{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:46:48Z","timestamp":1787021208199,"version":"build-2736575974"},"reference-count":44,"publisher":"The Endocrine Society","issue":"1","license":[{"start":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T00:00:00Z","timestamp":1749686400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000646","name":"JSPS","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000646","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"KAKENHI","doi-asserted-by":"publisher","award":["24K13531"],"award-info":[{"award-number":["24K13531"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"KAKENHI","doi-asserted-by":"publisher","award":["22H03355"],"award-info":[{"award-number":["22H03355"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"KAKENHI","doi-asserted-by":"publisher","award":["23K24613"],"award-info":[{"award-number":["23K24613"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100016573","name":"Japan Association for Diabetes Education and Care","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016573","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Immune checkpoint inhibitors (ICIs) are associated with various endocrine abnormalities. However, their underlying pathophysiology remains unclear. We investigated the effect of multiple endocrine abnormalities on the overall survival (OS) of patients treated with ICIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In total, 12 978 patients who received ICIs between 2014 and 2022 were investigated using the DeSC Japanese administrative claims database. Endocrine abnormalities were defined by each hormone replacement therapy, including levothyroxine, hydrocortisone, and insulin, in which it is difficult to distinguish central or primary hormone defect. Also, only patients with hypothyroidism after thyroiditis were included. Type 1 diabetes was additionally defined by the name of the disease and strict self-injection fees. Regression analyses were performed to identify risk factors for endocrine abnormalities and the effect of endocrine abnormalities on OS, adjusting for confounders including the number and duration of ICI administrations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Single and multiple endocrine abnormalities were observed in 12.0% and 1.4% of patients, respectively. The most common combination was hypothyroidism and adrenal insufficiency (1.3%). Kaplan\u2013Meier analysis indicated better survival in patients with multiple and single endocrine abnormalities than in those without (P &amp;lt; .01). Multivariable analysis revealed lower mortality in patients with multiple and single endocrine abnormalities [adjusted hazard ratio (aHR) 0.39; 95% confidence interval (CI), 0.28-0.54, P &amp;lt; .01; aHR 0.65; 95% CI, 0.5-80.72, P &amp;lt; .01, respectively) than in those without. Mortality was significantly lower with multiple abnormalities than with single (aHR 0.56; 95% CI, 0.39-0.79, P &amp;lt; .01).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The development of multiple endocrine abnormalities in patients treated with ICIs is associated with improved survival compared with that of patients with a single abnormality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/clinem\/dgaf347","type":"journal-article","created":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T07:54:24Z","timestamp":1749628464000},"page":"54-61","source":"Crossref","is-referenced-by-count":5,"title":["Multiple or Single Endocrine Abnormalities Associated With Immune Checkpoint Inhibitors"],"prefix":"10.1210","volume":"111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2838-7986","authenticated-orcid":false,"given":"Fumika","family":"Kamitani","sequence":"first","affiliation":[{"name":"Department of Diabetes and Endocrinology, Nara Medical University , Kashihara, Nara 634-8522 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1956-3925","authenticated-orcid":false,"given":"Yuichi","family":"Nishioka","sequence":"additional","affiliation":[{"name":"Department of Public Health, Health Management and Policy, Nara Medical University , Kashihara, Nara 634-8521 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5899-0903","authenticated-orcid":false,"given":"Hiroki","family":"Nakajima","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Nara