The DOI matches its Crossref record; 299 of the 316 references it cites were found in a registry or an index; 58 of the 311 sources its claims cite were checked for support.
Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline
Open accessAbstract
Objective To formulate clinical practice guidelines for hormonal replacement in hypopituitarism in adults. Participants The participants include an Endocrine Society-appointed Task Force of six experts, a methodologist, and a medical writer. The American Association for Clinical Chemistry, the Pituitary Society, and the European Society of Endocrinology co-sponsored this guideline. Evidence The Task Force developed this evidence-based guideline using the Grading of Recommendations, Assessment, Development, and Evaluation system to describe the strength of recommendations and the quality of evidence. The Task Force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies. Consensus process One group meeting, several conference calls, and e-mail communications enabled consensus. Committees and members of the Endocrine Society, the American Association for Clinical Chemistry, the Pituitary Society, and the European Society of Endocrinology reviewed and commented on preliminary drafts of these guidelines. Conclusions Using an evidence-based approach, this guideline addresses important clinical issues regarding the evaluation and management of hypopituitarism in adults, including appropriate biochemical assessments, specific therapeutic decisions to decrease the risk of co-morbidities due to hormonal over-replacement or under-replacement, and managing hypopituitarism during pregnancy, pituitary surgery,…
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Claims the paper makes
151 No full text of the sources · 21 Own interpretation · 20 Couldn’t confirm · 19 Partly supported · 13 Sources not found · 11 No basis given · 5 Own result · 4 Supported so far · 4 Not checked yet · 3 Supported · 2 Own method · 1 Not supported · accuracy not yet measured
At least one cited source doesn’t support this claim or points to a different paper, and none confirmed it — see the verdicts below.
In the paper
“Excess cardiovascular mortality might be specifically related to AC (30).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Disputedcites [30] Burman, 2013, Deaths among adult patients with hypopituitarism: hypocortisolism during acute stress, and de novo malignant brain tumors contribute to an increased mortality, J Clin Endocrinol Metab sourceExperimental — accuracy not yet measured
The Discussion (pp. 8–9) says this cohort’s excess mortality was not accounted for by cardiovascular or cerebrovascular deaths; cardiovascular mortality did not significantly exceed that of the reference population. It instead identifies adrenal crisis as a contributor to deaths associated with infection, so the paper does not link an excess of cardiovascular deaths to adrenal crisis. (LLM, conf=0.87)
Checked by a reasoning model — may be wrong.
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Disputed
Every source the paper cites for this claim was checked and supports it.
In the paper
“Accordingly, bilateral oophorectomy without estrogen replacement before the age of 45 increases cardiovascular mortality (51).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > MAY 4, 2016
What the sources say
- Supportedcites [51] Rivera, 2009, Increased cardiovascular mortality after early bilateral oophorectomy, Menopause source
The Results section reports increased cardiovascular mortality among women who underwent bilateral oophorectomy before age 45 and were not treated with estrogen through age 45 (HR 1.84 versus referent women). The paper presents this as an observed association. (LLM, conf=0.92)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“Studies have suggested that 10-18% of high-risk pituitary patients have unrecognized CH with low-normal fT4 levels (77,79).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not checked — no full text of the sourcecites [77] Persani, 2000, Circulating thyrotropin bioactivity in sporadic central hypothyroidism, J Clin Endocrinol Metab source
- Could not verifycites [79] Jonklaas, 2014, Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement, Thyroid sourceExperimental — accuracy not yet measured
The available Discussion of the clinical literature passages address thyroid hormone replacement, not the prevalence of unrecognized central hypothyroidism in high-risk pituitary patients. Searches for central hypothyroidism, low-normal FT4, pituitary patients, and the 10–18% figure found no passage supporting the claim. Our copy is truncated, so a relevant later section may be missing. (LLM, conf=0.73)
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“Since patients with primary hypothyroidism usually require high-normal or slightly elevated fT4 levels to normalize TSH levels (78), low-normal fT4 levels in hypopituitary patients may suggest the presence of CH.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Could not verifycites [78] Alexopoulou, 2004, Clinical and hormonal characteristics of central hypothyroidism at diagnosis and during follow-up in adult patients, Eur J Endocrinol sourceExperimental — accuracy not yet measured
The Discussion recommends upper-normal fT4 as a marker of adequate treatment in central hypothyroidism, not primary hypothyroidism. I searched for the claimed fT4 level needed to normalize TSH in primary hypothyroidism, but no passage in our copy states it. (LLM, conf=0.73)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Could not verify
Every source the paper cites for this claim was checked and supports it.
In the paper
“Stress doses of GC replacement for intercurrent illnesses and minor stress are similar to those used in primary AI (72).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Glucocorticoid Replacement
What the sources say
- Supportedcites [72] Bornstein, 2016, Diagnosis and treatment of primary adrenal insufficiency: an Endocrine Society Clinical Practice Guideline, J Clin Endocrinol Metab source
The guideline’s Suggested Action table (page not provided) gives stress doses for febrile illness and minor-to-moderate surgical stress in primary adrenal insufficiency. Its sick-day rules also call for doubling the routine oral glucocorticoid dose during illness or before a small outpatient procedure. These passages support the cited primary-adrenal-insufficiency dosing used as the comparison. (LLM, conf=0.88)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Researchers have used a cortisol day curve (108), but it has little value for routine clinical use (28).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Glucocorticoid Replacement
What the sources say
- Could not verifycites [108] Kahric-Janicic, 2007, Tandem mass spectrometry improves the accuracy of free thyroxine measurements during pregnancy, Thyroid sourceExperimental — accuracy not yet measured
The Discussion addresses the clinical usefulness of free-thyroxine measurement by LC/MS/MS, not cortisol day curves. Searches for a cortisol day curve and its routine clinical utility found no passage addressing the claim in our copy. (LLM, conf=0.76)
- Supportedcites [28] Bancos, 2015, Diagnosis and management of adrenal insufficiency, Lancet Diabetes Endocrinol source
The Chronic Replacement Therapy section (p. 12) explicitly says cortisol day curves are of limited value in routine monitoring. This supports the claim about routine clinical use. (LLM, conf=0.95)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Could not verify
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Clinicians are increasingly using newer liquid chromatography-mass spectrometric-based assays with suggested improved sensitivity and reduced interference.This is particularly true for steroids, namely E2, T (104,105), and thyroid and peptide hormones (78,106).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Hormone Assays
What the sources say
- Could not verifycites [104] De Bellis, 1999, A longitudinal study of vasopressin cell antibodies, posterior pituitary function, and magnetic resonance imaging evaluations in subclinical autoimmune central diabetes insipidus, J Clin Endocrinol Metab sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.
- Not checked — no full text of the sourcecites [105] Sikaris, 2005, Reproductive hormone reference intervals for healthy fertile young men: evaluation of automated platform assays, J Clin Endocrinol Metab source
- Could not verifycites [78] Alexopoulou, 2004, Clinical and hormonal characteristics of central hypothyroidism at diagnosis and during follow-up in adult patients, Eur J Endocrinol sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.
- Partly supportedcites [106] Rosner, 2013, Challenges to the measurement of estradiol: an Endocrine Society Position Statement, J Clin Endocrinol Metab sourceExperimental — accuracy not yet measured
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Could not verify
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Cortisol secretion exhibits a distinct circadian rhythm; low at the time of sleep onset, rising early morning, peaking just after the time of waking, then falling during the day (28,107).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Circadian rhythm-multiple daily dosing.
What the sources say
- Supportedcites [28] Bancos, 2015, Diagnosis and management of adrenal insufficiency, Lancet Diabetes Endocrinol source
The Diagnosis of Adrenal Insufficiency section (p. 8) describes cortisol rising in the early morning, peaking at 6–9 a.m., and falling to low levels in the evening and very low levels around midnight. This supports the claimed circadian pattern; the paper gives clock times rather than timing the peak and low point to waking and sleep onset. (LLM, conf=0.88)
- Not checked — no full text of the sourcecites [107] Kane, 2007, Measurement of serum testosterone in women; what should we do?, Ann Clin Biochem source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“A high proportion of patients on “conventional” corticosteroid replacement therapy for AI are over treated or on inappropriate replacement regimens (120).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Circadian rhythm-multiple daily dosing.
What the sources say
- Partly supportedcites [120] Stavreva, 2009, Ultradian hormone stimulation induces glucocorticoid receptor-mediated pulses of gene transcription, Nat Cell Biol sourceExperimental — accuracy not yet measured
The Discussion says corticosteroid replacement regimens for patients with hypocortisolaemia lack effective ultradian rhythmicity, which supports a concern about how replacement is administered. It does not say that a high proportion of patients are overtreated or quantify how many receive inappropriate regimens. (LLM, conf=0.84)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“Visceral adipose tissue mass is decreased by 9% in female patients receiving GH replacement ( 166”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Remarks
What the sources say
- Could not verifycites [166] Clemmons, 2014, Growth hormone should be used only for approved indications, J Clin Endocrinol Metab sourceExperimental — accuracy not yet measured
The paper’s concluding section says GH replacement can benefit patients with documented pituitary disease, and its References list studies of body composition. Neither the supplied passages nor searches for visceral adipose tissue and a 9% reduction report that result in female patients. (LLM, conf=0.76)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Could not verify
- It may state two separate claims as one. 84
- Probably not a substantial claim. 19
- The quote only partly states this claim. 1
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“Serum T3 or free T3 (fT3) levels are generally not helpful in diagnosing CH; most patients with CH have low fT3 levels, but there is considerable overlap between CH and non-CH patients with pituitary MAY 4, 2016 disease (75,77).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Could not verifycites [75] Krasowski, 2014, Cross-reactivity of steroid hormone immunoassays: clinical significance and two-dimensional molecular similarity prediction, BMC Clin Pathol sourceExperimental — accuracy not yet measured
The Background and Results discuss steroid hormone immunoassays, not T3 or free T3 testing. Searches for free T3, hypothyroidism, and pituitary disease found no passage addressing whether fT3 helps diagnose CH or whether levels overlap between patients with and without CH. (LLM, conf=0.76)
- Not checked — no full text of the sourcecites [77] Persani, 2000, Circulating thyrotropin bioactivity in sporadic central hypothyroidism, J Clin Endocrinol Metab source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Could not verify
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“Acute/subacute illness alters T levels acting at various levels of the hypothalamo-pituitary-gonadal axis (90,91).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Remarks
What the sources say
- Not checked — no full text of the sourcecites [90] Cooke, 1993, Circadian variation in serum free and non-SHBG-bound testosterone in normal men: measurements, and simulation using a mass action model, Clin Endocrinol (Oxf) source
- Could not verifycites [91] Brambilla, 2009, The effect of diurnal variation on clinical measurement of serum testosterone and other sex hormone levels in men, J Clin Endocrinol Metab sourceExperimental — accuracy not yet measured
The Discussion describes changes in testosterone levels by time of day and age, not by acute or subacute illness. Searches for illness and effects on the hypothalamo-pituitary-gonadal axis found no passage in our copy addressing the claimed mechanism. (LLM, conf=0.76)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“Many patients with CH have undetectable TSH levels on presentation, and almost all CH patients adequately treated with L-T4 to maintain serum fT4 levels in the mid-to high-normal range will have undetectable TSH levels (75,80,127,129).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Could not verifycites [75] Krasowski, 2014, Cross-reactivity of steroid hormone immunoassays: clinical significance and two-dimensional molecular similarity prediction, BMC Clin Pathol sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.
- Not checked — no full text of the sourcecites [80] Koulouri, 2011, Diagnosis and treatment of hypothyroidism in TSH deficiency compared to primary thyroid disease: pituitary patients are at risk of under-replacement with levothyroxine, Clin Endocrinol (Oxf) source
- Could not verifycites [127] Ekman, 2014, European Adrenal Insufficiency Registry (EU-AIR): a comparative observational study of glucocorticoid replacement therapy, BMC Endocr Disord sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.
