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Development and Resolution of Secondary Adrenal Insufficiency after an Intra-Articular Steroid Injection
Jia Wei Tan1, Sachin K Majumdar2
1Department of Internal Medicine, Bridgeport Hospital, Yale New Haven Health System, Bridgeport, Connecticut, USA.
Case Reports in Endocrinology
|January 2, 2023
Summary
Intra-articular steroid injections can suppress the hypothalamic-pituitary-adrenal (HPA) axis, leading to secondary adrenal insufficiency (SAI). Early testing for SAI is recommended in patients with nonspecific symptoms post-injection.
Area of Science:
- Endocrinology
- Pharmacology
Background:
- Corticosteroid injections are widely used for inflammatory conditions.
- While local administration reduces systemic risks, systemic absorption can occur, potentially impacting the hypothalamic-pituitary-adrenal (HPA) axis.
Observation:
- A 78-year-old female presented with gastrointestinal symptoms following an intra-articular steroid injection.
- She exhibited hyponatremia, low morning cortisol, and a blunted response to cosyntropin stimulation, indicative of secondary adrenal insufficiency (SAI).
Findings:
- The patient's SAI was directly linked to the intra-articular corticosteroid injection.
- HPA axis responsiveness recovered within two weeks of diagnosis and management.
Implications:
- This case underscores the potential for HPA axis suppression from intra-articular steroids.
- Clinicians should maintain a low threshold for testing corticosteroid users for adrenal insufficiency, particularly those with nonspecific symptoms.
- Prompt diagnosis and temporary corticosteroid treatment are crucial for managing SAI.
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