Medical University , Kashihara, Nara 634-8522 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukako","family":"Kurematsu","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Nara Medical University , Kashihara, Nara 634-8522 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3097-8152","authenticated-orcid":false,"given":"Sadanori","family":"Okada","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Nara Medical University , Kashihara, Nara 634-8522 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3820-6157","authenticated-orcid":false,"given":"Tomoya","family":"Myojin","sequence":"additional","affiliation":[{"name":"Department of Public Health, Health Management and Policy, Nara Medical University , Kashihara, Nara 634-8521 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3652-7547","authenticated-orcid":false,"given":"Tatsuya","family":"Noda","sequence":"additional","affiliation":[{"name":"Department of Public Health, Health Management and Policy, Nara Medical University , Kashihara, Nara 634-8521 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1981-9959","authenticated-orcid":false,"given":"Tomoaki","family":"Imamura","sequence":"additional","affiliation":[{"name":"Department of Public Health, Health Management and Policy, Nara Medical University , Kashihara, Nara 634-8521 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1337-9246","authenticated-orcid":false,"given":"Yutaka","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Nara Medical University , Kashihara, Nara 634-8522 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2025,6,12]]},"reference":[{"issue":"17","key":"2025121807430809700_dgaf347-B1","doi-asserted-by":"crossref","first-page":"1974","DOI":"10.1200\/JCO.2014.59.4358","article-title":"Immune checkpoint blockade in cancer therapy","volume":"33","author":"Postow","year":"2015","journal-title":"J Clin Oncol"},{"issue":"14","key":"2025121807430809700_dgaf347-B2","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1056\/NEJMoa1709684","article-title":"Overall survival with combined nivolumab and ipilimumab in advanced melanoma","volume":"377","author":"Wolchok","year":"2017","journal-title":"N Engl J Med"},{"issue":"14","key":"2025121807430809700_dgaf347-B3","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1056\/NEJMoa1712126","article-title":"Nivolumab plus ipilimumab versus sunitinib in advanced renal-cell carcinoma","volume":"378","author":"Motzer","year":"2018","journal-title":"N Engl J Med"},{"issue":"2","key":"2025121807430809700_dgaf347-B4","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1001\/jamaoncol.2017.3064","article-title":"Incidence of endocrine dysfunction following the use of different immune checkpoint inhibitor regimens: a systematic review and meta-analysis","volume":"4","author":"Barroso-Sousa","year":"2018","journal-title":"JAMA Oncol"},{"issue":"5","key":"2025121807430809700_dgaf347-B5","doi-asserted-by":"crossref","first-page":"e220513","DOI":"10.1530\/EC-22-0513","article-title":"Diagnostic criteria and proposed management of immune-related endocrinopathies following immune checkpoint inhibitor therapy for cancer","volume":"12","author":"Percik","year":"2023","journal-title":"Endocr Connect"},{"issue":"12","key":"2025121807430809700_dgaf347-B6","doi-asserted-by":"crossref","first-page":"1952","DOI":"10.1001\/jamaoncol.2020.5012","article-title":"Multisystem immune-related adverse events associated with immune checkpoint inhibitors for treatment of non-small cell lung cancer","volume":"6","author":"Shankar","year":"2020","journal-title":"JAMA Oncol"},{"issue":"1","key":"2025121807430809700_dgaf347-B7","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1186\/s40425-019-0805-8","article-title":"Immune-related adverse events and anti-tumor efficacy of immune checkpoint inhibitors","volume":"7","author":"Das","year":"2019","journal-title":"J Immunother Cancer"},{"issue":"6","key":"2025121807430809700_dgaf347-B8","doi-asserted-by":"crossref","first-page":"G1","DOI":"10.1530\/EJE-22-0689","article-title":"Endocrine-related adverse conditions in patients receiving immune checkpoint inhibition: an ESE clinical practice guideline","volume":"187","author":"Husebye","year":"2022","journal-title":"Eur J