- Not checked — no full text of the sourcecites [129] Shimon, 2002, Thyrotropin suppression by thyroid hormone replacement is correlated with thyroxine level normalization in central hypothyroidism, Thyroid source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Could not verify
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“T replacement increases libido, sexual motivation and sexual function (134,135,138-143), mood (144), sense of well being, concentration (135,139,143,145-147), self-reported sense of energy (134,135), muscle mass and strength (132,148,149), and the recovery of anemia related to T deficiency (134).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not checked — no full text of the sourcecites [134] Katznelson, 1996, Increase in bone density and lean body mass during testosterone administration in men with acquired hypogonadism, J Clin Endocrinol Metab source
- Could not verifycites [135] Behre, 1997, Long-term effect of testosterone therapy on bone mineral density in hypogonadal men, J Clin Endocrinol Metab sourceExperimental — accuracy not yet measured
The Abstract and Discussion report increased bone mineral density in hypogonadal men, not the sexual, psychological, muscular, or anemia-related outcomes in the claim. Searches for muscle strength and the other claimed outcomes found no passage reporting those effects; muscle mass and strength appear only in the title of another study in the References. (LLM, conf=0.76)
- Not checked — no full text of the sourcecites [138] Benito, 2005, Effect of testosterone replacement on trabecular architecture in hypogonadal men, J Bone Miner Res source
- Could not verifycites [139] Zhang, 2008, In vivo microMRI-based finite element and morphological analyses of tibial trabecular bone in eugonadal and hypogonadal men before and after testosterone treatment, J Bone Miner Res sourceExperimental — accuracy not yet measured
The citation to this paper appears in the group attached to the muscle-mass-and-strength claim. The Discussion reports improved mechanical properties of tibial trabecular bone after testosterone treatment, not changes in muscle mass or strength. Searches for those outcomes and the other listed benefits found no passage in our copy that reports them. (LLM, conf=0.78)
- Not checked — no full text of the sourcecites [140] Kwan, 1983, The nature of androgen action on male sexuality: a combined laboratory-self-report study on hypogonadal men, J Clin Endocrinol Metab source
- Partly supportedcites [141] Burris, 1992, A long-term, prospective study of the physiologic and behavioral effects of hormone replacement in untreated hypogonadal men, J Androl sourceExperimental — accuracy not yet measured
The Sexual Activity and Mood State section reports increased sexual interest, potency, spontaneous erections and vigor during hormone replacement in previously untreated hypogonadal men. It also reports improvements in mood measures. The paper does not establish the claimed gains in concentration, muscle mass or strength, or recovery from anemia. (LLM, conf=0.86)
- Not checked — no full text of the sourcecites [142] McNicholas, 2003, A novel testosterone gel formulation normalizes androgen levels in hypogonadal men, with improvements in body composition and sexual function, BJU Int source
- Not checked — no full text of the sourcecites [143] Seftel, 2004, Restorative increases in serum testosterone levels are significantly correlated to improvements in sexual functioning, J Androl source
- Not checked — no full text of the sourcecites [144] Boloña, 2007, Testosterone use in men with sexual dysfunction: a systematic review and meta-analysis of randomized placebo-controlled trials, Mayo Clin Proc source
- Not checked — no full text of the sourcecites [145] Zitzmann, 2013, IPASS: a study on the tolerability and effectiveness of injectable testosterone undecanoate for the treatment of male hypogonadism in a worldwide sample of 1,438 men, J Sex Med source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Treatment increases BMD (132-135) and improves trabecular structure (136) and bone mechanical properties (137).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not checked — no full text of the sourcecites [132] Gordon, 1999, Variations in adequate levothyroxine replacement therapy in patients with different causes of hypothyroidism, Endocr Pract source
- Not checked — no full text of the sourcecites [133] Mazziotti, 2014, Association between l-thyroxine treatment, GH deficiency, and radiological vertebral fractures in patients with adult-onset hypopituitarism, Eur J Endocrinol source
- Not checked — no full text of the sourcecites [134] Katznelson, 1996, Increase in bone density and lean body mass during testosterone administration in men with acquired hypogonadism, J Clin Endocrinol Metab source
- Supportedcites [135] Behre, 1997, Long-term effect of testosterone therapy on bone mineral density in hypogonadal men, J Clin Endocrinol Metab source
This source is cited for the BMD portion of the sentence (132–135), not for trabecular structure or mechanical properties (136–137). The Discussion reports that long-term testosterone therapy significantly increases BMD in hypogonadal men; page numbers are not provided for the passages. (LLM, conf=0.93)
- Not matchedcites [136] Snyder, 2000, Effects of testosterone replacement in hypogonadal men, J Clin Endocrinol Metab
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Supportedcites [137] Wang, 2004, Long-term testosterone gel (AndroGel) treatment maintains beneficial effects on sexual function and mood, lean and fat mass, and bone mineral density in hypogonadal men, J Clin Endocrinol Metab source
The citation is attached to the BMD portion of the sentence, not the separately cited claims about trabecular structure or bone mechanical properties. The Discussion reports that BMD increased at the hip and spine during testosterone replacement in hypogonadal men. (LLM, conf=0.93)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Primary ovarian failure is associated with reduced BMD and increased risk of fractures (154-156), and estrogen replacement protects against fractures (154,157,158).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > MAY 4, 2016
What the sources say
- Not checked — no full text of the sourcecites [154] Cardozo, 2004, A systematic review of the effects of estrogens for symptoms suggestive of overactive bladder, Acta Obstet Gynecol Scand source
- Not checked — no full text of the sourcecites [155] Tuppurainen, 1995, Risks of perimenopausal fractures–a prospective population-based study, Acta Obstet Gynecol Scand source
- Not checked — no full text of the sourcecites [156] van Der Voort, 2003, Early menopause: increased fracture risk at older age, Osteoporos Int source
- Partly supportedcites [157] Popat, 2009, Bone mineral density in estrogen-deficient young women, J Clin Endocrinol Metab sourceExperimental — accuracy not yet measured
The Abstract and Discussion report that women with primary ovarian insufficiency had lower BMD than controls. The Modifiable risk factors section associates not taking hormone replacement with low BMD, but does not establish protection against fractures. The Discussion says prospective fracture-rate studies are needed to establish the link between estrogen deficiency and fracture risk in this population. (LLM, conf=0.88)
- Not checked — no full text of the sourcecites [158] Lindsay, 1980, Prevention of spinal osteoporosis in oophorectomised women, Lancet source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Studies, primarily in women close to or after the natural age of menopause, have shown that oral estrogen or combined estrogen/progestogen therapy are very effective in alleviating vasomotor symptoms of hypoestrogenism (hot flushes and night sweats) (151) and improving vaginal atrophy (152), urinary frequency, and dysuria (153).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > MAY 4, 2016
What the sources say
- Could not verifycites [151] Swerdloff, 2015, Serum testosterone (T) level variability in T gel-treated older hypogonadal men: treatment monitoring implications, J Clin Endocrinol Metab sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.
- Supportedcites [152] Maclennan, 2004, Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes, Cochrane Database Syst Rev source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
- Not checked — no full text of the sourcecites [153] Cardozo, 1998, Meta-analysis of estrogen therapy in the management of urogenital atrophy in postmenopausal women: second report of the Hormones and Urogenital Therapy Committee, Obstet Gynecol source
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Could not verify
Every source the paper cites for this claim was checked and supports it.
In the paper
“The hypothalamic-pituitary-thyroid axis also influences GH dynamics, with altered GH and IGF-1 secretion occurring in hypothyroidism (34).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Supportedcites [34] Behan, 2011, The interaction between growth hormone and the thyroid axis in hypopituitary patients, Clin Endocrinol (Oxf) source
The “Growth hormone and the thyroid” section (p. 2) says the HPT axis influences GH secretion and action. The “Thyroid hormone effect on the GH-IGF-I axis” section (p. 2) reports reduced IGF-I in untreated primary hypothyroidism and decreased GH pulsatility and response to secretagogues in hypothyroidism. (LLM, conf=0.94)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Increased bone mass occurs after 12 months (173), and fracture development is slowed in patients with no previous osteoporosis (159).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Remarks
What the sources say
- Not checked — no full text of the sourcecites [173] Maison, 2004, Impact of growth hormone (GH) treatment on cardiovascular risk factors in GH-deficient adults: a metaanalysis of blinded, randomized, placebo-controlled trials, J Clin Endocrinol Metab source
- Partly supportedcites [159] van der Klift, 2004, Risk factors for incident vertebral fractures in men and women: the Rotterdam Study, J Bone Miner Res sourceExperimental — accuracy not yet measured
The Unadjusted analyses (p. 4) show fewer incident vertebral fractures among participants with no vertebral fracture at baseline than among those with a prior vertebral fracture. The paper does not establish that these participants had no previous osteoporosis or that fracture development was slowed; it reports an association with fracture history, not a change in the rate of development. (LLM, conf=0.78)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“Oral estrogen therapy increases circulating CBG (through a hepatic first-pass effect), leading to increased total cortisol levels; this does not occur with transdermal estrogen therapy (189,190).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not checked — no full text of the sourcecites [189] Giavoli, 2004, Effect of recombinant human growth hormone (GH) replacement on the hypothalamic-pituitary-adrenal axis in adult GH-deficient patients, J Clin Endocrinol Metab source
- Could not verifycites [190] Haugen, 2009, Drugs that suppress TSH or cause central hypothyroidism, Best Pract Res Clin Endocrinol Metab sourceExperimental — accuracy not yet measured
The Glucocorticoids section (page unavailable) discusses cortisol and glucocorticoid effects on TSH, not estrogen therapy. Searches for oral and transdermal estrogen, cortisol-binding globulin, and hepatic first-pass effects found no passage addressing the claimed difference in total cortisol levels. (LLM, conf=0.76)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“In a randomized placebo-controlled study, mean GH doses of 0.58 mg/day resulted in decreased visceral fat mass and improved QOL indices (231).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Partly supportedcites [231] Ku, 2014, Clinical predictors of GH deficiency in surgically cured acromegalic patients, Eur J Endocrinol sourceExperimental — accuracy not yet measured
The Introduction (page not provided) reports that GH replacement improves body composition and quality of life in cured acromegalic patients with GH deficiency. It does not report a 0.58 mg/day dose, a decrease specifically in visceral fat, or those outcomes from a randomized placebo-controlled study. The References list such a trial, but the cited paper does not link it to the claimed dose and outcomes. (LLM, conf=0.84)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“T therapy in males with central hypogonadism reduces fat mass and increases fat-free mass (132,135,140,148,149).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > MAY 4, 2016
What the sources say
- Not checked — no full text of the sourcecites [132] Gordon, 1999, Variations in adequate levothyroxine replacement therapy in patients with different causes of hypothyroidism, Endocr Pract source
- Could not verifycites [135] Behre, 1997, Long-term effect of testosterone therapy on bone mineral density in hypogonadal men, J Clin Endocrinol Metab sourceExperimental — accuracy not yet measured
The Patients section includes men with secondary hypogonadism, but the study measures bone mineral density, not changes in body composition. The Results and Discussion report increased bone mineral density with therapy; searches for fat mass, fat-free mass, and body composition found no passage supporting the claimed effects. (LLM, conf=0.76)
- Not checked — no full text of the sourcecites [140] Kwan, 1983, The nature of androgen action on male sexuality: a combined laboratory-self-report study on hypogonadal men, J Clin Endocrinol Metab source
- Partly supportedcites [148] Kovac, 2014, Patient satisfaction with testosterone replacement therapies: the reasons behind the choices, J Sex Med sourceExperimental — accuracy not yet measured
The Introduction reports improvements in body weight and waist circumference with testosterone replacement therapy, and the Results report patient-perceived improvement in muscle mass. Neither passage establishes reduced fat mass and increased fat-free mass specifically in men with central hypogonadism; the paper's mention of hypogonadotropic hypogonadism concerns secondary sexual characteristics instead. (LLM, conf=0.82)
- Not checked — no full text of the sourcecites [149] Brodsky, 1996, Effects of testosterone replacement on muscle mass and muscle protein synthesis in hypogonadal men–a clinical research center study, J Clin Endocrinol Metab source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“Partial or complete hypopituitarism is a prominent feature and contributes to high mortality (257,258).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not checked — no full text of the sourcecites [257] Källén, 1995, Diabetes insipidus and use of desmopressin (Minirin) during pregnancy, Eur J Endocrinol source
- Could not verifycites [258] Vila, 2015, Pregnancy outcomes in women with growth hormone deficiency, Fertil Steril sourceExperimental — accuracy not yet measured
The Background Characteristics section describes pituitary hormone deficiencies in pregnant patients with growth hormone deficiency, but does not identify pituitary apoplexy as their cause. A search of our copy for pituitary apoplexy and mortality found no passage addressing whether hypopituitarism is a prominent feature of apoplexy or contributes to mortality. (LLM, conf=0.76)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“Some AEDs enhance hepatic CYP450 isoenzyme activity (e.g., phenytoin, carbamazepine, oxcarbazepine, and topiramade), accelerating the hepatic metabolism of hormonal preparations and decreasing serum concentrations of relevant hormones (268).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Treatment of Hypopituitarism in Patients Receiving Antiepileptic Medications
What the sources say
- Could not verifycites [268] Verrees, 2004, Pituitary tumor apoplexy: characteristics, treatment, and outcomes, Neurosurg Focus sourceExperimental — accuracy not yet measured
The Patient Outcomes and Treatment sections discuss hormone deficiencies and replacement after pituitary apoplexy, but not antiepileptic drugs or drug-induced hormone metabolism. Searches for AEDs, CYP450, the named drugs, and hepatic metabolism found no passage addressing the claimed mechanism. Page numbers were not available in our copy. (LLM, conf=0.78)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Could not verify
