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Gavin P Vinson School of Biological and Chemical Sciences, Queen Mary University of London, London E1 4NS, UK

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Caroline H Brennan School of Biological and Chemical Sciences, Queen Mary University of London, London E1 4NS, UK

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neural POMC is multifactorial (e.g. (65, 67) , and this is primarily linked to its role in energy balance and nutrition, see text. There is, however, much evidence to show the feedback of glucocorticoids on CRH expression in several brain regions. Mostly

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Natacha Driessens Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Endocrinology, Route de Lennik, Brussels, Belgium

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Madhu Prasai Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Endocrinology, Route de Lennik, Brussels, Belgium

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Orsalia Alexopoulou Department of Endocrinology, Cliniques Universitaires Saint Luc, Brussels, Belgium

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Christophe De Block Department of Endocrinology-Diabetology-Metabolism, Universitair Ziekenhuis Antwerpen & University of Antwerp, Drie Eikenstraat, Edegem, Belgium

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Eva Van Caenegem Department of Endocrinology, Academisch Ziekenhuis Sint-Jan Brugge – Oostende AV, Ruddershove, Brugge, Belgium

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Guy T’Sjoen Department of Endocrinology, Ghent Universitary Hospital, C. Heymanslaan, Gent, Belgium

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Frank Nobels Department of Endocrinology, Onze-Lieve Vrouw Ziekenhuis, Moorselbaan, Aalst, Belgium

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Christophe Ghys Department of Endocrinology, Universitair Ziekenhuis Brussel, Laarbeeklaan, Brussels, Belgium

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Laurent Vroonen Department of Endocrinology, Cliniques Universitaires de Liège, Avenue de l’hôpital, Liège, Belgium

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Corinne Jonas Department of Endocrinology, CHU UCL Namur - Godinne, Avenue Docteur Gaston Thérasse, Yvoir, Belgium

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Bernard Corvilain Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Endocrinology, Route de Lennik, Brussels, Belgium

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Dominique Maiter Department of Endocrinology, Cliniques Universitaires Saint Luc, Brussels, Belgium

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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

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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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combination with other anteropituitary hormone deficiency (CPHD) ( 2 ). This rare condition needs chronic glucocorticoid and, sometimes, mineralocorticoid administration. Despite replacement therapy, AI is characterized by high mortality rate compared to

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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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suggests that this condition is confined to the anterior pituitary and primarily involves glucocorticoid deficiency ( 8 , 9 , 10 , 11 , 12 , 13 , 14 ). Published evidence of pituitary disease is restricted to case reports with a small number of case

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Bliss Anderson Department of Endocrinology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK

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Daniel L Morganstein Department of Endocrinology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK

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cessation of CPI therapy and immunosuppression with glucocorticoids as first-line agents ( 5 ). Figure 1 Graphic illustrating checkpoint inhibitor action to shift immune response. Without treatment self and tumour reacting T-cells are driven to

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Ruth Percik Institute of Endocrinology, Diabetes and Metabolism, Sheba Medical Centre, Ramat Gan, Israel

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Sherwin Criseno Department of Endocrinology, University Hospital Birmingham, Birmingham, UK

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Safwaan Adam Department of Endocrinology, The Christie NHS Foundation Trust, Manchester, UK

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Kate Young Royal Marsden Hospital, London, UK

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Daniel L Morganstein Department of Endocrinology, Chelsea and Westminster Hospital, London, UK
Royal Marsden Hospital, London, UK

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of immunotherapy and/or immunomodulation with glucocorticoid therapy is usually unnecessary, with immunosuppressive doses of glucocorticoids only rarely required where the initial inflammation causes severe symptoms. Lastly, optimal exogenous

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Thabiso R P Mofokeng Department of Medicine, University of the Free State, Bloemfontein, South Africa

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Salem A Beshyah Department of Medicine, Dubai Medical College, Duabi, United Arab Emirates
Department of Endocrinology, Mediclinic Airport Road Hospital, Abu Dhabi, United Arab Emirates

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Fazleh Mahomed Department of Medicine, University of the Free State, Bloemfontein, South Africa

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Kwazi C Z Ndlovu Department of Medicine, University of the Free State, Bloemfontein, South Africa

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Ian L Ross Division of Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa

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of glucocorticoids and mineralocorticoids, which are life-saving. Despite the availability of appropriate replacement therapy in developed countries, there is a residual increased mortality, morbidity, and reduced quality of life ( 12 ) associated

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Marta Araujo-Castro Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal & Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
University of Alcalá, Madrid, Spain

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Miguel Paja Fano Department of Endocrinology & Nutrition, OSI Bilbao-Basurto, Hospital Universitario de Basurton & Basque Country University, Medicine Department, Bilbao, Spain

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Begoña Pla Peris Department of Endocrinology & Nutrition, Hospital Universitario de Castellón, Castellón, Spain

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Marga González Boillos Department of Endocrinology & Nutrition, Hospital Universitario de Castellón, Castellón, Spain

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Eider Pascual-Corrales Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal & Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain

