{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:12:51Z","timestamp":1787026371452,"version":"build-2736575974"},"reference-count":65,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,11,20]],"date-time":"2023-11-20T00:00:00Z","timestamp":1700438400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:p>Adrenal insufficiency encompasses a group of congenital and acquired disorders that lead to inadequate steroid production by the adrenal glands, mainly glucocorticoids, mineralocorticoids and androgens. These may be associated with other hormone deficiencies. Adrenal insufficiency may be primary, affecting the adrenal gland\u2019s ability to produce cortisol directly; secondary, affecting the pituitary gland\u2019s ability to produce adrenocorticotrophic hormone (ACTH); or tertiary, affecting corticotrophin-releasing hormone (CRH) production at the level of the hypothalamus. Congenital causes of adrenal insufficiency include the subtypes of Congenital Adrenal Hyperplasia, Adrenal Hypoplasia, genetic causes of Isolated ACTH deficiency or Combined Pituitary Hormone Deficiencies, usually caused by mutations in essential transcription factors. The most commonly inherited primary cause of adrenal insufficiency is Congenital Adrenal Hyperplasia due to 21-hydroxylase deficiency; with the classical form affecting 1 in 10,000 to 15,000 cases per year. Acquired causes of adrenal insufficiency can be subtyped into autoimmune (Addison\u2019s Disease), traumatic (including haemorrhage or infarction), infective (e.g. Tuberculosis), infiltrative (e.g. neuroblastoma) and iatrogenic. Iatrogenic acquired causes include the use of prolonged exogenous steroids and post-surgical causes, such as the excision of a hypothalamic-pituitary tumour or adrenalectomy. Clinical features of adrenal insufficiency vary with age and with aetiology. They are often non-specific and may sometimes become apparent only in times of illness. Features range from those related to hypoglycaemia such as drowsiness, collapse, jitteriness, hypothermia and seizures. Features may also include signs of hypotension such as significant electrolyte imbalances and shock. Recognition of hypoglycaemia as a symptom of adrenal insufficiency is important to prevent treatable causes of sudden deaths. Cortisol has a key role in glucose homeostasis, particularly in the counter-regulatory mechanisms to prevent hypoglycaemia in times of biological stress. Affected neonates particularly appear susceptible to the compromise of these counter-regulatory mechanisms but it is recognised that affected older children and adults remain at risk of hypoglycaemia. In this review, we summarise the pathogenesis of hypoglycaemia in the context of adrenal insufficiency. We further explore the clinical features of hypoglycaemia based on different age groups and the burden of the disease, focusing on hypoglycaemic-related events in the various aetiologies of adrenal insufficiency. Finally, we sum up strategies from published literature for improved recognition and early prevention of hypoglycaemia in adrenal insufficiency, such as the use of continuous glucose monitoring or modifying glucocorticoid replacement.<\/jats:p>","DOI":"10.3389\/fendo.2023.1198519","type":"journal-article","created":{"date-parts":[[2023,11,19]],"date-time":"2023-11-19T23:42:41Z","timestamp":1700437361000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":31,"title":["Hypoglycaemia in adrenal insufficiency"],"prefix":"10.3389","volume":"14","author":[{"given":"Shien Chen","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth S.","family":"Baranowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh","family":"Sakremath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vrinda","family":"Saraff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zainaba","family":"Mohamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,11,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2018.03.012","article-title":"Central adrenal insufficiency in children and adolescents","volume":"32","author":"Patti","year":"2018","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2015-1710","article-title":"Diagnosis and treatment of primary adrenal insufficiency: an endocrine society clinical practice guideline","volume":"101","author":"Bornstein","year":"2016","journal-title":"J Clin Endocrinol Metab"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2019-231858","article-title":"A challenging diagnosis that eventually results in a life-threatening condition: Addison\u2019s disease and adrenal crisis","volume":"12","author":"Joersjo,\u00a8","year":"2019","journal-title":"BMJ Case Rep CP"},{"key":"B4","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1530\/EJE-09-0884","article-title":"Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies","volume":"162","author":"Hahner","year":"2010","journal-title":"Eur J Endocrinol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1159\/000481660","article-title":"Adrenal crises in children: perspectives and research directions","volume":"89","author":"Rushworth","year":"2018","journal-title":"Hormone Res Paediat"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2015-308799","article-title":"The diagnosis and treatment of adrenal insufficiency during childhood and adolescence","volume":"101","author":"Park","year":"2016","journal-title":"Arch Dis Childhood"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.302.6780.824","article-title":"Mortality, neoplasia, and creutzfeldt-jakob disease in patients treated with human pituitary growth hormone in the United