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“GC recommendations are relatively similar in central AI and primary AI; however, patients with central AI do not require mineralocorticoid replacement.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > MAY 4, 2016
What the sources say
- Partly supportedcites [72] Bornstein, 2016, Diagnosis and treatment of primary adrenal insufficiency: an Endocrine Society Clinical Practice Guideline, J Clin Endocrinol Metab sourceExperimental — accuracy not yet measured
The General Introduction (page unavailable) distinguishes primary adrenal insufficiency from secondary insufficiency, stating that the latter does not affect the renin–angiotensin–aldosterone system; this supports the mineralocorticoid distinction. The Evidence section describes glucocorticoid replacement for primary adrenal insufficiency, but our copy does not compare its recommendations with those for central adrenal insufficiency. (LLM, conf=0.82)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“Other AEDs increase SHBG, leading to the reduced bioavailability of E2 and T (268), which may compromise the efficacy of hormonal treatment.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Treatment of Hypopituitarism in Patients Receiving Antiepileptic Medications
What the sources say
- Could not verifycites [268] Verrees, 2004, Pituitary tumor apoplexy: characteristics, treatment, and outcomes, Neurosurg Focus sourceExperimental — accuracy not yet measured
The Patient Outcomes and Treatment sections discuss hormone replacement after pituitary apoplexy, not antiepileptic drugs or sex hormone–binding globulin (page numbers unavailable). Searches for AEDs, SHBG, and reduced estradiol or testosterone bioavailability found no passage addressing the cited claim. (LLM, conf=0.76)
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Could not verify
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Differences in anterior and posterior pituitary blood supply may explain the relative sparing of ADH secretion (258).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > MAY 4, 2016
What the sources say
- Partly supportedcites [258] Vila, 2015, Pregnancy outcomes in women with growth hormone deficiency, Fertil Steril sourceExperimental — accuracy not yet measured
Background Characteristics (page unavailable) reports ADH deficiency in 28% of these women, less often than the other listed pituitary deficiencies. The paper does not discuss differences in anterior and posterior pituitary blood supply or propose them as an explanation for relative sparing of ADH secretion. (LLM, conf=0.83)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Partly supported
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“Dexamethasone is metabolized primarily by hepatic CYP3A4 (269), and patients may need to increase dexamethasone doses (268).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Treatment of Hypopituitarism in Patients Receiving Antiepileptic Medications
What the sources say
- Could not verifycites [268] Verrees, 2004, Pituitary tumor apoplexy: characteristics, treatment, and outcomes, Neurosurg Focus sourceExperimental — accuracy not yet measured
The Treatment section discusses steroid replacement for pituitary tumor apoplexy and specifies intravenous hydrocortisone, but does not address dexamethasone dose increases. Searches for dexamethasone with enzyme-inducing antiepileptic drugs and for CYP3A4 metabolism found no passage addressing the claimed interaction. Page numbers were not available in our copy. (LLM, conf=0.77)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Could not verify
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Studies have reported that 44-62% of cases experience a reversal of hypogonadism, usually within 6 months after starting treatment (225,226).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Treatment of Hypopituitarism in Patients Receiving Antiepileptic Medications
What the sources say
- Not checked — no full text of the sourcecites [225] Pecori Giraldi, 2007, Significant GH deficiency after long-term cure by surgery in adult patients with Cushing’s disease, Eur J Endocrinol source
- Partly supportedcites [226] Melmed, 2011, Diagnosis and treatment of hyperprolactinemia: an Endocrine Society Clinical Practice Guideline, J Clin Endocrinol Metab sourceExperimental — accuracy not yet measured
Section 4.1 (Remarks) identifies reversal of hypogonadism as a goal of dopamine-agonist treatment. Section 4.1 (Evidence) reports prolactin normalization within six months in some patients with macroprolactinomas, but does not report that 44–62% experienced reversal of central hypogonadism or that reversal usually occurred within six months. Page numbers are unavailable in our copy. (LLM, conf=0.87)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Meta-analysis did not show an association between GH replacement and pituitary tumor recurrence (RR 0.87; 95% CI, 0.56-1.33)or the risk of secondary malignancies (RR 1.24; 95% CI, 0.65-2.33).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Commissioned Systematic Reviews
plainn = 22,654- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Each review addressed a question of association and both demonstrated that the evidence (overall) warrants low certainty in the provided estimates.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Commissioned Systematic Reviews
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Factors associated with increased mortality were female gender, younger age at diagnosis, an underlying diagnosis of a craniopharyngioma or aggressive tumor, the presence of DI, and prior treatment with surgery or radiotherapy.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Commissioned Systematic Reviews
plaincorrelationaln = 26,017- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Clinicians could observe reductions of up to 60% for FSH and 50% for LH.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not checked — no full text of the sourcecites [101] Drincic, 2003, Men with acquired hypogonadotropic hypogonadism treated with testosterone may be fertile, Pituitary source
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one. The quote only partly states this claim.
In the paper
“In 2,737 adult hypopituitary patients (122), those receiving the equivalent of ≤10 mg HC had the best QOL, and those receiving ≥25 mg HC had the poorest QOL.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Circadian rhythm-multiple daily dosing.
What the sources say
- Not checked — no full text of the sourcecites [122] Peacey, 1997, Glucocorticoid replacement therapy: are patients over treated and does it matter?, Clin Endocrinol (Oxf) source
plaincorrelationaln = 2,737- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“The HC 10 mg a.m./5 mg p.m. regimen showed improved physical QOL, but overall QOL did not differ between regimens and remained lower than in healthy controls.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Circadian rhythm-multiple daily dosing.
What the sources say
- Not checked — no full text of the sourcecites [121] Mager, 2003, Integrated QSPR–pharmacodynamic model of genomic effects of several corticosteroids, J Pharm Sci source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“However, a recent publication reported that increased risk of vertebral fracture in hypopituitary patients receiving higher daily doses of L-T4 correlated with higher fT4 levels (131).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not checked — no full text of the sourcecites [131] Klose, 2013, Central hypothyroidism and its replacement have a significant influence on cardiovascular risk factors in adult hypopituitary patients, J Clin Endocrinol Metab source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“A randomized controlled study of CH (80) measured fT4 levels 2 hours after dose ingestion and reported slightly elevated mean fT4 levels with adequate doses.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Remarks
What the sources say
- Not checked — no full text of the sourcecites [80] Koulouri, 2011, Diagnosis and treatment of hypothyroidism in TSH deficiency compared to primary thyroid disease: pituitary patients are at risk of under-replacement with levothyroxine, Clin Endocrinol (Oxf) source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Interestingly, the female sex and presence of DI in AC correlated with hospital admission in one study (29).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not checked — no full text of the sourcecites [29] Hahner, 2015, High incidence of adrenal crisis in educated patients with chronic adrenal insufficiency: a prospective study, J Clin Endocrinol Metab source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Studies have not associated HRT in women 40-49 years with increased risk of breast cancer (161), and there is no evidence that estrogen replacement in women with premature ovarian failure relates to a higher risk of breast cancer ( 162).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > MAY 4, 2016
What the sources say
- Not checked — no full text of the sourcecites [161] Mazziotti, 2010, Glucocorticoid replacement therapy and vertebral fractures in hypopituitary adult males with GH deficiency, Eur J Endocrinol source
- Not checked — no full text of the sourcecites [162] Stuenkel, 2015, Treatment of symptoms of the menopause: an Endocrine Society Clinical Practice Guideline, J Clin Endocrinol Metab source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“When clinicians substituted L-T3 for some of the L-T4, working memory was slightly better but at the expense of T3 levels above the reference range.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not checked — no full text of the sourcecites [80] Koulouri, 2011, Diagnosis and treatment of hypothyroidism in TSH deficiency compared to primary thyroid disease: pituitary patients are at risk of under-replacement with levothyroxine, Clin Endocrinol (Oxf) source
plaindirectn = 32- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Increasing the L-T4 dose from a mean of 1.0 to a mean of 1.6 mcg/kg/day led to mild weight loss; improvements in hypothyroid symptom scores; and decreased BMI, total and LDL cholesterol levels, and serum CK levels.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not checked — no full text of the sourcecites [80] Koulouri, 2011, Diagnosis and treatment of hypothyroidism in TSH deficiency compared to primary thyroid disease: pituitary patients are at risk of under-replacement with levothyroxine, Clin Endocrinol (Oxf) source
plaindirectn = 32- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“The effects of GH replacement on BMD are more beneficial in men (172) and with patients that have severe bone loss.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Remarks
What the sources say
- Not checked — no full text of the sourcecites [172] Widdowson, 2008, The effect of growth hormone replacement on exercise capacity in patients with GH deficiency: a metaanalysis, J Clin Endocrinol Metab source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Oral and sublingual DDAVP absorption rates are <1%, while intranasal is ~6% (180).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > MAY 4, 2016
What the sources say
- Not checked — no full text of the sourcecites [180] Juul, 2011, Desmopressin duration of antidiuretic action in patients with central diabetes insipidus, Endocrine source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Administering GH to GHD adults causes variable changes in thyroid hormone levels-the most consistent effect being decreased fT4 levels (81,191,192).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not checked — no full text of the sourcecites [81] Slawik, 2007, Thyroid hormone replacement for central hypothyroidism: a randomized controlled trial comparing two doses of thyroxine (T4) with a combination of T4 and triiodothyronine, J Clin Endocrinol Metab source
- Not checked — no full text of the sourcecites [191] Shifren, 2007, A randomized, open-label, crossover study comparing the effects of oral versus transdermal estrogen therapy on serum androgens, thyroid hormones, and adrenal hormones in naturally menopausal women, Menopause source
- Not checked — no full text of the sourcecites [192] Qureshi, 2007, The influence of the route of oestrogen administration on serum levels of cortisol-binding globulin and total cortisol, Clin Endocrinol (Oxf) source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“All assays exhibited adequate sensitivity and acceptable intra-assay variability at <20% (Appendix A).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Treatment of Hypopituitarism in Patients Receiving Antiepileptic Medications
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although, it is difficult to confirm this, since by definition many healthy subjects have fT4 levels in the lower part of the laboratory reference range, and there are no validated measures of thyroid function in hypopituitary patients.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Those with GHD are less often working full time, and more often on sick leave/disability, often live alone, and often with parents (14).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > MAY 4, 2016
What the sources say
- Not checked — no full text of the sourcecites [14] Holmer, 2013, Psychosocial health and levels of employment in 851 hypopituitary Swedish patients on long-term GH therapy, Psychoneuroendocrinology source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“GHD is measured via insulin tolerance, glucagon, and (if available) GHRH + arginine tests.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“1.3 We suggest that a cortisol level <3 mcg/dl is indicative of AI, and a cortisol level >15 mcg/dl likely excludes an AI diagnosis.(2|⊕OOO)”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Central Adrenal Insufficiency
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“However, GH replacement may reduce excess mortality from an SMR of 2.40 (95% CI 1.46-3.34) to 1.99 (95% CI 1.21-2.76),especially in men (60).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Adult Growth Hormone Deficiency
What the sources say
- Not checked — no full text of the sourcecites [60] Pappachan, 2015, Excess mortality associated with hypopituitarism in adults: a meta-analysis of observational studies, J Clin Endocrinol Metab source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“However this evidence may or may not be directly applicable to central pituitary deficiencies.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > 1. Diagnosis of Hypopituitarism
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
In the paper
“These patients often have a blunted or absent nocturnal surge in TSH levels, but this is impractical for diagnostic use (33).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not checked — no full text of the sourcecites [33] Persani, 2012, Clinical review: central hypothyroidism: pathogenic, diagnostic, and therapeutic challenges, J Clin Endocrinol Metab source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Accordingly, clinicians cannot use TSH levels alone to diagnose or monitor CH.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“As GCs suppress the HPA axis, and there are interferences in cortisol measurements, clinicians should perform biochemical testing at least 18-24 hours after the last HC dose or longer for synthetic GCs (74).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not checked — no full text of the sourcecites [74] Ospina, 2016, ACTH stimulation tests for the diagnosis of adrenal insufficiency: systematic review and meta-analysis, J Clin Endocrinol Metab source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, this approach may miss a significant number of patients with mild CH, as some pituitary patients with low-normal fT4 levels may have mild CH.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Therefore, it can be challenging to ascribe specific features to a single hormone deficiency.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Etiology, Clinical Manifestations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Rests on an assumption: The usual sequential pattern for hormonal deficiencies is the loss of GH initially, followed by gonadotropins, TSH, and ACTH, but there are several exceptions to this order (e.g., hypophysitis).
