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Department of Endocrinology, Diabetes and Metabolism, Karolinska University Hospital, Stockholm, Sweden
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Department of Medicine, Haukeland University Hospital, Bergen, Norway
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, and 8 mg/m 2 body surface/day in children divided over three to four doses ( 2 ). Patients with primary AI typically also require fludrocortisone, 0.05–0.2 mg daily. However, in situations of illness or severe stress, the ordinary replacement doses do
Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
Wallenberg Center for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
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(stress dose) during physical and/or psychological stress. Similarly, patients undergoing severe stress who have recently ceased GC treatment also require stress doses of GC ( 1 ). Common symptoms and signs of adrenal crisis include hypotension, abdominal
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Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
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with DEX have increased ACTH and cortisol levels, altered HPA axis activity ( 52 , 64 ) and also displayed changes in stress-related behaviour such as increased anxiety and depression, in particular in females ( 65 ). In humans, specifically, neonates
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stress doses of hydrocortisone (1.2 mg/day, ~200–300 mg/day human equivalent ( 2 )) resulted in further suppression of plasma ACTH concentrations after 7 days of critical illness as compared with infusion of placebo ( 3 ), without affecting plasma POMC
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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, fits of rage, irritability Less frequently described: ‘unexplained’ very large placenta. Laryngeal ventricular hernia, change in smile Two different scenarios: - No suspicion of disease, problems thought to be related to stress, ageing, weight gain or
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Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
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Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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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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dosage of which should be increased under stressors, such as infection, trauma or surgery, to prevent life-threatening adrenal crises, with increased stress doses recommended for patients with PAI and COVID-19 (1, 2 , 3 ). Despite advancements in
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Introduction Glucocorticoids (GCs) are primary stress hormones and critical regulators of several physiological mechanisms. GCs commonly elicit their function through glucocorticoid receptor (GR)-mediated genomic effects. However, these
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Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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glucocorticoid treatment has been effective in improving outcomes in patients with hypoxemic COVID-19 ( 9 ). This suggests an inadequate physiological stress response in COVID-19 patients. Our findings do not support the presence of CIRCI at an enzymatic level in
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define an ‘optimal range’ because of the challenges in normalising 17OHP levels with physiological doses of glucocorticoid ( 10 ). Where 17OHP and A4 were inconsistent, precedence was given to A4 results. Hydrocortisone stress dosing and fludrocortisone
Department of Endocrinology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Department of Endocrinology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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daily. Her symptoms improved with steroid replacement, but she reported intermittent postural hypotension following night-time shift work which required additional stress hydrocortisone dosing. Five years after diagnosis, her synacthen test was