Adrenal and Pituitary Functions during Long-Term Topical Steroid Therapy

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Abstract
The results of investigations in 6 psoriasis patients, who have been treated with corticosteroid ointments (15–50 g daily) under occlusive dressings over a long period (minimum of 2 till more than 5 years) on the consequences of this therapy for the pituitary-adrenocortical system are related. In accordance with the literature a systemic effect during therapy is evident by a lowering of the 17-ketogenic steroids in the 24-hour urine and the plasma cortisol levels, and in an insufficient reaction to metyrapone. Stimulation with exogenous ACTH was followed by a normal adrenocortical response in all patients. With the insulin-tolerance test a good reaction to stress during therapy is found in the 5 tested patients. It is plausible, therefore, that the feedback system will resume its responsiveness after discontinuing the local therapy and that the suppression does not indicate permanent damage to the pituitary adrenal functions.

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