Inhaled beclomethasone dipropionate suppresses the hypothalamo-pituitary-adrenal axis in a dose dependent manner.

Abstract:

OBJECTIVE:Little is known about the dose-response relationship of potential, unwanted, effects of inhaled beclomethasone (BDP) on the hypothalamo-pituitary-adrenal (HPA) axis, particularly in nonspecialist clinic settings. The purpose of our study was to investigate the dose-response relationship of inhaled BDP on the HPA axis in a general practice patient population. We also explored the optimal testing strategy in this population and correlated effects of inhaled BDP on the HPA axis with other systemic corticosteroid side effects. PATIENTS AND DESIGN:Controlled observational study employing 21 patients on inhaled BDP recruited from general practice, with minimal past and no present exposure to other corticosteroids, and 21 age and gender-matched controls. MEASUREMENTS:Twenty-four-hour urinary free cortisol excretion (UFC), serum cortisol before and 30 minutes after injection of 1 microgram and 250 micrograms of tetracosactrin, serum IGF-I and serum osteocalcin were measured. BDP use was estimated by inhaler weighing and prescription count. RESULTS:In subjects on inhaled BDP, 24-hour UFC (P < 0.008), serum cortisol 30 minutes after 250 micrograms tetracosactrin (P < 0.05) and the serum cortisol rise after 250 micrograms tetracosactrin (P < 0.04) were significantly lower when compared with controls. Measurements of HPA function correlated inversely with BDP dose estimated by inhaler weighing (all P < 0.03). Serum IGF-I and osteocalcin levels did not differ. CONCLUSIONS:We have demonstrated hypothalamo-pituitary-adrenal axis suppression in nonspecialist-clinic asthma patients on moderate to large doses of inhaled beclomethasone dipropionate. When accurate measurements of inhaled steroid dose are used, there is an exponential relationship between dose and hypothalamo-pituitary-adrenal axis suppression. There appears to be no 'safe' threshold, and around 15% of patients may have clinically significant suppression. However, the significance of hypothalamo-pituitary-adrenal axis suppression as a marker for concomitant corticosteroid effects on other organ systems remains uncertain.

journal_name

Clin Endocrinol (Oxf)

journal_title

Clinical endocrinology

authors

Grebe SK,Feek CM,Durham JA,Kljakovic M,Cooke RR

doi

10.1046/j.1365-2265.1997.2391059.x

subject

Has Abstract

pub_date

1997-09-01 00:00:00

pages

297-304

issue

3

eissn

0300-0664

issn

1365-2265

journal_volume

47

pub_type

杂志文章
  • Extensive experience in the management of macroprolactinomas.

    abstract:OBJECTIVES:Macroprolactinomas are pituitary tumours that can be managed with dopamine agonists (DA), surgery and radiotherapy. We aimed to assess the outcomes of these treatment modalities. DESIGN:Retrospective case-note study of patients managed in a single tertiary referral centre. PATIENTS:One hundred patients (68...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章

    doi:10.1111/cen.12418

    authors: Green AI,Sherlock M,Stewart PM,Gittoes NJ,Toogood AA

    更新日期:2014-07-01 00:00:00

  • Increased free testosterone but normal 5 alpha-reduced testosterone metabolites in obese premenopausal women.

    abstract:OBJECTIVE:The aim of the study was to investigate whether the absence of increased 5 alpha-reductase activity explained the absence of hirsutism in premenopausal obese women with increased free testosterone (FT) levels. DESIGN:As in hyperandrogenicity there generally exists evidence for increased 5 alpha-reductase act...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章

    doi:10.1111/j.1365-2265.1992.tb02264.x

    authors: Giagulli VA,De Pergola G,Giorgino F,Cignarelli M,Abbaticchio G,Vermeulen A,Giorgino R

    更新日期:1992-06-01 00:00:00

  • Modulation of glucocorticoid metabolism by the growth hormone - IGF-1 axis.

    abstract::The growth hormone-insulin-like growth factor 1 (GH-IGF-1) axis plays an important role in modulating the peripheral metabolism of glucocorticoids mainly through its effect on the isoenzyme 11 beta-hydroxysteroid dehydrogenase 1 (11beta-HSD1) which, in vivo, functions as a reductase catalysing the conversion of cortis...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章,评审

    doi:10.1111/j.1365-2265.2007.02763.x

    authors: Agha A,Monson JP

    更新日期:2007-04-01 00:00:00

  • Primary adrenal and thyroid insufficiencies associated with hypopituitarism: a diagnostic challenge.

