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Hypothalamo-pituitary-adrenal axis after a single epidural triamcinolone injection
Ali Iranmanesh1, Dakshinamurty Gullapalli1, Ravinder Singh2
1Endocrine and Neurology Sections, Medical Service, Salem Veterans Affairs Medical Center, Salem, VA, 24153, USA.
Endocrine
|July 5, 2017
Summary
Epidural triamcinolone significantly suppresses adrenocorticotropin (ACTH) and cortisol levels for 1-4 weeks, with prolonged effects on urinary free cortisol up to 12 weeks. This highlights the complex nature of hormonal suppression following glucocorticoid treatment.
Area of Science:
- Endocrinology
- Pharmacology
- Pain Management
Background:
- Epidural glucocorticoid injections are common for pain relief.
- The systemic effects of epidural steroids on the hypothalamic-pituitary-adrenal (HPA) axis are not fully understood.
- Quantifying hormonal changes is crucial for assessing patient safety and treatment efficacy.
Purpose of the Study:
- To quantify adrenocorticotropin (ACTH) and cortisol secretion following epidural glucocorticoid injection.
- To assess the duration of HPA axis suppression after epidural triamcinolone administration.
Main Methods:
- Eight male participants received an 80 mg epidural triamcinolone injection.
- Adrenocorticotropin and cortisol levels were measured at baseline, 1, 4, and 12 weeks post-injection.
- Hormonal responses to Corticotropin-releasing hormone (CRH) stimulation were evaluated.
Main Results:
- Epidural triamcinolone markedly suppressed unstimulated ACTH and cortisol at week 1 (P<.01 and P<.0001, respectively).
- CRH-stimulated ACTH and cortisol were significantly reduced at weeks 1 and 4 (P<.0001).
- Low serum cortisol persisted in most participants up to 12 weeks, with suppressed urinary free cortisol observed at week 12.
Conclusions:
- Epidural triamcinolone causes significant suppression of ACTH and cortisol secretion for at least 1-4 weeks.
- Urinary free cortisol levels remained suppressed for ≥12 weeks, indicating prolonged systemic effects.
- The hormonal suppression following epidural glucocorticoid treatment is complex and warrants further investigation.
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