Impact of Selected Endocrine Dysfunctions on Physical Performance and Sports Outcomes: A Literature Review
DOI:
https://doi.org/10.12775/QS.2026.53.69782Keywords
Endocrine Disorders, Exercise Capacity, Athletes, Muscle Function, Metabolism, Hypothyroidism, Hyperthyroidism, Adrenal Insufficiency, Addison’s Disease, Cushing’s Disease, Hypocortisolism, HypercortisolismAbstract
Hormonal regulation is essential for maintaining physiological homeostasis and enabling adaptation to physical stress, making the endocrine system a key factor influencing athletic performance and training responses. Hormones such as thyroid hormones, cortisol, testosterone, and growth hormone regulate metabolism, cardiovascular function, muscle performance, and recovery. Disruptions in endocrine function—resulting from gland disorders or training-related factors such as low energy availability—may impair exercise capacity and adaptation to training. This narrative review summarizes recent literature on the relationship between selected endocrine disorders and sports performance, focusing on thyroid dysfunction, cortisol-related disorders, and pituitary abnormalities. Evidence suggests that thyroid disorders can affect cardiovascular efficiency, neuromuscular performance, and metabolism, while adrenal dysfunction may impair stress responses and exercise tolerance. Hypercortisolism and Cushing syndrome are associated with reduced aerobic capacity, muscle weakness, and sarcopenia, whereas pituitary dysfunction, including that related to traumatic brain injury or relative energy deficiency in sport, can disrupt multiple hormonal axes and influence physical capacity. Overall, endocrine disorders may significantly affect physical performance and athlete health. Early detection, regular hormonal monitoring, and individualized medical and training strategies are essential to support safe training and optimize performance outcomes.
References
1. Mennitti, C., Farina, G., Imperatore, A., De Fonzo, G., Gentile, A., La Civita, E., Carbone, G., De Simone, R. R., Di Iorio, M. R., Tinto, N., Frisso, G., D'Argenio, V., Lombardo, B., Terracciano, D., Crescioli, C., & Scudiero, O. (2024). How Does Physical Activity Modulate Hormone Responses?. Biomolecules, 14(11), 1418. https://doi.org/10.3390/biom14111418
2. Kraemer, W. J., Ratamess, N. A., Hymer, W. C., Nindl, B. C., & Fragala, M. S. (2020). Growth Hormone(s), Testosterone, Insulin-Like Growth Factors, and Cortisol: Roles and Integration for Cellular Development and Growth With Exercise. Frontiers in endocrinology, 11, 33. https://doi.org/10.3389/fendo.2020.00033
3. Senefeld, J. W., & Hunter, S. K. (2024). Hormonal Basis of Biological Sex Differences in Human Athletic Performance. Endocrinology, 165(5), bqae036. https://doi.org/10.1210/endocr/bqae036
4. Cadegiani, F. A., da Silva, P. H. L., Abrao, T. C. P., & Kater, C. E. (2020). Diagnosis of Overtraining Syndrome: Results of the Endocrine and Metabolic Responses on Overtraining Syndrome Study: EROS-DIAGNOSIS. Journal of sports medicine (Hindawi Publishing Corporation), 2020, 3937819. https://doi.org/10.1155/2020/3937819
5. Cabre, H. E., Moore, S. R., Smith-Ryan, A. E., & Hackney, A. C. (2022). Relative Energy Deficiency in Sport (RED-S): Scientific, Clinical, and Practical Implications for the Female Athlete. Deutsche Zeitschrift fur Sportmedizin, 73(7), 225–234. https://doi.org/10.5960/dzsm.2022.546
6. Angelidi, A. M., Stefanakis, K., Chou, S. H., Valenzuela-Vallejo, L., Dipla, K., Boutari, C., Ntoskas, K., Tokmakidis, P., Kokkinos, A., Goulis, D. G., Papadaki, H. A., & Mantzoros, C. S. (2024). Relative Energy Deficiency in Sport (REDs): Endocrine Manifestations, Pathophysiology and Treatments. Endocrine reviews, 45(5), 676–708. https://doi.org/10.1210/endrev/bnae011