    abstract::Polyglandular syndromes have been described for many years but only one case of panhypopituitarism with adrenal and thyroid insufficiencies has been documented. We present a 69-year-old woman with the initial diagnosis of idiopathic primary hypopituitarism. An associated primary adrenal disease was suspected on low pl...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章

    doi:10.1111/j.1365-2265.1994.tb03023.x

    authors: Pholsena M,Young J,Couzinet B,Schaison G

    更新日期:1994-05-01 00:00:00

  • The natural history of congenital hypothyroidism with delayed TSH elevation in neonatal intensive care newborns.

    abstract:OBJECTIVE:To assess the clinical and neurological outcomes in newborns with primary congenital hypothyroidism presented with delayed TSH elevation (dTSH), and to define parameters that may predict the evolution of transient vs. permanent hypothyroidism in these newborns. DESIGN AND PATIENTS:An observational study was ...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章

    doi:10.1111/cen.14173

    authors: Zung A,Radi A,Almashanu S

    更新日期:2020-05-01 00:00:00

  • Sex hormone binding globulin in postmenopausal women: a predictor of osteoporosis superior to endogenous oestrogens.

    abstract::To quantify the role of endogenous oestrogen activity in osteoporosis we measured relative metacarpal cortical area (RCA), body mass, serum oestrone, oestradiol, androstenedione, and sex hormone binding globulin (SHBG) in 746 postmenopausal women aged 53 to 76 years, sampled from the general population. The occurrence...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章

    doi:10.1111/j.1365-2265.1989.tb01274.x

    authors: van Hemert AM,Birkenhäger JC,De Jong FH,Vandenbroucke JP,Valkenburg HA

    更新日期:1989-10-01 00:00:00

  • The effects of folate supplementation on inflammatory factors and biomarkers of oxidative stress in overweight and obese women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled clinical trial.

    abstract:OBJECTIVE:This study was conducted to determine the effects of folate supplementation on inflammatory factors and biomarkers of oxidative stress among women with polycystic ovary syndrome (PCOS). DESIGN, PATIENTS AND MEASUREMENTS:This randomized, double-blind, placebo-controlled clinical trial was conducted among 69 w...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章,随机对照试验

    doi:10.1111/cen.12451

    authors: Bahmani F,Karamali M,Shakeri H,Asemi Z

    更新日期:2014-10-01 00:00:00

  • Peripheral bone density in women with untreated multinodular goitre.

    abstract:OBJECTIVES:We wished to determine whether women with multinodular goitre and spontaneous subclinical hyperthyroidism have decreased bone density. DESIGN AND SUBJECTS:Bone density was measured at the distal and proximal forearm. Data were expressed as Z-scores relative to the mean values out of 125 control subjects mat...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章

    doi:10.1111/j.1365-2265.1992.tb02280.x

    authors: Mudde AH,Reijnders FJ,Kruseman AC

    更新日期:1992-07-01 00:00:00

  • The effects of acute hyponatraemia on bone turnover in patients with subarachnoid haemorrhage: A preliminary report.

    abstract:CONTEXT:Animal data and cross-sectional human studies have established that chronic hyponatraemia predisposes to osteoporosis; the effects of acute hyponatraemia on bone turnover have not been determined. Our objective was to test the hypothesis that acute hyponatraemia leads to dynamic effects on bone turnover. DESIG...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章

    doi:10.1111/cen.14367

    authors: Garrahy A,Galloway I,Hannon AM,Dineen R,Javadpour M,Tormey WP,Gan KJ,Twomey PJ,Mc Kenna MJ,Kilbane M,Crowley RK,Sherlock M,Thompson CJ

    更新日期:2020-11-11 00:00:00

  • Expression of the androgen metabolizing enzyme UGT2B15 in adipose tissue and relative expression measurement using a competitive RT-PCR method.

    abstract:OBJECTIVES:We have demonstrated previously that obesity in men was significantly associated with low plasma testosterone levels and higher concentrations of the androgen metabolite androstane-3 alpha, 17 beta-diol glucuronide, suggesting that androgen metabolism and elimination is increased in this condition. The objec...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章

    doi:10.1046/j.1365-2265.1999.00709.x

    authors: Tchernof A,Lévesque E,Beaulieu M,Couture P,Després JP,Hum DW,Bélanger A

    更新日期:1999-05-01 00:00:00

  • Association of FcGRIIa with Graves' disease: a potential role for dysregulated autoantibody clearance in disease onset/progression.

