scholarly journals Evaluation of Hypothalamic-Pituitary-Adrenal Axis Suppression following Cutaneous Use of Topical Corticosteroids in Children: A Meta-Analysis

2018 ◽  
Vol 89 (6) ◽  
pp. 389-396 ◽  
Author(s):  
Lauren K. Wood Heickman ◽  
Ladan Davallow Ghajar ◽  
Mark Conaway ◽  
Alan D. Rogol
Keyword(s):  
Adrenal Insufficiency ◽  
Hpa Axis ◽  
Meta Analysis ◽  
Signs And Symptoms ◽  
Adrenal Crisis ◽  
Short Term ◽  
Hypothalamic Pituitary Adrenal ◽  
Topical Corticosteroids ◽  
Clinically Significant ◽  
Pituitary Adrenal Axis

Background/Aims: A meta-analysis was performed to determine the likelihood of hypothalamic-pituitary-adrenal (HPA) axis suppression following short-term cutaneous treatment of atopic dermatitis with topical corticosteroids (TCS) in pediatric patients. Methods: All published pediatric clinical trials evaluating TCS use with pre- and post-treatment HPA axis assessment by cosyntropin stimulation testing were included. Results: Of 128 eligible trials, 12 were selected for meta-analysis with a total of 522 participants. There were 20 observed cases of HPA axis suppression (3.8%, 95% CI 2.4–5.8). The percentage of HPA axis suppression with low- (classes 6–7), medium- (classes 3–5) and high-potency (classes 1–2) TCS use was 2% (3 of 148 patients, 95% CI 0.7–5.8), 3.1% (7 of 223 patients, 95% CI 1.5–6.3), and 6.6% (10 of 151 patients, 95% CI 3.6–11.8), respectively. Conclusion: There is a low rate of reversible HPA axis suppression with the use of mid- to low-potency TCS compared to more potent formulations. In pediatric clinical practice, the limited use of mid- to low-potency TCS is rarely associated with clinically significant adrenal insufficiency or adrenal crisis. In the absence of signs and symptoms of adrenal insufficiency, there is little need to test the HPA axis of these patients.

Low Risk of Adrenal Insufficiency After Use of Low- to Moderate-Potency Topical Corticosteroids for Children With Atopic Dermatitis

2019 ◽  
Vol 58 (4) ◽  
pp. 406-412
Author(s):  
Ladan Davallow Ghajar ◽  
Lauren K. Wood Heickman ◽  
Mark Conaway ◽  
Alan D. Rogol
Keyword(s):  
Atopic Dermatitis ◽  
Adrenal Insufficiency ◽  
Clinical Evidence ◽  
Signs And Symptoms ◽  
Serum Cortisol ◽  
Low Risk ◽  
Adrenal Suppression ◽  
Adrenal Crisis ◽  
Short Term ◽  
Topical Corticosteroids

Our objective was to assess the risk of adrenal insufficiency (AI) with short-term use of low- to moderate-potency topical corticosteroids (TCS) for treatment of atopic dermatitis. Our systematic literature search revealed 9 studies (n = 371) that evaluated AI using adrenocorticotropic hormone stimulation testing, with measures of serum cortisol levels at baseline and following at least 2 weeks of TCS application. Biochemical AI was defined by a stimulated cortisol level of ≤18.0 µg/dL (~500 nmol/L). The overall proportion of AI with low-to-moderate TCS use was 2.7% (95% confidence interval = 1.47% to 4.89%). None of the children showed any clinical evidence of AI or adrenal crisis. Short-term use of low- to moderate-potency TCS for the treatment of atopic dermatitis is associated with a low risk of adrenal suppression. General practitioners do not need to test these patients for adrenal suppression in the absence of concerning signs and symptoms of AI.

A systematic review and meta-analysis of Synacthen tests for assessing hypothalamic-pituitary-adrenal insufficiency in children

2016 ◽  
Vol 101 (9) ◽  
pp. 847-853 ◽  
Author(s):  
Sze May Ng ◽  
Juliana Chizo Agwu ◽  
Kerry Dwan
Keyword(s):  
Systematic Review ◽  
Adrenal Insufficiency ◽  
Hpa Axis ◽  
Standard Dose ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Positive Likelihood Ratio ◽  
Hypothalamic Pituitary Adrenal ◽  
Synacthen Test

BackgroundThe diagnostic value of tests used in assessing hypothalamic-pituitary-adrenal axis (HPA) in children remains controversial.DesignA systematic review and meta-analysis with receiver-operated-characteristic curve was undertaken to assess the diagnostic values of conventional standard dose 250 μg tetracosactrin (ACTH), short Synacthen test (SSST) and/or low-dose Synacthen test (LDSST) in the assessment of HPA insufficiency in children. Studies eligible for inclusion were any study that compared the use of the LDSST and/or SSST in the assessment of central adrenal insufficiency in children compared with reference standard test.ResultsThere were no randomised trials found. SSST resulted in higher specificity and positive likelihood ratio than LDSST. The LDSST had a higher sensitivity (86% vs 61%) but a lower specificity (88% vs 99%) than the SSST, but there was high heterogeneity from the LDSST studies with various doses of Synacthen used.ConclusionsLack of standardisation of assays and protocols with regard to timing, frequency and dose has resulted in diagnostic inaccuracies. There is no clear evidence to indicate that LDSST is superior to SSST in the assessment of HPA axis in children. The choice of either SSST or LDSST should be individualised based on clinical judgement for each patient. This systematic review has identified the need for a well-designed, adequately powered, randomised controlled trial on the use of diagnostic tests used in assessing HPA axis in children.

