title: Is suppression of hypothalamic-pituitary-adrenal axis significant during clinical treatment of phimosis?
abstract: OBJECTIVE
  Corticoids have been an option for phimosis treatment since 1993. However, long-term use or repeated cycles pose a concern regarding drug absorption and consequent systemic effects. The aim of this study was to investigate the effect of topical corticoids used in treating phimosis on the hypothalamus-pituitary-adrenal axis in children.
  
  
  METHODS
  A total of 31 children were included in the study. Cortisol secretion was evaluated by the measurement of salivary cortisol in saliva samples collected at 9:00 a.m. before starting treatment and after 8 weeks of topical treatment with 0.05% clobetasol propionate. Salivary cortisol was determined by radioimmunoassay. To confirm that use of clobetasol propionate was not detected by the assay, the presence of cortisol circadian rhythm was checked by an extra saliva sample obtained at 11:00 p.m. from 10 children, and was observed to be maintained in all of them.
  
  
  RESULTS
  No significant difference in salivary cortisol levels was observed between samples obtained at 9:00 a.m. before starting treatment and after completing treatment when the entire group was analyzed. However, in 2 children the salivary cortisol levels after treatment were lower than the cutoff value (358 ng/dl) assumed to be suggestive of hypothalamus-pituitary-adrenal axis suppression.
  
  
  CONCLUSIONS
  Topical clobetasol propionate used twice daily for clinical treatment of phimosis does not affect the hypothalamus-pituitary-adrenal axis in most patients. However, salivary cortisol level should be considered as a laboratory marker in long-term treatment or during repeated cycles to detect possible hypothalamus-pituitary-adrenal axis suppression.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery and Anatomy, School of Medicine of Ribeirão Preto, University of São Paulo, 3900 CEP-14048-900, Ribeirão Preto-SP, Brazil. fopileggi@gmail.co
authors.forename: F O
authors.initials: FO
authors.lastname: Pileggi
authors.forename: C E
authors.initials: CE
authors.lastname: Martinelli
authors.forename: M F G S
authors.initials: MF
authors.lastname: Tazima
authors.forename: J C
authors.initials: JC
authors.lastname: Daneluzzi
authors.forename: Y A M V A
authors.initials: YA
authors.lastname: Vicente
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002990:Clobetasol / Q000494:pharmacology / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects*; D008297:Male; D010688:Phimosis / Q000188:drug therapy*; D010913:Pituitary-Adrenal System / Q000187:drug effects*; D012463:Saliva / Q000737:chemistry
chemical_list: D005938:Glucocorticoids; D002990:Clobetasol; D006854:Hydrocortisone