Adrenocortical suppression

The well-appreciated adverse effects of glucocorticoids include hyperglycemia, hypertension, osteoporosis, fluid retention and electrolyte disturbances, myopathies, psychosis, and reduced resistance to infection. In addition, glucocorticoid use may cause adrenocortical suppression. Specific regimens for withdrawal of glucocorticoid therapy have been suggested. 

Etomidate causes a high incidence of pain on injection, myoclonic activity, and postoperative nausea and vomiting. The involuntary muscle movements are not associated with electroencephalographic epileptiform activity. Etomidate may also cause adrenocortical suppression via inhibitory effects on steroidogenesis, with decreased plasma levels of cortisol after a single dose. Prolonged infusion of etomidate in critically ill patients may result in hypotension, electrolyte imbalance, and oliguria because of its adrenal suppressive effects. 

Hassanyeh F, Murray RB, Rodgers H. Adrenocortical suppression presenting with agitated depression, morbid jealousy, and a dementia-like state. Br J Psychiatry 1991 159 870-2. 

Newton RW, Browning MC, Iqbal J, Piercy N, Adamson DG. Adrenocortical suppression in workers manufacturing synthetic glucocorticoids. BMJ 1978 l(6105) 73 l. 

Shohat M, Mimouni M, Shuper A, Varsano I. Adrenocortical suppression by topical application of glucocorticoids in infants with seborrheic dermatitis. Clin Pediatr (Philo). 1986 25 209-212. 

Types of Hormones Adrenocorticosteroids Prednisone Prednisolone Others Primary Antineoplastic Indications(s) Acute lymphoblastic leukemia chronic lymphocytic leukemia Hodgkin disease Common Adverse Effects Adrenocortical suppression general catabolic effect on supporting tissues [see Chapter 29]... 

Dexamethasone and betamethasone are similar, powerful predominantly anti-inflammatory steroids. They are longer-acting than prednisolone and are used for therapeuhc adrenocortical suppression. 

For hypothalamic/pituitary/adrenocortical suppression, e.g. in adrenal hyperplasia, prednisolone or dexamethasortc. 

British Medical Journal 316 244-245 Newton R W et al 1978 Adrenocortical suppression in workers manufacturing synthetic glucocorticoids. British Medical Journal 1 73... 

The major advantage of measurements on blood is that direct extraction without prior hydrolysis of conjugates is all that is usually needed, and that collection of the sample is rapid and volumetrically reliable. The latter is of importance, but not essential, in allowing the rapid performance of adrenocortical suppression and stimulation tests which are now needed in the differential diagnosis of virilism in women. 

Adrenocortical suppressants Mitotane (o,p -DDD) Adrenal cortex cancer... 

Corticosteroids are more effective than NSAIDs in controlling acute severe flare-ups of joint inflammation. However, the severe toxicities of corticosteroids (adrenocortical suppression, weight gain, buffalo hump, striae, osteoporosis, diabetes, peptic ulcers, cataracts, glaucoma, and psychoses) preclude their use for chronic therapy in most patients. 

The rate of absorption is influenced by the status of the skin, chemical structure of the steroid and such other factors as formulation and formulation vehicle. Topical corticoids applied to diseased skin will be absorbed to some degree into the systemic circulation. When administration is chronic or when large areas of skin are involved, the absorption may be sufficient to cause systemic effects including cushinoid changes and adrenocortical suppression. 

Carr RD, Tarnowski WM (1968) Percutaneous absorption of corticosteroids adrenocortical suppression with total body inunction. Acta Derm Venereol 48 417-428... 

Side effects of topical administration of steroids have been reviewed recently (124 ). Further cases with Cushing s syndrome secondary to topical steroid therapy have been reported (131 ). It was shown that treatment with less than 50 g of clobetasol propionate ointment per week has no suppressive effect on the adrenal cortex. When more than SO g of ointment per week was used, a significant number of patients owed adrenocortical suppression (4 ). 

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