{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T18:23:51Z","timestamp":1791829431404,"version":"4.3.4"},"reference-count":37,"publisher":"The Endocrine Society","issue":"10","license":[{"start":{"date-parts":[[2023,4,6]],"date-time":"2023-04-06T00:00:00Z","timestamp":1680739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100005010","name":"Italian Association for Cancer Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005010","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005010","name":"Associazione Italiana per la Ricerca sul Cancro","doi-asserted-by":"publisher","award":["IG2019-23069"],"award-info":[{"award-number":["IG2019-23069"]}],"id":[{"id":"10.13039\/501100005010","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Because of the rarity of adrenocortical cancer (ACC), only a few population-based studies are available, and they reported limited details in the characterization of patients and their treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To describe in a nationwide cohort the presentation of patients with ACC, treatment strategies, and potential prognostic factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective analysis of 512 patients with ACC, diagnosed in 12 referral centers in Italy from January 1990 to June 2018.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>ACC diagnosed as incidentalomas accounted for overall 38.1% of cases, with a frequency that increases with age and with less aggressive pathological features than symptomatic tumors. Women (60.2%) were younger than men and had smaller tumors, which more frequently secreted hormones. Surgery was mainly done with an open approach (72%), and after surgical resection, 62.7% of patients started adjuvant mitotane therapy. Recurrence after tumor resection occurred in 56.2% of patients. In patients with localized disease, cortisol secretion, ENSAT stage III, Ki67%, and Weiss score were associated with an increased risk of recurrence, whereas margin-free resection, open surgery, and adjuvant mitotane treatment were associated with reduced risk. Death occurred in 38.1% of patients and recurrence-free survival (RFS) predicted overall survival (OS). In localized disease, age, cortisol secretion, Ki67%, ENSAT stage III, and recurrence were associated with increased risk of mortality. ACCs presenting as adrenal incidentalomas showed prolonged RFS and OS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our study shows that ACC is a sex-related disease and demonstrates that an incidental presentation is associated with a better outcome. Given the correlation between RFS and OS, RFS may be used as a surrogate endpoint in clinical studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/clinem\/dgad199","type":"journal-article","created":{"date-parts":[[2023,4,6]],"date-time":"2023-04-06T12:45:50Z","timestamp":1680785150000},"page":"2517-2525","source":"Crossref","is-referenced-by-count":44,"title":["New Findings on Presentation and Outcome of Patients With Adrenocortical Cancer: Results From a National Cohort Study"],"prefix":"10.1210","volume":"108","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2883-6139","authenticated-orcid":false,"given":"Soraya","family":"Puglisi","sequence":"first","affiliation":[{"name":"Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Hospital, University of Turin , 10043 Turin , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Calabrese","sequence":"additional","affiliation":[{"name":"Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Hospital, University of Turin , 10043 Turin , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Ferra\u00f9","sequence":"additional","affiliation":[{"name":"Endocrine Unit of University Hospital of Messina, University of Messina , 98124 Messina , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Antonia","family":"Violi","sequence":"additional","affiliation":[{"name":"Endocrine Unit of University Hospital of Messina, University of Messina , 98124 Messina , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Lagan\u00e0","sequence":"additional","affiliation":[{"name":"Oncology Unit, University of Brescia , 25123 Brescia , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Grisanti","sequence":"additional","affiliation":[{"name":"Oncology Unit, University of Brescia , 25123 Brescia , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Ceccato","sequence":"additional","affiliation":[{"name":"Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padua , 35128 Padua , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Scaroni","sequence":"additional","affiliation":[{"name":"Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padua , 35128 Padua , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Di Dalmazi","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Diabetes Prevention and Care Unit, IRCCS, University Hospital of Bologna , 40138 Bologna , Italy"},{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna , 40126 Bologna , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Stigliano","sequence":"additional","affiliation":[{"name":"Endocrinology, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome , 00189 Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Altieri","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolic Diseases, University-Hospital Gemelli, IRCCS, Catholic