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R A Feelders Departments of Internal Medicine, Immunology, St John's Hospital, Department of Medicine, Department of Ophthalmology, Academic Unit of Ophthalmology, Department of Oral Medicine, University Hospital, Department of Ophthalmology, Department of Rheumatology, Erasmus MC, University Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands

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dysfunctional humoral immune response. In general, BD might be regarded an immune-mediated inflammatory disease. Glucocorticoids (GC) play a key role in mediating a balanced inflammatory response. GCs exert their effects via interaction with the GC receptor (GR

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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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common in women and in those aged between 30 and 50 years old ( 2 ), although it can present at any age. Patients with AI need to take daily life-long medication. This consists of a glucocorticoid, typically hydrocortisone (HC) or prednisolone, and in

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Iulia Soare University of Medicine and Pharmacy ‘Carol Davila’ Bucharest, Bucharest, Romania

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Anca Sirbu University of Medicine and Pharmacy ‘Carol Davila’ Bucharest, Bucharest, Romania
Department of Endocrinology, Diabetes and Metabolic diseases, Elias Hospital, Bucharest, Romania

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Mihai Mircea Diculescu University of Medicine and Pharmacy ‘Carol Davila’ Bucharest, Bucharest, Romania
Department of Gastroenterology, Fundeni Clinical Institute, Bucharest, Romania

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Bogdan Radu Mateescu University of Medicine and Pharmacy ‘Carol Davila’ Bucharest, Bucharest, Romania
Department of Gastroenterology, Colentina Hospital, Bucharest, Romania

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Cristian Tieranu University of Medicine and Pharmacy ‘Carol Davila’ Bucharest, Bucharest, Romania
Department of Gastroenterology, Elias Hospital, Bucharest, Romania

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Sorina Martin University of Medicine and Pharmacy ‘Carol Davila’ Bucharest, Bucharest, Romania
Department of Endocrinology, Diabetes and Metabolic diseases, Elias Hospital, Bucharest, Romania

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Carmen Gabriela Barbu University of Medicine and Pharmacy ‘Carol Davila’ Bucharest, Bucharest, Romania
Department of Endocrinology, Diabetes and Metabolic diseases, Elias Hospital, Bucharest, Romania

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Mirela Ionescu University of Medicine and Pharmacy ‘Carol Davila’ Bucharest, Bucharest, Romania
Department of Gastroenterology, Elias Hospital, Bucharest, Romania

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Simona Fica University of Medicine and Pharmacy ‘Carol Davila’ Bucharest, Bucharest, Romania
Department of Endocrinology, Diabetes and Metabolic diseases, Elias Hospital, Bucharest, Romania

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previously conducted ( 3 ). Many factors are associated with decreased BMD, one of which is the use of high-dose glucocorticoids. A Swiss IBD cohort study has reported an increased percentage of steroid use in IBD patients with osteoporosis (79.2%) and

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Yue-Yue Wang Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

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Qian Wu Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

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Lu Chen Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

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Wen Chen Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

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Tao Yang Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

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Xiao-Quan Xu Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

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Fei-Yun Wu Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

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Hao Hu Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

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Huan-Huan Chen Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

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the first-line administration in the active stage, and intravenous glucocorticoids (GC) have been the mainstay of treatment for moderate-to-severe and active cases ( 2 ). However, the response rate of intravenous GC was reported as only 70–80% ( 3 , 4

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Arno Téblick Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium

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Ilse Vanhorebeek Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium

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Inge Derese Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium

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An Jacobs Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium

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Renata Haghedooren Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium

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Sofie Maebe Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium

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Gerdien A Zeilmaker-Roest Department of Neonatal & Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC – Sophia Children’s Hospital, Rotterdam, the Netherlands

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Enno D Wildschut Department of Neonatal & Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC – Sophia Children’s Hospital, Rotterdam, the Netherlands

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Lies Langouche Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium

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Greet Van den Berghe Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium

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Introduction Recently, we have found that during critical illness, the well-known constellation of ‘low plasma ACTH in the face of increased systemic glucocorticoid availability’ coincides with a substantial increase in plasma concentrations

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Sirazum Choudhury Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, Commonwealth Building, London, UK
Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK

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Tricia Tan Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, Commonwealth Building, London, UK
Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK

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Katharine Lazarus Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, Commonwealth Building, London, UK
Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK

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Karim Meeran Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, Commonwealth Building, London, UK
Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK

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Introduction Between 1928 and 1938, patients with Addison’s disease had a 100% 5-year mortality ( 1 ). With the availability of glucocorticoid replacement therapy, initially with animal adrenocortical extract and later synthetic 11

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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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Yiyan Wang Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China

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Yaoyao Dong Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China

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Yinghui Fang Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China

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Yao Lv Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China

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Qiqi Zhu Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China

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Xiaoheng Li Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China

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Qingquan Lian Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China

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Ren-Shan Ge Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China

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DES induced an intrauterine growth restriction of pups in the placentas ( 6 ). However, the mechanism has not been fully elucidated. Figure 1 Chemical structure of cortisol and diethylstilbestrol. Glucocorticoid hormone is an inducing

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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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). Glucocorticoids also have a negative impact on the Wnt/β-catenin pathway leading to an imbalance in bone formation and bone resorption, and thereby contributing to glucocorticoid-induced osteoporosis ( 1 , 3 , 10 , 11 , 12 , 13 ). In mice, glucocorticoids

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Sophie Howarth Clinical and Translational Research Institute, Newcastle University, Newcastle upon Tyne, UK
Department of Endocrinology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK

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Luca Giovanelli Department of Endocrinology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK

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Catherine Napier Department of Endocrinology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK

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Simon H Pearce Clinical and Translational Research Institute, Newcastle University, Newcastle upon Tyne, UK
Department of Endocrinology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK

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insufficient to meet the body’s needs. Overt mineralocorticoid deficiency causes the characteristic presentation of salt craving, postural hypotension, hyponatraemia and hyperkalaemia. Glucocorticoid deficiency causes loss of appetite, early satiety, weight

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