{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T02:08:29Z","timestamp":1793153309579,"version":"4.5.0"},"reference-count":174,"publisher":"The Endocrine Society","issue":"6","license":[{"start":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:00:00Z","timestamp":1774310400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004508","name":"Prince of Songkla University Scholarship","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004508","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Medical Research Council TARGET Partnership"},{"DOI":"10.13039\/501100018955","name":"National Institute for Health Research (NIHR) Leeds Biomedical Research Centre","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100018955","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NIHR Leeds Medtech"},{"name":"In Vitro Diagnostics Co-operative"},{"name":"NIHR Senior Investigator"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Chronic oral glucocorticoids (GCs) are widely prescribed for multiple diseases. Although long-term GC exposure causes systemic toxicity, the magnitude, dose-response relationship, and causes of GC-associated mortality remain incompletely defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To quantify overall and cause-specific mortality associated with chronic oral GC exposure and evaluate dose-response relationships across underlying disease groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic review and meta-analysis following PRISMA guidelines (PROSPERO CRD42017067530). PubMed\/MEDLINE, EMBASE, Cochrane Library, Web of Science, and CINAHL were searched from 1945 to March 2019. Eligible studies reported standardized mortality ratios (SMRs) or absolute deaths among adults receiving chronic oral GCs. Random-effects meta-analysis and mixed-effects meta-regression were used to synthesize mortality and dose-response associations across GC exposure metrics, exposure duration, and disease subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>One-hundred and sixteen studies encompassing 128 cohorts and 51 380 patients were included. Chronic GC exposure was associated with excess mortality (pooled SMR 1.87; 95%CI 1.32\u20132.61; I2 74.0%). The pooled proportion of death was 12.0% (95%CI 10\u201314%). Mortality risk was highest in inflammatory diseases (30.0%) and the vasculitides (18.0%). Higher cumulative dose (\u22655 g prednisolone-equivalent), average daily dose &amp;gt;5 mg\/day, and higher initial dose were each independently associated with increased mortality. Cardiovascular disease was the leading causes of death (25.6%), followed by malignancy (15.7%) and infection (13.4%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Chronic oral GC exposure was associated with increased mortality across disease groups, with higher cumulative and early-treatment doses correlating with higher risk. However, causal attribution remains uncertain due to confounding by indication, limited disease-severity data, and exposure misclassification. These findings support GC stewardship and targeted cardiovascular and infection risk mitigation, rather than indiscriminate dose reduction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/clinem\/dgag123","type":"journal-article","created":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T12:35:29Z","timestamp":1774096529000},"page":"1765-1785","source":"Crossref","is-referenced-by-count":4,"title":["Mortality risk and causes of death in exogenous Cushing's syndrome: a systematic review and meta-analysis"],"prefix":"10.1210","volume":"111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2205-3616","authenticated-orcid":false,"given":"Padiporn","family":"Limumpornpetch","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Health, University of Leeds , Leeds, LS2 9NL ,","place":["UK"]},{"name":"Endocrinology and Metabolism Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University , Hat Yai, Songkhla 90110 ,","place":["Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1749-9640","authenticated-orcid":false,"given":"Paul M","family":"Stewart","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, University of Leeds , Leeds, LS2 9NL ,","place":["UK"]},{"name":"NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust , Leeds, LS1 3EX ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1375-1028","authenticated-orcid":false,"given":"Mar","family":"Pujades-Rodriguez","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, University of Leeds , Leeds, LS2 9NL ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2699-3103","authenticated-orcid":false,"given":"Paul D","family":"Baxter","sequence":"additional","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds, LS2 9JT ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3688-2204","authenticated-orcid":false,"given":"Ana","family":"Tiganescu","sequence":"additional","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds, LS2 9JT ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8381-9964","authenticated-orcid":false,"given":"Victoria Nyawira","family":"Nyaga","sequence":"additional","affiliation":[{"name":"Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano , Brussels 1050 ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1109-624X","authenticated-orcid":false,"given":"Ann W","family":"Morgan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, University of Leeds , Leeds, LS2 9NL ,","place":["UK"]},{"name":"NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust , Leeds, LS1 3EX ,","place":["UK"]},{"name":"NIHR Leeds Medtech and in-Vitro Diagnostics Co-Operative, Leeds Teaching Hospitals NHS Trust , Leeds, LS1 3EX ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2026,3,24]]},"reference":[{"issue":"6","key":"2026051819570613600_dgag123-B1","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1210\/endrev\/bnad016","article-title":"Treating the side effects of exogenous glucocorticoids; 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