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Hypothalamic–Pituitary–Adrenocortical Function After the Dexamethasone–Promethazine Adhesion Regimen

From the Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, The C. S. Mott Center for Human Growth and Development, Detroit, Michigan

Abstract

Dexamethasone and promethazine are widely used as an antiadhesion regimen in infertility surgery. A major argument against the routine use of dexamethasone has been the concern that suppression of the hypothalamic–pituitary–adrenal axis may result. To investigate this concern, 25 healthy women undergoing surgery for infertility were administered dexamethasone and promethazine preoperatively, intraoperatively, and postoperatively for 48 hours. Insulin hypoglycemia testing was performed on postoperative day 6. A normal rise in cortisol of at least 7 (µg/dl was observed in 19 of 21 women. Two women failed to achieve this rise, despite adequate hypoglycemia. Short-term suppression of the hypothalamic–pituitary–adrenal axis may occur after administration of the dexamethasone–promethazine regimen. Patients receiving this regimen should be carefully supervised during the postoperative period.