Adrenal suppression

Daily oral doses are generally given before 9 00 am to minimize adrenal suppression and to coincide with normal adrenal function. However, alternate-day therapy may be prescribed for patients receiving long-term therapy (see below). Fludrocortisone is given orally and is well tolerated in the GI tract. 

Hydrocortisone 100 mg IV q8h or 50 mg IV q6h until adrenal suppression is excluded. Also blocks peripheral conversion of T — T... 

Systemic adverse effects are dose-dependent and are rare at low to medium doses however, high-dose inhaled corticosteroids have been associated with adrenal suppression, decreased bone mineral density, skin thinning, and easy bruising.3,29 Growth suppression in children may occur even with low-dose inhaled corticosteroids however, suppression appears to occur primarily in the first year of treatment and may be due to delayed growth with the potential of future catch-up growth.30... 

Although the optimal duration of systemic corticosteroids is unknown, therapy should be continued until PEF is greater than or equal to 80% of predicted or personal best. According to the NAEPP, the usual regimen is to continue frequent multiple doses until the patient s FEVi or PEF improves to 50% of predicted and then decrease the frequency to twice daily. In general, the duration of therapy ranges from 3 days for mild exacerbations to 14 days for severe exacerbations. It is not necessary to taper the systemic steroid dose in patients receiving short bursts of systemic corticosteroid therapy, as the adrenal suppression that occurs is transient and rapidly reversible.18... 

Adrenal suppression + Taper doses slowly administer every... 

Glucocorticoids Adrenal suppression, salt retention, diabetes,... 

Glucocorticoid therapy with IV hydrocortisone 100 mg every 8 hours should be given until coexisting adrenal suppression is ruled out. 

Side effects of inhaled corticosteroids are relatively mild and include hoarseness, sore throat, oral candidiasis, and skin bruising. Severe side effects such as adrenal suppression, osteoporosis, and cataract formation are reported less frequently than with systemic corticosteroids, but clinicians should monitor patients receiving high-dose chronic inhaled therapy. 

Miscellaneous Intra-arterial injection —> crystallization Fit threshold Toxic in children (metabolic acidosis and bradycardia) Salivation dissociative anaesthesia Adrenal suppression... 

The exogenous administration of glucocorticoids can result in hypothalamic-pituitary-adrenal axis (HPA) suppression, which may subsequently lead to adrenal atrophy The degree of adrenal suppression is dependent on the dosage, duration, frequency, time, and route of administration of the specific glucocorticoids. At least one patient who received prednisone for neurological symptoms developed Cushing s syndrome. ... 

Long-term use of oral corticosteroids may result in side-effects, such as peptic ulceration, adrenal suppression and subcapsular cataracts. 

Giving exogenous corticosteroids suppresses ACTH secretion which results in adrenal gland atrophy. Therefore glucocorticosteroid doses should be tapered off to allow the patient to adjust and prevent symptoms of adrenal insufficiency. For the short acting glucocorticosteroids an alternate day regimen should be considered to lower the risks for adrenal suppression. 

IV.a.1.9. Adrenal suppression. It results from inhibition of pituitary ACTH secretion, and some suppression of the normal adrenal response to stress may persist for years after stopping therapy. Rapid withdrawal of corticosteroid therapy can therefore precipitate dangerous acute adrenal insufficiency ( Addisonian crisis , with hypotension, vomiting, coma and ultimately death), and for this reason steroid treatment should always be reduced gradually, sometimes over many months, according to the dose and duration of therapy. 

Overdosage can occur from topically applied clobetasol propionate absorbed in sufficient amounts to produce systemic effects producing reversible adrenal suppression, manifestations of Cushi ng s syndrome, hyperglycemia, and glucosuria in some patients. 

Allergic contact dermatitis, adrenal suppression, atrophy, striae, miliaria, photosensitivity... 

When taken in excessive quantities, systemic hypercorticism and adrenal suppression may occur,... 

Inhibition of adrenocortical synthetic function. Etomidate inhibits the activity of ll-p-hydroxylase, an enzyme necessary for the synthesis of cortisol, aldosterone, 17-hydroxyprogesterone, and corticosterone. Even after a single dose, adrenal suppression persists for 5-8 hours. Although the clinical significance of short-term suppression of cortisol synthesis is unknown, maintenance infusions for anaesthesia cannot be recommended. 

Urgent treatment is often begun with an oral dose of 30-60 mg prednisone per day or an intravenous dose of 1 mg/kg methylprednisolone every 6 hours the daily dose is decreased after airway obstruction has improved. In most patients, systemic corticosteroid therapy can be discontinued in a week or 10 days, but in other patients symptoms may worsen as the dose is decreased to lower levels. Because adrenal suppression by corticosteroids is related to dose and because secretion of endogenous corticosteroids has a diurnal variation, it is customary to administer corticosteroids early in the morning after endogenous ACTH secretion has peaked. For prevention of nocturnal asthma, however, oral or inhaled corticosteroids are most effective when given in the late afternoon. 

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