In the paper
“TSH levels in CH may be low, normal, or slightly elevated, reflecting decreased 24-hour secretion and altered bioactivity with relatively preserved immunoactivity (75)(76)(77).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not matchedcites (75)(76)(77)
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
In the paper
“Androgen deprivation therapy in prostate cancer is associated with an increased incidence of myocardial infarctions and cardiovascular mortality (41)(42)(43) due to increased body weight, decreased lean body mass, increased serum low-density lipoprotein (LDL) and triglycerides, and reduced insulin sensitivity (43)(44)(45)(46).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > MAY 4, 2016
What the sources say
- Not matchedcites (41)(42)(43)
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Hypopituitary patients exhibit increased incapacitation and sick days, lower health status, and higher cost of care (12,13).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > MAY 4, 2016
What the sources say
- Not checked — no full text of the sourcecites [12] Hakkaart-van Roijen, 1998, The burden of illness of hypopituitary adults with growth hormone deficiency, Pharmacoeconomics source
- Not checked — no full text of the sourcecites [13] Ehrnborg, 2000, Cost of illness in adult patients with hypopituitarism, Pharmacoeconomics source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Past studies have attempted to categorize CH based on TSH responsiveness to exogenous TSHreleasing hormone administration (83), but this has not proven to be useful in clinical practice.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not checked — no full text of the sourcecites [83] Doin, 2012, Diagnosis of subclinical central hypothyroidism in patients with hypothalamic-pituitary disease by Doppler echocardiography, Eur J Endocrinol source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Diagnosis in adults with a prior diagnosis of childhood-onset GHD (congenital or acquired) is relatively straightforward, as these patients had short stature.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“However, as clinical features of acquired AGHD are often subtle, not necessarily specific to an underlying pituitary disorder, and commonly encountered in the general population, these patients should all be re-tested as adults.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“One study reported a SMR of 2.09 (95% CI 0.94-4.65) in females with untreated gonadotropin deficiency and an SMR of 0.94 (95% CI 0.35-2.49) in those with treated hypogonadism (52).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > MAY 4, 2016
What the sources say
- Not checked — no full text of the sourcecites [52] Lindholm, 2006, Hypopituitarism and mortality in pituitary adenoma, Clin Endocrinol (Oxf) source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Weight-adjusted, 3-times-daily dosing using HC reduces GC overexposure and represents the most refined regime available, although it does not replicate the normal cortisol rhythm (113).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Circadian rhythm-multiple daily dosing.
What the sources say
- Not checked — no full text of the sourcecites [113] Mah, 2004, Weight-related dosing, timing and monitoring hydrocortisone replacement therapy in patients with adrenal insufficiency, Clin Endocrinol (Oxf) source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“As no reliable marker to determine exact GC needs is available, initial dose requirements are largely estimated.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Glucocorticoid Replacement
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Systemic diseases, eating disorders, extensive exercise, and a number of medications or recreational drugs (e.g., GCs, opiates, ketoconazole, barbiturates, cocaine) affect T levels (92,93).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Remarks
What the sources say
- Not checked — no full text of the sourcecites [92] Spratt, 1992, Both hyper- and hypogonadotropic hypogonadism occur transiently in acute illness: bio- and immunoactive gonadotropins, J Clin Endocrinol Metab source
- Not checked — no full text of the sourcecites [93] Zitzmann, 2001, Testosterone levels in healthy men and the relation to behavioural and physical characteristics: facts and constructs, Eur J Endocrinol source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“T levels demonstrate an age-related decline (96,97).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Remarks
What the sources say
- Not checked — no full text of the sourcecites [96] Brambilla, 2007, Intraindividual variation in levels of serum testosterone and other reproductive and adrenal hormones in men, Clin Endocrinol (Oxf) source
- Not checked — no full text of the sourcecites [97] Bhasin, 2010, Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society Clinical Practice Guideline, J Clin Endocrinol Metab source
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Furthermore, one study proposed that in patients with hypogonadotropic hypogonadism the GnRH responses are variable and depend on the severity of gonadotropin deficiency, which is often reflected by the clinical phenotype (100).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not checked — no full text of the sourcecites [100] Dunn, 1981, Transport of steroid hormones: binding of 21 endogenous steroids to both testosterone-binding globulin and corticosteroid-binding globulin in human plasma, J Clin Endocrinol Metab source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“About 2% of circulating T is free (unbound), 44% is bound to sex hormone-binding globulin (SHBG), and 54% is bound to albumin and other proteins (98).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > MAY 4, 2016
What the sources say
- Not checked — no full text of the sourcecites [98] Feldman, 2002, Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the Massachusetts Male Aging Study, J Clin Endocrinol Metab source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“The authors recommended against the routine use of dehydroepiandrosterone due to limited MAY 4, 2016 data concerning its effectiveness and safety in women with AI.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Androgen Replacement in Women
What the sources say
- Not checked — no full text of the sourcecites [126] Johannsson, 2012, Improved cortisol exposure-time profile and outcome in patients with adrenal insufficiency: a prospective randomized trial of a novel hydrocortisone dual-release formulation, J Clin Endocrinol Metab source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“The same authors also recommended against the routine prescription of T in women with hypopituitarism (126).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Androgen Replacement in Women
What the sources say
- Not checked — no full text of the sourcecites [126] Johannsson, 2012, Improved cortisol exposure-time profile and outcome in patients with adrenal insufficiency: a prospective randomized trial of a novel hydrocortisone dual-release formulation, J Clin Endocrinol Metab source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“Daily physiologic cortisol production in healthy individuals is about 5-10 mg per square meter of body surface area (107), corresponding to a replacement dose of approximately 15-20 mg/day.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Glucocorticoid Replacement
What the sources say
- Not checked — no full text of the sourcecites [107] Kane, 2007, Measurement of serum testosterone in women; what should we do?, Ann Clin Biochem source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“11 β-hydroxisteroid dehydrogenase-1 converts cortisone acetate to biologically active cortisol, which might reduce circulating cortisol fluctuations (110).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Circadian rhythm-multiple daily dosing.
What the sources say
- Not checked — no full text of the sourcecites [110] Howlett, 1997, An assessment of optimal hydrocortisone replacement therapy, Clin Endocrinol (Oxf) source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Urine-free cortisol measurements have wide inter-and intra-variability, and thus are rarely useful MAY 4, 2016 (109,110).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Glucocorticoid Replacement
What the sources say
- Not checked — no full text of the sourcecites [109] Esteban, 1991, Daily cortisol production rate in man determined by stable isotope dilution/mass spectrometry, J Clin Endocrinol Metab source
- Not checked — no full text of the sourcecites [110] Howlett, 1997, An assessment of optimal hydrocortisone replacement therapy, Clin Endocrinol (Oxf) source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Normal GH secretion is characterized by a heterogeneous pulsatile pattern; therefore, measuring basal circulating GH MAY 4, 2016 levels does not provide useful diagnostic information.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Unlike GH, IGF-1 levels are relatively reproducible and stable, with a circulating half-life of 24-30 hours.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Published surveys of current practice for GC replacement therapy include mostly patients with primary AI, however some studies also include patients with central AI (116).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Circadian rhythm-multiple daily dosing.
What the sources say
- Not checked — no full text of the sourcecites [116] Hameed, 2013, Remission rate after transsphenoidal surgery in patients with pathologically confirmed Cushing’s disease, the role of cortisol, ACTH assessment and immediate reoperation: a large single center experience, Pituitary source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Studies on this topic are limited in that they employed various T formulations with different MAY 4, 2016 regimes, were usually short duration with a small number of patients, and were not randomized placebocontrolled.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“GH therapy is approved for replacement in adults with rigorously proven GHD or for treating HIVrelated muscle wasting (164).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Growth Hormone Replacement Therapy
What the sources say
- Not checked — no full text of the sourcecites [164] Pitkin, 2007, Management of premature menopause, Menopause Int source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“As there are no studies on premenopausal women with central hypogonadism, for this group of female patients clinicians often refer to the published results from women with primary hypogonadism.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > MAY 4, 2016
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Few studies have examined the use of L-T3 or other formulations of thyroid hormone for CH (80); there are no high-quality studies that document the superiority of these treatments over L-T4 in primary hypothyroidism, and there are potential safety concerns (reviewed in 76).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not checked — no full text of the sourcecites [80] Koulouri, 2011, Diagnosis and treatment of hypothyroidism in TSH deficiency compared to primary thyroid disease: pituitary patients are at risk of under-replacement with levothyroxine, Clin Endocrinol (Oxf) source
- Not checked — no full text of the sourcecites [76] Ferretti, 1999, Evaluation of the adequacy of levothyroxine replacement therapy in patients with central hypothyroidism, J Clin Endocrinol Metab source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“As women exhibit features of relative GH resistance, they usually require higher starting and maintenance replacement GH doses, as do women receiving oral estrogens (165).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > 5.
What the sources say
- Not checked — no full text of the sourcecites [165] King, 2011, Hormone replacement therapy and women with premature menopause–a cancer survivorship issue, Eur J Cancer source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“This is because thyroid hormone accelerates endogenous cortisol clearance and could unmask insufficient cortisol production and precipitate AC.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not checked — no full text of the sourcecites [33] Persani, 2012, Clinical review: central hypothyroidism: pathogenic, diagnostic, and therapeutic challenges, J Clin Endocrinol Metab source
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Oral estrogen treatment leads to decreased circulating IGF-1 levels in GHD women resulting in increased postprandial lipid oxidation and decreased protein synthesis, which antagonizes the metabolic actions of GH.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not matchedcites (197)(198)(199)
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
In the paper
“This does not occur with transdermally-administered estrogen, suggesting a first-pass effect of estrogen and the inhibition of hepatic GH actions (197)(198)(199).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not matchedcites (197)(198)(199)
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Clinicians could overdiagnose GHD in the setting of CH and should treat CH prior to performing stimulation tests for GHD.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“These effects can decrease fT4 levels into the hypothyroid range, suggesting that untreated GHD can mask CH by artificially maintaining fT4 levels in the reference range.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not checked — no full text of the sourcecites [81] Slawik, 2007, Thyroid hormone replacement for central hypothyroidism: a randomized controlled trial comparing two doses of thyroxine (T4) with a combination of T4 and triiodothyronine, J Clin Endocrinol Metab source
- Not checked — no full text of the sourcecites [191] Shifren, 2007, A randomized, open-label, crossover study comparing the effects of oral versus transdermal estrogen therapy on serum androgens, thyroid hormones, and adrenal hormones in naturally menopausal women, Menopause source
- Not checked — no full text of the sourcecites [192] Qureshi, 2007, The influence of the route of oestrogen administration on serum levels of cortisol-binding globulin and total cortisol, Clin Endocrinol (Oxf) source
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“IGF-1 levels are reduced in hypothyroidism, and GH stimulation with insulin or GH-releasing hormone may be blunted (185,195).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not checked — no full text of the sourcecites [185] Stewart, 2001, Growth hormone, insulin-like growth factor-I and the cortisol-cortisone shuttle, Horm Res source
- Not checked — no full text of the sourcecites [195] Agha, 2007, Unmasking of central hypothyroidism following growth hormone replacement in adult hypopituitary patients, Clin Endocrinol (Oxf) source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“This is particularly important in elderly individuals who may have increased renal sensitivity to the drug and/or may have abnormalities in osmoregulation (179).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > MAY 4, 2016
What the sources say
- Not checked — no full text of the sourcecites [179] Behan, 2015, Abnormal plasma sodium concentrations in patients treated with desmopressin for cranial diabetes insipidus: results of a long-term retrospective study, Eur J Endocrinol source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“As GH suppresses the conversion of cortisone to cortisol, patients receiving GC replacement may require higher doses once GH is initiated, and those with low adrenal reserve may be rendered hypoadrenal by the GH therapy (183,187).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Interactions Between Replacement Hormones
What the sources say
- Not checked — no full text of the sourcecites [183] Oiso, 2013, Clinical review: treatment of neurohypophyseal diabetes insipidus, J Clin Endocrinol Metab source
- Not checked — no full text of the sourcecites [187] Filipsson, 2009, GH replacement in adults: interactions with other pituitary hormone deficiencies and replacement therapies, Eur J Endocrinol source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Cortisol secretion in the first 24 hours after surgery rarely exceeds 200 mg and correlates with the duration and extent of surgery (247).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not checked — no full text of the sourcecites [247] Raff, 1990, Cortisol inhibition of vasopressin and ACTH responses to arterial hypotension in conscious dogs, Am J Physiol source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“In these patients, immediate (72 hours) postoperative GH levels, as well as the bilaterality of intrasellar tumor involvement, are significant determinants of subsequent GHD (seen in about 10% of patients) (229).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not checked — no full text of the sourcecites [229] Warfield, 1984, Bromocriptine treatment of prolactin-secreting pituitary adenomas may restore pituitary function, Ann Intern Med source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Adults secrete 75-100 mg of cortisol per day in response to major surgery and 50 mg per day in response to minor surgery (247).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not checked — no full text of the sourcecites [247] Raff, 1990, Cortisol inhibition of vasopressin and ACTH responses to arterial hypotension in conscious dogs, Am J Physiol source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“One study suggests new normal ranges for cortisol in pregnancy (251).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > MAY 4, 2016
