Addison's Disease Research Today is a free monthly online journal that collates and summarizes the latest research about Addison's Disease, including details on chronic adrenal insufficiency, treatment, causes, medication.

High Risk of Adrenal Insufficiency after a Single Articular Steroid Injection in Athletes.

Duclos M, Guinot M, Colsy M, Merle F, Baudot C, Corcuff JB, Lebouc Y

1University Hospital (CHU) Clermont-Ferrand, Hospital G. Montpied, Department of Sport Medicine and Functional Explorations, Clermont-Ferrand, FRANCE; 2Laboratory of Human Nutrition, INRA UMR 1019, Clermont-Ferrand, FRANCE; 3University of Auvergne I, Clermont-Ferrand, FRANCE; 4University Hospital (CHU) Grenoble, Department of Functional Cardiovascular Explorations, Grenoble, FRANCE; 5Sports Clinic of Bordeaux Mérignac, Mérignac, FRANCE; 6University Hospital (CHU) Bordeaux, Hospital Haut-Lévêque, Department of Nuclear Medicine, Pessac, FRANCE; 7University Hospital (AP HP), Child Hospital Armand Trousseau, Laboratory of Endocrine Functional Explorations, Paris, FRANCE; 8University Pierre and Marie Curie, Paris, FRANCE; 9INSERM U515, Paris, FRANCE; and 10University Hospital (AP HP), Hospital Saint Antoine, Paris, FRANCE.

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 mug) was performed. RESULTS:: Two days after corticosteroid administration, adrenal insufficiency (cortisol levels below 100 nM and/or blunted peak cortisol after stimulation with 1 mug 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.

Published 28 June 2007 in Med Sci Sports Exerc, 39(7): 1036-1043.
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