{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T22:25:13Z","timestamp":1793053513343,"version":"4.5.0"},"reference-count":55,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"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:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Adrenal incidentalomas are an increasing clinical concern and, while most are non-functioning adrenal adenomas (NFAA), a relevant subset is associated with mild autonomous cortisol secretion (MACS), condition linked to various comorbidities, including metabolic and musculoskeletal alterations. However, the association with a reduction in muscle strength and mass is still controversial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We evaluated the effects of mild cortisol excess on skeletal muscle health, body composition, and quality of life (QoL) in patients with adrenal incidentalomas associated with MACS, compared with those with NFAA and healthy controls. Sixty-two participants were enrolled: 21 with MACS, 21 with NFAA, and 20 healthy controls. Skeletal muscle strength was assessed using handgrip dynamometry, the sit-to-stand test, and the Medical Research Council (MRC) scale. Body composition was analyzed by bioelectrical impedance analysis (BIA), and quality of life was assessed using the EQ-5D and SARC-F questionnaires.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients with MACS had a significantly higher prevalence of osteopenia and osteoporosis compared to NFAA and controls (61.9% vs. 28.6% and 25%, respectively; p= 0.03). No significant differences were observed in fat-free mass (FFM), muscle mass (MM), or fat mass (FM) among groups. MACS patients showed significantly reduced MRC scores for biceps and quadriceps compared to controls (p=0.04). Patients with osteoporosis\/osteopenia and reduced muscle strength exhibited higher post-dexamethasone suppression test (DST) cortisol concentrations although not significant. Similarly, QoL scores showed a trend toward greater impairment in the MACS group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>It\u2019s one of the first studies assessing muscle mass and performance in MACS compared to NFAA and healthy controls. Our results underline the impact of mild hypercortisolism on proximal myopathy, suggesting an under-recognized musculoskeletal impact supporting the clinical relevance of MACS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1803910","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T04:23:28Z","timestamp":1777523008000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Is muscle strength an overlooked parameter in patients affected by mild autonomous cortisol secretion?"],"prefix":"10.3389","volume":"17","author":[{"given":"Martina","family":"Romanisio","sequence":"first","affiliation":[{"name":"Endocrinology, Department of Translational Medicine, Universit\u00e0 del Piemonte Orientale","place":["Novara, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Mele","sequence":"additional","affiliation":[{"name":"Endocrinology, Department of Translational Medicine, Universit\u00e0 del Piemonte Orientale","place":["Novara, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Sturnia","sequence":"additional","affiliation":[{"name":"Endocrinology, Department of Translational Medicine, Universit\u00e0 del Piemonte Orientale","place":["Novara, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carola","family":"Ciamparini","sequence":"additional","affiliation":[{"name":"Endocrinology, Department of Translational Medicine, Universit\u00e0 del Piemonte Orientale","place":["Novara, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Pitino","sequence":"additional","affiliation":[{"name":"Endocrinology, Department of Translational Medicine, Universit\u00e0 del Piemonte Orientale","place":["Novara, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Ferrero","sequence":"additional","affiliation":[{"name":"Endocrinology, Department of Translational Medicine, Universit\u00e0 del Piemonte Orientale","place":["Novara, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenza","family":"Scotti","sequence":"additional","affiliation":[{"name":"Statistics, Department of Translational Medicine, Universit\u00e0 del Piemonte Orientale","place":["Novara, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madalina Elena","family":"Iftimie","sequence":"additional","affiliation":[{"name":"Department of Endocrinology I,\u2019\u2019C.I.Parhon\u201d National Institute of Endocrinology","place":["Bucharest, Romania"]},{"name":"Department of Endocrinology, \u201cCarol Davila\u201d University of Medicine and Pharmacy","place":["Bucharest, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Aimaretti","sequence":"additional","affiliation":[{"name":"Endocrinology, Department of Translational Medicine, Universit\u00e0 del Piemonte Orientale","place":["Novara, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Marzullo","sequence":"additional","affiliation":[{"name":"Endocrinology, Department of Translational Medicine, Universit\u00e0 del Piemonte Orientale","place":["Novara, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavia","family":"Prodam","sequence":"additional","affiliation":[{"name":"Endocrinology, Department of Translational Medicine, Universit\u00e0 del Piemonte Orientale","place":["Novara, Italy"]},{"name":"Department of Health