Endocrinol"},{"issue":"3","key":"2025121807430809700_dgaf347-B9","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1159\/000510044","article-title":"Type 1 diabetes, ACTH deficiency, and hypothyroidism simultaneously induced by nivolumab therapy in a patient with gastric cancer: a case report","volume":"13","author":"Marshall","year":"2020","journal-title":"Case Rep Oncol"},{"issue":"6","key":"2025121807430809700_dgaf347-B10","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1210\/js.2017-00170","article-title":"Polyendocrinopathy resulting from pembrolizumab in a patient with a malignant melanoma","volume":"1","author":"Paepegaey","year":"2017","journal-title":"J Endocr Soc"},{"issue":"1","key":"2025121807430809700_dgaf347-B11","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1186\/s13256-019-2002-2","article-title":"Isolated adrenocorticotropic hormone deficiency and thyroiditis associated with nivolumab therapy in a patient with advanced lung adenocarcinoma: a case report and review of the literature","volume":"13","author":"Ohara","year":"2019","journal-title":"J Med Case Rep"},{"issue":"3","key":"2025121807430809700_dgaf347-B12","doi-asserted-by":"crossref","first-page":"bvad002","DOI":"10.1210\/jendso\/bvad002","article-title":"Combined hypophysitis and type 1 diabetes mellitus related to immune checkpoint inhibitors","volume":"7","author":"Fujita","year":"2023","journal-title":"J Endocr Soc"},{"issue":"4","key":"2025121807430809700_dgaf347-B13","doi-asserted-by":"crossref","first-page":"bvad012","DOI":"10.1210\/jendso\/bvad012","article-title":"Spectrum of clinical presentations, imaging findings, and HLA types in immune checkpoint inhibitor-induced hypophysitis","volume":"7","author":"Quandt","year":"2023","journal-title":"J Endocr Soc"},{"issue":"2","key":"2025121807430809700_dgaf347-B14","first-page":"190","article-title":"Prevalence of noncommunicable diseases in Japan using a newly developed administrative claims database covering young, middle-aged, and elderly people","volume":"5","author":"Okada","year":"2022","journal-title":"JMA J"},{"key":"2025121807430809700_dgaf347-B15","doi-asserted-by":"crossref","unstructured":"Kamitani F . Multiple or single endocrine abnormalities associated with immune checkpoint inhibitors. Zenodo. 2025. 10.5281\/zenodo.15628750","DOI":"10.1210\/clinem\/dgaf347"},{"issue":"10","key":"2025121807430809700_dgaf347-B16","doi-asserted-by":"crossref","first-page":"1797","DOI":"10.1111\/jdi.13540","article-title":"Association between influenza and the incidence rate of new-onset type 1 diabetes in Japan","volume":"12","author":"Nishioka","year":"2021","journal-title":"J Diabetes Investig"},{"issue":"2","key":"2025121807430809700_dgaf347-B17","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1111\/jdi.14362","article-title":"Immune checkpoint inhibitor-related type 1 diabetes incidence, risk, and survival association","volume":"16","author":"Kamitani","year":"2025","journal-title":"J Diaetes Investig"},{"issue":"6","key":"2025121807430809700_dgaf347-B18","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1093\/aje\/kwq433","article-title":"Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries","volume":"173","author":"Quan","year":"2011","journal-title":"Am J Epidemiol"},{"issue":"4","key":"2025121807430809700_dgaf347-B19","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1093\/aje\/kwm324","article-title":"Immortal time bias in pharmaco-epidemiology","volume":"167","author":"Suissa","year":"2008","journal-title":"Am J Epidemiol"},{"issue":"4","key":"2025121807430809700_dgaf347-B20","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1158\/1078-0432.CCR-14-2353","article-title":"Systemic high-dose corticosteroid treatment does not improve the outcome of ipilimumab-related hypophysitis: a retrospective cohort study","volume":"21","author":"Min","year":"2015","journal-title":"Clin Cancer Res"},{"issue":"10","key":"2025121807430809700_dgaf347-B21","doi-asserted-by":"crossref","first-page":"1458","DOI":"10.1089\/thy.2020.0032","article-title":"Thyroid toxicity following immune checkpoint inhibitor treatment in advanced cancer","volume":"30","author":"Muir","year":"2020","journal-title":"Thyroid"},{"issue":"3","key":"2025121807430809700_dgaf347-B22","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1093\/annonc\/mdw640","article-title":"Antibody-mediated