TY - JOUR
T1 - Hypothalamo-pituitary-adrenal axis after a single epidural triamcinolone injection
AU - Iranmanesh, Ali
AU - Gullapalli, Dakshinamurty
AU - Singh, Ravinder
AU - Veldhuis, Johannes D.
N1 - Publisher Copyright:
© 2017, Springer Science+Business Media, LLC.
PY - 2017/8/1
Y1 - 2017/8/1
N2 - Purpose: To quantify adrenocorticotropin and cortisol secretion after epidural glucocorticoid injection. Methods: Eight men (ages 25–63 year) were studied at baseline, 1, 4, and 12 weeks after triamcinolone (80 mg) injection epidurally. Adrenocorticotropin (pg/mL) and cortisol (µg/dL) were measured every 10 min for 4 h, and after Corticotropin-releasing hormone (CRH) (1 µg/kg) injection. Results: Epidural triamcinolone markedly suppressed: (1) pre-CRH injection ACTH (from 18 ± 3.1 to 4.8 ± 0.4: P < 0.01) and cortisol (from 12.2 ± 1.6 to 1.6 ± 0.3: P < 0.0001) at week 1, with recovery at 4 weeks, and (2) CRH-stimulated 3-h summed ACTH (from 633 ± 116 to 129 ± 10 pg/mL, P < 0.0001), and 3-h summed cortisol at week 1 (from 385 ± 29 to 56 ± 22 µg/dL, P < 0.0001) and 4 weeks (284 ± 53; P < 0.01). Serum cortisol was <18 µg/dL in eight of eight men at 4 weeks, and six of eight men at week 12. Urinary-free cortisol (µg/24 h) remained low at week 12: baseline (60 ± 6.5); week 1 (9.0 ± 1.3, P < 0.01); week 4 (36 ± 8.6) and week 12 (38 ± 4.1). Urinary cortisol/cortisone ratios rose at week 4 only. Serum triamcinolone peaked at week 1 (16/16 samples), declining at week 4 (13/16 samples) and week 12 (6/16 samples). Limitations: Relatively small group. Conclusion: Epidural triamcinolone suppresses unstimulated and CRH-stimulated ACTH and cortisol secretion for 1–4 weeks but urinary free cortisol ≥12 weeks. Suppression of ACTH and cortisol after glucocorticoid treatment is thus complex.
AB - Purpose: To quantify adrenocorticotropin and cortisol secretion after epidural glucocorticoid injection. Methods: Eight men (ages 25–63 year) were studied at baseline, 1, 4, and 12 weeks after triamcinolone (80 mg) injection epidurally. Adrenocorticotropin (pg/mL) and cortisol (µg/dL) were measured every 10 min for 4 h, and after Corticotropin-releasing hormone (CRH) (1 µg/kg) injection. Results: Epidural triamcinolone markedly suppressed: (1) pre-CRH injection ACTH (from 18 ± 3.1 to 4.8 ± 0.4: P < 0.01) and cortisol (from 12.2 ± 1.6 to 1.6 ± 0.3: P < 0.0001) at week 1, with recovery at 4 weeks, and (2) CRH-stimulated 3-h summed ACTH (from 633 ± 116 to 129 ± 10 pg/mL, P < 0.0001), and 3-h summed cortisol at week 1 (from 385 ± 29 to 56 ± 22 µg/dL, P < 0.0001) and 4 weeks (284 ± 53; P < 0.01). Serum cortisol was <18 µg/dL in eight of eight men at 4 weeks, and six of eight men at week 12. Urinary-free cortisol (µg/24 h) remained low at week 12: baseline (60 ± 6.5); week 1 (9.0 ± 1.3, P < 0.01); week 4 (36 ± 8.6) and week 12 (38 ± 4.1). Urinary cortisol/cortisone ratios rose at week 4 only. Serum triamcinolone peaked at week 1 (16/16 samples), declining at week 4 (13/16 samples) and week 12 (6/16 samples). Limitations: Relatively small group. Conclusion: Epidural triamcinolone suppresses unstimulated and CRH-stimulated ACTH and cortisol secretion for 1–4 weeks but urinary free cortisol ≥12 weeks. Suppression of ACTH and cortisol after glucocorticoid treatment is thus complex.
KW - ACTH
KW - Cortisol
KW - Glucocorticoid
KW - Human
KW - Inhibition
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U2 - 10.1007/s12020-017-1357-7
DO - 10.1007/s12020-017-1357-7
M3 - Article
C2 - 28674775
AN - SCOPUS:85021833350
SN - 1355-008X
VL - 57
SP - 308
EP - 313
JO - Endocrine
JF - Endocrine
IS - 2
ER -