{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T22:00:32Z","timestamp":1776722432924,"version":"3.51.2"},"reference-count":12,"publisher":"The Endocrine Society","issue":"4","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"vor","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Osteoporosis is a major public health problem. Glucocorticoids alter the number of cells within bone, reducing bone forming cells (osteoblasts) and those that resorb bone (osteoclasts), the former more so than the latter. Glucocorticoid-induced osteoporosis predominately affects regions of the skeleton such as the spine and the neck of the femur. We describe a 14.5-year-old male with congenital adrenal hyperplasia who developed osteopenia (spinal bone mineral density [BMD] Z-score \u22121.5; hip BMD \u22121.7; previously \u22120.2 and \u22121.7, respectively) as a result of treatment with prednisolone and high doses of dexamethasone. He was subsequently shown to have a rapid clearance and a half-life of 40\u2005minutes (average normal value 80\u2005minutes) for hydrocortisone. Hydrocortisone delivery using a continuous tiered subcutaneous infusion pump to mimic the normal cortisol circadian rhythm normalized all biochemical parameters and prevented further bone mineral loss over the following 5 years and over 20 years of treatment normalized BMD (spine Z-score +0.4; hip Z-score +0.7). Continuous tiered subcutaneous hydrocortisone pump therapy delivering plasma cortisol concentrations indistinguishable from normal individuals, can prevent bone mineral loss and over a long period leads to a normalization of BMD.<\/jats:p>","DOI":"10.1210\/jcemcr\/luag036","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T12:51:51Z","timestamp":1770900711000},"source":"Crossref","is-referenced-by-count":1,"title":["Restoration of bone mineral density in a patient with congenital adrenal hyperplasia using hydrocortisone pump therapy"],"prefix":"10.1210","volume":"4","author":[{"given":"Rebecca","family":"Gorrigan","sequence":"first","affiliation":[{"name":"Department of Endocrinology, St Bartholomew's Hospital , London EC1A 7BE ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Todd","sequence":"additional","affiliation":[{"name":"The Harvey Practice Broadstone , Poole BH18 8EE ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John W","family":"Honour","sequence":"additional","affiliation":[{"name":"Institute for Women's Health, University College London , London WC1E 6BT ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2490-8518","authenticated-orcid":false,"given":"Peter C","family":"Hindmarsh","sequence":"additional","affiliation":[{"name":"Genomics and Genetic Medicine, University College London , London WC1N 1EH ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"80","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"issue":"6","key":"2026040205495957600_luag036-B1","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1359\/jbmr.2000.15.6.993","article-title":"Use of oral corticosteroids and risk of fractures","volume":"15","author":"Van Staa","year":"2000","journal-title":"J Bone Miner 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cortisol concentrations","volume":"82","author":"Hindmarsh","year":"2015","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"9","key":"2026040205495957600_luag036-B8","doi-asserted-by":"crossref","first-page":"3477","DOI":"10.1210\/jc.2009-0630","article-title":"Management of altered hydrocortisone pharmacokinetics in a boy with congenital adrenal hyperplasia using a continuous subcutaneous hydrocortisone infusion","volume":"94","author":"Bryan","year":"2009","journal-title":"J Clin Endocrinol Metab"},{"key":"2026040205495957600_luag036-B9","volume-title":"Replacement Therapies in Adrenal Insufficiency","author":"Hindmarsh","year":"2024"},{"issue":"1","key":"2026040205495957600_luag036-B10","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1111\/j.1365-2265.2006.02544.x","article-title":"Circadian hydrocortisone infusions in patients with adrenal insufficiency and congenital adrenal hyperplasia","volume":"65","author":"Merza","year":"2006","journal-title":"Clin Endocrinol 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