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Purpose To quantify adrenocorticotropin (ACTH) and cortisol secretion after epidural glucocorticoid injection. Methods Eight men (ages 25–63 yr) were studied at baseline, 1, 4, and 12 wk after triamcinolone (80 mg) injection epidurally. ACTH (pg/mL) and cortisol (μg/dL) were measured every 10 min for 4 h, and after ACTH-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 wk 1, with recovery at 4 wk, and (2) CRH-stimulated summed ACTH (from 633 ± 116 to 129 ± 10 pg/mL/min, P<0.0001), and summed cortisol at wk 1 (from 385 ± 29 to 56 ± 22 μg/dL/min, P<0.0001) and 4 wk (284 ± 53; P<0.01). Serum cortisol was <18 μg/dL in 8 of 8 men at 4 wk, and 6 of 8 men at wk 12. Urinary free cortisol (μg/24 hr) remained low at wk 12: baseline (60 ± 6.5); wk 1 (9.0 ± 1.3, P<0.01); wk 4 (36 ± 8.6) and wk 12 (38 ± 4.1). Urinary cortisol/cortisone ratios rose at wk 4 only. Serum triamcinolone peaked at wk 1 (16/16 samples), declining at wk 4 (13/16 samples) and wk 12 (6/16 samples). Limitations Relatively small group. Conclusion Epidural triamcinolone suppresses unstimulated and CRH-stimulated ACTH and cortisol secretion for 1–4 wk but urinary free cortisol ≥12 wk. Suppression of ACTH and cortisol after glucocorticoid treatment is thus complex.

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