Local injection of methylprednisolone acetate is asssociated with transient secondary adrenal insufficiency in patients with greater trochanteric pain syndrome

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Local injection of methylprednisolone acetate is asssociated with transient secondary adrenal insufficiency in patients with greater trochanteric pain syndrome

One of the common clinical entity is the greater trochanteric pain syndrome (GTPS) for which the most effective treatment is the local corticosteroid injection (LCI). No studies have been performed to study the effect of LCI among patients with GTPS on the hypothalamic-pituitary-adrenal axis. In this present study, nonselected patients diagnosed with GTPS were enrolled.

At 09.00., the patients received low dose (1 μg) of adrenocorticotropin hormone (ACTH) stimulation test, with their consent. Immediately after the test, participants received a LCI of 80 mg of methylprednisolone acetate at the larger trochanteric region. Stimulation test for ACTH was repeated after 1, 2, 4, and 6 weeks following LCI. Following every ACTH stimulation test, cortisol samples were obtained at just prior to (basal) and 30 min of post-stimulation. An evidence of secondary adrenal insufficiency was considered as serum cortisol levels of <500 μmol/L obtained 30 min following the ACTH stimulation test.

Out of the total 22 patients enrolled in the study, 21 patentients participated completely. There were 19 female participants (~90%) with a mean age of 55.2 ± 8.6 years. Following the LCI, 4 participants revealed evidence of secondary adrenal insufficiency, which was observed only at weeks 1 and 2. The mean serum cortisol level among these four participants 30 min following the ACTH stimulation test was 354 μmol/L and in the range of 268–430 μmol/L.

Mainly 1 week following the injection, LCI of 80 mg of methylprednisolone acetate in the greater trochanteric area among patients with GTPS was associated with transient secondary adrenal insufficiency in ~20% of the patients.

Source:

Clin Rheumatol.

Link to the source:

http://link.springer.com/article/10.1007/s10067-016-3517-1

Original title of article:

The effect of local injection of methylprednisolone acetate on the hypothalamic-pituitary-adrenal axis among patients with greater trochanteric pain syndrome

Authors:

 George Habib et al.

Clin Rheumatol.
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