7. Ihalainen, J. K., Mikkonen, R. S., Ackerman, K. E., Heikura, I. A., Mjøsund, K., Valtonen, M., & Hackney, A. C. (2024). Beyond Menstrual Dysfunction: Does Altered Endocrine Function Caused by Problematic Low Energy Availability Impair Health and Sports Performance in Female Athletes?. Sports medicine (Auckland, N.Z.), 54(9), 2267–2289. https://doi.org/10.1007/s40279-024-02065-6
8. Nokoff, N. J., Senefeld, J., Krausz, C., Hunter, S., & Joyner, M. (2023). Sex Differences in Athletic Performance: Perspectives on Transgender Athletes. Exercise and sport sciences reviews, 51(3), 85–95. https://doi.org/10.1249/JES.0000000000000317
9. Hackney A. C. (2020). Hypogonadism in Exercising Males: Dysfunction or Adaptive-Regulatory Adjustment?. Frontiers in endocrinology, 11, 11. https://doi.org/10.3389/fendo.2020.00011
10. Polakowska, N., Skowron, P., Dyda, M., Kiselowska, I., & Skowron, K. (2025). Influence of levothyroxine supplementation on athletic performance in subclinical hypothyroidism - a review of the literature. Folia medica Cracoviensia, 65(2), 49–58. https://doi.org/10.24425/fmc.2025.156123
11. Mainenti, M. R., Vigário, P. S., Teixeira, P. F., Maia, M. D., Oliveira, F. P., & Vaisman, M. (2009). Effect of levothyroxine replacement on exercise performance in subclinical hypothyroidism. Journal of endocrinological investigation, 32(5), 470–473. https://doi.org/10.1007/BF03346488
12. Hanke, L., Poeten, P., Spanke, L., Britz, S., & Diel, P. (2023). The Influence of Levothyroxine on Body Composition and Physical Performance in Subclinical Hypothyroidism. Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme, 55(1), 51–58. https://doi.org/10.1055/a-1968-0106
13. Duñabeitia, I., González-Devesa, D., Varela-Martínez, S., Diz-Gómez, J. C., & Ayán-Pérez, C. (2023). Effect of physical exercise in people with hypothyroidism: systematic review and meta-analysis. Scandinavian journal of clinical and laboratory investigation, 83(8), 523–532. https://doi.org/10.1080/00365513.2023.2286651
14. Wu, K., Zhou, Y., Ke, S., Huang, J., Gao, X., Li, B., Lin, X., Liu, X., Liu, X., Ma, L., Wang, L., Wu, L., Wu, L., Xie, C., Xu, J., Wang, Y., & Liu, L. (2021). Lifestyle is associated with thyroid function in subclinical hypothyroidism: a cross-sectional study. BMC endocrine disorders, 21(1), 112. https://doi.org/10.1186/s12902-021-00772-z
15. Almas, S. P., Werneck, F. Z., Coelho, E. F., Teixeira, P. F. S., & Vaisman, M. (2023). Endurance training improves heart rate on-kinetics in women with subclinical hypothyroidism: a preliminary study. Journal of endocrinological investigation, 46(1), 51–57. https://doi.org/10.1007/s40618-022-01882-8
16. Almas, S. P., Werneck, F. Z., Coelho, E. F., Teixeira, P. F., & Vaisman, M. (2017). Heart rate kinetics during exercise in patients with subclinical hypothyroidism. Journal of applied physiology (Bethesda, Md. : 1985), 122(4), 893–898. https://doi.org/10.1152/japplphysiol.00094.2016
17. Schok, K., Jasek, J., Wiejak, K., Skoczylas, K., Mikulska, J., & Rokicki, S. (2023). The relationship between hypothyroidism and physical exercise: impact on exercise tolerance and health. Journal of Education, Health and Sport, 35(1), 160–172. https://doi.org/10.12775/JEHS.2023.35.01.012
18. Sundus, H., Khan, S. A., Zaidi, S., Chhabra, C., Ahmad, I., & Khan, H. (2025). Effect of long-term exercise-based interventions on thyroid function in hypothyroidism: A systematic review and meta-analysis of randomized controlled trials. Complementary therapies in medicine, 92, 103196. https://doi.org/10.1016/j.ctim.2025.103196
19. Ahmad, A. M., Serry, Z. H., Abd Elghaffar, H. A., Ghazi, H. A., & El Gayar, S. L. (2023). Effects of aerobic, resistance, and combined training on thyroid function and quality of life in hypothyroidism. A randomized controlled trial. Complementary therapies in clinical practice, 53, 101795. https://doi.org/10.1016/j.ctcp.2023.101795
