Impact of Study Design on the Evaluation of Inhaled and Intranasal Corticosteroids' Effect on Hypothalamic–Pituitary–Adrenal Axis Function

Use of a Risk-Stratification Tool in Identification of Potential Adrenal Suppression Preceding Steroid Injection Therapy in Chronic Pain Patients

“…While sufficient evidence exists to suggest that oral steroids lead to HPA axis suppression, less convincing evidence exists detailing the possibility of adrenal suppression from nasal and inhaled corticosteroids. A recent meta‐analysis conducted by Fan et al (2014) revealed that many of the findings regarding HPA axis suppression and intranasal/inhaled corticosteroids use vary widely between studies . Factors such as steroid dose, duration, study population, and assay sensitivity all contributed to varying results across studies.…”