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A Chinoy Royal Manchester Children’s Hospital, Manchester, UK

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M Skae Royal Manchester Children’s Hospital, Manchester, UK

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A Babiker King Abdullah Specialized Children’s Hospital, Riyadh, Saudi Arabia

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D Kendall Royal Preston Hospital, Preston, UK

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M Z Mughal Royal Manchester Children’s Hospital, Manchester, UK

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R Padidela Royal Manchester Children’s Hospital, Manchester, UK

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on the specific aetiology and genetic mutations. There is scanty information in the medical literature, which describes the impact that intercurrent illness may have on serum cCa concentration in children with HPT. We describe a case series of three

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Kathrin Zopf Department of Endocrinology, Diabetes and Nutrition, Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany

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Kathrin R Frey Department of Medicine I, Endocrine and Diabetes Unit, University Hospital, University of Würzburg, Würzburg, Germany

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Tina Kienitz Department of Endocrinology, Diabetes and Nutrition, Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany

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Manfred Ventz Department of Endocrinology, Diabetes and Nutrition, Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany

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Britta Bauer Endocrinology in Charlottenburg, Berlin, Germany

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Marcus Quinkler Endocrinology in Charlottenburg, Berlin, Germany

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need a lifelong glucocorticoid replacement therapy ( 11 , 12 ), which needs to be tailored individually to the daily needs, to stress situations, and intercurrent illnesses such as infectious diseases ( 13 ). This is even more important since the daily

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S E Baldeweg Department of Diabetes and Endocrinology, University College London NHS Foundation Trust and Univeristy College London, London, UK

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S Ball Department of Medicine and Endocrinology, Manchester University Foundation Trust & Manchester Academic Health Science Centre Manchester, Manchester, UK

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A Brooke Royal Devon and Exeter NHS Foundation Trust, Exeter, UK

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H K Gleeson Department of Endocrinology, Queen Elizabeth Hospital, Birmingham, UK

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M J Levy University of Leicester and University of Leicester Hospitals Trust, Leicester, UK

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M Prentice Croydon Health Services NHS Trust, Croydon, UK

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J Wass Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology & Metabolism, Oxford, UK

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the Society for Endocrinology Clinical Committee The Society for Endocrinology, Starling House, 1600 Bristol Parkway North, Bristol, UK

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-availability, disability or inter-current illness) in a patient with CDI can lead to life-threatening dehydration. This position can be further exacerbated through the omission of DDAVP. Recent data have highlighted serious adverse events (including deaths) in patients

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Margret J Einarsdottir Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden

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Penelope Trimpou Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden

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Gudmundur Johannsson Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden

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Oskar Ragnarsson Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
Wallenberg Center for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden

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. Administration of GC stress dose Stress dose administration is essential to prevent adrenal crisis and death during intercurrent illness ( 5 , 13 ). In case 3, the patient should have received stress doses of GC directly upon admission. Similarly, in case 5

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Marie Freel Queen Elizabeth University Hospital, Glasgow, UK

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document clearly outlines key points in the recognition and management of a new presentation of adrenal insufficiency as well as clarifying how to alter glucocorticoid therapy in the event of intercurrent illness of medical procedures. The lead author of

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Wiebke Arlt Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK

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the Society for Endocrinology Clinical Committee The Society for Endocrinology, 22 Apex Court, Woodlands, Bradley Stoke, Bristol, UK

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suddenly stopped Failure to observe Sick Day Rule 1 : the need to double daily oral glucocorticoid dose during intercurrent illness with fever that requires bed rest and/or antibiotics Failure to observe Sick Day Rule 2 : the need to administer

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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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least in part, the limitations related to conventional glucocorticoid treatment: premature mortality ( 3 ), high frequency of hospitalization for intercurrent illnesses, especially infections ( 3 , 12 ), quality of life impairment ( 13 ), poor

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Gregory Knowles Walsall Manor Hospital, Walsall, UK

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Emily Warmington College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK

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Lisa M Shepherd Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK

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Jonathan M Hazlehurst Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Institute of Applied Health Research, University of Birmingham, Birmingham, UK

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Anne de Bray Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK

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Helena Gleeson Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

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Wiebke Arlt Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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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Alessandro Prete Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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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intercurrent illness, with suspected or confirmed COVID-19 being the second most common reason after general malaise/fatigue (18.5% and 23.7% of all sick day events, respectively). During the year preceding the interview, 18 patients with PAI (11.1%) suffered

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M Guftar Shaikh Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, UK
Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK

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Timothy G Barrett Department of Endocrinology, Birmingham Womens and Children’s Hospital, Birmingham, UK
Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK

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Nicola Bridges Department of Paediatric Endocrinology, Chelsea and Westminster Hospital, London, UK

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Robin Chung Research Working Group, Prader-Willi Syndrome Association, Northampton, UK

