Allergic rhinitis is a common condition that frequently coexists with asthma and atopic dermatitis. It is commonly treated with intranasal corticosteroids which may increase the potential inception of side effects of the same type of drugs used for the treatment of other allergic diseases. A method to assess the systemic effect of corticosteroids is the evaluation of their effect on the hypothalamic-pituitary-adrenal (HPA) axis. However, it is not clear which test is best for detection of clinically relevant HPA axis suppression in children Morning plasma cortisol levels are twice that of late afternoon and evening values and a delay in the time of onset in peak cortisol levels has been observed in children treated with inhaled corticosteroids. Single morning cortisol level has a low sensitivity for detecting adrenal insufficiency in children. 24-Hour plasma cortisol is a good test because it is a non-invasive measure of the biologically active free cortisol levels for the entire day. For research purposes, the 24-hour integrated concentration plasma cortisol test is preferred. Studies that have looked at HPA axis suppression with intranasal corticosteroids indicate that overall, intranasal corticosteroids have a minimal effect on the HPA axis. A review of the literature reveals one study in which there was a decreased output of urinary cortisol during treatment with either budesonide or fluticasone propionate in adults. Other studies with fluticasone propionate or budesonide have shown no effect on the HPA axis in children. Beclomethasone dipropionate was shown to affect urinary cortisol output in one study on healthy volunteers. However, in a long-term study in children, no effect on the HPA axis was found. Mometasone furoate has been extensively studied in more than 20 trials of adults and children. No effects on the HPA axis were detected in either children or adults. Fluticasone furoate nasal spray was not associated with HPA axis suppression. It is unlikely that children are more sensitive to corticosteroids than adults. There is no reason to perform routine monitoring of adrenal function in children who are treated with intranasal corticosteroid unless those drugs are used concomitantly with inhaled corticosteroids and/or steroid ointments for the possible concomitant presence of asthma and/or atopic dermatitis.
Our current understanding of adrenal function is still at its infancy at best. It is therefore very difficult for any health professional to have a good grasp of the Adrenal Fatigue condition from a purely pathological and physiological perspective. The number of physicians with true expertise in advanced Adrenal Fatigue is very small. Those who are good in this gain their expertise not from textbooks, but from years of clinical experience. There is no short cut, because text-book cases are few and far between. Because the full recovery cycle can take years to complete in severe cases, practitioners with little experience will find it hard to handle cases other than the most mild and straight forward ones.
Steroids killed nine-year-old Lexie McConnell after only five and a half weeks. In August 1993, Lexie was diagnosed as having toxoplasmosis. The consultant put her on 80 mg per day of prednisolone. Immediately, she suffered severe side effects, huge weight gain , terrible pains, holes in her tongue and black stools. After nearly a month, at her parents' pleading, the doctors quickly lowered the dosage to 60 mg, 40 mg, 20 mg. In excruciating pain, Lexie was taken to a hospital, where it was discovered she'd contracted chickenpox. Four days later, she died. A few years later, another eye specialist declared that a simple course of antibiotics could have cleared up her infection. The above excerpt is from Ursula Kelly's site