Kingdom","volume":"302","author":"Buchanan","year":"1991","journal-title":"Br Med J"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.81.5.8626817","article-title":"Mortality in canadian children with growth hormone (gh) deficiency receiving gh therapy 1967-1992. the canadian growth hormone advisory committee","volume":"81","author":"Taback","year":"1996","journal-title":"J Clin Endocrinol Metab"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2003.12.036","article-title":"Long-term mortality in the United States cohort of pituitary-derived growth hormone recipients","volume":"144","author":"Mills","year":"2004","journal-title":"J Pediatr"},{"key":"B10","first-page":"463","article-title":"Glucose counterregulatory responses to hypoglycemia","volume":"9","author":"Sprague","year":"2011","journal-title":"Pediatr Endocrinol reviews: PER"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1152\/ajpendo.1989.257.1.E35","article-title":"Contribution of cortisol to glucose counterregulation in humans","volume":"257","author":"De Feo","year":"1989","journal-title":"Am J PhysiologyEndocrinol And Metab"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1152\/ajpendo.1989.256.6.E835","article-title":"Demonstration of a role for growth hormone in glucose counterregulation","volume":"256","author":"De Feo","year":"1989","journal-title":"Am J Physiology-Endocrinol And Metab"},{"key":"B13","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1111\/j.1749-6632.2010.05820.x","article-title":"Neuroendocrine responses to hypoglycemia","volume":"1212","author":"Tesfaye","year":"2010","journal-title":"Ann New York Acad Sci"},{"key":"B14","doi-asserted-by":"publisher","first-page":"145","DOI":"10.6065\/apem.2017.22.3.145","article-title":"Effects of growth hormone on glucose metabolism and insulin resistance in human","volume":"22","author":"Kim","year":"2017","journal-title":"Ann Pediatr Endocrinol Metab"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0166077","article-title":"Association between higher serum cortisol levels and decreased insulin secretion in a general population","volume":"11","author":"Kamba","year":"2016","journal-title":"PloS One"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.77.1.8325951","article-title":"The effect of recombinant human growth hormone on regulation of growth hormone secretion and blood glucose in insulin-dependent diabetes","volume":"77","author":"Wurzburger","year":"1993","journal-title":"J Clin Endocrinol Metab"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.684011","article-title":"An overview of hypoglycemia in children including a comprehensive practical diagnostic flowchart for clinical use","volume":"724","author":"Casertano","year":"2021","journal-title":"Front Endocrinol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1177\/0883073811406730","article-title":"The effect of recurrent severe hypoglycemia on cognitive performance in children with type 1 diabetes: a meta-analysis","volume":"26","author":"Blasetti","year":"2011","journal-title":"J Child Neurol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-54-1-131","article-title":"Cortisol-induced insulin resistance in man: impaired suppression of glucose production and stimulation of glucose utilization due to a postreceptor defect of insulin action","volume":"54","author":"Rizza","year":"1982","journal-title":"J Clin Endocrinol Metab"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-57-3-529","article-title":"Insulin resistance in cushing\u2019s syndrome","volume":"57","author":"Nosadini","year":"1983","journal-title":"J Clin Endocrinol Metab"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.2337\/diab.40.10.1228","article-title":"Stimulation of lipolysis in humans by physiological hypercortisolemia","volume":"40","author":"Divertie","year":"1991","journal-title":"Diabetes"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1210\/jc.83.2.626","article-title":"Effects of physiological hypercortisolemia on the regulation of lipolysis in subcutaneous adipose tissue","volume":"83","author":"Samra","year":"1998","journal-title":"J Clin Endocrinol Metab"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2007-0445","article-title":"Effects of cortisol on carbohydrate, lipid, and protein metabolism: studies of acute cortisol withdrawal in adrenocortical failure","volume":"92","author":"Christiansen","year":"2007","journal-title":"J Clin Endocrinol Metab"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2003-032051","article-title":"Stress dose of hydrocortisone is not beneficial in patients with classic congenital adrenal hyperplasia undergoing short-term, high-intensity exercise","volume":"89","author":"Weise","year":"2004","journal-title":"J Clin Endocrinol Metab"},{"key":"B25","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/B978-0-12-027305-8.50022-9","article-title":"Adrenocortical control of epinephrine synthesis in health and disease","volume":"5","author":"Wurtman","year":"1971","journal-title":"Adv Metab Disord"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2003-030634","article-title":"Patients with classic congenital adrenal hyperplasia have decreased epinephrine reserve and defective glucose elevation in response to high-intensity exercise","volume":"89","author":"Weise","year":"2004","journal-title":"J Clin Endocrinol Metab"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200011093431903","article-title":"Adrenomedullary dysplasia and hypofunction in patients with classic 21-hydroxylase deficiency","volume":"343","author":"Merke","year":"2000","journal-title":"New Engl