scholarly journals Dream Recall/Affect and the Hypothalamic–Pituitary–Adrenal Axis

2021 ◽  
Vol 3 (3) ◽  
pp. 403-408
Author(s):  
Athanasios Tselebis ◽  
Emmanouil Zoumakis ◽  
Ioannis Ilias
Keyword(s):  
Hpa Axis ◽  
Glucocorticoid Receptors ◽  
Hypothalamic Pituitary Adrenal Axis ◽  
Free Form ◽  
Dream Recall ◽  
Hypothalamic Pituitary Adrenal ◽  
Adrenal Axis ◽  
Concise Review ◽  
Pathological Conditions ◽  
Pituitary Adrenal Axis

In this concise review, we present an overview of research on dream recall/affect and of the hypothalamic–pituitary–adrenal (HPA) axis, discussing caveats regarding the action of hormones of the HPA axis (mainly cortisol and its free form, cortisol-binding globulin and glucocorticoid receptors). We present results of studies regarding dream recall/affect and the HPA axis under physiological (such as waking) or pathological conditions (such as in Cushing’s syndrome or stressful situations). Finally, we try to integrate the effect of the current COVID-19 situation with dream recall/affect vis-à-vis the HPA axis.

scholarly journals Varicella causing remission of Cushing’s disease

2018 ◽  
pp. bcr-2018-225867
Author(s):  
Henith Raj ◽  
Sadishkumar Kamalanathan ◽  
Jaya Prakash Sahoo ◽  
Tamilarasu Kadhiravan
Keyword(s):  
Adrenal Insufficiency ◽  
Cushing’S Disease ◽  
Pituitary Apoplexy ◽  
Cushing's Disease ◽  
Varicella Infection ◽  
Persistent Vomiting ◽  
Hypothalamic Pituitary Adrenal ◽  
Adrenal Axis ◽  
Hormonal Evaluation ◽  
Pituitary Adrenal Axis

An 18-year-old male with Cushing’s disease presented with generalised skin eruptions and backache. He was diagnosed with varicella infection. During the course of the illness, he developed persistent vomiting. Hormonal evaluation suggested adrenal insufficiency. MRI of brain showed features of pituitary apoplexy. Initially, he required hydrocortisone replacement. Later on his hypothalamic–pituitary–adrenal axis recovered and he is currently asymptomatic without any treatment.

scholarly journals Repeated Ferret Odor Exposure Induces Different Temporal Patterns of Same-Stressor Habituation and Novel-Stressor Sensitization in Both Hypothalamic-Pituitary-Adrenal Axis Activity and Forebrain c-fos Expression in the Rat

Endocrinology ◽  
2009 ◽  
Vol 150 (2) ◽  
pp. 749-761 ◽  
Author(s):  
Marc S. Weinberg ◽  
Aadra P. Bhatt ◽  
Milena Girotti ◽  
Cher V. Masini ◽  
Heidi E. W. Day ◽  
...  
Keyword(s):  
Hpa Axis ◽  
Rapid Development ◽  
Brain Regions ◽  
Hypothalamic Pituitary Adrenal Axis ◽  
Repeated Exposure ◽  
Early Gene ◽  
Hypothalamic Pituitary Adrenal ◽  
Adrenal Axis ◽  
Psychological Stressor ◽  
Pituitary Adrenal Axis

Repeated exposure to a moderately intense stressor typically produces attenuation of the hypothalamic-pituitary-adrenal (HPA) axis response (habituation) on re-presentation of the same stressor; however, if a novel stressor is presented to the same animals, the HPA axis response may be augmented (sensitization). The extent to which this adaptation is also evident within neural activity patterns is unknown. This study tested whether repeated ferret odor (FO) exposure, a moderately intense psychological stressor for rats, leads to both same-stressor habituation and novel-stressor sensitization of the HPA axis response and neuronal activity as determined by immediate early gene induction (c-fos mRNA). Rats were presented with FO in their home cages for 30 min a day for up to 2 wk and subsequently challenged with FO or restraint. Rats displayed HPA axis activity habituation and widespread habituation of c-fos mRNA expression (in situ hybridization) throughout the brain in as few as three repeated presentations of FO. However, repeated FO exposure led to a more gradual development of sensitized HPA-axis and c-fos mRNA responses to restraint that were not fully evident until after 14 d of prior FO exposure. The sensitized response was evident in many of the same brain regions that displayed habituation, including primary sensory cortices and the prefrontal cortex. The shared spatial expression but distinct temporal development of habituation and sensitization neural response patterns suggests two independent processes with opposing influences across overlapping brain systems. Repeated exposure of rats to ferret odor leads to rapid development of stimulus-specific habituation and slower development of novel-stressor sensitization of forebrain and hypothalamic-pituitary-adrenal axis activity.

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