Sciences, Universit\u00e0 del Piemonte Orientale","place":["Novara, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Caputo","sequence":"additional","affiliation":[{"name":"Endocrinology, Department of Translational Medicine, Universit\u00e0 del Piemonte Orientale","place":["Novara, Italy"]},{"name":"Department of Health Sciences, Universit\u00e0 del Piemonte Orientale","place":["Novara, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"G1","DOI":"10.1530\/EJE-16-0467","article-title":"Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors","volume":"175","author":"Fassnacht","year":"2016","journal-title":"Eur J Endocrinol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"G1","DOI":"10.1093\/ejendo\/lvad066","article-title":"European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors","volume":"189","author":"Fassnacht","year":"2023","journal-title":"Eur J Endocrinol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgz284","article-title":"Adrenal incidentalomas are tied to increased risk of diabetes: Findings from a prospective study","volume":"105","author":"Reimondo","year":"2020","journal-title":"J Clin Endocrinol Metab"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1007\/s42000-022-00406-6","article-title":"Predictive model for autonomous cortisol secretion development in non-functioning adrenal incidentalomas","volume":"22","author":"Araujo-Castro","year":"2023","journal-title":"Hormones"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-17-0372","article-title":"Optimal follow-up strategies for adrenal incidentalomas: Reappraisal of the 2016 ESE-ENSAT guidelines in real clinical practice","volume":"177","author":"Hong","year":"2017","journal-title":"Eur J Endocrinol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaa270","article-title":"Prevalence and incidence of atrial fibrillation in a large cohort of adrenal incidentalomas: A long-term study","volume":"105","author":"Di Dalmazi","year":"2020","journal-title":"J Clin Endocrinol Metab"},{"key":"B7","doi-asserted-by":"publisher","first-page":"26","DOI":"10.3803\/EnM.2020.35.1.26","article-title":"Is follow-up of adrenal incidentalomas always mandatory","volume":"35","author":"Reimondo","year":"2020","journal-title":"Endocrinol Metab"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.7326\/M18-3630","article-title":"Natural history of adrenal incidentalomas with and without mild autonomous cortisol excess: A systematic review and meta-analysis","volume":"171","author":"Elhassan","year":"2019","journal-title":"Ann Internal Med"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-023-02154-9","article-title":"Tumor enlargement in adrenal incidentaloma is related to glaucoma: A new prognostic feature","volume":"47","author":"Caputo","year":"2024","journal-title":"J Endocrinol Invest"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.7326\/M21-1737","article-title":"Cardiometabolic disease burden and steroid excretion in benign adrenal tumors: A cross-sectional multicenter study","volume":"175","author":"Prete","year":"2022","journal-title":"Ann Intern Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1016\/S2213-8587(22)00100-0","article-title":"Age-dependent and sex-dependent disparity in mortality in patients with adrenal incidentalomas and autonomous cortisol secretion: An international, retrospective, cohort study","volume":"10","author":"Deutschbein","year":"2022","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"S88","DOI":"10.1093\/ejendo\/lvad134","article-title":"Comorbidities in mild autonomous cortisol secretion and the effect of treatment: Systematic review and meta-analysis","volume":"189","author":"Pelsma","year":"2023","journal-title":"Eur J Endocrinol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(25)00195-0","article-title":"Surgery for the treatment of arterial hypertension in patients with unilateral adrenal incidentalomas and mild autonomous cortisol secretion (CHIRACIC): A multicenter, open-label, superiority randomized controlled trial","volume":"13","author":"Tabarin","year":"2025","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1093\/ejendo\/lvae167","article-title":"Body composition and cardiometabolic risks of patients with adrenal tumors in relation to hormonal activity: A large cross-sectional single-center study","volume":"192","author":"Kim","year":"2025","journal-title":"Eur J Endocrinol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(25)00302-X","article-title":"Effect of surgical versus conservative management on cardiovascular outcomes in patients with bilateral adrenal tumors and cortisol excess: An international, retrospective cohort study","volume":"14","author":"Nowak","year":"2026","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2002-021518","article-title":"Gender-related differences in the presentation and course of Cushing's disease","volume":"88","author":"Pecori Giraldi","year":"2003","journal-title":"J Clin Endocrinol Metab"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1007\/BF03347462","article-title":"Steroid myopathy: Some unresolved issues","volume":"34","author":"Minetto","year":"2011","journal-title":"J Endocrinol Invest"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-15-0354","article-title":"Metabolic comorbidities in Cushing's syndrome","volume":"173","author":"Ferra\u00f9","year":"2015","journal-title":"Eur