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Ana María García-Cano Department of Biochemistry, Hospital Universitario Ramón y Cajal, Madrid, Spain

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Paola Parra Ramírez Department of Endocrinology & Nutrition, Hospital Universitario La Paz Madrid, Spain

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Patricia Martín Rojas-Marcos Department of Endocrinology & Nutrition, Hospital Universitario La Paz Madrid, Spain

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Jorge Gabriel Ruiz-Sanchez Department of Endocrinology & Nutrition, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain

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Almudena Vicente Department of Endocrinology & Nutrition, Hospital Universitario de Toledo, Toledo, Spain

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Emilia Gómez-Hoyos Department of Endocrinology & Nutrition, Hospital Universitario de Valladolid, Valladolid, Spain

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Rui Ferreira Department of Endocrinology & Nutrition, Hospital Universitario Rey Juan Carlos, Madrid, Spain

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Iñigo García Sanz Department of General & Digestive Surgery, Hospital Universitario de La Princesa, Madrid, Spain

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Mónica Recasens Department of Endocrinology & Nutrition, Institut Català de la Salut Girona, Girona, Spain

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Rebeca Barahona San Millan Department of Endocrinology & Nutrition, Institut Català de la Salut Girona, Girona, Spain

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María José Picón César Department of Endocrinology & Nutrition, Hospital Universitario Virgen de la Victoria de Málaga, IBIMA Malaga, Spain CIBEROBN, Madrid, Spain

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Patricia Díaz Guardiola Department of Endocrinology & Nutrition, Hospital Universitario Infanta Sofía, Madrid, Spain

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Carolina Perdomo Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, Pamplona, Spain

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Laura Manjón Department of Endocrinology & Nutrition, Hospital Universitario Central de Asturias & Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain

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Rogelio García-Centeno Department of Endocrinology & Nutrition, Hospital Universitario Gregorio Marañón, Madrid, Spain

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Juan Carlos Percovich Department of Endocrinology & Nutrition, Hospital Universitario Gregorio Marañón, Madrid, Spain

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Ángel Rebollo Román Department of Endocrinology & Nutrition, Hospital Reina Sofía, Córdoba, Spain

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Paola Gracia Gimeno Department of Endocrinology & Nutrition, Hospital Rollo Villanova, Zaragoza, Spain

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Cristina Robles Lázaro Department of Endocrinology & Nutrition, Complejo Universitario de Salamanca, Salamanca, Spain

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Manuel Morales Biochemistry and Molecular Genetics Department-CDB, Hospital Clinic, IDIBAPS, CIBERehd, Barcelona, Spain

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María Calatayud Department of Endocrinology & Nutrition, Hospital Doce de Octubre, Madrid, Spain

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Simone Andree Furio Collao Department of Endocrinology & Nutrition, Hospital Doce de Octubre, Madrid, Spain

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Diego Meneses Department of Endocrinology & Nutrition, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain

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Miguel Antonio Sampedro Nuñez Department of Endocrinology & Nutrition, Hospital Universitario La Princesa, Madrid, Spain

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Verónica Escudero Quesada Department of Nephrology, Hospital Universitario Doctor Peser, Valencia, Spain

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Elena Mena Ribas Department of Endocrinology & Nutrition, Hospital Universitario Son Espases, Islas Baleares, Spain

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Alicia Sanmartín Sánchez Department of Endocrinology & Nutrition, Hospital Universitario Son Espases, Islas Baleares, Spain

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Cesar Gonzalvo Diaz Department of Endocrinology & Nutrition, Hospital Universitario De Albacete, Albacete, Spain

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Cristina Lamas Department of Endocrinology & Nutrition, Hospital Universitario De Albacete, Albacete, Spain

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Raquel Guerrero-Vázquez Department of Endocrinology & Nutrition, Hospital Virgen de la Macarena, Sevilla, Spain

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María del Castillo Tous Department of Endocrinology & Nutrition, Hospital Virgen de la Macarena, Sevilla, Spain

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Joaquín Serrano Department of Endocrinology & Nutrition, Hospital General Universitario de Alicante, Alicante, Spain

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Theodora Michalopoulou Department of Endocrinology and Nutrition, Joan XXIII University Hospital, Tarragona, Spain

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Eva María Moya Mateo Internal Medicine, Hospital Infanta Leonor de Vallecas, Madrid, Spain

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Felicia Hanzu Department of Endocrinology & Nutrition, Hospital Clinic, IDIPAS, Barcelona, 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

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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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Introduction Cushing’s syndrome (CS) comprises diverse manifestations resulting from chronic exposure to excess glucocorticoids. The incidence is 0.2–5.0 per million people per year. Approximately 80% of endogenous CS is adrenocorticotrophin

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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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chromatography-tandem mass spectrometry (LC–MS/MS). Antibody-based immunoassays can be affected by cross-reactivity (especially cortisone, which has a structure similar to that of cortisol) and synthetic glucocorticoids ( 9 ). In fact, cortisol is converted into

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