{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:06:53Z","timestamp":1792026413794,"version":"4.4.0"},"reference-count":35,"publisher":"The Endocrine Society","issue":"4","license":[{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Medical therapy for Cushing's syndrome (CS) is increasingly used. A potent adrenal steroidogenesis inhibitor, osilodrostat, has been rarely linked to prolonged adrenal insufficiency (AI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We hypothesized that osilodrostat-induced AI could be associated with adrenal gland shrinkage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Noninterventional, retrospective, longitudinal, institutional review board-approved study of patients with CS treated at Oregon Health and Science University between January 1, 2000, and July 1, 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Ambulatory and inpatient, academic, quaternary medical center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients or Other Participants<\/jats:title>\n                    <jats:p>Patients with ACTH-dependent CS, treated with osilodrostat for &amp;gt;3 months, and computed tomography (CT) imaging before and after osilodrostat available for adrenal volume (AV) measurement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention(s)<\/jats:title>\n                    <jats:p>Age, sex, osilodrostat doses and duration, laboratory data, and AI were recorded. AV was calculated using manual segmentation on CT images by a board-certified radiologist.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measure(s)<\/jats:title>\n                    <jats:p>AV before and after initiation of osilodrostat was expressed as percent reduction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ten patients (5 ectopic CS, 4 unknown ACTH source, 1 Cushing's disease) were included. Osilodrostat mean starting, maximum, and final doses: 7.7, 13.8, and 5.9\u2005mg\/day, respectively, over 23 months. Four patients received block-and-replace regimen, AI developed in 5. Adrenal gland volume decreased by 46.7 \u00b1 22.2% from 25.5 \u00b1 9.9\u2005mL to 12.7 \u00b1 6.4\u2005mL, P &amp;lt; .001 over a median of 19 months. AV reduction positively correlated with maximum osilodrostat dose, r = 0.626, P = .027.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We found that in selected patients with ACTH-dependent CS, osilodrostat can induce significant adrenal shrinkage, with or without AI. Further confirmation by larger studies of different CS types and monitoring for AI is required for all patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/clinem\/dgaf552","type":"journal-article","created":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T11:43:13Z","timestamp":1759578193000},"page":"1084-1090","source":"Crossref","is-referenced-by-count":16,"title":["Osilodrostat-associated Adrenal Gland Shrinkage: A Case Series of Patients With ACTH-dependent Cushing's Syndrome"],"prefix":"10.1210","volume":"111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0713-025X","authenticated-orcid":false,"given":"Elena V","family":"Varlamov","sequence":"first","affiliation":[{"name":"Department of Medicine (Division of Endocrinology, Diabetes and Clinical Nutrition) and Neurological Surgery and Pituitary Center, Oregon Health & Science University , Portland, OR 97239 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian 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