What the sources say
- Not checked — no full text of the sourcecites [251] Glowniak, 1997, A double-blind study of perioperative steroid requirements in secondary adrenal insufficiency, Surgery source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Other causes of postsurgical abundant diuresis include steroid-induced hyperglycemia, abundant intraoperative fluid administration, and (in the case of acromegaly) an abrupt reduction of serum GH levels (241).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > MAY 4, 2016
What the sources say
- Not checked — no full text of the sourcecites [241] Ladenson, 1984, Complications of surgery in hypothyroid patients, Am J Med source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Short-term GC replacement increase (7-day increase in HC to 30 mg/day) (206) resulted in reduced endothelial function and improved left ventricular systolic loading.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not checked — no full text of the sourcecites [206] Walker, 2007, Glucocorticoids and cardiovascular disease, Eur J Endocrinol source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“A prospective study of 42 subjects reported that GH replacement enhanced QOL and improved both body composition and lipid profiles (232).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not checked — no full text of the sourcecites [232] Tritos, 2014, Effects of long-term growth hormone replacement in adults with growth hormone deficiency following cure of acromegaly: a KIMS analysis, J Clin Endocrinol Metab source
plaindirectn = 42- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“High-dose perioperative GCs increase the incidence of postoperative DI, possibly mediated by an increased glomerular filtration rate (242), reduced ADH secretion, and reduced renal sensitivity to GCs (243-245).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > MAY 4, 2016
What the sources say
- Not checked — no full text of the sourcecites [242] Weinberg, 1983, Outcome of anesthesia and surgery in hypothyroid patients, Arch Intern Med source
- Not checked — no full text of the sourcecites [243] Devin, 2012, Hypopituitarism and central diabetes insipidus: perioperative diagnosis and management, Neurosurg Clin N Am source
- Not checked — no full text of the sourcecites [244] Zada, 2010, Significance of postoperative fluid diuresis in patients undergoing transsphenoidal surgery for growth hormone-secreting pituitary adenomas, J Neurosurg source
- Not checked — no full text of the sourcecites [245] Rajaratnam, 2003, Hydrocortisone dose and postoperative diabetes insipidus in patients undergoing transsphenoidal pituitary surgery: a prospective randomized controlled study, Br J Neurosurg source
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Pituitary apoplexy is a life-threatening acute pituitary infarction, hemorrhage, and/or necrosis presenting as rapid onset headache, and may include vomiting, fever, meningismus, vision abnormalities, and changes in mental status (256).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not checked — no full text of the sourcecites [256] Ball, 2007, Vasopressin and disorders of water balance: the physiology and pathophysiology of vasopressin, Ann Clin Biochem source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Hypopituitarism may be permanent or transient after pituitary apoplexy, with recovery occurring from weeks to months from the initial event.(265)”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > MAY 4, 2016
What the sources say
- Not checked — no full text of the sourcecites [265] Randeva, 1999, Classical pituitary apoplexy: clinical features, management and outcome, Clin Endocrinol (Oxf) source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Pituitary dysfunction may be due to preexisting deficiencies (20)(21)(22) or occurs quickly from a rapid increase of intrasellar pressure (257).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not matchedcites (20)(21)(22)
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked — no full text of the sourcecites [257] Källén, 1995, Diabetes insipidus and use of desmopressin (Minirin) during pregnancy, Eur J Endocrinol source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
In the paper
“In general, the DDAVP requirement is unchanged, but it sometimes might be slightly higher (253).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Evidence
What the sources say
- Not checked — no full text of the sourcecites [253] Kamoun, 2014, Adrenal diseases during pregnancy: pathophysiology, diagnosis and management strategies, Am J Med Sci source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Many fT4 assays from pregnant patients are imprecise; an alternative approach is to monitor total T4 levels, adjusting the non-pregnant reference range upward by 50% to account for TBG effects (196).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > MAY 4, 2016
What the sources say
- Not checked — no full text of the sourcecites [196] Losa, 2008, Long-term effects of growth hormone replacement therapy on thyroid function in adults with growth hormone deficiency, Thyroid source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“AEDs accelerate T4 and sex hormone clearance, and patients may require compensatory increases in hormone replacement doses (274).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Treatment of Hypopituitarism in Patients Receiving Antiepileptic Medications
What the sources say
- Not checked — no full text of the sourcecites [274] Burstein, 1965, Phenobarbital-induced increase in 6-β-hydroxycortisol excretion: clue to its significance in human urine, J Clin Endocrinol Metab source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Transsphenoidal decompression and immediately instituting high-dose IV corticosteroid replacement therapy are the standard of care (260-262).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > MAY 4, 2016
What the sources say
- Not checked — no full text of the sourcecites [260] Arafah, 1990, Improvement of pituitary function after surgical decompression for pituitary tumor apoplexy, J Clin Endocrinol Metab source
- Not checked — no full text of the sourcecites [261] Veldhuis, 1980, Endocrine function after spontaneous infarction of the human pituitary: report, review, and reappraisal, Endocr Rev source
- Not checked — no full text of the sourcecites [262] Capatina, 2015, Management of endocrine disease: pituitary tumour apoplexy, Eur J Endocrinol source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“However, a recent report found that oxcarbazepine increases cortisol elimination in normal MAY 4, 2016 subjects (272), suggesting that attention should also be paid to symptoms of underdosing in patients on HC.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Treatment of Hypopituitarism in Patients Receiving Antiepileptic Medications
What the sources say
- Not checked — no full text of the sourcecites [272] Gentile, 1996, Dexamethasone metabolism by human liver in vitro. Metabolite identification and inhibition of 6-hydroxylation, J Pharmacol Exp Ther source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“Lean body mass cardiac stroke volume and left ventricular mass are increased (170).”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Treatment of Hypopituitarism in Patients Receiving Antiepileptic Medications
What the sources say
- Not checked — no full text of the sourcecites [170] Hoffman, 2004, Growth hormone (GH) replacement therapy in adult-onset gh deficiency: effects on body composition in men and women in a double-blind, randomized, placebo-controlled trial, J Clin Endocrinol Metab source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Pituitary adenomas, as well as the associated surgical and radiation treatments, can cause hypopituitarism.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > Treatment of Hypopituitarism in Patients Receiving Antiepileptic Medications
What the sources say
- Not checked — no full text of the sourcecites [66] Fleseriu, 2010, Normal hypothalamic-pituitary-adrenal axis by high-dose cosyntropin testing in patients with abnormal response to low-dose cosyntropin stimulation: a retrospective review, Endocr Pract source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper relies on this without support.
Evidence from studies on primary gland failure is applicable to central pituitary deficiencies.
“In several instances where data were lacking on the central deficiency state, we extrapolated it from studies on primary gland failure.”
The authors state this as an assumption.
The Task Force's strong recommendations will, on average, yield more good than harm for persons receiving care according to them.
“The Task Force has confidence that persons who receive care according to the strong recommendations will derive, on average, more good than harm.”
The paper relies on this without support.
Central hypogonadism in males manifests with low serum T levels and features of T deficiency and/or impaired spermatogenesis.
“Central hypogonadism in males manifests with low serum T levels and features of T deficiency and/or impaired spermatogenesis.”
The paper relies on this without support.
In premenopausal females, central hypogonadism manifests with low serum estrogens and impaired ovulation with oligomenorrhea or amenorrhea.
“In premenopausal females, it manifests with low serum estrogens and impaired ovulation with oligomenorrhea or amenorrhea.”
The paper relies on this without support.
The usual sequential pattern for hormonal deficiencies is the loss of GH initially, followed by gonadotropins, TSH, and ACTH, but there are several exceptions to this order (e.g., hypophysitis).
“The usual sequential pattern for hormonal deficiencies is the loss of GH initially, followed by gonadotropins, TSH, and ACTH, but there are several exceptions to this order (e.g., hypophysitis).”
The paper relies on this without support.
Hyperprolactinemia can cause hypogonadotropic hypogonadism, and dopamine agonist treatment can reverse the hypogonadism.
“Hyperprolactinemia can cause hypogonadotropic hypogonadism, and clinicians need to take into account the possibility of a prolactinoma, as dopamine agonist treatment can reverse the hypogonadism.”
The paper relies on this without support.
Total testosterone levels at the low end of the reference range are associated with conditions or medications affecting sex hormone-binding globulin and albumin.
“Total T levels at the low end of the reference range are associated with conditions or medications affecting SHBG and albumin (e.g., hypothyroidism/hyperthyroidism, obesity, diabetes mellitus, nephrotic syndrome, liver disease, HIV infection, GCs, or anticonvulsants).”
The paper relies on this without support.
Prednisolone cross-reacts in many cortisol assays, while dexamethasone exhibits limited cross-reactivity.
“Prednisolone cross-reacts in many cortisol assays, while dexamethasone exhibits limited cross-reactivity.”
The paper relies on this without support.
No currently available glucocorticoid treatment regimen is capable of accurately simulating the normal cortisol circadian rhythm.
“No currently available GC treatment regimen is capable of accurately simulating the normal cortisol circadian rhythm.”
The paper relies on this without support.
Central hypogonadism in males leads to adverse manifestations and sequelae, which testosterone replacement may reverse.
“Central hypogonadism in males leads to adverse manifestations and sequelae, which T replacement may reverse.”
The paper relies on this without support.
Younger patients require higher growth hormone doses, especially if serum IGF-1 levels are particularly low.
“Younger patients require higher doses, especially if serum IGF-1 levels are particularly low.”
The paper relies on this without support.
Initial low growth hormone replacement doses are preferred because fluid retention is dose-dependent.
“Initial low GH replacement doses are preferred as fluid retention is dose-dependent.”
The paper relies on this without support.
Morbid obesity may also require increased growth hormone dosing.
“Morbid obesity may also require increased GH dosing.”
The paper relies on this without support.
Overall, growth hormone replacement results in improved lipoprotein metabolism, body composition, and bone mineral density.
“Overall, GH replacement results in improved lipoprotein metabolism, body composition, and BMD.”
The paper relies on this without support.
Side effects of growth hormone replacement at the recommended doses manifest in about 20% of patients and are usually reversible by lowering the growth hormone dose.
“Side effects of GH replacement at the recommended doses manifest in about 20% of patients and are usually reversible by lowering the GH dose.”
The paper relies on this without support.
Reported side effects of growth hormone replacement include fluid retention, arthralgias, myalgias, paresthesias, carpal tunnel syndrome, sleep apnea, sleep disturbances, and dyspnea.
“Reported side effects include fluid retention, arthralgias, myalgias, paresthesias, carpal tunnel syndrome, sleep apnea, sleep disturbances, and dyspnea.”
The paper relies on this without support.
If growth hormone replacement doses are too high, insulin resistance with diabetes may occur.
“If replacement doses are too high, insulin resistance with diabetes may occur.”
The paper relies on this without support.
Desmopressin acts mostly on the V2 receptor and thus has only minimal vasopressor activity.
“DDAVP, a longer-acting analog of ADH, acts mostly on the V2 receptor and thus has only minimal vasopressor activity.”
The paper relies on this without support.
Hypothalamic pathology or surgery may alter the thirst mechanism due to damaged hypothalamic osmoreceptors.
“Sometimes hypothalamic pathology or surgery may alter the thirst mechanism due to damaged hypothalamic osmoreceptors.”
The paper relies on this without support.
About 95% of circulating cortisol is bound mainly to cortisol-binding globulin and to a lesser extent to albumin, and unbound cortisol is the active fraction.
“About 95% of circulating cortisol is bound mainly to CBG and to a lesser extent to albumin, and unbound cortisol is the active fraction.”
The paper relies on this without support.
Over-replacement with glucocorticoids in male patients with pituitary dysfunction can increase vertebral fracture risk, despite the restoration of gonadal status.
“Over-replacement with GC in male patients with pituitary dysfunction can increase vertebral fracture risk, despite the restoration of gonadal status.”
The paper relies on this without support.
Adrenal crisis may be the initial presenting feature of pituitary failure.
“AC may be the initial presenting feature of pituitary failure.”
The paper relies on this without support.
L-T4 over-replacement in patients with primary hypothyroidism may increase bone turnover and increase the fracture risk, especially in postmenopausal women.
“L-T4 over-replacement in patients with primary hypothyroidism may increase bone turnover and increase the fracture risk, especially in postmenopausal women.”
The paper relies on this without support.
HC is the preferred physiologic GC replacement in pregnancy as it is degraded by the enzyme 11beta-HSD2 and does not cross the placenta.
“HC is the preferred physiologic GC replacement in pregnancy as it is degraded by the enzyme 11beta-HSD2 and does not cross the placenta.”
The paper relies on this without support.
The placenta produces large amounts of the enzyme vasopressinase, which degrades endogenous ADH and thus requires increased secretion.
“The placenta produces large amounts of the enzyme vasopressinase, which degrades endogenous ADH and thus requires increased secretion.”
The paper relies on this without support.
Pregnancy may unmask mild forms of DI, which often occurs with subsequent pregnancies.
“Pregnancy may unmask mild forms of DI, which often occurs with subsequent pregnancies.”
The paper relies on this without support.
Treating hypothyroidism is critical for optimal pregnancy outcomes and fetal brain development.
“Treating hypothyroidism is critical for optimal pregnancy outcomes and fetal brain development.”
The paper relies on this without support.
As fertility is often impaired in hypopituitarism, natural pregnancy is rare.
“As fertility is often impaired in hypopituitarism, natural pregnancy is rare.”
The paper relies on this without support.
The diagnosis of AI may be missed in the first trimester due to confounding symptoms of normal pregnancy.
“The diagnosis of AI may be missed in the first trimester due to confounding symptoms of normal pregnancy.”
The paper relies on this without support.
GH itself is an insulin-antagonist.