20. Turova, E., Tenyaeva, E., Artikulova, I., & Badtieva, V. (2023). SUBCLINICAL HYPOTHYROIDISM IN ATHLETES: A RETROSPECTIVE ANALYSIS OF THE DATA FROM A COMPLETE MEDICAL EXAMINATION. Human. Sport. Medicine, 23(1), 132-139. https://doi.org/10.14529/hsm230118
21. Gierach, M., & Junik, R. (2023). Assessment of Metabolic Parameters in Female Triathletes with Hashimoto's Thyroiditis in Poland. Biomedicines, 11(3), 769. https://doi.org/10.3390/biomedicines11030769
22. Skrzypiec-Spring, M., Pokrywka, A., Szeląg, A., & Zembroń-Łacny, A. (2025). Autoimmune Thyroid Diseases and Physical Activity and Sports-More Unknowns than Facts. Biomedicines, 13(10), 2352. https://doi.org/10.3390/biomedicines13102352
23. Zhang, S. Y., Hu, X. Q., Xiang, C., Xiang, T., Guo, S. X., Zhi, F. H., Zhao, P., Zhu, J. Y., & Zhang, C. Y. (2024). Physical activity affects dysthyreosis by thyroid hormones sensitivity: a population-based study. Frontiers in endocrinology, 15, 1418766. https://doi.org/10.3389/fendo.2024.1418766
24. Lankhaar, J. A. C., Kemler, E., Hofstetter, H., Collard, D. C. M., Zelissen, P. M. J., Stubbe, J. H., & Backx, F. J. G. (2021). Physical activity, sports participation and exercise-related constraints in adult women with primary hypothyroidism treated with thyroid hormone replacement therapy. Journal of sports sciences, 39(21), 2493–2502. https://doi.org/10.1080/02640414.2021.1940696
25. Stuart, M., Rhumorbarbe, D., Kinahan, A., Gild, M. L., Clifton-Bligh, R., & Handelsman, D. (2025). Self-Reported Use of Thyroid Hormones by Athletes at the Olympic Games. Drug testing and analysis, 17(11), 2121–2126. https://doi.org/10.1002/dta.3923
26. Szlejf, C., Suemoto, C. K., Janovsky, C. C. P. S., Barreto, S. M., Diniz, M. F. H. S., Lotufo, P. A., & Bensenor, I. M. (2020). Thyroid Function and Sarcopenia: Results from the ELSA-Brasil Study. Journal of the American Geriatrics Society, 68(7), 1545–1553. https://doi.org/10.1111/jgs.16416
27. Baral, B., Parajuli, S. R., De Nieva, H. B., Wagle, L., & Pant, H. N. (2024). The Significance of Rhabdomyolysis Secondary to Hypothyroidism. Cureus, 16(9), e69715. https://doi.org/10.7759/cureus.69715
28. Boryushkina, V., Ahmed, S., Quadri, K., & Ramdass, A. (2019). Recurrent Rhabdomyolysis Induced by Severe Hypothyroidism. Cureus, 11(6), e4818. https://doi.org/10.7759/cureus.4818
29. Guerin, G., Gordon, R., Zumbro, E. L., Amuta, A., & Duplanty, A. (2021). Survey analysis of exercise participation and skeletal muscle symptoms in women with hypothyroidism. Women & health, 61(2), 160–170. https://doi.org/10.1080/03630242.2020.1831682
30. Wei, J., Hou, S., Hei, P., & Wang, G. (2024). Thyroid dysfunction and sarcopenia: a two-sample Mendelian randomization study. Frontiers in endocrinology, 15, 1378757. https://doi.org/10.3389/fendo.2024.1378757
31. Oliveira, T. S., Pereira-Rosa, A., Ferreira, M. D. S., Monteiro, V. R. S., de Brito, J., Gomes, H. R., Bagri, K. M., Pires, L. M. M., Taconi da Silva, J., Mermelstein, C., Guarnier, F. A., Ortiga-Carvalho, T. M., & Bloise, F. F. (2025). Thyroxine does not improve skeletal muscle regeneration after injury in aged mice. The Journal of endocrinology, 267(3), e250203. https://doi.org/10.1530/JOE-25-0203
32. Vaidya, A., Findling, J., & Bancos, I. (2025). Adrenal Insufficiency in Adults: A Review. JAMA, 334(8), 714–725. https://doi.org/10.1001/jama.2025.5485
33. Vollrath, S., Bitterlich, N., Lüdin, D., Rothenbühler, A., Hackney, A. C., Lorenzetti, S. R., Drewek, A., Achermann, B., du Toit, T., & Stute, P. (2025). Acute Adrenal Suppression Following Resistance Training in Elite Female Athletes: A Comprehensive Steroid Profile. Sports (Basel, Switzerland), 13(12), 426. https://doi.org/10.3390/sports13120426