    abstract:OBJECTIVE:Although autoantibody production is a key feature of autoimmunity, it is not known whether variation in autoantibody production and clearance pathways is involved in disease susceptibility. The Fc Gamma Receptor IIa (FcGRIIa) molecule is involved in the clearance of autoantibodies and a functional single nucl...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章

    doi:10.1111/j.1365-2265.2010.03780.x

    authors: Yesmin K,Hargreaves C,Newby PR,Brand OJ,Heward JM,Franklyn JA,Gough SC,Simmonds MJ

    更新日期:2010-07-01 00:00:00

  • Utility of I-124 PET/CT in identifying radioiodine avid lesions in differentiated thyroid cancer: a systematic review and meta-analysis.

    abstract:INTRODUCTION:Diagnostic I-123 scans have been shown to underestimate the disease burden in differentiated thyroid cancer (DTC) when compared to I-131 post-treatment scans, especially in children and patients who have had prior radioiodine (RAI) therapy and/or distant metastasis. I-124 PET/CT has been shown to be highly...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章,meta分析,评审

    doi:10.1111/cen.13306

    authors: Santhanam P,Taieb D,Solnes L,Marashdeh W,Ladenson PW

    更新日期:2017-05-01 00:00:00

  • A novel PRKAR1A mutation associated with hepatocellular carcinoma in a young patient and a variable Carney complex phenotype in affected subjects in older generations.

    abstract:CONTEXT:Carney complex (CNC) is an autosomal dominant multiple endocrine neoplasia syndrome (OMIM 160980). About 70% of cases are familiar; most have mutations of the PRKAR1A gene on chromosome 17q22-24. There is little phenotype-genotype correlation known to date. OBJECTIVE:To study the genotype-phenotype correlation...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章

    doi:10.1111/j.1365-2265.2008.03286.x

    authors: Gennari M,Stratakis CA,Hovarth A,Pirazzoli P,Cicognani A

    更新日期:2008-11-01 00:00:00

  • Hepatotoxicity and cutaneous reactions after antithyroid drug administration.

    abstract:OBJECTIVE:Use of the antithyroid drugs (ATDs) thiamazole (MMI) and propylthiouracil (PTU) is associated with a high frequency of side effects. When patients experience side effects with one (the 1st) ATD, it is usually discontinued and another is administered (the 2nd ATD). We investigated side effects associated with ...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章,随机对照试验

    doi:10.1111/j.1365-2265.2012.04365.x

    authors: Otsuka F,Noh JY,Chino T,Shimizu T,Mukasa K,Ito K,Ito K,Taniyama M

    更新日期:2012-08-01 00:00:00

  • Risk for severe hypoglycaemia with unawareness in GH-deficient patients during the insulin tolerance test.

    abstract:OBJECTIVE:The insulin tolerance test (ITT) has been suggested as the gold standard for diagnosing GH deficiency (GHD). The ITT is, however, potentially hazardous. Glucose monitoring during the ITT varies between centres and there is surprisingly little information on the actual level of blood glucose nadir and the dura...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章

    doi:10.1111/j.1365-2265.2006.02436.x

    authors: Holmer H,Link K,Erfurth EM

    更新日期:2006-02-01 00:00:00

  • Impaired quality of life in patients with treated acromegaly despite long-term biochemically stable disease: Results from a 5-years prospective study.

    abstract:OBJECTIVE:Patients with acromegaly demonstrate impaired quality of life (QoL), but data on long-term QoL changes in treated acromegaly are limited. This study evaluates and identifies factors that influence QoL in patients with long-term biochemical remission. DESIGN:The study consists of a cross-sectional arm compari...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章

    doi:10.1111/cen.13331

    authors: Kyriakakis N,Lynch J,Gilbey SG,Webb SM,Murray RD

    更新日期:2017-06-01 00:00:00

  • IGF-I in a normal population: relation to psychosocial factors.

    abstract:OBJECTIVE:IGF-I has important actions on cell division, apoptosis, differentiation and metabolism, as well as on cell proliferation in vascular smooth muscle. Deficiency of GH, an important regulator of IGF-I, is associated with reduced well-being. IGF-I levels have been related to cognitive function in older individua...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章

    doi:10.1046/j.1365-2265.2002.01671.x

    authors: Unden AL,Elofsson S,Knox S,Lewitt MS,Brismar K

    更新日期:2002-12-01 00:00:00

  • Cushing's disease in older patients: Presentation and outcome.