“Although the beneficial effects of weight loss confound the impact of GH on insulin sensitivity, GH itself is an insulin-antagonist.”
The paper relies on this without support.
As phenytoin may impair fT4 measurements, an equilibrium dialysis fT4 assay is preferred.
“As phenytoin may impair fT4 measurements, an equilibrium dialysis fT4 assay is preferred.”
The paper relies on this without support.
ACTH excess from a pituitary tumor suppresses normal pituitary corticotroph cells.
“ACTH excess from a pituitary tumor will suppress normal pituitary corticotroph cells”
The paper relies on this without support.
Low-dose hydrocortisone replacement might be associated with increased bone formation and a positive bone remodeling balance.
“this approach might be associated with increased bone formation and a positive bone remodeling balance”
The paper relies on this without support.
Glucocorticoid over-replacement increases the risk of osteoporosis.
“avoid over-replacement to reduce the risk of osteoporosis”
The paper relies on this without support.
L-T4 over-replacement increases the risk of fractures.
“monitor L-T4 replacement, as recommended in previous sections, and avoid over-replacement to reduce the risk of fractures.”
The paper relies on this without support.
In the vast majority of cases, diabetes insipidus resolves spontaneously.
“allowing for safer use in the vast majority of cases in whom DI resolves spontaneously”
The paper relies on this without support.
After transient diabetes insipidus resolves, there is a risk of hyponatremia.
“because of the risk of hyponatremia after transient DI resolves”
The paper relies on this without support.
SIADH may occur 7-10 days after surgery.
“the risk of SIADH that may occur 7-10 days after surgery”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“In primary and secondary adrenal insufficiency, peak cortisol levels < 500 nmol/L (< 18.1 μg/dL), depending on assay, are indicative of adrenal insufficiency (38, 39).”
From European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and Therapy of Glucocorticoid-induced Adrenal Insufficiency (2024) · cites this paper as [39]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“As suppression of the HPA axis subsequently results in adrenocortical atrophy with impaired cortisol response, the test may yield less reliable results in patients on shorter duration of glucocorticoid therapy (39).”
From European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and Therapy of Glucocorticoid-induced Adrenal Insufficiency (2024) · cites this paper as [39]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“In primary and secondary adrenal insufficiency, a peak cortisol level <500 nmol/L (<18.1 μg/dL), depending on assay, at 30 or 60 minutes is indicative of adrenal insufficiency (38, 39).”
From European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and Therapy of Glucocorticoid-induced Adrenal Insufficiency (2024) · cites this paper as [39]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Diagnosing GC-induced AI should be performed after tapering the GC dose to the equivalent of ≤5 mg/day of prednisone, preferably hydrocortisone, as long-acting GCs may alter the results of cortisol levels for at least 48 h [33,44].”
From Glucocorticoid withdrawal-an overview on when and how to diagnose adrenal insufficiency in clinical practice (2021) · cites this paper as [33]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“undiagnosed and untreated deficiencies confer increased morbidity and mortality, which can be reversed by appropriate hormone replacement.”
From Neuroendocrine Disruptions Following Head Injury (2023) · cites this paper as [54]
Experimental — accuracy not yet measured
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“In adults, guidelines propose total daily hydrocortisone doses of 15 to 20 mg per day in 2 or 3 divided doses, with the highest dose in the morning, with a view to approximating typical circadian patterns”
From Approach to the patient with acquired hypothalamic syndrome (2026) · cites this paper as [16]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“The benefits of replacing deficient pituitary hormones are well established [54 · ].”
From Neuroendocrine Disruptions Following Head Injury (2023) · cites this paper as [54]
In the citing paper
“the approach at our institution to the diagnosis of adrenal insufficiency (and especially recovery from adrenal insufficiency) in this unique population of patients following adrenalectomy for a cortisol-secreting adenoma does not follow the Endocrine Society guidelines28,29.”
From Extensive clinical experience: hypothalamic-pituitary-adrenal axis recovery after adrenalectomy for corticotropin-independent cortisol excess (2018) · cites this paper as [29]
In the citing paper
“The Endocrine Society suggests performing dynamic testing, which is essential for making the diagnosis of AI, when the morning cortisol level is between 3 and 15 μg/dL [33].”
From Glucocorticoid withdrawal-an overview on when and how to diagnose adrenal insufficiency in clinical practice (2021) · cites this paper as [33]
In the citing paper
“the standard dose (250 μg) corticotropin (1–24 ACTH) test (SDCT) represents the gold standard dynamic test for PAI, while the insulin tolerance test (ITT) is the gold standard if SAI is suspected [1–5].”
In the citing paper
“Although morning serum cortisol concentrations are helpful to determine hypothalamic-pituitary-adrenal axis function, the evidence in the literature is as yet insufficient to support the use of basal cortisol concentrations alone in order to either rule out or confirm AI [1–5].”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > MAY 4, 2016
“The mean dose ratio of sublingual to intranasal DDAVP is 1:24 (181); we list dose comparisons in Table 6.”
§ Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline > MAY 4, 2016
“Table 6.Dose Comparisons of Available Desmopressin Formulations Melts Tablets Spray Drops Injections Bioavailability 0.25% (CI 0.21-0.31%)0.16±0.17%6.0±2.29%Similar to spray?NA Dose Equivalence 60 µg 120 µg 240 µg 100 µg 200 µg 400 µg 2.5 µg 5.0 µg 10.0 µg”
Citations
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Cited by
Sorted by citations
Items 201–300 of 947
Aldahmani, K. M., Almalki, M., Ekhzaimy, A. A., Aziz, F., Bashier, A. M., Mahzari, M. M., & Beshyah, S. (2022) · Pituitary · doi:10.1007/s11102-022-01242-y · Cited by 20
Craniopharyngioma—An update on metabolic and cognitive complications and new therapy
Erfurth, E. M. (2023) · Journal of Internal Medicine · doi:10.1111/joim.13684 · Cited by 21
He, X., & Barkan, A. L. (2020) · Pituitary · doi:10.1007/s11102-020-01031-5 · Cited by 22
Guaraldi, F., Zoli, M., Asioli, S., Corona, G., Gori, D., Friso, F., Pasquini, E., Bacci, A., Sforza, A., & Mazzatenta, D. (2020) · Journal of Endocrinological Investigation · doi:10.1007/s40618-020-01225-5 · Cited by 13
IgG4-related hypophysitis: a retrospective cohort study
Bhargava, R., Hussein, Z., Dorward, N., et al. (2022) · Acta Neurochirurgica · doi:10.1007/s00701-022-05231-9 · Cited by 19
“There is no fixed pattern for hypopituitarism in IgG4RH unlike that typically seen with pituitary adenomas [16].”
BackgroundItalian Guidelines for the Management of Prolactinomas
Cozzi, R. C., Auriemma, R. S., Menis, E. D., Esposito, F., Ferrante, E., Iatì, G., Mazzatenta, D., Poggi, M., Rudà, R., Tortora, F., et al. (2023) · Endocrine Metabolic & Immune Disorders - Drug Targets · doi:10.2174/1871530323666230511104045 · Cited by 19
“Fractionated radiotherapy achieves tumor control in over 80% of cases and normalization of PRL levels in 20-30% of the patients [67, 68].”
BackgroundA Contemporary Approach to the Diagnosis and Management of Adrenal Insufficiency
Charoensri, S., & Auchus, R. J. (2024) · Endocrinology and Metabolism · doi:10.3803/enm.2024.1894 · Cited by 22
A 2024 Update on Growth Hormone Deficiency Syndrome in Adults: From Guidelines to Real Life
Aversa, L. S., Cuboni, D., Grottoli, S., Ghigo, E., & Gasco, V. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13206079 · Cited by 23
“…marker: • A different target the various guidelines proposed throughout the years, being “the age-adjusted reference range provided by the laboratory” for AACE 2019 guideline [3], “the upper half of that range” for ES 2011 guideline [2], “below the upper limit of normal” for ES 2016 guideline [4].”
BackgroundMethodInfluentialAdrenal insufficiency in HIV/AIDS: a review
Mifsud, S., Gauci, Z., Gruppetta, M., Mallia Azzopardi, C., & Fava, S. (2021) · Expert Review of Endocrinology & Metabolism · doi:10.1080/17446651.2021.1979393 · Cited by 19
“The 2016 Endocrine Society Guidelines and the 2016 Society for Endocrinology guidelines recommend that this should be followed by fluid resuscitation and a 200 mg hydrocortisone continuous infusion over 24 hours or intra-venous or intra-muscular 50 mg hydrocortisone boluses given every 6 hours [99,144].”
BackgroundInfluentialMetabolic syndrome and its components in adult hypopituitary patients
Abe, S. Y., dos Santos, K. S., Barbosa, B. F. B., Biondo, C., Takito, D., Hayashi, S. K., Amarilla, V. G. V., Ulbrich, A. Z., & Boguszewski, C. L. (2020) · Pituitary · doi:10.1007/s11102-020-01048-w · Cited by 18
ACTH Stimulation Test for the Diagnosis of Secondary Adrenal Insufficiency: Light and Shadow
Birtolo, M. F., Antonini, S., Saladino, A., Zampetti, B., Lavezzi, E., Chiodini, I., Mazziotti, G., Lania, A. G., & Cozzi, R. C. (2023) · Biomedicines · doi:10.3390/biomedicines11030904 · Cited by 19
“1 μg/dL (500 nmol/L) at 30 or 60 min after corticotropin analogs administration indicates an appropriate cortisol secretion and therefore excludes the diagnosis of AI [5,11].”
BackgroundMethodCastro, M. A., Paredes, I., Pérez-López, C., et al. (2023) · Pituitary · doi:10.1007/s11102-023-01315-6 · Cited by 18
Brue, T. C., Rahabi-Layachi, H., Barry, A., Barlier, A., Bertherat, J. Y., Borson‐Chazot, F., Castinetti, F., Cazabat, L., Chabre, O., Chevalier, N., et al. (2023) · Annales d Endocrinologie · doi:10.1016/j.ando.2023.08.003 · Cited by 18
van der Leij, S., Suijkerbuijk, K. P. M., van den Broek, M. F. M., Valk, G. D., Dankbaar, J. W., & van Santen, H. M. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1400841 · Cited by 19
“Reassessment of ACTH de fi ciency is not recommended, given the virtually absent recovery from ACTH de fi ciency in the literature (9, 10, 17 – 20).”
BackgroundLuigi, L. D., Pigozzi, F., Sgrò, P., et al. (2019) · Journal of Endocrinological Investigation · doi:10.1007/s40618-019-01145-z · Cited by 18
Levy, M. J., Prentice, M., & Wass, J. A. H. (2019) · BMJ · doi:10.1136/bmj.l321 · Cited by 18
Zdrojowy-Wełna, A., Stachowska, B., & Bolanowski, M. (2024) · Pituitary · doi:10.1007/s11102-024-01427-7 · Cited by 21
“Sex steroid replacement therapy is generally recommended in hypogonadism to restore bone health, but there are no specific data in CD [46].”
van Iersel, L., Xu, J., Potter, B. S., Conklin, H. M., Zhang, H., Chemaitilly, W., van Santen, H. M., & Merchant, T. E. (2019) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2019-00539 · Cited by 18
Castro, M. A., Corrales, E. P., Cancela, A. A., Duque, S. G., Urzaiz, L. L., & Berrocal, V. R. (2020) · Endocrine · doi:10.1007/s12020-020-02455-6 · Cited by 17
Yoshimura, K., Yamamoto, M., Inoue, T., Fukuoka, H., Iida, K., & Ogawa, W. (2022) · Endocrine Journal · doi:10.1507/endocrj.ej22-0108 · Cited by 17
Adrenal Failure: An Evidence-Based Diagnostic Approach
Shaikh, S., Nagendra, L., Shaikh, S. S., & Pappachan, J. M. (2023) · Diagnostics · doi:10.3390/diagnostics13101812 · Cited by 20
“The ACTH stimulation test should be performed 6 weeks after surgery and at least 18 h after the last dose of hydrocortisone [40].”
BackgroundEndocrinopathies Associated With Immune Checkpoint Inhibitor Use
Kotwal, A., Kennedy, R., Kikani, N. J., Thosani, S., Goldner, W. S., & Shariff, A. I. (2024) · Endocrine Practice · doi:10.1016/j.eprac.2024.03.023 · Cited by 20
Diagnosis of hypoprolactinemia
Urhan, E., & Karaca, Z. (2024) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-024-09896-8 · Cited by 20
Financial Conflicts of Interest Among Authors of Endocrine Society Clinical Practice Guidelines*
Irwig, M. S., Kyinn, M., & Shefa, M. C. (2018) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2018-00526 · Cited by 17
“Hyperprolactinemia (33) Endocrine Society 2011 7 5 Yes 5 M 3 3 220 2265 Hypopituitarism (34) Endocrine Society 2016 7 4 Yes 3 2 3 3 274 6300 Pituitary incidentaloma (35) Endocrine Society 2011 7 5 Yes 5 M 4 3 151 2617 Thyroid Thyroid dysfunction in pregnancy (36) Endocrine Society 2012 13 2 No 2 M 1 0 78 14”
Romano, A., Rigante, D., & Cipolla, C. (2019) · Autoimmunity Reviews · doi:10.1016/j.autrev.2019.102363 · Cited by 17
Experience of a Pituitary Clinic for US Military Veterans With Traumatic Brain Injury
Lee, J., Anderson, L. J., Migula, D., Yuen, K. C. J., McPeak, L., & Garcia, J. M. (2021) · Journal of the Endocrine Society · doi:10.1210/jendso/bvab005 · Cited by 17
“0 ng/mL during a successful ITT [21] or ACTH stimulation test [22, 23].”
