Original Article

Journal of Investigative Dermatology (1988) 90, 532–535; doi:10.1111/1523-1747.ep12461062

Comparison of Hypothalamus-Pituitary-Adrenal Axis Suppression From Superpotent Topical Steroids by Standard Endocrine Function Testing and Gas Chromatographic Mass Spectrometry

William L Weston, Paul V Fennessey, Joseph Morelli, Henriette Schwab, John Mooney, Cesar Samson, Lois Huff, L Mark Harrison and Ronald Gotlin

Department of Dermatology, Pharmacology, and Pediatrics, University of Colorado School of Medicine, Denver, Colorado, U.S.A.

Received 16 June 1987; Accepted 12 November 1987.

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Abstract

We evaluated 38 males who had psoriasis vulgaris for evidence of hypothalamus-pituitary-adrenal axis suppression (HPAS) during treatment with superpotent topical gluco-corticosteroids. All men were treated with 49 g per week of either Betamethasone Diproprionate in an optimized vehicle or Clobetasol Proprionate ointment.

Three methods used to assess HPAS were compared. Classic 8 a.m. plasma cortisol measurements, urinary-free cortisol, and 17-hydroxycorticosteroid determinations and gas chromatograph-mass spectrometry (GCMS) quantitation of urinary cortisol metabolites were compared. Values for all methods were obtained just prior to therapy and at days 4, 7, 14, and 21 during therapy and at day 28 after treatment was stopped for 7 d.

Plasma cortisol measurements correlated well with other measures of HPAS. GCMS determination of urinary cortisol metabolites was slightly more sensitive at detecting HPAS than the other two methods. Persistent HPAS after day 7 was only appreciated by GCMS. Urinary-free cortisol and 17-hydroxycortisol was the least sensitive of the three methods. Analysis of urinary cortisol metabolites by GCMS may be most useful in the monitoring of HPAS resulting from use of topical glucocorticosteroid preparations.

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References

  1. Carruthers, JA, August, PJ, Staughton, RCD: Observations on the systemic effect of topical clobetasol (Dermovate). Brit Med J 1975 4: 203–204,
  2. Keczkes, K, Teasdale, P, Wiseman, RA, Mugglestone, CJ: Plasma cortisol levels after topical application of diflucortolone valerate (0.3%) or clobetasol (0.05%) in psoriatic subjects. Brit J Derm 1978 99: 417–420,
  3. Marriott, PJ, Munro, DD: Clobetasol ointment compared with dithranol in Lassar's paste in the treatment of psoriasis. Brit J Derm 1976 94: 101–105,
  4. Corbett, MF: The response of psoriasis to betamethasone valerate and clobetasol propionate. Brit J Derm 1976 94: 89–93,
  5. Jacobson, C, Cornell, RC, Savin, RC: A comparison of clobetasol 0.05 percent ointment and an optimized betamethasone dipropionate 0.05 percent ointment in the treatment of psoriasis. Cutis 1986 37: 213–220,
  6. Munro, DD: The effect of percutaneously absorbed steroids on hypothalamic-pituitary-adrenal function after intensive use in in-patients. Brit J Derm 1976 94: 67–76,
  7. Katz, HI, Hien, NT, Prawer, SE, Mastbaum, LI, Mooney, JJ, Samson, CR: Superpotent topical steroid treatment of psoriasis vulgaris – clinical efficacy and adrenal function. J Am Acad Dermatol 1987 16: 804–811,
  8. Migeon, CJ, Kenny, FM, Taylor, FH: Cortisol production rate: VIII. Pregnancy. J Clin Endo Metab 1968 28: 661–672,
  9. Pike, AW, Moynihan, C, Kibler, K, Marsh, PG, Fennessey, PV: Semimicro quantitative analysis of complex urinary steroid mixtures in healthy and diseased states. J Chromatog 1984 306: 39–50,
  10. Landon, J, Snitcher, E, Rees, L: The use and interpretation of tests for steroid impaired hypothalamic-pituitary-adrenocorticil functions. Brit J Derm 1976 94: 61–65,
  11. Sparkes, CG: Measuring adrenal function in out-patients using topical corticosteroids. Brit J Derm 1976 94: 77–82,
  12. Curtis, JA, Cormode, E, Laski, B, Toole, J, Howard, N: Endocrine complications of topical and intralesional corticosteroid therapy. Arch Dis Childh 1982 57: 204–207,
  13. Streck, WF, Lockwood, DH: Pituitary adrenal recovery following short-term suppression with corticosteroids. Amer J Med 1979 66: 910–913,
  14. Allenby, CF, Sparkes, CG: Halogenation and topical corticosteroids: A comparison between the 17-buryrate esters of hydrocorrisone and clobetasone in ointment bases. Brit J Derm 1981 104: 179–183,
  15. Cornell, RC, Stoughton, RB: The use of topical steroids in psoriasis. Dermatologic Clinics 1984 2: 397–409,
  16. Sneddon, IB: Atrophy of the skin. Brit J Derm 1976 94: 121–123,
  17. Baker, H: Corticosteroids and pustular psoriasis. Brit J Derm 1976 94: 83–87,
  18. Kligman, AM, Frosch, PJ: Steroid addiction. Int J Derm 1979 18: 23–31,
  19. Vickers, CFH, Charters, SC, Walker, SR: The use of topical steroids of differing potency in the management of the atopic child. Brit J Derm 1976 94: 129–131,
  20. Harst, LCA, deJonge, H, Pot, F, Polano, MK: Comparison of two application schedules for clobetasol-17-propionate. Acta Dermatovener (Stockholm) 1982 62: 270–272,

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