Adrenal suppression betamethasone

A study in 10 women has been conducted to determine whether betamethasone administered at risk of preterm delivery causes adrenal suppression (375). After adrenal stimulation with corticotropin 1 microgram at 24-25 weeks, each woman received two intramuscular doses of betamethasone 12 mg 24 hours apart 1 week later, another... 

The effect of prolonged antenatal betamethasone (three or more weekly administrations) has been studied in 414 fetuses (387). Multidose betamethasone was not associated with higher risks of antenatal maternal fever, chorioamnionitis, reduced birthweight, neonatal adrenal suppression, neonatal sepsis, or neonatal death. 

As far as the child is concerned, there may be only moderate adrenal suppression (392), although in some cases substitution treatment with glucocorticoids can be necessary in such babies short-term treatment with betamethasone shortly before birth generally does not inhibit the infant s adrenal capacity to react to corticotropin (393). A single case of a leukemoid reaction in a preterm infant has been observed, after the mother was given betamethasone shortly before delivery (SEDA-3, 306). 

Helal KJ, Gordon MC, Lightner CR, Barth WH Jr. Adrenal suppression induced by betamethasone in women at risk for premature delivery. Obstet Gynecol 2000 96(2) 287-90. 

Intralesional injection of steroid can lead to adrenal suppression. Infents and small children are especially susceptible, because a given amoimt of steroid is distributed in a smaller volume of fluid and tissue compartments. Infents injected with mixtiu es of triamcinolone acetonide and betamethasone or dexamethasone fiar periocular hemangiomas exhibited depressed serum cortisol and adrenocorticotropic hormone levels. The adrenal suppression can last up to 5 months and can result in weight loss and growth retardation. It is not known whether other corticosteroid preparations would produce similar effects or which other fectors might influence these results. In general, topical and periocular use of steroids produces minimal systemic effects. Withdrawal of topical or periocular steroids does not generally cause adrenal crisis. 

The percutaneous absorption of high-potency topical glucocorticoids has been documented, but hypothalamic-pituitary-adrenal axis suppression, leading to clinically significant adrenal insufficiency or Cushing s syndrome, is infrequent. Two patients developed adrenal suppression after the unregulated use of betamethasone dipropionate 0.05% ointment (about 80 g/week) or clobetasol 0.05% ointment (up to 100 g/week), obtained without prescription to treat psoriasis (362). 

All absorbable corticoids possess the ability to produce adrenal suppression [11, 76]. The degree of suppression is related to potency. Comparative quantitative studies employ the Food and Drug Association s (FDA) diseased-skin protocol. As little as 14 g per week of clobetasol has induced suppression. Optimized betamethasone diproprionate is somewhat less suppressive, requiring over 49 g per week to significantly reduce plasma cortisol. Incomplete data with difluorosone suggests that it may be less suppressive. Fortunately, plasma cortisol usually returns to normal within 3 days when the superpotents are discontinued, at least in short-time application studies. 

Betamethasone, as with all steroids, is used to suppress inflammatory reactions. It can be used topically or systemically. Indications for its use include eczema, asthma and congenital adrenal hyperplasia. It is contraindicated in ocular herpes simplex and in the red eye syndrome since it may clear the symptoms while not addressing the infective component of the underlying condition. 

Two further communications [31,32] reported that prednisolone stearoylglycollate, in substantial doses, was the least potent anti-inflammatory steroid (among the representative series studied) with respect to pituitary-adrenal inhibition. The order of increasing suppressive potency in this test was prednisolone stearoylglycollate, prednisolone, triamcinolone, dexamethasone, betamethasone. Techniques used in the comparative evaluations included the metyrapone test and gas-liquid chromatography. 

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