J Med"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1152\/ajpendo.00539.2003","article-title":"Hypoglycemia and the sympathoadrenal system: neurogenic symptoms are largely the result of sympathetic neural, rather than adrenomedullary, activation","volume":"287","author":"DeRosa","year":"2004","journal-title":"Am J Physiol-Endocrinol Metab"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-07-0176","article-title":"Reduced epinephrine reserve in response to insulin-induced hypoglycemia in patients with pituitary adenoma","volume":"157","author":"Morita","year":"2007","journal-title":"Eur J Endocrinol"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.2003.tb05165.x","article-title":"Adrenal crises in children treated with high-dose inhaled corticosteroids for asthma","volume":"178","author":"Macdessi","year":"2003","journal-title":"Med J Aust"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2003-030135","article-title":"Neonates with symptomatic hyperinsulinemic hypoglycemia generate inappropriately low serum cortisol counterregulatory hormonal responses","volume":"88","author":"Hussain","year":"2003","journal-title":"J Clin Endocrinol Metab"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-3191","article-title":"High incidence of adrenal crisis in educated patients with chronic adrenal insufficiency: a prospective study","volume":"100","author":"Hahner","year":"2015","journal-title":"J Clin Endocrinol Metab"},{"key":"B33","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1111\/cen.12865","article-title":"Incidence of adrenal crisis in patients with adrenal insufficiency","volume":"84","author":"Smans","year":"2016","journal-title":"Clin Endocrinol"},{"key":"B34","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1530\/EJE-12-0161","article-title":"Frequency and causes of adrenal crises over lifetime in patients with 21-hydroxylase deficiency","volume":"167","author":"Reisch","year":"2012","journal-title":"Eur J Endocrinol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-15-0775","article-title":"Children with classic congenital adrenal hyperplasia experience salt loss and hypoglycemia: evaluation of adrenal crises during the first 6 years of life","volume":"174","author":"Odenwald","year":"2016","journal-title":"Eur J Endocrinol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"bvac119","DOI":"10.1210\/jendso\/bvac119","article-title":"Frequency of adrenal insufficiency in patients with hypoglycemia in an emergency department: A cross-sectional study","volume":"6","author":"Kawahara","year":"2022","journal-title":"J Endocrine Soc"},{"key":"B37","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1507\/endocrj.EJ16-0387","article-title":"Usage of continuous glucose monitoring (cgm) for detecting an unrecognized hypoglycemia and management of glucocorticoid replacement therapy in adult patients with central hypoadrenalism","volume":"65","author":"Watanabe","year":"2018","journal-title":"Endocrine J"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1530\/acta.0.112S275","article-title":"Frequency of hypoglycemia in children with adrenal insufficiency","volume":"113","author":"Artavia-Loria","year":"1986","journal-title":"Eur J Endocrinol"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1136\/adc.70.3.214","article-title":"Presentation, acute illness, and learning difficulties in salt wasting 21-hydroxylase deficiency","volume":"70","author":"Donaldson","year":"1994","journal-title":"Arch Dis childhood"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2002-021433","article-title":"Followup of 68 children with congenital adrenal hyperplasia due to 21-hydroxylase deficiency: relevance of genotype for management","volume":"88","author":"Pinto","year":"2003","journal-title":"J Clin Endocrinol Metab"},{"key":"B41","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.pedn.2008.06.003","article-title":"Hypoglycemia during acute illness in children with classic congenital adrenal hyperplasia","volume":"25","author":"Keil","year":"2010","journal-title":"J Pediatr Nurs"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.29271\/jcpsp.2020.10.1086","article-title":"Spectrum of addison\u2019s disease in children","volume":"30","author":"Laghari","year":"2020","journal-title":"J Coll Physicians Surg Pak"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgab096","article-title":"Increased mortality risk in patients with primary and secondary adrenal insufficiency","volume":"106","author":"Ngaosuwan","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1159\/000098400","article-title":"How many deaths can be prevented by newborn screening for congenital adrenal hyperplasia","volume":"67","author":"Grosse","year":"2007","journal-title":"Hormone Res Paediatrics"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(98)70060-5","article-title":"Mortality in patients with congenital adrenal hyperplasia: a cohort study","volume":"133","author":"Swerdlow","year":"1998","journal-title":"J Pediatr"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1210\/jc.86.7.2958","article-title":"Lessons from 30 years of clinical diagnosis and treatment of congenital adrenal hyperplasia in five middle european countries","volume":"86","author":"Kovacs,\u00b4","year":"2001","journal-title":"J Clin Endocrinol Metab"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-2957","article-title":"Increased mortality in patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency","volume":"99","author":"Falhammar","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1159\/000179126","article-title":"Maturation