Adrenocortical suppression by synthetic corticosteroid drugs: a comparative study of prednisolone and betamethasone.

Downie, Walker; Dixon, J. S.; Lowe, J. R.; Rhind, Vm M.; Leatham, Pa; Pickup, M. E.

doi:10.1111/j.1365-2125.1978.tb04603.x

Cited by 15 publications

(9 citation statements)

References 4 publications

(2 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Betamethasone, as mention earlier, suppresses the hypothalamic‐pituitary‐adrenal axis in a more severe manner than other GCs and was the most commonly used GC in our study. The higher frequency of betamethasone use seems specific for Scandinavian countries.…”

Section: Discussionsupporting

confidence: 64%

High prescription rate of oral glucocorticoids in children and adults: A retrospective cohort study from Western Sweden

Einarsdóttír

Ekman

Trimpou

et al. 2019

Clinical Endocrinology

View full text Add to dashboard Cite

Objective Glucocorticoids (GCs) are a cornerstone in treating various common and uncommon diseases. The aim of this study was to estimate the prevalence of GC use in terms of doses associated with risk of tertiary adrenal insufficiency in adults and children, and treatment indications. Methods This was a retrospective cohort study. Information on dispensed prescriptions was obtained from the Swedish Prescribed Drug Register. Patients with prescriptions of prednisolone (or equivalent dose of other GCs) ≥5 mg daily for ≥21 days between 2007 and 2014 were included. Information on concurrent diseases was obtained from the Swedish National Patient Register and the Västra Götaland Regional Healthcare Database. Results Of 1 585 335 inhabitants in Västra Götaland County, 223 211 were included in the study (women 55.6%). Mean age was 48 ± 24 years. Period prevalence of oral GC use during the 8‐year study period was 14.1%. The highest prevalence (27.4%) was in men aged 80‐89 years and lowest (7.5%) in men 10‐19 years of age. The period prevalence in children 0‐9 years of age was 10.6%. COPD and asthma were the most common indications for treatment (17.2%) followed by allergy (12.5%) and malignant neoplasms (11.5%). Allergy was the most frequent indication (20.5%) in children and adolescents. Conclusion Between 2007 and 2014, every seventh inhabitant in western Sweden received a GC prescription at doses associated with risk of developing tertiary adrenal insufficiency. These findings illustrate the importance of awareness of the potential development of tertiary adrenal insufficiency in both paediatric and adult patients.

show abstract

Section: Discussionsupporting

confidence: 64%

High prescription rate of oral glucocorticoids in children and adults: A retrospective cohort study from Western Sweden

Einarsdóttír

Ekman

Trimpou

et al. 2019

Clinical Endocrinology

View full text Add to dashboard Cite

show abstract

“…This is much greater than the ratio predicted by the relative potency of the two steroids in suppressing inflammation in man (approxi¬ mately 6 : 1 ; Haynes & Murad, 1985). This discrepancy between the relative potencies of steroids in these two pharmacological effects has also been reported for prednisolone and betamethasone (Downie, Dixon, Lowe et al 1978). The therapeutic concentration of prednisolone in the blood required in man when the glucocorticoid is used for cortisol replacement is in the range 100-150 nmol/1 and this is achieved using doses of 20-70 mg/day (Haynes & Murad, 1985).…”

Section: Discussionmentioning

confidence: 84%

Recovery of the components of the hypothalamo-pituitary-adrenocortical axis in the rat after chronic treatment with prednisolone

