{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T21:00:14Z","timestamp":1788210014419,"version":"build-2803163510"},"reference-count":43,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Only 5 prior studies, each involving 12 to 32 patients, have evaluated the impact of high-dose intravenous methylprednisolone (IVMP) on hypothalamic\u2013pituitary\u2013adrenal (HPA) axis function in patients with active moderate-to-severe thyroid eye disease (TED). Due to their small sample sizes and methodological limitations, uncertainty remains regarding the risk of adrenal suppression following this regimen.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective observational study of 127 adults with active moderate-to-severe TED treated with the standard IVMP protocol (cumulative dose: 4.5\u2005g over 12 weeks) at the Department of Endocrinology and Metabolic Diseases, University General Hospital of Larissa, Greece. HPA axis integrity was assessed 7-10 days after the final IVMP dose using the 250-\u03bcg ACTH(1-24) stimulation test. Serum cortisol was measured at baseline, 30-, and 60-min post-ACTH. A peak cortisol level \u226518.1 \u03bcg\/dL (\u2265500\u2005nmol\/L) was considered indicative of adrenal sufficiency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twelve patients were excluded due to unavailability of testing or contraindications. Among the 115 patients tested, 15 (13%) had baseline cortisol \u226518.1 \u03bcg\/dL. At 30\u2005min, 93% achieved adequate cortisol response, and at 60\u2005min, 100% met the sufficiency threshold. All patients with baseline cortisol &amp;lt;5 \u03bcg\/dL (150\u2005nmol\/L) demonstrated intact adrenal function on dynamic testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this cohort, adrenal responsiveness to the 250 \u03bcg ACTH test 7-10 days after completion of IVMP was preserved in all patients, suggesting that early post-treatment secondary adrenal insufficiency is uncommon. Although reassuring, these results should be interpreted cautiously, and clinicians should continue to rely on clinical judgment, supported by biochemical testing when indicated.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejendo\/lvag077","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T12:04:20Z","timestamp":1778760260000},"page":"653-662","source":"Crossref","is-referenced-by-count":1,"title":["Adrenal axis integrity after IV methylprednisolone therapy for thyroid eye disease: a retrospective cohort study"],"prefix":"10.1093","volume":"194","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7313-8391","authenticated-orcid":false,"given":"Grigoris","family":"Effraimidis","sequence":"first","affiliation":[{"name":"Faculty of Medicine, School of Health Sciences, University of Thessaly , Larissa 41500 ,","place":["Greece"]},{"name":"Department of Endocrinology and Metabolic Diseases, Larissa University Hospital , , Biopolis, Larissa 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