High risk of adrenal insufficiency after a single articular steroid injection in athletes

Martine Duclos, Michel Guinot, Marina Colsy, Francis Merle, Christophe Baudot, Jean Benoit Corcuff, Yves Lebouc
Medicine and Science in Sports and Exercise 2007, 39 (7): 1036-43

PURPOSE: To determine whether a single intra- or periarticular injection of corticosteroid for posttraumatic or microtraumatic articular injuries in young healthy subjects can induce a biological suppression of hypothalamo-pituitary-adrenal axis activity and reactivity.

METHODS: Ten healthy young male athletes (aged 28.8 +/- 2.5 yr) received a single intra- or periarticular injection of either cortivazol (available in Europe but not in the United States) or betamethasone. Morning cortisol levels were measured on four occasions: the day of steroid injection (D0) and 2 d (D2), 7 d (D7), and 14 d (D14) later. During the second visit (D2), a short ACTH test (1 microg) was performed.

RESULTS: Two days after corticosteroid administration, adrenal insufficiency (cortisol levels below 100 nM and/or blunted peak cortisol after stimulation with 1 microg of ACTH) occurred in 9 of the 10 subjects. Seven days after steroid injection, cortisol levels were still lower than basal values in all subjects (48.2 +/- 7.3% of D0 levels), and five subjects had abnormal cortisol levels (< 260 nM). Fourteen days after steroid injection, cortisol levels remained significantly lower than preinjection levels (P = 0.02), averaging only 77.3 +/- 8.3% of D0 levels, and three participants remained with abnormal cortisol levels. The extent of biological adrenal suppression was directly related to the steroid dose injected.

CONCLUSION: As some athletes are exposed to a high risk of trauma, which can lead to an acute adrenal crisis, they should be informed about the risk of adrenal insufficiency after an intra- or periarticular corticosteroid injection, and they should report any symptoms to their physician.

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