    abstract:BACKGROUND:To define the symptoms, signs and treatment outcomes in a population of older patients with Cushing's disease (CD). METHODS:We analysed the clinical presentation and treatment outcomes in 45 CD patients older than 60 years, in comparison with 90 CD patients younger than 60, and a control group of 45 older p...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章

    doi:10.1111/cen.13799

    authors: Qiao N,Swearingen B,Tritos NA

    更新日期:2018-10-01 00:00:00

  • Diagnosis and complications of Cushing's disease: gender-related differences.

    abstract:OBJECTIVE:Cushing's disease (CD) presents a remarkable preponderance in female gender, with a female-to-male ratio of 3-8:1. The aim of this study was to evaluate gender-related differences in the presentation of CD, as regards: biochemical indices of hypercortisolism; sensitivity of diagnostic tests; clinical features...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章

    doi:10.1111/cen.12299

    authors: Zilio M,Barbot M,Ceccato F,Camozzi V,Bilora F,Casonato A,Frigo AC,Albiger N,Daidone V,Mazzai L,Mantero F,Scaroni C

    更新日期:2014-03-01 00:00:00

  • The dynamics of prolactin secretion during the puerperium in women.

    abstract::This study deals with serum prolactin concentrations during various conditions in the early puerperium in an attempt to investigate some characteristics of the mechanisms responsible for the regulation of the lactotropes. In nursing, in non-nursing, non-medicated and in non-nursing, bromocriptine-treated women prolact...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章

    doi:10.1111/j.1365-2265.1981.tb00650.x

    authors: Vemer HM,Rolland R

    更新日期:1981-08-01 00:00:00

  • Influence of different genotypes on 17-hydroxyprogesterone levels in patients with nonclassical congenital adrenal hyperplasia due to 21-hydroxylase deficiency.

    abstract:OBJECTIVE:The diagnosis of the nonclassical form of 21-hydroxylase (NC-21OH) deficiency, established before molecular studies, is based on basal 17OH-progesterone (17OH-P) values > 15 nmol/l or ACTH-stimulated 17OH-P values > 30 nmol/l. This disease is caused by mutations in the structural gene that can be grouped into...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章

    doi:10.1046/j.1365-2265.2000.00995.x

    authors: Bachega TA,Billerbeck AE,Marcondes JA,Madureira G,Arnhold IJ,Mendonca BB

    更新日期:2000-05-01 00:00:00

  • High frequency of adrenal myelolipomas and testicular adrenal rest tumours in adult Norwegian patients with classical congenital adrenal hyperplasia because of 21-hydroxylase deficiency.

    abstract:BACKGROUND:Increased frequencies of adrenal tumours and testicular adrenal rest tumours (TART) have been reported in patients with 21-hydroxylase deficiency (21OHD). OBJECTIVE:Patients, methods and design From a cross-sectional population-based study of 101 adult Norwegian patients with 21OHD, sixty-two participated i...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章

    doi:10.1111/j.1365-2265.2011.04151.x

    authors: Nermoen I,Rørvik J,Holmedal SH,Hykkerud DL,Fougner KJ,Svartberg J,Husebye ES,Løvås K

    更新日期:2011-12-01 00:00:00

  • Elevated circulating adiponectin in type 1 diabetes is associated with long diabetes duration.

    abstract:OBJECTIVE:To study circulating adiponectin concentrations in relation to diabetes duration and endogenous insulin secretion in patients with type 1 diabetes. PATIENTS:Patients with haemoglobin A1c (HbA1c) < 6% (reference range 3.6-5.4%) were selected for the study. Twenty-two men and 24 women [age 41.3 +/- 13.8 years ...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章

    doi:10.1111/j.1365-2265.2006.02666.x

    authors: Lindström T,Frystyk J,Hedman CA,Flyvbjerg A,Arnqvist HJ

    更新日期:2006-12-01 00:00:00

  • Effects of four years' treatment with biosynthetic human growth hormone (GH) on glucose homeostasis, insulin secretion and lipid metabolism in GH-deficient adults.

