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January 1977

Long-Term Intramuscular Administration of Triamcinolone Acetonide

Arch Dermatol. 1977;113(1):111. doi:10.1001/archderm.1977.01640010113027

To the Editor.—  With interest, we read the article by Carson et al.1 We wish to comment on this paper and add some of our observations on the effects of long-term intramuscular administration of triamcinolone acetonide.The statement by the authors that metyrapone tartrate can be used to evaluate the ability of the hypothalamic-pituitary-adrenal axis (HPAA) to respond to stress is questionable. "Stress" is not produced by metyrapone testing. This drug is used to test the integrity of the HPAA feedback mechanism.2 Metyrapone inhibits the adrenal enzyme 11-β-hydroxylase, which is essential for the formation of cortisol from its precursors. This action lowers the plasma cortisol and induces hypothalamic stimulation of adrenocorticotropic hormone (ACTH) release by the pituitary, which in turn stimulates the adrenal cortex. Since the latter is unable to synthesize cortisol while 11-β-hydroxylase is inhibited, a large amount of the cortisol precursor 11-deoxycortisol (compound S) is poured into

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