Regulation of craving (ROC) by focusing on long-term negative consequences of drug use has been shown to successfully reduce subjective craving. This process is supported by the dorsolateral prefrontal cortex (dlPFC), which exerts control over reward and value signals in the ventral striatum (VS) and ventromedial prefrontal cortex (vmPFC). As stress impairs cognitive control and addiction is characterized by altered value computations manifesting in delay discounting, we examined how these factors interact with ROC and its neural correlates to better understand the use of ROC in high-risk situations. Sixty-eight male smokers underwent a delay discounting task and either a stress (socially evaluated cold pressor task) or a control condition. They subsequently completed a ROC task during fMRI while focusing on (1) long-term negative consequences (LATER) versus (2) short-term positive consequences (NOW). We found lower subjective craving ratings and attenuated neural responses in the VS (t = 4.33, p = 0.012) and vmPFC (t = 5.79, p < 0.001), as well as higher activation in the dlPFC (t = 4.09, p = 0.038) in the LATER compared to the NOW strategy. Although no neural or behavioural difference in ROC was observed between stress and control groups, both individual stress (cortisol) and delay discounting were positively related to vmPFC activity (NOW > LATER). We replicated previous results on ROC. Importantly, the association of vmPFC signals with stress response and delay discounting suggests that enhancing ROC success may involve reinforcing changes in self-referentiality of future thoughts to subjective value of drug use.

Paraneoplastic endocrine syndromes are well-recognised complications of lung malignancies, specifically small-cell lung cancer. The majority of patients with panhypopituitarism associated with lung cancer result from pituitary metastasis. In those with an enlarged pituitary stalk without obvious pituitary metastasis presenting with a combination of panhypopituitarism and arginine vasopressin deficiency (AVP-D), metastatic pituitary stalk infiltration should be considered rather than a paraneoplastic immune-mediated hypophysitis. We report a case of a 67-year-old gentleman with newly diagnosed lung adenocarcinoma, found to have panhypopituitarism before starting systemic anti-cancer treatment. Further hormonal tests revealed central hypothyroidism, hypogonadotropic hypogonadism and growth hormone deficiency. MRI of the pituitary demonstrated heterogeneous contrast enhancement without an obvious focal lesion. The pituitary stalk was slightly enlarged at the level of the optic chiasm, raising the possibility of hypophysitis. The patient was initiated on hydrocortisone and levothyroxine replacement therapy. Following hormone replacement, previously occult AVP-D became clinically apparent, manifesting as worsening dehydration, polyuria and polydipsia. The overnight water deprivation test confirmed AVP-D. The patient showed subsequent clinical improvement with desmopressin. Serum prolactin was mildly elevated, likely reflecting both pituitary stalk infiltration and concomitant metoclopramide therapy. This case discusses an exceptionally rare presentation of lung adenocarcinoma with isolated pituitary stalk infiltration, panhypopituitarism, and AVP-D before exposure to immune checkpoint inhibitors. Clinicians should be aware of this unusual manifestation, as prompt hormone replacement can significantly reduce morbidity and improve patient outcomes.

This case report describes a newborn diagnosed with very-early-onset autosomal dominant polycystic kidney disease (VEO-ADPKD) and congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency. The patient presented with prenatally detected kidney cysts and exhibited clinical and laboratory features consistent with salt-wasting, including markedly elevated 17-hydroxyprogesterone levels, requiring treatment with hydrocortisone, fludrocortisone, and sodium chloride. Genetic analysis revealed a de novo truncating variant in PKD1 and two variants in CYP21A2. Hypertension developed at 3 years and 7 months despite unchanged steroid replacement doses, requiring antihypertensive treatment, and resolved after mineralocorticoid dose reduction. This case highlights the competing therapeutic demands of concurrent salt-wasting CAH and VEO-ADPKD, underscoring the importance of early genetic evaluation and integrated multidisciplinary surveillance.

This study investigated physiological responses during professional competitions by measuring heart rate variability (HRV) and salivary α-amylase and cortisol in elite archers. Based on the vagal tank theory, we examined psychophysiological dynamics and assessed differences in HRV and salivary biomarkers between high- and low-scoring matches to evaluate their association with performance. Eight elite archers (four male, four female) participated, with data collected across 184 matches of the Chinese Enterprise Archery League. HRV was recorded pre- and during matches, and salivary α-amylase and cortisol were measured pre- and post-match. Heart rate significantly increased from 97.0 ± 11.5 bpm pre-match to 110.7 ± 15.3 bpm during matches, while RMSSD, an index of cardiac vagal control, remained stable. Heart rate, RMSSD, and high-frequency power were similar between high- and low-scoring matches. Post-match α-amylase concentrations were lower in high-scoring matches (51.37 ± 49.44 U/ml) than in low-scoring matches (71.00 ± 88.13 U/ml; p = 0.037), after controlling for pre-match values, whereas cortisol levels remained unchanged. These findings suggest that elite archers engage sympathetic arousal to mobilize cognitive and physiological resources while maintaining vagal regulation to preserve precision and composure. The observed autonomic profile aligns with the vagal tank theory, indicating that self-regulation capacity was maintained during competition. Lower post-match AA levels, an indicator of sympathetic-adrenal-medullary pathway activity, were associated with better performance, suggesting that effective anxiety management may enhance accuracy. Psychological skills training to manage competition-related stress may therefore improve performance in elite archery.