    abstract:OBJECTIVE:To study the effects of long-term growth hormone (GH) treatment on lipid metabolism and carbohydrate tolerance in GH-deficient adults. DESIGN:Open trial of GH treatment for 4 years. GH dose was (median, range) 0.025 (0.010-0.050) IU/kg daily. PATIENTS:Thirteen GH-deficient hypopituitary adults (seven men, s...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章

    doi:10.1046/j.1365-2265.1998.00460.x

    authors: al-Shoumer KA,Gray R,Anyaoku V,Hughes C,Beshyah S,Richmond W,Johnston DG

    更新日期:1998-06-01 00:00:00

  • Impaired glucose tolerance and insulin insensitivity in primary hyperparathyroidism.

    abstract:OBJECTIVE:A high prevalence of diabetes mellitus has been shown in patients with primary hyperparathyroidism (PHPT). However, it is unclear whether this is related to the metabolic abnormalities in PHPT or to the presence of other risk factors for glucose intolerance in these patients. The aim of our study was to deter...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章

    doi:10.1111/j.1365-2265.1994.tb02442.x

    authors: Kumar S,Olukoga AO,Gordon C,Mawer EB,France M,Hosker JP,Davies M,Boulton AJ

    更新日期:1994-01-01 00:00:00

  • The effect of the menopause on prolactin levels in patients with hyperprolactinaemia.

    abstract:OBJECTIVE:Microprolactinomas have been reported to resolve spontaneously after pregnancy and there have been suggestions that oestrogen therapy increases the size of microprolactinomas. Little is known, however, about the effect of the menopause in patients previously known to be hyperprolactinaemic. The aim of this st...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章

    doi:10.1046/j.1365-2265.2001.01190.x

    authors: Karunakaran S,Page RC,Wass JA

    更新日期:2001-03-01 00:00:00

  • Gene expression profiles of phaeochromocytomas with ERBB2 overexpression reveal a new molecular mechanism tumourigenicity.

    abstract:OBJECTIVE:Phaeochromocytomas (PHEO) and functional paragangliomas (PGLs) are catecholamine-secreting neuroendocrine tumours. Although most PHEO/PGLs are benign, 10-35% present as (or develop into) malignant tumours with a poor prognosis. Overexpression of ERBB2 (v-erb-b2 erythroblastic leukaemia viral oncogene homologu...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章

    doi:10.1111/j.1365-2265.2012.04388.x

    authors: Qi Y,Su T,Zhang X,Jiang Y,Yuan W,Wang W,Cui B,Ning G

    更新日期:2012-09-01 00:00:00

  • ACTH-independent Cushing's syndrome in pregnancy with spontaneous resolution after delivery: control of the hypercortisolism with metyrapone.

    abstract::A 25-year-old primigravid woman presented with Cushing's syndrome at 23 weeks gestation; serum cortisol was 1090 nmol/l at 0900 h, 1230 nmol/l at 2200 h; basal urinary free cortisol excretion was 3680 nmol/24 h, and 8830 nmol/24 h after dexamethasone 8 mg daily for 48 hours; plasma ACTH was < 1.1 pmol/l. CT scan of th...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章

    doi:10.1111/j.1365-2265.1993.tb02380.x

    authors: Close CF,Mann MC,Watts JF,Taylor KG

    更新日期:1993-09-01 00:00:00

  • Increased secretion of 32,33 split proinsulin after intravenous glucose in glucose-tolerant first-degree relatives of patients with non-insulin dependent diabetes of European, but not Asian, origin.

    abstract:OBJECTIVE:The aetiology of non-insulin dependent diabetes is unknown, but defective insulin secretion is a feature. The disease also has a strong genetic basis and first-degree relatives of patients have an increased risk of future diabetes. To investigate whether beta-cell dysfunction is an early feature of the diseas...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章

    doi:10.1111/j.1365-2265.1995.tb01873.x

    authors: Gelding SV,Andres C,Niththyananthan R,Gray IP,Mather H,Johnston DG

    更新日期:1995-03-01 00:00:00

  • Aromatase deficiency: A case series of 46, XX Chinese children and a systematic review of the literature.

    abstract:BACKGROUND:Aromatase deficiency (AD) caused by cytochrome P450 family 19 subfamily A polypeptide 1 (CYP19A1) variants is characterized by a deficiency in androgen-to-oestrogen conversion. OBJECTIVE:To investigate the clinical characteristics and accurate management of aromatase-deficient children. PATIENTS AND METHOD...

    journal_title:Clinical endocrinology

    pub_type: 杂志文章

    doi:10.1111/cen.14277

    authors: Fan L,Zhang B,Li L,Gong C

    更新日期:2020-12-01 00:00:00