The effect of a @entity134 "burst" and long-term, inhaled XXXX on adrenal reserve.

@entity1 @entity353 @entity229 @entity73 @entity5304 @entity134 @entity2339 @entity230 @entity5023
BACKGROUND: Although widely used, the effects of @entity134 "bursts" on the @entity2339 , especially with long-term, concomitant topical @entity230 use, have not been studied. OBJECTIVE: To examine the effect of a @entity229 burst, long-term intranasal @entity230 , and inhaled @entity5023 on the suppression and recovery of adrenal function. METHODS: Adult @entity1 taking long-term intranasal @entity230 , either moderate-dose (440 microg/d) or high-dose (880 microg/d) inhaled @entity5023 , underwent a low-dose @entity5304 stimulation test (LDCST) before and 2 days after a @entity229 burst. Suppressed adrenal responses were monitored with a weekly LDCST. Persistent abnormal LDCST results were confirmed by 8-hour cosyntropin infusion. Inhaled @entity5023 dosages were decreased; adrenal recovery was evaluated by a monthly LDCST. Adverse effects of @entity230 were monitored by questionnaires. RESULTS: Sixty-three @entity1 participated in the study. Three of 31 @entity1 not taking inhaled @entity230 and 1 of 13 @entity1 taking moderate-dose @entity5023 had abnormal LDCST results on day 2 after the @entity229 burst, which normalized by the second week. In the high-dose @entity5023 group, 14 of 19 @entity1 had suppressed LDCST responses on day 2 and adrenal function recovered in 10 of 19 @entity1 by the fourth week. These @entity1 complained significantly of decreased libido (P = 0.02), listlessness (P = 0.03), and @entity353 (P = 0.05). High-dose @entity5023 (r = 0.66, P < 0.001) and duration of use (r = 0.32, P = 0.01) were statistically correlated with @entity73 . Of the 4 @entity1 with persistent @entity73 , 3 @entity1 successfully reduced dosages of inhaled @entity5023 and adrenal function recovered in 2 to 10 months. CONCLUSIONS: @entity229 bursts induce brief @entity73 . Intranasal @entity230 and moderate-dose @entity5023 had no effect on adrenal function. High-dose, inhaled @entity5023 caused mild-to-significant adrenal suppression and delayed the recovery after a @entity134 burst. Avoiding or limiting the duration of high-dose inhaled @entity230 would minimize systemic adverse effects.