BackgroundSzydełko, J., Szydełko-Gorzkowicz, M., & Matyjaszek‐Matuszek, B. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10173997 · Cited by 17
“Hypopituitarism was defined as the presence of at least one pituitary deficiency documented biochemically through basal pituitary function tests, and when necessary dynamic tests were performed following the Endocrine Society Guidelines [46].”
MethodReview on Recent Topics in Hypophysitis
Sugihara, H. (2017) · Journal of Nippon Medical School · doi:10.1272/jnms.84.201 · Cited by 17
Biagetti, B., Cordero, E., Pérez-López, C., et al. (2024) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgae649 · Cited by 16
Hypothalamic abnormalities: Growth failure due to defects of the GHRH receptor
Aguiar-Oliveira, M. H., Davalos, C., Campos, V. C., et al. (2017) · Growth Hormone & IGF Research · doi:10.1016/j.ghir.2017.12.011 · Cited by 16
Pituitary Disorders and COVID-19, Reimagining Care: The Pandemic A Year and Counting
Fleseriu, M. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.656025 · Cited by 16
Self-citationGH Replacement in the Elderly: Is It Worth It?
Bitti, S. R., Franco, M., Albertelli, M., Gatto, F., Vera, L., Ferone, D., & Boschetti, M. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.680579 · Cited by 16
Neuro-Endocrine Recovery After Pituitary Apoplexy: Prolactin as a Predictive Factor
Lammert, A., Walter, M. S., Giordano, F. A., Zhgloul, M. A., Krämer, B. K., Nittka, S., Schulte, D. M., Ratliff, M., Hänggi, D., & Seiz‐Rosenhagen, M. (2018) · Experimental and Clinical Endocrinology & Diabetes · doi:10.1055/a-0640-2915 · Cited by 16
Exogenous Opioids and the Human Endocrine System: An Endocrine Society Scientific Statement
Karavitaki, N., Bettinger, J. J., Biermasz, N., Christ-Crain, M., Gadelha, M. R., Inder, W. J., Tsourdi, E., Wakeman, S. E., & Zatelli, M. (2024) · Endocrine Reviews · doi:10.1210/endrev/bnae023 · Cited by 14
Self-citationGrowth hormone deficiency testing and treatment following mild traumatic brain injury
Mercier, L. J., Kruger, N., Le, Q. B., Fung, T. S., Kline, G. A., & Debert, C. T. (2021) · Scientific Reports · doi:10.1038/s41598-021-87385-7 · Cited by 15
Sasaki, K., Kobayashi, S., Kudo, M., Sugimoto, M., Takahashi, S., Nakamura, Y., Kawazoe, A., Shitara, K., Kinoshita, T., & Gotohda, N. (2021) · Surgical Case Reports · doi:10.1186/s40792-021-01346-w · Cited by 14
“Current guidelines require the replacement of deficient hormones to manage hypopituitarism [21].”
BackgroundCasale, M., Baldini, M., Monte, P. D., Gigante, A., Grandone, A., Origa, R., Poggi, M., Gadda, F., Lai, R., Marchetti, M., et al. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11071826 · Cited by 15
Bitencourt, M. R., Batista, R. L., Biscotto, I. P., & Carvalho, L. R. S. (2022) · Archives of Endocrinology and Metabolism · doi:10.20945/2359-3997000000493 · Cited by 15
“For adequate stimulation, a glucose level of 40 mg/dL is mandatory at any point after insulin administration (1,2,32) ACTH (Synacthen ® or Cortrosyn ® ) as a stimulus.”
BackgroundMethodInfluentialScreening, diagnosis and management of hypothyroidism in pregnancy
Solha, S. T. G., Mattar, R., Teixeira, P. D. F. D. S., Chiamolera, M. I., Maganha, C. A., Zaconeta, A. M., & Souza, R. T. (2022) · Revista Brasileira Ginecologia e Obstetrícia · doi:10.1055/s-0042-1758490 · Cited by 15
“As gonadotropic or corticotrophic impairment is common, patients usually need to replace other hormones before they need TH replacement.(5) More rarely, central hypothyroidism has a tertiary origin resulting from hypothalamic disorders impairing the production or release of thyrotropin releasing hormone (TRH).”
BackgroundPeixe, C. R., Alexandre, M. I., Gomes, A. C., Nobre, E. L., Silva, A. L., Oliveira, T., Lopéz‐Presa, D., Faria, C. C., Miguéns, J., Bugalho, M. J., et al. (2023) · Pituitary · doi:10.1007/s11102-023-01319-2 · Cited by 15
“Hypopituitarism at diagnosis or at last follow-up was defined as the presence of at least 1 pituitary hormone deficiency recognized on basal pituitary function tests, while dynamic tests were performed as appropriate [15].”
MethodCui, Q., Liu, X., Sun, Q., Sun, W., Zheng, H., He, M., Zhang, Z., Ma, Z., Shen, M., Shou, X., et al. (2023) · Endocrine · doi:10.1007/s12020-023-03405-8 · Cited by 15
“CAI Central adrenal insufficiency, CAS Central adrenal sufficiency, UFC urinary free cortisol, ACTH adrenocorticotrophic hormone, DXM dexamethasone, TSH thyroid-stimulating hormone, TT3 total triiodothyronine, TT4 total thyroxine, FT3 free triiodothyronine, FT3 free triiodothyronine, IGF-1 insulin-like growth factor 1…”
BackgroundInfluentialAcute neuroendocrine changes after traumatic brain injury
Magyar-Sümegi, Z. D., Stankovics, L., Lendvai-Emmert, D., Czigler, A., Hegedus, E., Csendes, M., Tóth, L., Ungvari, Z. I., Büki, A., & Tóth, P. (2024) · Brain and Spine · doi:10.1016/j.bas.2024.102830 · Cited by 23
“Additionally, body mass index (BMI) has been noted to influence both GH and IGF-1 levels, with IGF-1 decreasing in cases of very high or low BMI (Fleseriu et al., 2016).”
BackgroundCuny, T., Reynaud, R., Raverot, G., Coutant, R., Chanson, P., Kariyawasam, D., Poitou, C., Thomas‐Teinturier, C., Baussart, B., Samara‐Boustani, D., et al. (2024) · Annales d Endocrinologie · doi:10.1016/j.ando.2024.07.002 · Cited by 19
Early Pulse Glucocorticoid Therapy and Improved Hormonal Outcomes in Primary Hypophysitis
Krishnappa, B., Shah, R., Sarathi, V., et al. (2021) · Neuroendocrinology · doi:10.1159/000516006 · Cited by 15
What to Do with Incidentally Discovered Pituitary Abnormalities?
Langlois, F., & Fleseriu, M. (2021) · Medical Clinics of North America · doi:10.1016/j.mcna.2021.05.015 · Cited by 15
Self-citationHypopituitarism and pregnancy: clinical characteristics, management and pregnancy outcome
Aulinas, A., Stantonyonge, N., García‐Patterson, A., Adelantado, J. M., Medina, C., Espinós, J. J., López, E., Webb, S. M., & Corcoy, R. (2021) · Pituitary · doi:10.1007/s11102-021-01196-7 · Cited by 15
“While it is known that adequate substitution prior to pregnancy is needed, because GH deficiency is related to subfertility, the current recommendation is to stop treatment once pregnancy is confirmed [4].”
BackgroundInfluentialDonegan, D. M., & Honegger, J. B. (2022) · Endocrine Practice · doi:10.1016/j.eprac.2022.06.009 · Cited by 15
Transsphenoidal surgery for pituitary adenomas: early results from a single center
Karamouzis, I., Caputo, M., Mele, C., Nuzzo, A., Zavattaro, M., Car, P., Panzarasa, G., Prodam, F., Marzullo, P., & Aimaretti, G. (2018) · HORMONES · doi:10.1007/s42000-018-0082-9 · Cited by 15
IgG4-related hypophysitis in patients with autoimmune pancreatitis
Kanie, K., Bando, H., Iguchi, G., Shiomi, H., Masuda, A., Fukuoka, H., Nishizawa, H., Fujita, Y., Sakai, A., Kobayashi, T., et al. (2019) · Pituitary · doi:10.1007/s11102-018-00930-y · Cited by 15
Rathke’s cleft cyst: From history to molecular genetics
Hacıoğlu, A., Tekiner, H., Altinoz, M. A., et al. (2025) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-025-09949-6 · Cited by 14
“Clinical observation with serial MRIs may be practiced for the patients with asymptomatic and small RCCs. Pituitary dysfunction should be managed by replacement of the deficient hormones in accordance to relevant guidelines [190].”
Wu, J., Fu, J., Huang, Z. J., et al. (2022) · Obesity · doi:10.1002/oby.23447 · Cited by 14
“1 μg/dL after a corticotropin stimulation test or a morning cortisol level <3 μg/dL (20).”
BackgroundLaway, B. A., Rasool, A., Baba, M. S., Misgar, R. A., Bashir, M. I., Wani, A. I., Choh, N. A., Shah, O. A., Lone, A. A., & Shah, Z. A. (2022) · Clinical Endocrinology · doi:10.1111/cen.14871 · Cited by 14
“There is no data available comparing effect of E + P on CAC in SS patients, however, studies suggest that gonadal hormone replacement decreases CV mortality in hypopituitary subjects.(20) The MESA score was higher in patients with SS than controls predicting higher 10‐year risk of CV diseases.”
BackgroundResultManagement of pituitary incidentalomas
Westall, S., Aung, E. T., Kejem, H., et al. (2023) · Clinical Medicine · doi:10.7861/clinmed.2023-0020 · Cited by 14
“13,15 Testosterone, GH and AVP replacement should be initiated on advice from local endocrine teams.”
BackgroundClinical course of pituitary function and image in IgG4-related hypophysitis
Anno, T., Kawasaki, F., Takai, M., et al. (2017) · Endocrinology Diabetes and Metabolism Case Reports · doi:10.1530/edm-16-0148 · Cited by 14
Castillo, A., Zantut‐Wittmann, D. E., Neto, A. M., Jales, R. M., & Garmes, H. M. (2018) · Hormone and Metabolic Research · doi:10.1055/a-0649-8010 · Cited by 14
“Adequate substitution was assumed when medication had not been adjusted for at least six months, patients had no complaints, and basal hormone levels were within the recommended values [29].”
BackgroundPrevalence of hypopituitarism and quality of life in survivors of post‐traumatic brain injury
Meriem, B., Donaldson, M., Labassen, M., Cherfi, L., Nebbal, M., Haffaf, E. M., Abdennebi, B., Guenane, K., Kemali, Z., & Kablia, S. O. (2020) · Endocrinology Diabetes & Metabolism · doi:10.1002/edm2.146 · Cited by 15
Staby, I., Krogh, J., Klose, M., Bækdal, J. A., Feldt‐Rasmussen, U., Poulsgaard, L., Springborg, J. B., & Andreassen, M. (2021) · Endocrine Connections · doi:10.1530/ec-21-0155 · Cited by 14
“Thus, several approaches have been suggested, ranging from routine use of prophylactic glucocorticoid treatment to glucocorticoid sparing regimens with close observation and only treatment in case of clinical signs of AI (3, 4, 11).”
BackgroundHypophysitis: A comprehensive overview
de Vries, F., van Furth, W. R., Biermasz, N. R., & Pereira, A. M. (2021) · La Presse Médicale · doi:10.1016/j.lpm.2021.104076 · Cited by 14
Pituitary surgery in Cushing’s disease: first line treatment and role of reoperation
Jones, P., & Swearingen, B. (2022) · Pituitary · doi:10.1007/s11102-022-01254-8 · Cited by 11
“Patients in remission require glucocorticoid replacement until a cortisol stimulation test demonstrates hypothalamic–pituitary–adrenal (HPA) axis recovery [10].”
BackgroundBakhsheshian, J., Wheeler, S., Strickland, B. A., et al. (2018) · Operative Neurosurgery · doi:10.1093/ons/opy078 · Cited by 14
Primary Pituitary Lymphoma As Rare Cause Of A Pituitary Mass And Hypopituitarism In Adulthood
Caputo, M., Prencipe, N., Bisceglia, A., Bona, C., Maccario, M., Aimaretti, G., Grottoli, S., & Gasco, V. (2020) · Endocrine Practice · doi:10.4158/ep-2020-0286 · Cited by 14
Kanie, K., Iguchi, G., Inuzuka, M., Sakaki, K., Bando, H., Urai, S., Shichi, H., Fujita, Y., Matsumoto, R., Suda, K., et al. (2020) · Journal of the Endocrine Society · doi:10.1210/jendso/bvaa194 · Cited by 14
“Hormone provocation tests were performed to achieve a definitive diagnosis [8].”
