A comparative study of the effects of intranasal triamcinolone acetonide aerosol (ITAA) and prednisone on adrenocortical function

Feiss, Gary; Morris, Richard J.; Rom, Dror; Mansfield, Lyndon E.; Dockhorn, Robert J.; Elliss, Elliot; Smith, Joseph A.; Tobey, Raymond E.

doi:10.1016/0091-6749(92)90299-h

Cited by 26 publications

(5 citation statements)

References 16 publications

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“…No meaningful changes of morning serum cortisol levels were recorded in 93 patients with allergic rhinitis taking TA (110, 220, and 440 μg/day) for more than 1 year ( 237). The lack of effects on the HPAA by TA was further confirmed in three medium‐term studies on adult patients ( 238–240). In a recent crossover controlled study ( 241), 5‐day courses of BUD, MF, and TA at clinically recommended doses did not affect the HPAA, bone metabolism, or blood white cells.…”

Section: Nasal Corticosteroidsmentioning

confidence: 69%

Inhaled and nasal corticosteroids: safety aspects*

Passalacqua¹,

Albano²,

Canonica³

et al. 2000

Allergy

101

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Section: Nasal Corticosteroidsmentioning

confidence: 69%

Inhaled and nasal corticosteroids: safety aspects*

Passalacqua¹,

Albano²,

Canonica³

et al. 2000

Allergy

101

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“…Furthermore, no major changes in morning cortisol levels have been reported in 93 patients with AR, treated with different dosages (110, 220, 440 g/day) for more than 1 year [47] . The safety of this drug in patients with AR was further confirmed in two medium-term studies in adult patients [48,49] . In adults, there is no significant additive adrenal suppression with 220 g inhaled TAA once daily in patients with asthma already receiving inhaled TAA therapy (800 g twice daily), but the adrenal suppression was already induced by the asthma treatment [50] .…”

Section: Budesonidementioning

confidence: 76%

Intranasal Corticosteroids and Adrenal Suppression

Bruni¹,

Luca²,

Venturoli³

et al. 2009

Neuroimmunomodulation

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Allergic rhinitis is a common condition that frequently coexists with asthma and atopic dermatitis. It is commonly treated with intranasal corticosteroids which may increase the potential inception of side effects of the same type of drugs used for the treatment of other allergic diseases. A method to assess the systemic effect of corticosteroids is the evaluation of their effect on the hypothalamic-pituitary-adrenal (HPA) axis. However, it is not clear which test is best for detection of clinically relevant HPA axis suppression in children Morning plasma cortisol levels are twice that of late afternoon and evening values and a delay in the time of onset in peak cortisol levels has been observed in children treated with inhaled corticosteroids. Single morning cortisol level has a low sensitivity for detecting adrenal insufficiency in children. 24-Hour plasma cortisol is a good test because it is a non-invasive measure of the biologically active free cortisol levels for the entire day. For research purposes, the 24-hour integrated concentration plasma cortisol test is preferred. Studies that have looked at HPA axis suppression with intranasal corticosteroids indicate that overall, intranasal corticosteroids have a minimal effect on the HPA axis. A review of the literature reveals one study in which there was a decreased output of urinary cortisol during treatment with either budesonide or fluticasone propionate in adults. Other studies with fluticasone propionate or budesonide have shown no effect on the HPA axis in children. Beclomethasone dipropionate was shown to affect urinary cortisol output in one study on healthy volunteers. However, in a long-term study in children, no effect on the HPA axis was found. Mometasone furoate has been extensively studied in more than 20 trials of adults and children. No effects on the HPA axis were detected in either children or adults. Fluticasone furoate nasal spray was not associated with HPA axis suppression. It is unlikely that children are more sensitive to corticosteroids than adults. There is no reason to perform routine monitoring of adrenal function in children who are treated with intranasal corticosteroid unless those drugs are used concomitantly with inhaled corticosteroids and/or steroid ointments for the possible concomitant presence of asthma and/or atopic dermatitis.

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“…A summary of these groups is presented in Table 1 , while a condensed version of the data extraction table can be seen in Supplementary File 3 . There were thirteen RCTs [19] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] with random allocation and blinding maintained throughout; the remaining 60 studies were classified as observational studies [12] , [13] , [14] , [15] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] …”

Section: Resultsmentioning

confidence: 99%

Systemic glucocorticoid therapy and adrenal insufficiency in adults: A systematic review

Joseph

Hunter

Ray

et al. 2016

Seminars in Arthritis and Rheumatism

147

119

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ObjectivesThe aim of this systematic literature review was to summarize the current knowledge regarding the prevalence of, time to recovery from, and influence of glucocorticoid dose and duration on glucocorticoid-induced adrenal insufficiency (AI).MethodsEligible studies were original research articles, which included adult patients with an indication for glucocorticoids and measured adrenal function following exposure to systemic glucocorticoids. Searches were performed in Web of Science and MEDLINE, with further articles identified from reference lists. Screening was performed in duplicate. Data were extracted for each group of glucocorticoid-exposed patients within eligible studies. The reported proportion of patients with AI was summarized as median and inter-quartile range. Results were then stratified by daily dose, cumulative dose, duration of exposure and time since last glucocorticoid use. The risk of bias within and across studies was considered: for randomised controlled trials risk of bias was assessed using the tool developed by the Cochrane Collaboration.ResultsOverall, 73 eligible studies were identified out of 673 screened. The percentage of patients with AI ranged from 0% to 100% with a median (IQR) = 37.4% (13–63%). Studies were small—median (IQR) group size 16 (9–38)—and heterogeneous in methodology. AI persisted in 15% of patients retested 3 years after glucocorticoid withdrawal. Results remained widely distributed following stratification. AI was demonstrated at <5 mg prednisolone equivalent dose/day, <4 weeks of exposure, cumulative dose <0.5 g, and following tapered withdrawal.ConclusionsThe heterogeneity of studies and variability in results make it difficult to answer the research questions with confidence based on the current literature. There is evidence of AI following low doses and short durations of glucocorticoids. Hence, clinicians should be vigilant for adrenal insufficiency at all degrees of glucocorticoid exposure.

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A comparative study of the effects of intranasal triamcinolone acetonide aerosol (ITAA) and prednisone on adrenocortical function

Cited by 26 publications

References 16 publications

Inhaled and nasal corticosteroids: safety aspects*

Inhaled and nasal corticosteroids: safety aspects*

Intranasal Corticosteroids and Adrenal Suppression

Systemic glucocorticoid therapy and adrenal insufficiency in adults: A systematic review

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