J Endocrinol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1093\/ageing\/afx162","article-title":"Frailty index as a predictor of mortality: A systematic review and meta-analysis","volume":"47","author":"Kojima","year":"2018","journal-title":"Age Ageing"},{"key":"B20","article-title":"Screening for frailty in primary care: Accuracy of gait speed and hand-grip strength","volume":"63","author":"Lee","year":"2017","journal-title":"Can Family Physician Medecin Famille Canadien"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1093\/ejendo\/lvad113","article-title":"High prevalence of frailty in patients with adrenal adenomas and adrenocortical hormone excess: A cross-sectional multi-center study with prospective enrolment","volume":"189","author":"Dogra","year":"2023","journal-title":"Eurpopean J Endocrinol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1002\/agm2.12286","article-title":"Unveiling the hidden impact: Subclinical hypercortisolism and its subtle influence on bone health","volume":"7","author":"Lou","year":"2024","journal-title":"Aging Med"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2015-4061","article-title":"The management of primary aldosteronism: Case detection, diagnosis, and treatment: An Endocrine Society Clinical Practice Guideline","volume":"101","author":"Funder","year":"2016","journal-title":"J Clin Endocrinol Metab"},{"key":"B24","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1093\/ageing\/afy169","article-title":"Sarcopenia: Revised European consensus on definition and diagnosis","volume":"48","author":"Cruz-Jentoft","year":"2019","journal-title":"Age Ageing"},{"key":"B25","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1002\/jcsm.12048","article-title":"SARC-F: A symptom score to predict persons with sarcopenia at risk for poor functional outcomes","volume":"7","author":"Malmstrom","year":"2016","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.4081\/monaldi.2012.121","article-title":"EuroQol-5D (EQ-5D): An instrument for measuring quality of life","volume":"78","author":"Balestroni","year":"2012","journal-title":"Monaldi Arch For Chest Dis"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1111\/j.1530-7085.2003.03034.x","article-title":"The numeric rating scale for clinical pain measurement: A ratio measure","volume":"3","author":"Hartrick","year":"2003","journal-title":"Pain Practice: Off J World Institute Pain"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1079\/phn2005898","article-title":"The International Physical Activity Questionnaire (IPAQ): A study of concurrent and construct validity","volume":"9","author":"Hagstr\u00f6mer","year":"2006","journal-title":"Public Health Nutr"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-025-04170-6","article-title":"Should adrenal incidentaloma patients be evaluated for muscle mass, function, and quality? A cross-sectional study","volume":"88","author":"Alkan","year":"2025","journal-title":"Endocrine"},{"key":"B30","doi-asserted-by":"publisher","first-page":"6693","DOI":"10.1038\/ncomms7693","article-title":"A muscle-liver-fat signaling axis is essential for central control of adaptive adipose remodeling","volume":"6","author":"Shimizu","year":"2015","journal-title":"Nat Commun"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1159\/000514434","article-title":"Dynamic tests in pituitary endocrinology: Pitfalls in interpretation during aging","volume":"112","author":"Caputo","year":"2022","journal-title":"Neuroendocrinology"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.85.10.6861","article-title":"Sexual dimorphism in the influence of advanced aging on adrenal hormone levels: The Rancho Bernardo Study","volume":"85","author":"Laughlin","year":"2000","journal-title":"J Clin Endocrinol Metab"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.81.7.8675562","article-title":"Effects of gender and age on the levels and circadian rhythmicity of plasma cortisol","volume":"81","author":"Van Cauter","year":"1996","journal-title":"J Clin Endocrinol Metab"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2019.00054","article-title":"Adrenal aging and its implications on stress responsiveness in humans","volume":"10","author":"Yiallouris","year":"2019","journal-title":"Front Endocrinol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2008.03212.x","article-title":"The relationship between cortisol, muscle mass and muscle strength in older persons and the role of genetic variations in the glucocorticoid receptor","volume":"69","author":"Peeters","year":"2008","journal-title":"Clin Endocrinol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1111\/j.1365-2265.2007.02900.x","article-title":"Relationship between cortisol and physical performance in older persons","volume":"67","author":"Peeters","year":"2007","journal-title":"Clin Endocrinol"},{"key":"B37","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1007\/s00223-021-00863-y","article-title":"Diurnal salivary cortisol in sarcopenic postmenopausal women: The OsteoLaus cohort","volume":"109","author":"Gonzalez Rodriguez","year":"2021","journal-title":"Calcif Tissue Int"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/63.5.536","article-title":"Altered growth hormone, cortisol, and leptin secretion in healthy elderly persons with sarcopenia and mixed body composition