thyroid dysfunction during T-cell checkpoint blockade in patients with non-small-cell lung cancer","volume":"28","author":"Osorio","year":"2017","journal-title":"Ann Oncol"},{"issue":"11","key":"2025121807430809700_dgaf347-B23","doi-asserted-by":"crossref","first-page":"4078","DOI":"10.1210\/jc.2014-2306","article-title":"Ipilimumab-induced hypophysitis: a detailed longitudinal analysis in a large cohort of patients with metastatic melanoma","volume":"99","author":"Faje","year":"2014","journal-title":"J Clin Endocrinol Meta"},{"issue":"2","key":"2025121807430809700_dgaf347-B24","doi-asserted-by":"crossref","first-page":"e000779","DOI":"10.1136\/jitc-2020-000779","article-title":"Pituitary dysfunction induced by immune checkpoint inhibitors is associated with better overall survival in both malignant melanoma and non-small cell lung carcinoma: a prospective study","volume":"8","author":"Kobayashi","year":"2020","journal-title":"J Immunother Cancer"},{"issue":"1","key":"2025121807430809700_dgaf347-B25","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1146\/annurev-med-050219-034237","article-title":"Autoimmune endocrinopathies: an emerging complication of immune checkpoint inhibitors","volume":"72","author":"Quandt","year":"2021","journal-title":"Annu Rev Med"},{"issue":"1","key":"2025121807430809700_dgaf347-B26","doi-asserted-by":"crossref","first-page":"89","DOI":"10.3390\/cancers14010089","article-title":"CANDIED: a pan-Canadian cohort of immune checkpoint inhibitor-induced insulin-dependent diabetes mellitus","volume":"14","author":"Muniz","year":"2021","journal-title":"Cancers (Basel)"},{"issue":"5","key":"2025121807430809700_dgaf347-B27","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.2337\/dc21-2213","article-title":"Immune checkpoint inhibitors and risk of type 1 diabetes","volume":"45","author":"Chen","year":"2022","journal-title":"Diabetes Care"},{"key":"2025121807430809700_dgaf347-B28","doi-asserted-by":"crossref","first-page":"73","DOI":"10.2147\/ITT.S126227","article-title":"Clinical features, predictive correlates, and pathophysiology of immune-related adverse events in immune checkpoint inhibitor treatments in cancer: a short review","volume":"6","author":"Yoest","year":"2017","journal-title":"Immunotargets Ther"},{"issue":"11","key":"2025121807430809700_dgaf347-B29","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1016\/j.bulcan.2018.07.005","article-title":"Physiopathological mechanisms of immune-related adverse events induced by anti-CTLA-4, anti-PD-1 and anti-PD-L1 antibodies in cancer treatment","volume":"105","author":"Passat","year":"2018","journal-title":"Bull Cancer"},{"issue":"2","key":"2025121807430809700_dgaf347-B30","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1056\/NEJMra1703481","article-title":"Immune-related adverse events associated with immune checkpoint blockade","volume":"378","author":"Postow","year":"2018","journal-title":"N Engl J Med"},{"issue":"6","key":"2025121807430809700_dgaf347-B31","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1507\/endocrj.EJ23-0050","article-title":"Paraneoplastic autoimmune hypophysitis: a novel form of paraneoplastic endocrine syndrome","volume":"70","author":"Takahashi","year":"2023","journal-title":"Endocr J"},{"issue":"12","key":"2025121807430809700_dgaf347-B32","doi-asserted-by":"crossref","first-page":"3669","DOI":"10.1007\/s00262-021-02955-y","article-title":"Mechanistic insights into immune checkpoint inhibitor-related hypophysitis: a form of paraneoplastic syndrome","volume":"70","author":"Kanie","year":"2021","journal-title":"Cancer Immunol Immunother"},{"issue":"1","key":"2025121807430809700_dgaf347-B33","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1507\/endocrj.EJ23-0524","article-title":"Clinical characteristics and potential biomarkers of thyroid and pituitary immune-related adverse events","volume":"71","author":"Kobayashi","year":"2024","journal-title":"Endocr J"},{"key":"2025121807430809700_dgaf347-B34","doi-asserted-by":"crossref","first-page":"100374","DOI":"10.1016\/j.iotech.2023.100374","article-title":"Autoantibodies involved in primary and secondary adrenal insufficiency following treatment with immune checkpoint