Prednisolone metasulphobenzoate foam retention enemas suppress the hypothalamo‐pituitary‐adrenal axis

Luman, W; Gray, R. S.; Pendek, R.; Palmer, K R

doi:10.1111/j.1365-2036.1994.tb00284.x

Cited by 19 publications

(4 citation statements)

References 7 publications

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“…For example, pharmacokinetic studies have demonstrated systemic bioavailability of 2–90% when hydrocortisone acetate foam is administered as an enema compared with an intravenous dose 58–61 . Although in most individuals the risk of systemic side effects is probably low, one study showed that 4 weeks of treatment with prednisolone enemas resulted in HPA axis suppression 62 . Furthermore, Cushing’s syndrome, 63 avascular necrosis of the knees 64 and acute adrenal insufficiency 65 are all reported in association with steroid enemas.…”

Section: Corticosteroids: When Which How Much and Howmentioning

confidence: 99%

Review article: appropriate use of corticosteroids in Crohn’s disease

Irving

Gearry

Sparrow

et al. 2007

Aliment Pharmacol Ther

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Summary Background Corticosteroids are a well‐established treatment for active Crohn’s disease and have been widely used for decades. It has become apparent, however, that a proportion of patients either fails to respond to corticosteroids or is unable to withdraw from them without relapsing. Furthermore, their use is associated with a range of side effects, such that long‐term treatment carries unacceptable risk. Aim To review the evidence regarding the appropriate use of corticosteroids in Crohn’s disease, along with their side effects, safety and alternatives. Methods To collect relevant articles, a PubMed search was performed from 1966 to November 2006 using the terms ‘steroid’, ‘corticosteroid’, ‘glucocorticoid’, ‘prednisolone’, ‘prednisone’, ‘methylprednislone’, ‘hydrocortisone’, ‘dexamethasone’ and ‘budesonide’ in combination with ‘Crohn(s) disease’. Relevant articles were reviewed, as were their reference lists to identify further articles. Results When used correctly, corticosteroids are a highly effective, well tolerated, cheap and generally safe treatment for active Crohn’ disease. Nevertheless, approximately 50% of recipients will either fail to respond (steroid‐resistant) or will be steroid dependent at 1 year. Newer alternatives to corticosteroids are not, however, without risk themselves and, moreover, are not necessarily available universally. Conclusions Steroids are used widely to treat Crohn’s disease, a situation that is unlikely to change in the near future. Accordingly, efforts should be made to ensure that they are used correctly and that their side effects are minimized. Reference is made to recently published guidelines and a simplified ‘users guide’ is presented.

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Section: Corticosteroids: When Which How Much and Howmentioning

confidence: 99%

Review article: appropriate use of corticosteroids in Crohn’s disease

Irving

Gearry

Sparrow

et al. 2007

Aliment Pharmacol Ther

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“…Although short term use is safe, systemic glucocorticoid absorption is possible 106. GI-AI has been described in users of prednisolone enemas 107. Rectal budesonide and beclometasone dipropionate may be safer than other glucocorticoids108109110111; however, most of the evidence is based on single serum cortisol measurements.…”

Section: Factors Affecting Likelihood Of Glucocorticoid Induced Adrenal Insufficiencymentioning

confidence: 99%

Glucocorticoid induced adrenal insufficiency

Prete

Bancos

2021

BMJ

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Synthetic glucocorticoids are widely used for their anti-inflammatory and immunosuppressive actions. A possible unwanted effect of glucocorticoid treatment is suppression of the hypothalamic-pituitary-adrenal axis, which can lead to adrenal insufficiency. Factors affecting the risk of glucocorticoid induced adrenal insufficiency (GI-AI) include the duration of glucocorticoid therapy, mode of administration, glucocorticoid dose and potency, concomitant drugs that interfere with glucocorticoid metabolism, and individual susceptibility. Patients with exogenous glucocorticoid use may develop features of Cushing’s syndrome and, subsequently, glucocorticoid withdrawal syndrome when the treatment is tapered down. Symptoms of glucocorticoid withdrawal can overlap with those of the underlying disorder, as well as of GI-AI. A careful approach to the glucocorticoid taper and appropriate patient counseling are needed to assure a successful taper. Glucocorticoid therapy should not be completely stopped until recovery of adrenal function is achieved. In this review, we discuss the factors affecting the risk of GI-AI, propose a regimen for the glucocorticoid taper, and make suggestions for assessment of adrenal function recovery. We also describe current gaps in the management of patients with GI-AI and make suggestions for an approach to the glucocorticoid withdrawal syndrome, chronic management of glucocorticoid therapy, and education on GI-AI for patients and providers.

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“…The risk of GIAI is dose-and duration-dependent in patients taking oral budesonide, being higher when patients take more than 6 mg daily for at least 8 weeks. 64 GIAI has been reported in patients using prednisolone enemas, 65 whereas beclomethasone dipropionate enemas seem to be safer. 66…”

Section: Unrecognized Sources Of Exogenous Glucocorticoidsmentioning

confidence: 99%

Glucocorticoid-induced adrenal insufficiency and glucocorticoid withdrawal syndrome: Two sides of the same coin

Nachawi,

Li,

Lansang

2024

CCJM

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Diseases of the adrenal glands can lead to primary adrenal insuffi ciency, and suppression of the hypothalamic-pituitary-adrenal axis can cause secondary adrenal insuffi ciency (adrenal suppression). The most common cause of adrenal suppression is exogenous steroids, a condition recently termed glucocorticoid-induced adrenal insuffi ciency (GIAI). Similarly, weaning from high doses of glucocorticoids or giving insuffi cient glucocorticoid replacement after curative surgery for endogenous hypercortisolism (Cushing syndrome) can lead to glucocorticoid withdrawal syndrome, which overlaps with GIAI. KEY POINTSGIAI is common in patients treated with glucocorticoids. GIAI may go unrecognized when caused by non-oral formulations of glucocorticoids: intra-articular, epidural, inhaled, and even topical.

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Prednisolone metasulphobenzoate foam retention enemas suppress the hypothalamo‐pituitary‐adrenal axis

Cited by 19 publications

References 7 publications

Review article: appropriate use of corticosteroids in Crohn’s disease

Review article: appropriate use of corticosteroids in Crohn’s disease

Glucocorticoid induced adrenal insufficiency

Glucocorticoid-induced adrenal insufficiency and glucocorticoid withdrawal syndrome: Two sides of the same coin

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