Angelica Sharma
Angelica Sharma
Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
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Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
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Katharine Lazarus
Katharine Lazarus
Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
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Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
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Deborah Papadopoulou
Deborah Papadopoulou
Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
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Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
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Hemanth Prabhudev
Hemanth Prabhudev
Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
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Tricia Tan
Tricia Tan
Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
Department of Clinical Biochemistry, North West London Pathology, London, UK
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Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
Department of Clinical Biochemistry, North West London Pathology, London, UK
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Karim Meeran
Karim Meeran
Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
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Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
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Sirazum Choudhury
Sirazum Choudhury
Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
Department of Clinical Biochemistry, North West London Pathology, London, UK
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Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
Department of Clinical Biochemistry, North West London Pathology, London, UK
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Introduction Patients with adrenal insufficiency (AI) have premature morbidity and mortality ( 1 ). Mildly elevated levels of glucocorticoids or non-circadian timing of therapy may contribute towards cardiovascular disease and increased
Dafydd Aled Rees
Dafydd Aled Rees
Cardiff University, Cardiff, United Kingdom
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Deborah P Merke
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
Wiebke Arlt
MRC LMS, London, United Kingdom
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Aude Brac De La Perriere
Aude Brac De La Perriere
Hospices Civils de Lyon - GHE - Endocrinologie, Bron, France
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Angelica Linden Hirschberg
Angelica Linden Hirschberg
Karolinska Institute, Solna, Sweden
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Anders Juul
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
John Newell-Price
The University of Sheffield, Sheffield, United Kingdom
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Alessandro Prete
Alessandro Prete
University of Birmingham, Birmingham, United Kingdom
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Nicole Reisch
Nicole Reisch
Endokrinologie, Nephrologie und weitere Sektionen - Medizinische Klinik und Poliklinik IV - Campus Innenstadt, München, Germany
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Nike M Stikkelbroeck
Nike M Stikkelbroeck
Radboud University Nijmegen, Nijmegen, Netherlands
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Philippe A Touraine
Philippe A Touraine
University Hospitals Pitié Salpêtrière - Charles Foix, Paris, France
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Alex Lewis
Alex Lewis
Neurocrine Biosciences Inc, London, United Kingdom
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John Porter
John Porter
Neurocrine Biosciences Inc, London, United Kingdom
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Helen Coope
Helen Coope
Neurocrine Biosciences Inc, London, United Kingdom
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Richard J Ross
Richard J Ross
The University of Sheffield, Sheffield, United Kingdom
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adrenal androgens ( 1 ). To address this, clinicians have used a variety of treatment regimens, including the use of a higher dose of glucocorticoid at night in a reverse circadian treatment pattern. A recent comparison, using a higher dose of
Ditte Sofie Dahl Sørensen
Ditte Sofie Dahl Sørensen
Department of Endocrinology and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Jesper Krogh
Jesper Krogh
Department of Endocrinology and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Åse Krogh Rasmussen
Åse Krogh Rasmussen
Department of Endocrinology and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Mikkel Andreassen
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
Ramjan Sanas Mohamed
Ramjan Sanas Mohamed
Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
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Biyaser Abuelgasim
Biyaser Abuelgasim
Imperial College School of Medicine, Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK
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Sally Barker
Sally Barker
Imperial College School of Medicine, Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK
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Hemanth Prabhudev
Hemanth Prabhudev
Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
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Niamh M Martin
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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Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
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Karim Meeran
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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Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
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Emma L Williams
Emma L Williams
Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK
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Sarah Darch
Sarah Darch
Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK
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Whitlock Matthew
Whitlock Matthew
Department of Biochemistry, Imperial College Healthcare NHS Trust, London, UK
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Tricia Tan
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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Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
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Florian Wernig
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
Kuang Hung
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
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
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
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
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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Department and Graduate Institute of Forensic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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Vin-Cent Wu
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
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
Riccardo Pofi
Riccardo Pofi
Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism and NIHR Oxford Biomedical Research Centre, Churchill Hospital, University of Oxford, Oxford, UK
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Ilaria Bonaventura
Ilaria Bonaventura
Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena, Rome, Italy
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Joanne Duffy
Joanne Duffy
Department of Clinical Chemistry and Immunology, Heartlands Hospital, Birmingham, UK
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Zoe Maunsell
Zoe Maunsell
Department of Clinical Biochemistry, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Brian Shine
Brian Shine
Department of Clinical Biochemistry, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Andrea M Isidori
Andrea M Isidori
Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena, Rome, Italy
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Jeremy W Tomlinson
Jeremy W Tomlinson
Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism and NIHR Oxford Biomedical Research Centre, Churchill Hospital, University of Oxford, Oxford, UK
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prescribed MC since its discovery in 1954 ( 8 ). The pharmacokinetic characteristics of FC ( 9 ), alongside the ambition to mimic the physiological circadian secretion of aldosterone which is similar to that of cortisol ( 10 ), mean that it is usually taken
Susan M Webb
Susan M Webb
IIB-Sant Pau, Research Center for Pituitary Diseases, Barcelona, Spain
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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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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Jette Kristensen
Jette Kristensen
ePAG & Chair of Danish Addison Patient Association, Aarhus, Denmark
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Anna Nordenström
Anna Nordenström
Pediatric Endocrinology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Diana Vitali
Diana Vitali
ePAG & Chair SOD ITALIA - Italian Patients Organization for Septo Optic Dysplasia and other Neuroendocrine Conditions, Rome, Italy
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Vincent Amodru
Vincent Amodru
Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics, Institut MarMaRa, Marseille, France
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Lenja Katharina Wiehe
Lenja Katharina Wiehe
EURORDIS - Rare Diseases Europe, Paris, France
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Matt Bolz-Johnson
Matt Bolz-Johnson
EURORDIS - Rare Diseases Europe, Paris, France
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throughout the day. Information on the physiology of normal cortisol secretion to understand the importance of adequate hydrocortisone dose with adequate circadian distribution (not too late at night which favours night-time waking). Risks of both under- and
Marcus Imamovic
Marcus Imamovic
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Nils Bäcklund
Nils Bäcklund
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Staffan Lundstedt
Staffan Lundstedt
Department of Medical Biosciences, Umeå University, Umeå, Sweden
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Göran Brattsand
Göran Brattsand
Department of Medical Biosciences, Umeå University, Umeå, Sweden
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Elisabeth Aardal
Elisabeth Aardal
Department of Clinical Chemistry and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Tommy Olsson
Tommy Olsson
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Per Dahlqvist
Per Dahlqvist
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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; problems with the oral mucosa or saliva; current pregnancy; abnormal circadian rhythm (not sleeping at night between 00:30 and 05:00 h). The study was approved by the local ethics committee in Umeå (Dnr 2018-162-31M). Written informed consent was obtained
Deirdre Green
Deirdre Green
Academic Department of Endocrinology, Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin
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Rosemary Dineen
Rosemary Dineen
Academic Department of Endocrinology, Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin
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Michael W O’Reilly
Michael W O’Reilly
Academic Department of Endocrinology, Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin
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Mark Sherlock
Mark Sherlock
Academic Department of Endocrinology, Beaumont Hospital and the Royal College of Surgeons in Ireland, Dublin
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the form of immediate-release hydrocortisone fails to replicate the physiological cortisol circadian rhythm, and together with the uncertainties of GC dose adjustment and the absence of reliable biomarkers, patients receiving GC therapy may be over- or