University of the Sacred Heart , 00168 Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Letizia","family":"Canu","sequence":"additional","affiliation":[{"name":"Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence , 50134 Florence , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Loli","sequence":"additional","affiliation":[{"name":"Endocrinology, Clinica Polispecialistica San Carlo , 20037 Milan , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosario","family":"Pivonello","sequence":"additional","affiliation":[{"name":"Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II , 80131 Naples , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuela","family":"Arvat","sequence":"additional","affiliation":[{"name":"Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin , 10043 Turin , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Morelli","sequence":"additional","affiliation":[{"name":"Department of Endocrine and Metabolic Disease, Istituto Auxologico Italiano, IRCCS , 20145 Milan , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Perotti","sequence":"additional","affiliation":[{"name":"Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Hospital, University of Turin , 10043 Turin , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vittoria","family":"Basile","sequence":"additional","affiliation":[{"name":"Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Hospital, University of Turin , 10043 Turin , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Berchialla","sequence":"additional","affiliation":[{"name":"Statistical Unit, Department of Clinical and Biological Sciences, University of Turin , 10043 Turin , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Urru","sequence":"additional","affiliation":[{"name":"Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua , 35121 Padua , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian","family":"Fiori","sequence":"additional","affiliation":[{"name":"Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin , 10043 Turin , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Porpiglia","sequence":"additional","affiliation":[{"name":"Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin , 10043 Turin , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfredo","family":"Berruti","sequence":"additional","affiliation":[{"name":"Oncology Unit, University of Brescia , 25123 Brescia , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Pia","sequence":"additional","affiliation":[{"name":"Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Hospital, University of Turin , 10043 Turin , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Reimondo","sequence":"additional","affiliation":[{"name":"Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Hospital, University of Turin , 10043 Turin , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Cannav\u00f2","sequence":"additional","affiliation":[{"name":"Endocrine Unit of University Hospital of Messina, University of Messina , 98124 Messina , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Terzolo","sequence":"additional","affiliation":[{"name":"Internal Medicine, Department of Clinical and Biological Sciences, S. Luigi Hospital, University of Turin , 10043 Turin , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2023,4,6]]},"reference":[{"issue":"4","key":"2024020722084742100_dgad199-B1","doi-asserted-by":"crossref","first-page":"G1","DOI":"10.1530\/EJE-18-0608","article-title":"European Society of Endocrinology Clinical Practice Guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal Tumors","volume":"179","author":"Fassnacht","year":"2018","journal-title":"Eur J Endocrinol"},{"key":"2024020722084742100_dgad199-B2","volume-title":"Third National Cancer Survey: Incidence Data. National Cancer Institute Monograph","author":"National Cancer Institute","year":"1975"},{"issue":"4","key":"2024020722084742100_dgad199-B3","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1007\/BF02067349","article-title":"Adrenal cortical carcinoma in Norway, 1970\u20131984","volume":"16","author":"S\u00f8reide","year":"1992","journal-title":"World J Surg"},{"issue":"5","key":"2024020722084742100_dgad199-B4","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1007\/s00268-005-0329-x","article-title":"Extent of disease at presentation and outcome for adrenocortical carcinoma: have we made progress?","volume":"30","author":"Kebebew","year":"2006","journal-title":"World J Surg"},{"issue":"11","key":"2024020722084742100_dgad199-B5","doi-asserted-by":"crossref","first-page":"2579","DOI":"10.1016\/j.ejca.2013.02.034","article-title":"Adrenocortical carcinoma: a population-based study on incidence and survival in the Netherlands since 1993","volume":"49","author":"Kerkhofs","year":"2013","journal-title":"Eur J Cancer"},{"issue":"9","key":"2024020722084742100_dgad199-B6","doi-asserted-by":"crossref","first-page":"3566","DOI":"10.1210\/jc.2018-00918","article-title":"Predictors of survival in adrenocortical carcinoma: an analysis from the National Cancer Database","volume":"103","author":"Tella","year":"2018","journal-title":"J Clin Endocrinol Metab"},{"issue":"4","key":"2024020722084742100_dgad199-B7","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1001\/jamasurg.2015.4516","article-title":"Nomograms to predict recurrence-free and overall survival after curative