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Adrenal Suppression

The Experts below are selected from a list of 297 Experts worldwide ranked by ideXlab platform

M I Mulford – 1st expert on this subject based on the ideXlab platform

  • Super potent topical corticosteroid use associated with Adrenal Suppression: clinical considerations.
    Journal of the American Academy of Dermatology, 1998
    Co-Authors: E O Gilbertson, M C Spellman, D J Piacquadio, M I Mulford

    Abstract:

    The potential for a variety of local and systemic side effects from the use of potent topical corticosteroids has long been recognized. However, Adrenal Suppression has only rarely been documented. We describe two patients with profound hypothalamic-pituitary-Adrenal axis Suppression resulting from the unregulated use of super potent topical corticosteroids.

  • super potent topical corticosteroid use associated with Adrenal Suppression clinical considerations
    Journal of The American Academy of Dermatology, 1998
    Co-Authors: E O Gilbertson, M C Spellman, D J Piacquadio, M I Mulford

    Abstract:

    Abstract The potential for a variety of local and systemic side effects from the use of potent topical corticosteroids has long been recognized. However, Adrenal Suppression has only rarely been documented. We describe two patients with profound hypothalamic-pituitary-Adrenal axis Suppression resulting from the unregulated use of super potent topical corticosteroids. (J Am Acad Dermatol 1998;38:318-21.)

  • Super potent topical corticosteroid use associated with Adrenal Suppression: Clinical considerations ☆ ☆☆ ★
    Journal of The American Academy of Dermatology, 1998
    Co-Authors: E O Gilbertson, M C Spellman, D J Piacquadio, M I Mulford

    Abstract:

    Abstract The potential for a variety of local and systemic side effects from the use of potent topical corticosteroids has long been recognized. However, Adrenal Suppression has only rarely been documented. We describe two patients with profound hypothalamic-pituitary-Adrenal axis Suppression resulting from the unregulated use of super potent topical corticosteroids. (J Am Acad Dermatol 1998;38:318-21.)

Brian J. Lipworth – 2nd expert on this subject based on the ideXlab platform

  • Adrenal Suppression with dry powder formulations of fluticasone propionate and mometasone furoate
    American Journal of Respiratory and Critical Care Medicine, 2004
    Co-Authors: Thomas C Fardon, Lesley C. Mcfarlane, K Haggart, Brian J. Lipworth

    Abstract:

    Mometasone furoate (MF) and fluticasone propionate (FP) are high potency inhaled corticosteroids. The systemic bioavailability of MF is claimed to be negligible, leading to a minimal potential for systemic adverse effects. We assessed the overnight urinary cortisol/creatinine as the primary outcome of Adrenal Suppression in 21 patients with persistent asthma (mean FEV1 = 91%). Patients were randomized in a crossover fashion to receive 2 weekly consecutive doubling incremental doses of either FP Accuhaler (500, 1,000, and 2,000 μg/day) or MF Twisthaler (400, 800, and 1,600 μg/day). For the 21 per protocol completed patients, there was significant Suppression of overnight urinary cortisol/creatinine with high and medium doses of both drugs—as geometric mean fold Suppression (95% confidence interval) from baseline: FP 2,000 μg, 1.85 (1.21–2.82, p = 0.002); FP 1,000 μg, 1.45 (1.07–1.96, p = 0.02); MF 1,600 μg, 1.92 (1.26–2.93, p = 0.001); and MF 800 μg, 1.39 (1.04–1.88, p = 0.02). For secondary outcomes of 8:…

  • Adrenal Suppression with high doses of inhaled fluticasone propionate and triamcinolone acetonide in healthy volunteers.
    European Journal of Clinical Pharmacology, 1997
    Co-Authors: Andrew M. Wilson, D. J. Clark, Lesley C. Mcfarlane, Brian J. Lipworth

    Abstract:

    Study objective: This study was conducted to compare the Adrenal Suppression of inhaled fluticasone propionate and triamcinolone acetonide in healthy volunteers, both given via their respective pressurised metered dose inhaler (pMDI) devices at high doses within the manufacturers recommended dose range.

  • comparative Adrenal Suppression with inhaled budesonide and fluticasone propionate in adult asthmatic patients
    Thorax, 1996
    Co-Authors: D. J. Clark, Alison Grove, Robert I Cargill, Brian J. Lipworth

    Abstract:

    BACKGROUND: A study was performed to compare the Adrenal Suppression caused by inhaled fluticasone propionate and budesonide on a microgram equivalent basis, each given by metered dose inhaler to asthmatic patients. METHODS: Twelve asthmatic patients of mean age 29.9 years, with a forced expiratory volume in one second (FEV1) 92.9% predicted and forced expiratory flow 25-75% (FEF25-75) 69.5% predicted, on less than or equal to 400 micrograms/day inhaled corticosteroid, were studied in a double blind placebo controlled crossover design comparing single doses of inhaled budesonide 400, 1000, 1600, 2000 micrograms and fluticasone propionate 500, 1000, 1500, 2000 micrograms. Doses were administered at 22.00 hours by metered dose inhaler with mouth rinsing and measurements were made in the laboratory 10 hours later. RESULTS: Serum cortisol levels compared with placebo (mean 325.2 nmol/l) were suppressed by fluticasone at doses of 1500 micrograms (211.6 nmol/l) and 2000 micrograms (112.3 nmol/l) and by budesonide at 2000 micrograms (243.4 nmol/l). Fluticasone propionate 2000 micrograms produced lower absolute serum cortisol levels than budesonide 2000 micrograms (95% CI for difference 42.9 to 219.2). The dose ratio (geometric mean) for the relative potency was 2.89 fold (95% CI 1.19 to 7.07). In terms of percentage Suppression versus placebo, fluticasone propionate also produced greater effects (means and 95% CI for difference): budesonide 1600 micrograms (16.0) versus fluticasone propionate 1500 micrograms (40.9) (95% CI -0.6 to 50.6), budesonide 2000 micrograms (26.0) versus fluticasone 2000 micrograms (65.2) (95% CI 10.5 to 67.8). Individual serum cortisol levels at the two highest doses showed 15 of 24 patients below the normal limit of the reference range (150 nmol/l) for fluticasone and five of 24 for budesonide. Fluticasone propionate also caused greater ACTH Suppression than budesonide (as % versus placebo): budesonide 1600 micrograms (12.0) versus fluticasone propionate 1500 micrograms (31.9) (95% CI 7.6 to 32.1), budesonide 2000 micrograms (13.5) versus fluticasone propionate 2000 micrograms (44.4) (95% CI 13.2 to 48.7). For overnight 10 hour urinary cortisol (nmol/10 hours) there was a difference between the lowest doses of the two drugs: budesonide 400 micrograms (37.2) versus fluticasone propionate 500 micrograms (19.9) (95% CI 6.9 to 27.8). CONCLUSIONS: Like budesonide the systemic bioactivity of fluticasone propionate is mainly due to lung vascular absorption. Fluticasone propionate exhibited at least twofold greater Adrenal Suppression than budesonide on a microgram equivalent basis in asthmatic patients.

Dennis Carson – 3rd expert on this subject based on the ideXlab platform

  • monitoring growth in asthmatic children treated with high dose inhaled glucocorticoids does not predict Adrenal Suppression
    Archives of Disease in Childhood, 2004
    Co-Authors: Kathryn Anne Dunlop, Dennis Carson, J Mcnaboe, H J Steen, Vincent Mcgovern, Michael D Shields

    Abstract:

    Aims: To determine whether routine outpatient monitoring of growth predicts Adrenal Suppression in prepubertal children treated with high dose inhaled glucocorticoid. Methods: Observational study of 35 prepubertal children (aged 4–10 years) treated with at least 1000 μg/day of inhaled budesonide or equivalent potency glucocorticoid for at least six months. Main outcome measures were: changes in HtSDS over 6 and 12 month periods preceding Adrenal function testing, and increment and peak cortisol after stimulation by low dose tetracosactrin test. Adrenal Suppression was defined as a peak cortisol ⩽500 nmol/l. Results: The areas under the receiver operator characteristic curves for a decrease in HtSDS as a predictor of Adrenal insufficiency 6 and 12 months prior to Adrenal testing were 0.50 (SE 0.10) and 0.59 (SE 0.10). Prediction values of an HtSDS change of −0.5 for Adrenal insufficiency at 12 months prior to testing were: sensitivity 13%, specificity 95%, and positive likelihood ratio of 2.4. Peak cortisol reached correlated poorly with change in HtSDS (ρ = 0.23, p = 0.19 at 6 months; ρ = 0.33, p = 0.06 at 12 months). Conclusions: Monitoring growth does not enable prediction of which children treated with high dose inhaled glucocorticoids are at risk of potentially serious Adrenal Suppression. Both growth and Adrenal function should be monitored in patients on high dose inhaled glucocorticoids. Further research is required to determine the optimal frequency of monitoring Adrenal function.

  • growth and Adrenal Suppression in asthmatic children treated with high dose fluticasone propionate
    The Lancet, 1996
    Co-Authors: G Todd, K Dunlop, J Mcnaboe, M F Ryan, Dennis Carson

    Abstract:

    Summary Background Fluticasone propionate was introduced in 1993 in the UK as a potentially safer inhaled corticosteroid than those already in use. The efficacy and safety of fluticasone has been established at recommended doses of 200μg/day, but not at the higher doses that are often used. Methods Growth retardation was observed in six severely asthmatic children after introduction of high-dose fluticasone propionate treatment (dry powder). Assessment of cortisol response was by insulin-induced hypoglycaemia in three cases, by short tetracosactrin test in two, and by low-dose tetracosactrin and 24-hour urinary cortisol/ creatinine ratio in one. Findings Six children with growth retardation noted after treatment with high-dose fluticasone propionate were found to have Adrenal Suppression. In one case the growth rate and cortisol response returned to normal 9 months after the fluticasone dose was reduced to 500μg/day. Interpretation When high doses of fluticasone propionate are used, growth may be retarded and Adrenal Suppression may occur.