Transportation inevitable in modern beef industry disrupts physiological homeostasis and compromises cattle health. This study evaluated bovine appeasing pheromone (BAP) in alleviating transport-induced dysfunctions. Herein, 120 Simmental crossbred bulls (235 ± 5 kg) underwent a 1402-km transport trial with or without BAP treatment (5 mL topically). Data showed BAP decreased (p < 0.01) serum cortisol and haptoglobin levels on day 1 (D1) and D14 post-transport, with cortisol reduced by 32.99% and 47.09%, and haptoglobin by 51.67% and 53.48%, respectively. Concurrently, BAP lowered (p < 0.05) serum IL-1 (by 57.01%) and TNF-α (by 44.12%) on D1, reduced IL-1 (by 22.24%), IL-6 (by 15.18%), and TNF-α (by 23.29%) on D14, and increased (p < 0.01) IgG by 38.58% on D14. Consequently, BAP facilitated metabolic recovery, elevating (p < 0.01) serum glucose and insulin-like growth factor-1 from D14 to D35. Clinically, BAP reduced (p < 0.01) the incidence and duration of respiratory symptoms, increasing (p < 0.05) total feed intake. In summary, BAP protects beef cattle against transport stress-induced health impairment and growth decline by maintaining physiological homeostasis, offering a highly practical intervention to optimize animal welfare in the modern beef industry.

Objective. Adrenal insufficiency is predominantly managed by glucocorticoids, from which hydrocortisone is most frequently prescribed. However, limited data are available on prescription patterns among Indian healthcare professionals (HCPs). This study assessed the prescription practices of hydrocortisone among Indian HCPs and evaluated their awareness of tapering protocols and necessity for modified-release formulations of hydrocortisone. Methods. This online questionnaire-based survey involved 300 HCPs across India who prescribe oral hydrocortisone for various endocrinological and non-endocrinological indications. Google Forms were used and survey was carried out over a period of two months. Only fully accomplished responses were included in the analysis and the response rate was calculated. Results. The survey response rate was 84.27%. Among HCPs, 94.7% prescribed oral hydrocortisone with 47.5% using it often and 28.9% very often. Prescription frequency varied from 29.9% (prescribed once weekly) to 25.7% (two or more times weekly). Awareness of approved indications was high (96.8%). Tapering protocols were widely practiced (95.4%) often or very often by 82.7% HCPs. Hydrocortisone was mainly prescribed for primary adrenal insufficiency (77.5%), secondary adrenal insufficiency (63.0%), and congenital adrenal hyperplasia (55.6%). Frequent adverse events included hyperglycemia (43.3%) and weight gain (43.0%). Most HCPs (89.8%) felt need for sustained-release hydrocortisone, particularly for primary adrenal insufficiency (81.7%). Alternatives of hydrocortisone mainly included prednisolone (65.8%), prednisone (37.3%), and dexamethasone (21.8%). Conclusion. Indian HCPs frequently prescribe oral hydrocortisone and are well-versed in tapering protocols. However, frequent adverse events and unmet needs emphasize strong demand for modified-release formulations, particularly for management of adrenal insufficiency.

Endocrine systems are characterised by complex dynamic behaviours-oscillations, transient responses, feedback regulation, and noise filtering-that are essential to physiological stability. Despite extensive molecular and clinical research, the quantitative principles governing these dynamics remain incompletely understood. In particular, the mechanistic relationship between the metabolic clearance rates of individual hormones and emergent system-level properties such as oscillatory frequency, damping, and stability has not been systematically integrated into endocrine theory. This paper introduces a control-theoretic framework for systems endocrinology, modelling endocrine networks as cascades of second-order negative feedback systems whose parameters are derived directly from measurable clearance-rate values. Two transfer function architectures are defined-G-type (feed-forward) and H-type (feedback)-which encode a spectrum from rapid, responsive regulation to stable, noise-rejecting maintenance. Frequency-domain analysis via Bode plots extracts biologically interpretable metrics including cutoff frequency, bandwidth, phase margin, and stability margins. The framework is demonstrated using the cortisol-HPA axis as a worked example, where model-predicted timescales are shown to be consistent with experimentally observed ultradian pulsatility (~90-minute period), ACTH-stimulation response kinetics, and dexamethasone suppression dynamics. A reference table of clearance-rate-derived parameters for 36 hormones and substrates is provided, enabling immediate application across major endocrine axes. All computational tools are implemented in R and made freely available. By translating standard pharmacokinetic data into the language of control engineering, the framework provides a candidate, testable account of questions that static endocrine models leave qualitative: why cortisol pulsatility occurs on an approximately ultradian timescale, how stable the HPA axis is, and why the timing-not just the dose-of cortisol replacement determines clinical outcome.