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Schematic of the HPA axis (CRH, corticotropin-releasing hormone; ACTH, adrenocorticotropic hormone) Hypothalamus, pituitary gland, and adrenal cortex The hypothalamic–pituitary–adrenal axis (HPA axis or HTPA axis) is a complex set of direct influences and feedback interactions among three components: the hypothalamus (a part of the brain located below the thalamus), the pituitary gland (a ...
When the body is stressed, the sympathetic adrenal-medullary (SAM) axis is activated, followed by the hypothalamic-pituitary-adrenal (HPA) axis. [12] These events suppress the HPO axis because the corticotropin-releasing hormone (CRH) released by the HPA axis inhibit the secretion of GnRH by the hypothalamus. [12]
Some topical glucocorticoids can cause hypothalamic-pituitary axis (HPA) suppression. [15] Reasons that lead to suppression of the HPA include the use of high-potency glucocorticoids, long-term use, application to highly permeable areas, treatment of large areas, occlusion, changed skin barrier and young age. [15]
The chronic use of glucocorticoids suppress the activity of hypothalamic- pituitary-adrenal (HPA) axis. The severity of HPA axis suppression is directly proportional to the dose and the duration of therapy. [20] HPA axis suppression results in a weakened immune system, making the patients more prone to infections in long term. [20]
Symptoms of HPA axis suppression are often subtle and variable, but can often be detected using simple blood or urine tests such at ACTH stimulation test or urinary free cortisol. [6] Those at increased risk for HPA axis suppression are those who are more likely to absorb more of the steroid through the skin. These groups include:
Glucocorticoid induced suppression of the hypothalamic-pituitary-adrenal (HPA) axis has 2 components. Firstly, within 15 minutes of increased glucocorticoid exposure in the anterior pituitary, there is a reduction in the release of preformed adrenocorticotrophic hormone (ACTH).
The activation of the GR by dexamethasone results in dose-dependent suppression of the hypothalamic–pituitary–adrenal axis (HPA axis) and of production of endogenous corticosteroids by the adrenal glands, thereby reducing circulating endogenous concentrations of corticosteroids like cortisol and corticosterone. [72]
Topical clobetasone butyrate has shown minimal suppression of the hypothalamic–pituitary–adrenal axis. [2] It is available as clobetasone butyrate under the brand names Eumosone or Eumovate [3] both manufactured by GlaxoSmithKline. Trimovate also contains oxytetracycline, an antibiotic, and nystatin, an antifungal. [4]