inhibitors","volume":"17","author":"Helderman","year":"2023","journal-title":"Immunooncol Technol"},{"issue":"8","key":"2025121807430809700_dgaf347-B35","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1634\/theoncologist.2019-0555","article-title":"Immune checkpoint inhibitor-associated primary adrenal insufficiency: WHO VigiBase report analysis","volume":"25","author":"Grouthier","year":"2020","journal-title":"Oncologist"},{"issue":"9","key":"2025121807430809700_dgaf347-B36","doi-asserted-by":"crossref","first-page":"e3704","DOI":"10.1210\/clinem\/dgab263","article-title":"Thyroid immune-related adverse events following immune checkpoint inhibitor treatment","volume":"106","author":"Muir","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"issue":"10","key":"2025121807430809700_dgaf347-B37","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1089\/thy.2018.0116","article-title":"Immune-related thyroiditis with immune checkpoint inhibitors","volume":"28","author":"Iyer","year":"2018","journal-title":"Thyroid"},{"key":"2025121807430809700_dgaf347-B38","doi-asserted-by":"crossref","first-page":"886930","DOI":"10.3389\/fendo.2022.886930","article-title":"Immune related adverse events of the thyroid\u2014a narrative review","volume":"13","author":"Muir","year":"2022","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"3","key":"2025121807430809700_dgaf347-B39","doi-asserted-by":"crossref","first-page":"101668","DOI":"10.1016\/j.beem.2022.101668","article-title":"Immune checkpoint inhibitor-related hypophysitis","volume":"36","author":"Mizukoshi","year":"2022","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"issue":"1","key":"2025121807430809700_dgaf347-B40","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00262-021-02950-3","article-title":"Intratumoral Foxp3(+)ROR\u03b3t(+) T cell infiltration determines poor prognosis and immunoevasive contexture in gastric cancer patients","volume":"71","author":"Fei","year":"2022","journal-title":"Cancer Immunol Immunother"},{"issue":"1","key":"2025121807430809700_dgaf347-B41","doi-asserted-by":"crossref","first-page":"e000591","DOI":"10.1136\/bmjdrc-2018-000591","article-title":"Immune checkpoint inhibitors: an emerging cause of insulin-dependent diabetes","volume":"7","author":"Kotwal","year":"2019","journal-title":"BMJ Open Diabetes Res Care"},{"issue":"24","key":"2025121807430809700_dgaf347-B42","doi-asserted-by":"crossref","first-page":"5786","DOI":"10.3390\/cancers15245786","article-title":"Life-threatening endocrinological immune-related adverse events of immune checkpoint inhibitor therapy","volume":"15","author":"Basek","year":"2023","journal-title":"Cancers (Basel)"},{"issue":"1","key":"2025121807430809700_dgaf347-B43","doi-asserted-by":"crossref","first-page":"e001262","DOI":"10.1136\/bmjdrc-2020-001262","article-title":"Incidence and seasonality of type 1 diabetes: a population-based 3-year cohort study using the national database in Japan","volume":"8","author":"Nishioka","year":"2020","journal-title":"BMJ Open Diabetes Res Care"},{"issue":"Supplement_1","key":"2025121807430809700_dgaf347-B44","doi-asserted-by":"crossref","first-page":"S15","DOI":"10.2337\/dc21-S002","article-title":"2. Classification and diagnosis of diabetes: standards of Medical Care in Diabetes-2021","volume":"44","author":"American Diabetes Association","year":"2021","journal-title":"Diabetes Care"}],"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\/dgaf347\/63476999\/dgaf347.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcem\/article-pdf\/111\/1\/54\/63476999\/dgaf347.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcem\/article-pdf\/111\/1\/54\/63476999\/dgaf347.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T12:44:31Z","timestamp":1766061871000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcem\/article\/111\/1\/54\/8160854"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,12]]},"references-count":44,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,6,12]]},"published-print":{"date-parts":[[2025,12,18]]}},"URL":"https:\/\/doi.org\/10.1210\/clinem\/dgaf347","relation":{},"ISSN":["0021-972X","1945-7197"],"issn-type":[{"value":"0021-972X","type":"print"},{"value":"1945-7197","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,1]]},"published":{"date-parts":[[2025,6,12]]}}}