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Salivary cortisol concentration changes after epidural steroid injection.
1Department of Anesthesiology and Pain Medicine, The Catholic University of Korea, Seoul, Korea.
Pain Physician
|November 20, 2012
Summary
Epidural steroid injections suppress the hypothalamus-pituitary-adrenal axis for about 20 days. Salivary cortisol measurements are useful for monitoring this recovery, suggesting a one-month interval between injections.
Area of Science:
- Endocrinology
- Pain Management
- Neurosurgery
Background:
- Epidural steroid injections (ESI) are common for disc herniation and spinal stenosis.
- Evidence on the safety and systemic effects of ESI, particularly steroid safety, is limited.
Purpose of the Study:
- To determine the duration of hypothalamus-pituitary-adrenal (HPA) axis suppression following a single epidural injection of triamcinolone.
- To assess the utility of salivary cortisol measurements in evaluating HPA axis function post-ESI.
Main Methods:
- A clinical observational pilot study involving 8 patients with lumbar disc herniation or spinal stenosis.
- Salivary cortisol levels were measured before and after a 40 mg triamcinolone ESI, with follow-up assessments up to 28 days.
- Additional monitoring included body weight, blood pressure, pain scores (NRS), and fasting blood sugar.
Main Results:
- HPA axis suppression was observed in all patients, lasting an average of 19.9 ± 6.8 days.
- 5 out of 8 patients returned to baseline salivary cortisol levels within the study period (average 19.4 ± 8.3 days).
- No correlation was found between HPA axis suppression duration and baseline cortisol or pain scores.
Conclusions:
- HPA axis function was suppressed for approximately 20 days post-ESI, returning to normal ranges after about 3 weeks.
- Salivary cortisol measurements are effective predictors of HPA axis function.
- A minimum interval of one month between epidural steroid injections is recommended.
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