of the circadian rhythm of the adrenocortical functions in human neonates and infants","volume":"12","author":"Vermes","year":"1980","journal-title":"Hormone Res Paediatrics"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1111\/cen.12123","article-title":"Nocturnal hypoglycaemia in acth and gh deficient children: role of continuous glucose monitoring","volume":"79","author":"Cambiaso","year":"2013","journal-title":"Clin Endocrinol"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-17-0154","article-title":"Management of endocrine disease: risk of overtreatment in patients with adrenal insufficiency: current and emerging aspects","volume":"177","author":"Mazziotti","year":"2017","journal-title":"Eur J Endocrinol"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaa626","article-title":"A prospective study of children aged 0\u20138 years with cah and adrenal insufficiency treated with hydrocortisone granules","volume":"106","author":"Neumann","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2011.0158","article-title":"Nocturnal hypoglycemia identified by a continuous glucose monitoring system in patients with primary adrenal insufficiency (addison\u2019s disease)","volume":"14","author":"Meyer","year":"2012","journal-title":"Diabetes Technol Ther"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2008.03210.x","article-title":"The impact of fasting and treatment omission on susceptibility to hypoglycaemia in children and adolescents with gh and cortisol insufficiency","volume":"69","author":"Johnstone","year":"2008","journal-title":"Clin Endocrinol"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.757566","article-title":"Acute illness and death in children with adrenal insufficiency","volume":"1264","author":"Worth","year":"2021","journal-title":"Front Endocrinol"},{"key":"B55","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-12-1057","article-title":"Subcutaneous hydrocortisone administration for emergency use in adrenal insufficiency","volume":"169","author":"Hahner","year":"2013","journal-title":"Eur J Endocrinol"},{"key":"B56","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-1926","article-title":"Improved cortisol exposure-time profile and outcome in patients with adrenal insufficiency: a prospective randomized trial of a novel hydrocortisone dual-release formulation","volume":"97","author":"Johannsson","year":"2012","journal-title":"J Clin Endocrinol Metab"},{"key":"B57","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-3809","article-title":"A phase 2 study of chronocort, a modified-release formulation of hydrocortisone, in the treatment of adults with classic congenital adrenal hyperplasia","volume":"100","author":"Mallappa","year":"2015","journal-title":"J Clin Endocrinol Metab"},{"key":"B58","doi-asserted-by":"publisher","DOI":"10.1111\/cen.14275","article-title":"Systematic review and meta-analysis of the metabolic effects of modified-release hydrocortisone versus standard glucocorticoid replacement therapy in adults with adrenal insufficiency","volume":"93","author":"Bannon","year":"2020","journal-title":"Clin Endocrinol"},{"key":"B59","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2020.610904","article-title":"Switching from immediate-release to fractionated dual-release hydrocortisone may improve metabolic control and qol in selected primary adrenal insufficiency patients","volume":"11","author":"Delle Cese","year":"2021","journal-title":"Front Endocrinol"},{"key":"B60","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgab051","article-title":"Modified-release hydrocortisone in congenital adrenal hyperplasia","volume":"106","author":"Merke","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"B61","first-page":"1116864","article-title":"Continuous glucose monitoring for children with hypoglycaemia: evidence in 2023","volume-title":"Front Endocrinol","author":"Worth","year":"2023"},{"key":"B62","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2012-301661","article-title":"Validation of the continuous glucose monitoring sensor in preterm infants","volume":"98","author":"Beardsall","year":"2013","journal-title":"Arch Dis Childhood-Fetal Neonatal Edition"},{"key":"B63","doi-asserted-by":"publisher","DOI":"10.1159\/000506230","article-title":"Continuous glucose monitoring systems: are they useful for evaluating glycemic control in children with hyperinsulinism","volume":"92","author":"Rayannavar","year":"2019","journal-title":"Hormone Res paediat"},{"key":"B64","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1111\/pedi.13029","article-title":"Continuous glucose monitoring for hypoglycaemia in children: perspectives in 2020","volume":"21","author":"Worth","year":"2020","journal-title":"Pediatr Diabetes"},{"key":"B65","doi-asserted-by":"publisher","first-page":"bvad021","DOI":"10.1210\/jendso\/bvad021","article-title":"Paediatric society and hyperinsulinism charity national surveys on cgm access for patients with recurrent hypoglycaemia","volume":"7","author":"Ng","year":"2023","journal-title":"J Endocrine Soc"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2023.1198519\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,19]],"date-time":"2023-11-19T23:42:45Z","timestamp":1700437365000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2023.1198519\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,20]]},"references-count":65,"alternative-id":["10.3389\/fendo.2023.1198519"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2023.1198519","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,20]]},"article-number":"1198519"}}