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We wish to thank Drs Mikhail, Sweet, and Mellinger for their interest that was expressed in our recent report on the effects of long-term administration of triamcinolone acetonide on the hypothalamic-pituitary-adrenal axis (HPAA). Our study was completed prior to the publication of their excellent paper, and we apologize for not referring to it.We agree that metyrapone tartrate does not produce a "stress," as such, to the HPAA. However, we believe this test measures an integrity of the axis necessary for increased adrenal corticosteroid secretion in stressful situations.The important point is that abnormal HPAA function exists for months after persons have received long-term intramuscular triamcinolone acetonide. We agree with Mikhail et al that possibly the interval between injections may be primary.In their paper, Mikhail et al touched on the possibility that triamcinolone acetonide produces other endocrine alterations as evidenced by some of their patients' inability to
Carson TE, Daane TA. Long-Term Intramuscular Administration of Triamcinolone Acetonide-Reply. Arch Dermatol. 1977;113(1):111. doi:10.1001/archderm.1977.01640010113028