Nicholson¹,

Campbell²,

Gillham³

et al. 1987

Journal of Endocrinology

View full text Add to dashboard Cite

Male Wistar-derived rats (200-250 g) were treated for 14 days with prednisolone 21-sodium succinate at a concentration of 1035 mumol/l in their drinking water. The drug was then replaced with normal tap water and groups of animals were killed at various times during recovery, trunk blood being collected after decapitation. At the same time, hypothalamic slices, anterior pituitary gland fragments and adrenals were removed and their responsiveness assessed by exposure to appropriate stimuli in vitro. Tissues were also extracted to measure changes in content of hormones during recovery. Treatment with prednisolone produced marked reductions in body weight gain, adrenal weight and pituitary ACTH content, but no significant change in hypothalamic corticotrophin-releasing factor (CRF) bio- or immunoreactivity. The ACTH content was restored by 5 days after withdrawal but adrenal weight remained significantly reduced after 9 days of recovery. The responsiveness of the hypothalamus to acetylcholine in vitro was markedly inhibited and was still significantly reduced 7 days after withdrawal. The responsiveness of the anterior pituitary gland to synthetic CRF or arginine vasopressin and that of the adrenal gland to ACTH added in vitro were restored simultaneously after 7 days of withdrawal. In vivo, recovery was assessed by measurement of the response to laparotomy stress. Treatment with prednisolone prevented the increase in the plasma concentrations of ACTH and corticosterone produced by stress, and these responses recovered by 5 days (corticosterone) and 7 days (ACTH) after withdrawal. The abolition of the circadian rhythms of ACTH and corticosterone by treatment was also reversed by 5 days after withdrawal.(ABSTRACT TRUNCATED AT 250 WORDS)

show abstract

“…Downie et al performed a single-dose study to investigate the relative potency of predni-solone and betamethasone in suppressing adreno-cortical function [35]. Betamethasone produced a more profound suppression of plasma cortisol than a supposed equivalent antiinflammatory dose of prednisolone.…”

Section: Suppression Of Cortisol Productionmentioning

confidence: 98%

Clinical Potencies of Glucocorticoids: What do we Really Measure?

Dubois

2005

CRMR

View full text Add to dashboard Cite

Glucocorticoids (GC) are used in pulmonary medicine since the early nineteen-thirties; in the beginning by using extracts of adrenal glands of animals, later on synthetically composed and since the early nineteen-seventies in inhaled formulation. In pulmonary medicine the majority of prescriptions are related to asthma and exacerbations of COPD. In determining the pharmacological potency of the different GC's many efforts were made for quantification. In this respect in vitro, in vivo, ex vivo and clinical studies were performed. Examples in estimating the GC potency range from skin-blanching tests to suppressive effect on the adrenal gland, the latter representing 'a classical paradigm'. Thus far different quantifying attempts that have been made did not take into account the tissue concentration-effect relationship, which can be achieved by pharmacokinetic/pharmaco-dynamic (PK/PD) modelling. Moreover, in the clinical studies described, the suggestion was risen that GC's may have a different potency towards each target tissue separately and that the suppressive effect on the adrenal gland does not reflect for instance its anti-inflammatory action. In this respect the studies describe a quantifying inflammation model for asthma e.g. by granulocyte colony stimulating factor (GCSF) stimulated rise in eosinophilic cationic protein (ECP), which could be inhibited by different GC's.In conclusion, studies on potencies of GC should comprise PK/PD modelling and should target as much as possible on the different outcome parameters of the therapeutical and adverse effects separately and simultaneously, thereby describing 'the spectrum of potency' of a GC rather than 'the potency'.

show abstract

Adrenocortical suppression by synthetic corticosteroid drugs: a comparative study of prednisolone and betamethasone.

Abstract: 1 Single-dose studies were conducted to investigate the relative potency of prednisolone and betamethasone in suppressing adrenocortical function. 2 Betamethasone produced more profound suppression of plasma cortisol than an equivalent antiinflammatory dose of prednisolone.

Cited by 15 publications

References 4 publications

High prescription rate of oral glucocorticoids in children and adults: A retrospective cohort study from Western Sweden

High prescription rate of oral glucocorticoids in children and adults: A retrospective cohort study from Western Sweden

Recovery of the components of the hypothalamo-pituitary-adrenocortical axis in the rat after chronic treatment with prednisolone

Clinical Potencies of Glucocorticoids: What do we Really Measure?

Contact Info

Product

Resources

About