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Diagnosis of Overtraining Syndrome: Results of the Endocrine and Metabolic Responses on Overtraining Syndrome Study: EROS-DIAGNOSIS
Open accessAbstract
Objectives. Overtraining syndrome (OTS), a common dysfunction among elite athletes, causes decreased performance and fatigue and has no standardized diagnostic criteria. The Endocrine and Metabolic Responses on Overtraining Syndrome (EROS) study identified more than 45 potential biomarkers of OTS. In the present study, we hypothesized that combinations of these biomarkers could be an accurate diagnostic tool for OTS. Methods. We selected parameters with largest difference and fewest overlapping results compared to healthy athletes and highest feasibility and reproducibility. Among the multiple combinations attempted, we chose those that did not show overlapping results, according to the objective. Results. We included 11 clinical parameters, 4 basal hormones, and 5 hormonal responses in Insulin Tolerance Test (ITT). The three selected diagnostic tools were the (i) EROS-CLINICAL, with only clinical parameters, which was suitable as an initial assessment for athletes suspected of OTS; (ii) EROS-SIMPLIFIED, with clinical parameters and basal hormones, when the EROS-CLINICAL was inconclusive; and (iii) EROS-COMPLETE, with basal and hormonal responses to stimulation tests, which was valuable for population-based screening, research purposes, and unusual presentations of OTS. Conclusion. We identified innovative tools with 100% accuracy for the diagnosis of OTS, without the need to exclude confounding disorders.
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Athletes with overtraining syndrome have impaired cortisol regulation and metabolic imbalance, reflecting prolonged HPA hyperactivation.
“Cadegiani and Kater (2019) observed impaired cortisol regulation and metabolic imbalance in athletes with overtraining syndrome (OTS), reflecting prolonged HPA hyperactivation [57].”
From Chronic Stress and Autoimmunity: The Role of HPA Axis and Cortisol Dysregulation (2025) · cites this paper as [57]
The Introduction (page unavailable) describes hormonal and metabolic dysfunction in OTS, and Results §3.1 (page unavailable) includes cortisol responses among the markers used to distinguish affected from healthy athletes. These passages support the broad description of metabolic imbalance and altered cortisol response, but they do not establish prolonged HPA hyperactivation as the explanation. (LLM, conf=0.86)
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Metadata
- Authors
- Cadegiani, F. A., da Silva, P. H. L., Abrao, T. C. P., & Kater, C. E.
- Affiliations
- Universidade Federal de São Paulo (BR)
- Adrenal and Hypertension Unit, Division of Endocrinology and Metabolism, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil
- Corresponding author
- Cadegiani, Flavio Adsuara
- Venue
- Journal of Sports Medicine
- Publisher
- Wiley
- Published
- 2020-04-22
- Volume
- 2020
- Pages
- 1-17
- ISSN
- 2314-6176 (ISSN-L)
- 2356-7651
- PMC
- PMC7193300
- OpenAlex
- W3018559107
- Cited by
- 33
- References
- 14
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 4 · 2023: 6 · 2022: 9 · 2021: 4 · 2020: 3
- FWCI
- 5.50
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Sports Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Universidade de São Paulo
- Defence and Security Accelerator
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
- Health Sciences › Medicine › Physiology (medical) › Exercise and Physiological Responses
- Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
- Keywords
- overtraining syndrome, diagnostic criteria, biomarkers, insulin tolerance test, endocrine response, clinical features, elite athletes, fatigue
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