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Evelien F Gevers Department of Paediatric Endocrinology, Barts Health NHS Trust, Royal London Hospital, London, UK
Centre for Endocrinology, William Harvey Research Institute, Barts and The London Medical School, Queen Mary University of London, London, UK

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Anthony P Goldstone PsychoNeuroEndocrinologyResearch Group, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
Department of Endocrinology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK

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Anthony Holland Department of Psychiatry, University of Cambridge, Cambridge, UK

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Shankar Kanumakala Royal Alexandra Children’s Hospital, Brighton, UK

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Ruth Krone Department of Endocrinology, Birmingham Womens and Children’s Hospital, Birmingham, UK

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Andreas Kyriakou Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, UK
Department of Paediatric Endocrinology, Makarios Children's Hospital, Nicosia, Cyprus

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E Anne Livesey Royal Alexandra Children’s Hospital, Brighton, UK
Sussex Community NHS Trust, Brighton, UK

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Angela K Lucas-Herald Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, UK
Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK

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Christina Meade CHI at Tallaght University Hospital, Dublin, Republic of Ireland

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Susan Passmore Prader-Willi Syndrome Association, Northampton, UK

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Edna Roche CHI at Tallaght University Hospital, Dublin, Republic of Ireland
The University of Dublin, Trinity College Dublin, Dublin, Republic of Ireland

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Chris Smith Royal Alexandra Children’s Hospital, Brighton, UK

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Sarita Soni Learning Disability Psychiatry, NHS Greater Glasgow and Clyde, Glasgow, UK

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variation in practice with some international centres recommending steroid cover during intercurrent illness, some suggesting steroid cover during anaesthesia and major surgery, and others suggesting neither ( 111 , 133 , 141 ). If there are clinical

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Veronica Kieffer
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Kate Davies University Hospitals of Leicester NHS Trust, Great Ormond Street Hospital for Children NHS Trust, Central Manchester University Hospitals NHS Foundation Trust, NHS Grampian, Portsmouth Hospitals NHS Trust, Salford Royal Hospitals Foundation Trust, Heart of England NHS Foundation Trust, The London Clinic, Department of Diabetes and Endocrinology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK

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Christine Gibson University Hospitals of Leicester NHS Trust, Great Ormond Street Hospital for Children NHS Trust, Central Manchester University Hospitals NHS Foundation Trust, NHS Grampian, Portsmouth Hospitals NHS Trust, Salford Royal Hospitals Foundation Trust, Heart of England NHS Foundation Trust, The London Clinic, Department of Diabetes and Endocrinology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK

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Morag Middleton University Hospitals of Leicester NHS Trust, Great Ormond Street Hospital for Children NHS Trust, Central Manchester University Hospitals NHS Foundation Trust, NHS Grampian, Portsmouth Hospitals NHS Trust, Salford Royal Hospitals Foundation Trust, Heart of England NHS Foundation Trust, The London Clinic, Department of Diabetes and Endocrinology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK

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Jean Munday University Hospitals of Leicester NHS Trust, Great Ormond Street Hospital for Children NHS Trust, Central Manchester University Hospitals NHS Foundation Trust, NHS Grampian, Portsmouth Hospitals NHS Trust, Salford Royal Hospitals Foundation Trust, Heart of England NHS Foundation Trust, The London Clinic, Department of Diabetes and Endocrinology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK

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Shashana Shalet University Hospitals of Leicester NHS Trust, Great Ormond Street Hospital for Children NHS Trust, Central Manchester University Hospitals NHS Foundation Trust, NHS Grampian, Portsmouth Hospitals NHS Trust, Salford Royal Hospitals Foundation Trust, Heart of England NHS Foundation Trust, The London Clinic, Department of Diabetes and Endocrinology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK

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Lisa Shepherd University Hospitals of Leicester NHS Trust, Great Ormond Street Hospital for Children NHS Trust, Central Manchester University Hospitals NHS Foundation Trust, NHS Grampian, Portsmouth Hospitals NHS Trust, Salford Royal Hospitals Foundation Trust, Heart of England NHS Foundation Trust, The London Clinic, Department of Diabetes and Endocrinology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK

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Phillip Yeoh University Hospitals of Leicester NHS Trust, Great Ormond Street Hospital for Children NHS Trust, Central Manchester University Hospitals NHS Foundation Trust, NHS Grampian, Portsmouth Hospitals NHS Trust, Salford Royal Hospitals Foundation Trust, Heart of England NHS Foundation Trust, The London Clinic, Department of Diabetes and Endocrinology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK

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take control of steroid management and administration on a daily basis and during inter-current illness • Initiates additional necessary biochemical and radiological investigations a • Can explain the reasons for taking and the consequences of not

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