The effect of epidural methylprednisolone acetate injection on the hypothalamic-pituitary-adrenal axis

Corticosteroid and Cortisol Serum Levels Following Intra‐articular Triamcinolone Acetonide Lumbar Facet Joint Injections

“…Suppression of the HPA axis has been reported following spinal corticosteroid injections . Serum cortisol levels were suppressed for approximately 4 days following intra‐articular facet joint injections.…”

“…Despite widespread use, little is known about the systemic absorption and serum levels of corticosteroids following intra‐articular facet joint injections. Current pharmacokinetic literature surrounding the administration of spinal corticosteroids has focused on adverse drug–drug interactions, serum blood glucose fluctuations among patients with diabetes, and effects on the hypothalamic‐pituitary‐adrenal (HPA) axis …”

Hypothalamo-pituitary-adrenal axis after a single epidural triamcinolone injection

“…Modulation of corticotropic function after glucocorticoid injection into paraspinal and epidural spaces has been investigated sporadically over the past decades [3, 8–13, 15]. However, dynamic testing of the HPA axis in this setting is quite limited.…”

“…Suppression can occur as early as 15 min for ACTH and 30 min for cortisol after epidural triamcinolone administration [13]. Moreover, suppression of insulin-induced hypoglycemia-stimulated cortisol secretion occurs after epidural injection of triamcinolone in dogs [14], and impairment of adrenal cortisol secretion occurs in response to synthetic ACTH stimulation after extradural methylprednisolone and epidural prednisone administration in humans [9, 15]. The duration of suppression after paraspinal glucocorticoid injections is less well defined, possibly up to 21 days after a single glucocorticoid dose [10], and 3 months after repeated dosing [13].…”

Serum Triamcinolone Levels Following Interlaminar Epidural Injection

“…21 The findings from our study suggest the initial high peak serum concentrations of triamcinolone that occur Alterations in the HPA axis have also been observed following epidural-administered corticosteroids including triamcinolone. [23][24][25] In a previous study that involved 14 patients (7 men, 7 women) with chronic low-back pain, lumbar interlaminar ESI was performed weekly for 3 weeks using 80 mg of triamcinolone acetate. 24 Suppression of serum adrenocorticotropic hormone (ACTH) and cortisol was observed 45 minutes following the first injection, and significant reductions were observed 7 days following the first injection.…”