resection of adrenocortical carcinoma","volume":"151","author":"Kim","year":"2016","journal-title":"JAMA Surg"},{"issue":"17","key":"2024020722084742100_dgad199-B8","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1056\/NEJM199004263221705","article-title":"Clinical features of adrenocortical carcinoma, prognostic factors, and the effect of mitotane therapy","volume":"322","author":"Luton","year":"1990","journal-title":"N Engl J Med"},{"issue":"2","key":"2024020722084742100_dgad199-B9","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/S0039-6060(96)80164-4","article-title":"The Italian Registry for Adrenal Cortical Carcinoma: analysis of a multiinstitutional series of 129 patients. The ACC Italian Registry Study Group","volume":"119","author":"Crucitti","year":"1996","journal-title":"Surgery"},{"issue":"8","key":"2024020722084742100_dgad199-B10","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1007\/s10434-999-0719-7","article-title":"Long-term survival after complete resection and repeat resection in patients with adrenocortical carcinoma","volume":"6","author":"Schulick","year":"1999","journal-title":"Ann Surg Oncol"},{"issue":"2","key":"2024020722084742100_dgad199-B11","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1002\/cncr.24030","article-title":"Limited prognostic value of the 2004 International Union Against Cancer staging classification for adrenocortical carcinoma: proposal for a Revised TNM Classification","volume":"115","author":"Fassnacht","year":"2009","journal-title":"Cancer"},{"issue":"3","key":"2024020722084742100_dgad199-B12","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1210\/jc.2014-3182","article-title":"Major prognostic role of Ki67 in localized adrenocortical carcinoma after complete resection","volume":"100","author":"Beuschlein","year":"2015","journal-title":"J Clin Endocrinol Metab"},{"issue":"6","key":"2024020722084742100_dgad199-B13","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1530\/EJE-18-0923","article-title":"Adjuvant mitotane therapy is beneficial in non-metastatic adrenocortical carcinoma at high risk of recurrence","volume":"180","author":"Calabrese","year":"2019","journal-title":"Eur J Endocrinol"},{"issue":"1","key":"2024020722084742100_dgad199-B14","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1530\/EJE-21-0510","article-title":"S-GRAS score for prognostic classification of adrenocortical carcinoma: an international, multicenter ENSAT study","volume":"186","author":"Elhassan","year":"2022","journal-title":"Eur J Endocrinol"},{"issue":"11","key":"2024020722084742100_dgad199-B15","doi-asserted-by":"crossref","first-page":"1476","DOI":"10.1016\/j.annonc.2020.08.2099","article-title":"Adrenocortical carcinomas and malignant phaeochromocytomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"31","author":"Fassnacht","year":"2020","journal-title":"Ann Oncol"},{"issue":"7","key":"2024020722084742100_dgad199-B16","doi-asserted-by":"crossref","first-page":"2650","DOI":"10.1210\/jc.2005-2730","article-title":"Clinical and biological features in the prognosis of adrenocortical cancer: poor outcome of cortisol-secreting tumors in a series of 202 consecutive patients","volume":"91","author":"Abiven","year":"2006","journal-title":"J Clin Endocrinol Metab"},{"issue":"4","key":"2024020722084742100_dgad199-B17","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1016\/j.eururo.2013.11.006","article-title":"Prognostic role of overt hypercortisolism in completely operated patients with adrenocortical cancer","volume":"65","author":"Berruti","year":"2014","journal-title":"Eur Urol"},{"issue":"6","key":"2024020722084742100_dgad199-B18","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1016\/j.amjsurg.2015.09.020","article-title":"Outcomes after resection of cortisol-secreting adrenocortical carcinoma","volume":"211","author":"Margonis","year":"2016","journal-title":"Am J Surg"},{"issue":"2","key":"2024020722084742100_dgad199-B19","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/j.ecl.2018.02.003","article-title":"Adrenocortical carcinoma with hypercortisolism","volume":"47","author":"Puglisi","year":"2018","journal-title":"Endocrinol Metab Clin North Am"},{"issue":"6","key":"2024020722084742100_dgad199-B20","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1530\/EJE-10-1147","article-title":"AME position statement on adrenal incidentaloma","volume":"164","author":"Terzolo","year":"2011","journal-title":"Eur J Endocrinol"},{"issue":"11","key":"2024020722084742100_dgad199-B21","doi-asserted-by":"crossref","first-page":"1721","DOI":"10.1016\/S0959-8049(98)00170-1","article-title":"Incidentally found adrenocortical carcinoma. A study of 21 patients","volume":"34","author":"Kasperlik-Za\u0142uska","year":"1998","journal-title":"Eur J Cancer"},{"issue":"12","key":"2024020722084742100_dgad199-B22","doi-asserted-by":"crossref","first-page":"5948","DOI":"10.1210\/jc.2019-00915","article-title":"National treatment practice for adrenocortical carcinoma: have they changed and have we made any progress?","volume":"104","author":"Tierney","year":"2019","journal-title":"J Clin Endocrinol Metab"},{"issue":"6","key":"2024020722084742100_dgad199-B23","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1530\/EC-20-0196","article-title":"Characteristics of adrenocortical carcinoma in South Korea: a registry-based