34. Szivak, T. K., Schafer, E. A., MacDonald, H. V., & Saenz, C. (2025). Impact of Stress on Adrenal and Neuroendocrine Responses, Body Composition, and Physical Performance Amongst Women in Demanding Tactical Occupations: A Scoping Review. Metabolites, 15(8), 506. https://doi.org/10.3390/metabo15080506
35. Athanasiou, N., Bogdanis, G. C., & Mastorakos, G. (2023). Endocrine responses of the stress system to different types of exercise. Reviews in endocrine & metabolic disorders, 24(2), 251–266. https://doi.org/10.1007/s11154-022-09758-1
36. Simunkova, K., Jovanovic, N., Rostrup, E., Methlie, P., Øksnes, M., Nilsen, R. M., Hennø, H., Tilseth, M., Godang, K., Kovac, A., Løvås, K., & Husebye, E. S. (2016). Effect of a pre-exercise hydrocortisone dose on short-term physical performance in female patients with primary adrenal failure. European journal of endocrinology, 174(1), 97–105. https://doi.org/10.1530/EJE-15-0630
37. Bonnecaze, A. K., Reynolds, P., & Burns, C. A. (2019). Stress-Dosed Glucocorticoids and Mineralocorticoids Before Intensive Endurance Exercise in Primary Adrenal Insufficiency. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, 29(6), e73–e75. https://doi.org/10.1097/JSM.0000000000000540
38. Görar S, Alphan Üç Z, Kuş G, et al. Evaluation of exercise time and cardiac autonomic responses with an exercise stress test in primary adrenal insufficiency. Endocrinol Res Pract. 2024;28(1):37-42. https://doi.org/10.5152/erp.2024.23259
39. Ferrera, A., Di Gioia, G., Spinelli, A., Fiore, R., Zampaglione, D., Serdoz, A., & Squeo, M. R. (2025). Blood test findings in a large cohort of Olympic athletes: a cross-sectional study. Journal of science and medicine in sport, 28(12), 964–968. https://doi.org/10.1016/j.jsams.2025.07.002
40. Caplin, A., Chen, F. S., Beauchamp, M. R., & Puterman, E. (2021). The effects of exercise intensity on the cortisol response to a subsequent acute psychosocial stressor. Psychoneuroendocrinology, 131, 105336. https://doi.org/10.1016/j.psyneuen.2021.105336
41. Daly, W., & Hackney, A. C. (2005). IS EXERCISE CORTISOL RESPONSE OF ENDURANCE ATHLETES SIMILAR TO LEVELS OF CUSHING'S SYNDROME?. Biology of sport, 22(3), 209–214.
42. Roerink, S. H. P. P., Cocks, M. S., Wagenmakers, M. A. E. M., Rodighiero, R. P., Strauss, J. A., Shepherd, S. O., Plantinga, T. S., Thijssen, D. H. J., Hopman, M. T. E., Pereira, A. M., Smit, J. W., Wagenmakers, A. J. M., Netea-Maier, R. T., & Hermus, A. R. M. M. (2020). Decreased Aerobic Exercise Capacity After Long-Term Remission From Cushing Syndrome: Exploration of Mechanisms. The Journal of clinical endocrinology and metabolism, 105(4), e1408–e1418. https://doi.org/10.1210/clinem/dgz286
43. Martel-Duguech, L., Alonso-Jimenez, A., Bascuñana, H., Díaz-Manera, J., Llauger, J., Nuñez-Peralta, C., Montesinos, P., Webb, S. M., & Valassi, E. (2021). Prevalence of sarcopenia after remission of hypercortisolism and its impact on HRQoL. Clinical endocrinology, 95(5), 735–743. https://doi.org/10.1111/cen.14568
44. Assimakopoulou, A., Louvaris, Z., Balomenaki, M., Chynkiamis, N., Tzanela, M., Vogiatzis, I., & Tsagarakis, S. (2015). Functional muscle capacity and daily physical activity deficits in patients with endogenous Cushing's syndrome. Endocrine Abstracts, 37, EP79. https://doi.org/10.1530/endoabs.37.EP79
45. Vogel, Frederick & Braun, Leah & Rubinstein, German & Zopp, Stephanie & Künzel, Heike & Strasding, Finn & Albani, Adriana & Riester, Anna & Schmidmaier, Ralf & Bidlingmaier, Martin & Quinkler, Marcus & Deutschbein, Timo & Beuschlein, Felix & Reincke, Martin. (2020). Persisting Muscle Dysfunction in Cushing's Syndrome Despite Biochemical Remission. Journal of Clinical Endocrinology & Metabolism. 105. 10.1210/clinem/dgaa625. https://doi.org/10.1210/clinem/dgaa625
46. Reincke, M. (2021). Cushing Syndrome Associated Myopathy: It Is Time for a Change. Endocrinology and Metabolism, 36(3), 564–571. https://doi.org/10.3803/EnM.2021.1069