phenotypes","volume":"63","author":"Waters","year":"2008","journal-title":"Journals Gerontology Ser A Biol Sci Med Sci"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2018-01942","article-title":"Urinary sex steroid and glucocorticoid hormones are associated with muscle mass and strength in healthy adults","volume":"104","author":"Bochud","year":"2019","journal-title":"J Clin Endocrinol Metab"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgab862","article-title":"Impact of cortisol on reduction in muscle strength and mass: A Mendelian randomization study","volume":"107","author":"Katsuhara","year":"2022","journal-title":"J Clin Endocrinol Metab"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1093\/ejendo\/lvad069","article-title":"Determinants of muscle function and health-related quality of life in patients with endogenous hypercortisolism: A cross-sectional study","volume":"188","author":"Li","year":"2023","journal-title":"Eur J Endocrinol"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-15-046","article-title":"Cushing's syndrome: Update on signs, symptoms and biochemical screening","volume":"173","author":"Nieman","year":"2015","journal-title":"Eur J Endocrinol"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.1983.tb03198.x","article-title":"Corticosteroid myopathy: A clinical and pathological study","volume":"18","author":"Khaleeli","year":"1983","journal-title":"Clin Endocrinol"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-10-1169","article-title":"Do muscle fiber conduction slowing and decreased levels of circulating muscle proteins represent sensitive markers of steroid myopathy? A pilot study in Cushing's disease","volume":"164","author":"Minetto","year":"2011","journal-title":"Eur J Endocrinol"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-018-1598-0","article-title":"Alteration in skeletal muscle mass in women with subclinical hypercortisolism","volume":"61","author":"Kim","year":"2018","journal-title":"Endocrine"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.3390\/ijms23084340","article-title":"Pathophysiological link between insulin resistance and adrenal incidentalomas","volume":"23","author":"Higgs","year":"2022","journal-title":"Int J Mol Sci"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1111\/cen.13512","article-title":"Impact of hypercortisolism on skeletal muscle mass and adipose tissue mass in patients with adrenal adenomas","volume":"88","author":"Delivanis","year":"2018","journal-title":"Clin Endocrinol (Oxf)"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1111\/cen.13743","article-title":"Assessment of vertebral microarchitecture in overt and mild Cushing's syndrome using trabecular bone score","volume":"89","author":"Vinolas","year":"2018","journal-title":"Clin Endocrinol"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1210\/er.2018-00097","article-title":"Glucocorticoids and bone: Consequences of endogenous and exogenous excess and replacement therapy","volume":"39","author":"Hardy","year":"2018","journal-title":"Endocr Rev"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.1648","article-title":"Bone quality, as measured by trabecular bone score in patients with adrenal incidentalomas with and without subclinical hypercortisolism","volume":"27","author":"Eller-Vainicher","year":"2012","journal-title":"J Bone Mineral Research: Off J Am Soc For Bone Mineral Res"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1093\/jbmr\/zjae067","article-title":"Fracture risk and bone health in adrenal adenomas with mild autonomous cortisol secretion\/subclinical hypercortisolism: a systematic review, meta-analysis and meta-regression","volume":"39","author":"Pal","year":"2024","journal-title":"J Bone Mineral Research: Off J Am Soc For Bone Mineral Res"},{"key":"B52","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1111\/cen.70048","article-title":"Bone health in patients with adrenal adenomas and hypercortisolism: a multicenter cross-sectional study","volume":"104","author":"Dogra","year":"2025","journal-title":"Clin Endocrinol"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000044153","article-title":"Impact of mild cortisol excess on osteoporosis and the mediating role of sarcopenia-related traits: a Mendelian randomization study","volume":"104","author":"Zhu","year":"2025","journal-title":"Medicine"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2024.1385808","article-title":"Are comorbidities of patients with adrenal incidentaloma tied to sex","volume":"15","author":"Puglisi","year":"2024","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B55","doi-asserted-by":"publisher","DOI":"10.1093\/ejendo\/lvad038","article-title":"Mild autonomous cortisol secretion in adrenal incidentalomas and risk of fragility fractures: a large cross-sectional study","volume":"188","author":"Zavatta","year":"2023","journal-title":"Eur J Endocrinol"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1803910\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T04:23:31Z","timestamp":1777523011000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1803910\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,30]]},"references-count":55,"alternative-id":["10.3389\/fendo.2026.1803910"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1803910","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,30]]},"article-number":"1803910"}}