nationwide survey","volume":"9","author":"Lim","year":"2020","journal-title":"Endocr Connect"},{"key":"2024020722084742100_dgad199-B24","doi-asserted-by":"publisher","author":"Puglisi","DOI":"10.6084\/m9.figshare.22303318"},{"issue":"27","key":"2024020722084742100_dgad199-B25","doi-asserted-by":"crossref","first-page":"4781","DOI":"10.1002\/sim.5874","article-title":"Estimating the correlation of bivariate failure times under censoring","volume":"32","author":"Schemper","year":"2013","journal-title":"Stat Med"},{"issue":"2","key":"2024020722084742100_dgad199-B26","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1111\/biom.13453","article-title":"Nonparametric estimation of Spearman's rank correlation with bivariate survival data","volume":"78","author":"Eden","year":"2022","journal-title":"Biometrics"},{"key":"2024020722084742100_dgad199-B27","doi-asserted-by":"publisher","author":"Puglisi","DOI":"10.6084\/m9.figshare.22300846"},{"issue":"2","key":"2024020722084742100_dgad199-B28","doi-asserted-by":"crossref","first-page":"G1","DOI":"10.1530\/EJE-16-0467","article-title":"Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors","volume":"175","author":"Fassnacht","year":"2016","journal-title":"Eur J Endocrinol"},{"issue":"3","key":"2024020722084742100_dgad199-B29","doi-asserted-by":"crossref","DOI":"10.1016\/j.beem.2020.101434","article-title":"Next-generation therapies for adrenocortical carcinoma","volume":"34","author":"Altieri","year":"2020","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"issue":"3","key":"2024020722084742100_dgad199-B30","doi-asserted-by":"crossref","DOI":"10.1016\/j.beem.2020.101408","article-title":"Surgery for adrenocortical carcinoma: when and how?","volume":"34","author":"Sinclair","year":"2020","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"issue":"3","key":"2024020722084742100_dgad199-B31","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1111\/bju.13618","article-title":"Surgical quality of minimally invasive adrenalectomy for adrenocortical carcinoma: a contemporary analysis using the National Cancer Database","volume":"119","author":"Maurice","year":"2017","journal-title":"BJU Int"},{"issue":"4","key":"2024020722084742100_dgad199-B32","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1245\/s10434-015-4900-x","article-title":"Open versus laparoscopic adrenalectomy for adrenocortical carcinoma: a meta-analysis of surgical and oncological outcomes","volume":"23","author":"Autorino","year":"2016","journal-title":"Ann Surg Oncol"},{"issue":"21","key":"2024020722084742100_dgad199-B33","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.1093\/jnci\/djt270","article-title":"Disease-free survival as a surrogate for overall survival in adjuvant trials of gastric cancer: a meta-analysis","volume":"105","author":"Oba","year":"2013","journal-title":"J Natl Cancer Inst"},{"issue":"1","key":"2024020722084742100_dgad199-B34","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1093\/jnci\/djx133","article-title":"Relapse-free survival as a surrogate for overall survival in the evaluation of stage II\u2013III melanoma adjuvant therapy","volume":"110","author":"Suciu","year":"2018","journal-title":"J Natl Cancer Inst"},{"issue":"3","key":"2024020722084742100_dgad199-B35","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/S1470-2045(18)30750-2","article-title":"Disease-free survival as a surrogate for overall survival in patients with HER2-positive, early breast cancer in trials of adjuvant trastuzumab for up to 1 year: a systematic review and meta-analysis","volume":"20","author":"Saad","year":"2019","journal-title":"Lancet Oncol"},{"issue":"23","key":"2024020722084742100_dgad199-B36","doi-asserted-by":"crossref","first-page":"2372","DOI":"10.1056\/NEJMoa063360","article-title":"Adjuvant mitotane treatment for adrenocortical carcinoma","volume":"356","author":"Terzolo","year":"2007","journal-title":"N Engl J Med"},{"issue":"4","key":"2024020722084742100_dgad199-B37","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1210\/clinem\/dgab865","article-title":"Cytoreductive surgery of the primary tumor in metastatic adrenocortical carcinoma: impact on patients' survival","volume":"107","author":"Srougi","year":"2022","journal-title":"J Clin Endocrinol Metab"}],"container-title":["The Journal of Clinical Endocrinology &amp; Metabolism"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jcem\/advance-article-pdf\/doi\/10.1210\/clinem\/dgad199\/50066602\/dgad199.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcem\/article-pdf\/108\/10\/2517\/56616281\/dgad199.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcem\/article-pdf\/108\/10\/2517\/56616281\/dgad199.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,7]],"date-time":"2024-02-07T17:09:09Z","timestamp":1707325749000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcem\/article\/108\/10\/2517\/7110035"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,6]]},"references-count":37,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,4,6]]},"published-print":{"date-parts":[[2023,9,18]]}},"URL":"https:\/\/doi.org\/10.1210\/clinem\/dgad199","relation":{},"ISSN":["0021-972X","1945-7197"],"issn-type":[{"value":"0021-972X","type":"print"},{"value":"1945-7197","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,10]]},"published":{"date-parts":[[2023,4,6]]}}}