47. Zdrojowy-Wełna, A., Stachowska, B. & Bolanowski, M. Cushing’s disease and bone. Pituitary 27, 837–846 (2024). https://doi.org/10.1007/s11102-024-01427-7
48. Yılmaz, F., Babayeva, A., Yetkin, İ., & Boşnak-Güçlü, M. (2024). Comparison of exercise capacity and physical activity in patients with hyperthyroidism and controls. Journal of bodywork and movement therapies, 40, 1752–1760. https://doi.org/10.1016/j.jbmt.2024.10.029
49. Karmisholt, J., Carlé, A., & Andersen, S. (2021). Body Weight Changes in Hyperthyroidism: Timing and Possible Explanations during a One Year Repeated Measurement Study. European thyroid journal, 10(3), 208–214. https://doi.org/10.1159/000512078
50. Di Gioia, G., Squeo, M. R., Lemme, E., Maestrini, V., Monosilio, S., Ferrera, A., Buzzelli, L., Valente, D., & Pelliccia, A. (2024). Association between FT3 Levels and Exercise-Induced Cardiac Remodeling in Elite Athletes. Biomedicines, 12(7), 1530. https://doi.org/10.3390/biomedicines12071530
51. Hadley Diep, Mohamed K M Shakir, Glen A Cook, Thanh Duc Hoang, SAT-378 A Rare Case of Persistent Exercise-Induced Myopathy in a Patient with Treated Graves’ Disease, Journal of the Endocrine Society, Volume 9, Issue Supplement_1, October-November 2025, bvaf149.2295, https://doi.org/10.1210/jendso/bvaf149.2295
52. Ren, Y., Liu, Z., Wang, M., Wang, Y., & Wang, Y. (2025). Acute immunometabolic changes in first-presentation Graves' hyperthyroidism patients undergoing strenuous physical activity. Frontiers in endocrinology, 16, 1685496. https://doi.org/10.3389/fendo.2025.1685496
53. Brun, J.-F., Boegner, C., & Fédou, C. (2014). Hyperthyroidism in an athlete: At the borders of overtraining. Science & Sports. https://doi.org/10.1016/j.scispo.2014.01.002vBrun, J.-F., Boegner, C., & Fédou, C. (2014). Hyperthyroidism in an athlete: At the borders of overtraining. Science & Sports. https://doi.org/10.1016/j.scispo.2014.01.002
54. Cutovic, M., Konstantinovic, L., Stankovic, Z., & Vesovic-Potic, V. (2021). Structured exercise program improves functional capacity and delays relapse in euthyroid patients with Graves’ disease. Disability and Rehabilitation, 34(18), 1511–1518. https://doi.org/10.3109/09638288.2012.660599
55. Gilis‑Januszewska, A., Kluczyński, Ł., & Hubalewska‑Dydejczyk, A. (2020). Traumatic brain injuries induced pituitary dysfunction: A call for algorithms. Endocrine Connections, 9(5), R112–R123. https://doi.org/10.1530/EC‑20‑0117
56. Kara, C. S., & Karaca, Z. (2025). Pituitary dysfunction due to sports injuries. Best Practice & Research Clinical Endocrinology & Metabolism, 39(3), Article 101995. https://doi.org/10.1016/j.beem.2025.101995
57. Eggertsdóttir Claessen, L. Ó., Kristjánsdóttir, H., Jónsdóttir, M. K., Lund, S. H., Unnsteinsdóttir Kristensen, I., & Sigurjónsdóttir, H. Á. (2024). Pituitary dysfunction following mild traumatic brain injury in female athletes. Endocrine connections, 13(2), e230363. https://doi.org/10.1530/EC-23-0363
58. Skrzypiec-Spring, M., Kuliczkowska-Płaksej, J., Szeląg, A., & Bolanowski, M. (2024). Atypical thyroid tests in an athlete treated for hypothyroidism as the first symptom of pituitary dysfunction due to relative energy deficiency. Endocrinology, diabetes & metabolism case reports, 2024(4), 24-0066. https://doi.org/10.1530/EDM-24-0066
59.Sung, W.H., Chang, S.T., Teng, L.Y. et al. Evaluations of exercise intolerance with cardiopulmonary exercise tests in an 18-year-old adolescent with pituitary stalk interruption syndrome: a case report. BMC Endocr Disord 22, 82 (2022). https://doi.org/10.1186/s12902-022-00986-9
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Konrad Gawin, Wiktoria Zawiślak, Michał Cisowski, Maria Dąbrowska, Kacper Rychlica, Jolanta Cholewińska-Rychlica , Paulina Madura, Daria Mrozik-Gałecka
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 185
Number of citations: 0
