Recovery of Adrenocortical Function during Long-term Treatment with Corticosteroids

Westerhof, L.; Ditmars, M. J. van; Kinderen, P. J. der; Thijssen, J. H. H.; Schwarz, Franz

doi:10.1136/bmj.4.5734.534

Cited by 20 publications

(4 citation statements)

References 16 publications

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“…In another patient we had a similar, though less alarming, reaction to depot injections with swellings at the site of every previous depot injection. ' CONCLUSIONS Our studies have confirmed previous suggestions (Nelson et al, 1968;el-Shaboury, 1968;Galvao-Teles, Burke, and Russell Fraser, 1971;Westerhof et al, 1972) that the use of depot tetracosactrin injections, albeit for a prolonged time, is usually successful in reactivation of the adrenal glands and in providing more satisfactory control of asthma in those whose condition was severe enough to warrant long-term oral steroid administration. We failed to produce satisfactory adrenal response in only six out of 41 patients, even though initial testing had sometimes suggested complete adrenal suppression.…”

Section: Difficulties With Tetracosactrinsupporting

confidence: 89%

“…The dangers, because of adrenal suppression, of removing oral steroids from severe asthmatic patients after their long-term use, and the unpleasantness of steroid withdrawal symptoms in such patients, are well known (Anderson, 1960;Walsh and Grant, 1966;Maunsell, Pearson, and Livingstone, 1968;Dwyer, Lazaras, and Hickie, 1967;Malone, Grant, and Percy-Robb, 1970;Westerhof et al, 1972). We have reviewed our experience of taking patients off long-term oral steroids and substituting depot tetracosactrin injections either as a method of treatment in itself or as a step towards the use of beclomethasone dipropionate aerosol.…”

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confidence: 99%

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Tetracosactrin for the management of asthmatic patients after long-term corticosteroids.

Hugh‐Jones¹,

Pearson²,

Booth³

1975

Thorax

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Section: Difficulties With Tetracosactrinsupporting

confidence: 89%

mentioning

confidence: 99%

Tetracosactrin for the management of asthmatic patients after long-term corticosteroids.

Hugh‐Jones¹,

Pearson²,

Booth³

1975

Thorax

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“…Although it might be expected that at this dosage level some recoverv of adrenal function would have occurred (Westerhof et al, 1970) the rate of recovery anneared to be larelv related to the Dreceding steroid dose (Westerhof et al, 1972), and longer follow-up is necessary. This failure of recovery does not negate the probable beneficial effects of a lower dose in preventing the occurence of other side effects of long-term systemic steroids.…”

Section: Discussionmentioning

confidence: 95%

Recovery of Adrenal Function after Substitution of Beclomethasone Dipropionate for Oral Corticosteroids

Maberly¹,

Gibson²,

Butler³

1973

BMJ

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Whatever the reason for this excess of chronic bronchitis among the "droopers"-more prolonged and concentrated tobacco smoke exposure or differing proportions of "sidestream" and "mainstream" smoke-there seems little doubt that it is a dangerous method of smoking cigarettes involving greater risk of developing chronic bronchitis and, on the evidence of Brett and Benjamin (1968), of increased mortality from lung cancer than is the normal method.I wish to thank Professor M. R. Alderson, formerly Director of the Regional Cancer Registration Bureau, who helped plan the investigation, and the Manchester Regional Hospital Board who allowed the staff of the Ma.f Radiography Service to obtain the histories and the computer section to process the information. I am particularly grateful for the care and attention to detail given by the staffs of these departments.

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“…Other reports dealing with this subject (London et al 1965;Jacobson et al 1968;Westerhof et al 1970) came to a different conclusion but the discrepancy may be merely apparent since the amounts of steroid given daily to patients must be considered. Only for daily doses of prednisone (or equivalent) ranging from 2.5 to 10 mg was some relationship found (London et al 1965;Westerhof et al 1970;Carter 8c James 1971), although there was considerable individual variation. This no longer applies when the daily dose reaches or exceeds 15 mg, presumably because hypothalamo-pituitary-adrenal function is then totally suppressed.…”

Section: Discussionmentioning

confidence: 80%

Adrenocortical Response Upon Repeated Stimulation With Corticotrophin in Patients Lacking Endogenous Corticotrophin Secretion

Kolanowski¹,

Esselinckx²,

Deuxchaisnes³

et al. 1977

Acta Endocrinologica

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The role played by a normal endogenous corticotrophin secretion in the mechanism by which adrenocortical steroidogenic response to ACTH increases as a result of previous administration of the peptide, was assessed by repeated ACTH administration in 25 patients under prolonged cortico-therapy and in 13 patients with anterior hypophyseal insufficiency.The response to ACTH (250 \g=m\gtetracosapeptide iv over 8 h) was evaluated on the basis of changes in plasma cortisol and in the urinary excretion of cortisol and 17-ketogenic steroids. The steroidogenic response to the first ACTH infusion was markedly reduced in these patients when compared to control subjects, or even to subjects on short-term dexametasone. However, in these patients as in normals, acute ACTH administration was followed by a phase, lasting for 3 days at least, during which the steroidogenic response to further ACTH stimulation was increased.When ACTH was infused repeatedly on 4 consecutive days in patients on long-term cortico-therapy, adrenocortical responsiveness was rapidly restored to normal. By contrast, when ACTH was administered every fourth day, a less pronounced enhancement of adrenocortical responsiveness occurred, the secretory activity returning to previous hypo-adrenal state between each stimulation..These data indicate that the mechanism of amplified adrenocortical re-

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Recovery of Adrenocortical Function during Long-term Treatment with Corticosteroids

Cited by 20 publications

References 16 publications

Tetracosactrin for the management of asthmatic patients after long-term corticosteroids.

Tetracosactrin for the management of asthmatic patients after long-term corticosteroids.

Recovery of Adrenal Function after Substitution of Beclomethasone Dipropionate for Oral Corticosteroids

Adrenocortical Response Upon Repeated Stimulation With Corticotrophin in Patients Lacking Endogenous Corticotrophin Secretion

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