MethodEnglish, K. A., Inder, W. J., Weedon, Z., Dimeski, G., Sorbello, J., Russell, A. W., Duncan, E. L., & Cuneo, R. C. (2017) · Clinical Endocrinology · doi:10.1111/cen.13334 · Cited by 14
The hypothalamic-pituitary-gonad axis in male Cushing’s disease before and after curative surgery
Zheng, H., Wang, Q., Cui, Q., Sun, Q., Wu, W., Ji, L., He, M., Lü, B., Zhang, Z., Ma, Z., et al. (2022) · Endocrine · doi:10.1007/s12020-022-03083-y · Cited by 15
Bioletto, F., Berton, A. M., Varaldo, E., Cuboni, D., Bona, C., Parasiliti‐Caprino, M., Prencipe, N., Ghigo, E., Grottoli, S., Maccario, M., et al. (2022) · Journal of Endocrinological Investigation · doi:10.1007/s40618-022-01926-z · Cited by 13
Endocrine immune-related adverse effects of immune-checkpoint inhibitors
Trevisani, V., Iughetti, L., Lucaccioni, L., & Predieri, B. (2023) · Expert Review of Endocrinology & Metabolism · doi:10.1080/17446651.2023.2256841 · Cited by 15
Arosio, M., Sciannameo, V., Contarino, A., Berchialla, P., Puglisi, S., Pesatori, A. C., Ferrante, E., Filopanti, M., Pivonello, R., Dassie, F., et al. (2024) · Journal of Endocrinological Investigation · doi:10.1007/s40618-023-02257-3 · Cited by 14
Once upon a time: the glucagon stimulation test in diagnosing adult GH deficiency
Cuboni, D., Caputo, M., Ghigo, E., Aimaretti, G., & Gasco, V. (2024) · Journal of Endocrinological Investigation · doi:10.1007/s40618-024-02322-5 · Cited by 13
“…and several studies involving panhypopituitary patients have shown that under certain circumstances GH stimulation tests may be unnecessary to diagnose GHD [3, 49–51]; therefore the remaining pituitary function can be used as a valid gold standard to establish the presence or absence of GHD.”
BackgroundGuidelines on diagnostics and treatment of acromegaly (draft)
Przhiyalkovskaya, E. G., Mokrysheva, N. G., Troshina, E. A., Mel'nichenko, G. A., Dedov, I. I., Antsiferov, M. B., Astafieva, L. I., Bardymova, T. P., Belaya, Z. E., Vagapova, G. R., et al. (2024) · Obesity and metabolism · doi:10.14341/omet13153 · Cited by 13
Evaluation and follow-up of patients diagnosed with hypophysitis: a cohort study
Hacıoğlu, A., Karaca, Z., Uysal, S., et al. (2024) · European Journal of Endocrinology · doi:10.1093/ejendo/lvae101 · Cited by 13
Bonert, V. S., & Melmed, S. K. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-804169-7.00004-0 · Cited by 14
Self-citationAdult Growth Hormone Deficiency: Diagnostic and Treatment Journeys From the Patients’ Perspective
Hoffman, A. R., Mathison, T., Andrews, D., Murray, K., Kelepouris, N., & Fleseriu, M. (2022) · Journal of the Endocrine Society · doi:10.1210/jendso/bvac077 · Cited by 14
“AGHD, adult growth hormone deficiency; AO-AGHD, adult-onset growth hormone deficiency; CO-AGHD, childhood-onset growth hormone deficiency; GH, growth hormone; IGF-I, insulin-like growth factor I [1, 6, 7].”
BackgroundInfluentialSelf-citationHypophysitis in the era of immune checkpoint inhibitors and immunoglobulin G4-related disease
Wehbeh, L., Alreddawi, S., & Salvatori, R. (2019) · Expert Review of Endocrinology & Metabolism · doi:10.1080/17446651.2019.1598260 · Cited by 13
“In terms of management (Figure 3), the mainstay is hormonal replacement per guidelines [113].”
BackgroundSelf-citationWang, D., Zhang, M., Guan, H., et al. (2019) · Frontiers in Endocrinology · doi:10.3389/fendo.2019.00193 · Cited by 13
Other Pituitary Conditions and Pregnancy
Chanson, P. (2019) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2019.05.005 · Cited by 13
Endocrine Adverse Events Related with Immune Checkpoint Inhibitors: An Update for Clinicians
Deligiorgi, M. V., Panayiotidis, M. I., & Trafalis, D. T. (2020) · Immunotherapy · doi:10.2217/imt-2019-0132 · Cited by 13
Pituitary dysfunction after traumatic brain injury: prevalence and screening strategies
Ntali, G., & Tsagarakis, S. (2020) · Expert Review of Endocrinology & Metabolism · doi:10.1080/17446651.2020.1810561 · Cited by 16
Anesthetic management during transsphenoidal pituitary surgery
Esfahani, K., & Dunn, L. K. (2021) · Current Opinion in Anaesthesiology · doi:10.1097/aco.0000000000001035 · Cited by 13
Craniopharyngioma and Metabolic Syndrome: A 5-Year Follow-Up Single-Center Experience
Scarano, E., Solari, D., Riccio, E., Arianna, R., Somma, T., Cavallo, L. M., Romano, F., Colao, A., & Somma, C. D. (2022) · Frontiers in Neurology · doi:10.3389/fneur.2022.783737 · Cited by 11
Boguszewski, C. L. (2023) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2023.101817 · Cited by 12
Natural history and surgical outcomes of Rathke’s cleft cysts: a Spanish multicenter study
Torre, E. L. M., Gutiérrez-Hurtado, A., Ollero, M. D., et al. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1413810 · Cited by 12
Biller, B. M. K., Höybye, C., Carroll, P., Gordon, M. B., Birkegård, A. C., Kelepouris, N., Nedjatian, N., & Weber, M. M. (2021) · Pituitary · doi:10.1007/s11102-021-01138-3 · Cited by 12
“GHRT is not approved for use during pregnancy and current guidelines recommend stopping GHRT after conception [26].”
BackgroundBlacha, A. K., Kropp, P., Rahvar, A.-H., Flitsch, J., van de Loo, I., & Harbeck, B. (2021) · Irish Journal of Medical Science · doi:10.1007/s11845-021-02731-y · Cited by 9
“The fact that patients with PAI showed worse results in AddiQoL than those with SAI is plausible due to the diseasespecific design of this questionnaire [22, 26].”
InfluentialAcute Sheehan’s Syndrome Presenting with Hyponatremia Followed by a Spontaneous Pregnancy
Pineyro, M. M., Diaz, L., Guzzetti, M., Risso, M., & Pereda, J. (2022) · Case Reports in Endocrinology · doi:10.1155/2022/9181365 · Cited by 12
Hwang, Y.-A., Lee, H. W., Ahn, S. H., Lee, E. J., Ku, C. R., & Kim, S. U. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.1057769 · Cited by 13
Jung, H. N., Kim, S. T., Kong, D., et al. (2020) · World Neurosurgery · doi:10.1016/j.wneu.2020.03.086 · Cited by 12
Normal and Abnormal Growth in the Pediatric Patient
Nejedly, N. (2020) · Current problems in pediatric and adolescent health care · doi:10.1016/j.cppeds.2020.100771 · Cited by 12
Metabolomics as a potential tool for the diagnosis of growth hormone deficiency (GHD): a review
Martin, B. S. D. S., Ferreira, V. G., Bitencourt, M. R., Pereira, P. C. G., Carrilho, E., Assunção, N. A., & Carvalho, L. R. S. (2020) · Archives of Endocrinology and Metabolism · doi:10.20945/2359-3997000000300 · Cited by 16
“GHD in children and adults have different diagnosis procedures, different treatment regimens and efficacy control (19,23).”
BackgroundNgaosuwan, K., Johnston, D. G., Godsland, I. F., Cox, J., Majeed, A., Quint, J. K., Oliver, N. S., & Robinson, S. (2021) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgab347 · Cited by 12
Craniopharyngioma, Chronotypes and Metabolic Risk Profile
Somma, C. D., Scarano, E., Barrea, L., Solari, D., Riccio, E., Arianna, R., Cavallo, L. M., Romano, F., Benedetto, E. D., Rodriguez, A., et al. (2021) · Nutrients · doi:10.3390/nu13103444 · Cited by 11
“Hypopituitarism was diagnosed clinically based on the clinical manifestations, the baseline assessment of pituitary function and stimulus test, according to the Clinical Practice Guidelines of the Endocrine Society [29].”
MethodEnhancing the Trustworthiness of the Endocrine Society’s Clinical Practice Guidelines
McCartney, C. R., Corrigan, M. D., Drake, M. T., Fuleihan, G. E., Korytkowski, M. T., Lash, R. W., Lieb, D. C., McCall, A. L., Muniyappa, R., Piggott, T., et al. (2022) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgac290 · Cited by 12
Self-citationHerodes, M., Le, N., Anderson, L. J., Migula, D., Miranda, G., Paulsen, L., & Garcia, J. M. (2023) · Growth Hormone & IGF Research · doi:10.1016/j.ghir.2023.101544 · Cited by 11
Hussein, Z., Marcus, H. J., Grieve, J., Dorward, N., Kosmin, M., Fersht, N. L., Bouloux, P. M., Jaunmuktane, Z., & Baldeweg, S. E. (2023) · Endocrine · doi:10.1007/s12020-023-03434-3 · Cited by 11
Urai, S., Watanabe, M., Bando, H., et al. (2023) · Frontiers in Immunology · doi:10.3389/fimmu.2023.1284301 · Cited by 11
Opioid-induced adrenal insufficiency: diagnostic and management considerations
Patel, E., & Ben-Shlomo, A. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1280603 · Cited by 11
“Peak cortisol ≤ 18 mcg/dL (500 nmol/L) at 30 or 60 minutes after ACTH 1-24 stimulation is diagnostic for adrenal insuf fi ciency according to older cortisol assays (13).”
BackgroundMethodInfluentialBioletto, F., Sibilla, M., Gasco, V., Ghigo, E., & Grottoli, S. (2024) · Journal of Endocrinological Investigation · doi:10.1007/s40618-024-02356-9 · Cited by 12
“In fact, the diagnosis of hypopituitarism essentially relies on standardized tests and reference values, taking little account of individual hormonal setpoints [26, 44] and potentially leading to an under-recognition of milder functional derangements.”
BackgroundHypopituitarism and bone disease: pathophysiology, diagnosis and treatment outcomes
Akirov, A., Rudman, Y., & Fleseriu, M. (2024) · Pituitary · doi:10.1007/s11102-024-01391-2 · Cited by 12
“This can include hypocortisolism (secondary adrenal insufficiency), hypothyroidism, hypogonadism, growth hormone deficiency (GHD) and more rarely, vasopressin deficiency (AVP-D), oxytocin deficiency, and hypoprolactinemia [2].”
InfluentialSelf-citationHypophysitis in COVID-19: a systematic review
Menotti, S., di Filippo, L., Terenzi, U., et al. (2024) · Pituitary · doi:10.1007/s11102-024-01462-4 · Cited by 11
Prevalence of comorbidities among patients with Acromegaly
Khan, S., Ram, N., Masood, M. Q., et al. (2021) · Pakistan Journal of Medical Sciences · doi:10.12669/pjms.37.7.4277 · Cited by 11
Frequently Asked Questions in Patients With Adrenal Insufficiency in the Time of COVID-19
Sabbadin, C., Betterle, C., Scaroni, C. M., & Ceccato, F. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.805647 · Cited by 11
Metadata
- Authors
- Fleseriu, M., Hashim, I. A., Karavitaki, N., Melmed, S., Murad, M. H., Salvatori, R., & Samuels, M. H.
- Affiliations
- Oregon Health & Science University (US)
- The University of Texas Southwestern Medical Center (US)
- University of Birmingham (GB)
- Cedars-Sinai Medical Center (US)
- Mayo Clinic (US)
- Johns Hopkins University (US)
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2016-10-13
- Volume
- 101
- Issue
- 11
- Pages
- 3888-3921
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2530850399
- Cited by
- 945
- References
- 316
- Citations by year
- 2026: 80 · 2025: 121 · 2024: 136 · 2023: 93 · 2022: 109 · 2021: 122 · 2020: 95 · 2019: 69 · 2018: 73 · 2017: 40 · 2016: 1
- FWCI
- 61.22
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- hypopituitarism, hormone replacement therapy, adults, pituitary function testing, pituitary surgery
- MeSH terms
- Adult, Age Factors, Aged, Endocrinology, Female, Humans, Hypopituitarism, International Agencies, Male, Middle Aged, Sex Characteristics, Societies, Scientific, Drug Monitoring, Evidence-Based Medicine, Hormone Replacement Therapy, Consensus, Precision Medicine
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