Development and Resolution of Secondary Adrenal Insufficiency after an Intra-Articular Steroid Injection
Corticosteroid injections are commonly indicated in inflammatory conditions involving the soft tissues, tendon sheaths, bursae, and joints. Local corticosteroids carry a lower risk of complications than systemic corticosteroid but may be systemically absorbed and subsequently suppress the hypothalam...
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| Format: | Article |
| Language: | English |
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Wiley
2022-01-01
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| Series: | Case Reports in Endocrinology |
| Online Access: | http://dx.doi.org/10.1155/2022/4798466 |
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| author | Jia Wei Tan Sachin K. Majumdar |
| author_facet | Jia Wei Tan Sachin K. Majumdar |
| author_sort | Jia Wei Tan |
| collection | DOAJ |
| description | Corticosteroid injections are commonly indicated in inflammatory conditions involving the soft tissues, tendon sheaths, bursae, and joints. Local corticosteroids carry a lower risk of complications than systemic corticosteroid but may be systemically absorbed and subsequently suppress the hypothalamic-pituitary-adrenal (HPA) axis. This can cause secondary adrenal insufficiency (SAI) as well as iatrogenic Cushing’s syndrome. We report a 78-year-old female who presented with nonspecific gastrointestinal symptoms after a recent intra-articular steroid injection in her shoulder. She had hyponatremia, low morning cortisol, and failed to respond to high-dose cosyntropin. Further workup revealed the underlying cause to be SAI. Follow-up testing revealed a recovery of HPA responsiveness within 2 weeks of her initial diagnosis. Conclusion. Our case highlights how the hypothalamic-pituitary axis (HPA) can be suppressed with intra-articular steroids. The threshold to test corticosteroid users for adrenal insufficiency should be low in clinical practice, especially for those patients with nonspecific symptoms after steroid injections. Once diagnosed, temporary treatment with steroids may be required. |
| format | Article |
| id | doaj-art-cc1f206ad66948dab0b4fe573ceaff06 |
| institution | DOAJ |
| issn | 2090-651X |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Endocrinology |
| spelling | doaj-art-cc1f206ad66948dab0b4fe573ceaff062025-08-20T03:04:42ZengWileyCase Reports in Endocrinology2090-651X2022-01-01202210.1155/2022/4798466Development and Resolution of Secondary Adrenal Insufficiency after an Intra-Articular Steroid InjectionJia Wei Tan0Sachin K. Majumdar1Department of Internal MedicineDepartment of EndocrinologyCorticosteroid injections are commonly indicated in inflammatory conditions involving the soft tissues, tendon sheaths, bursae, and joints. Local corticosteroids carry a lower risk of complications than systemic corticosteroid but may be systemically absorbed and subsequently suppress the hypothalamic-pituitary-adrenal (HPA) axis. This can cause secondary adrenal insufficiency (SAI) as well as iatrogenic Cushing’s syndrome. We report a 78-year-old female who presented with nonspecific gastrointestinal symptoms after a recent intra-articular steroid injection in her shoulder. She had hyponatremia, low morning cortisol, and failed to respond to high-dose cosyntropin. Further workup revealed the underlying cause to be SAI. Follow-up testing revealed a recovery of HPA responsiveness within 2 weeks of her initial diagnosis. Conclusion. Our case highlights how the hypothalamic-pituitary axis (HPA) can be suppressed with intra-articular steroids. The threshold to test corticosteroid users for adrenal insufficiency should be low in clinical practice, especially for those patients with nonspecific symptoms after steroid injections. Once diagnosed, temporary treatment with steroids may be required.http://dx.doi.org/10.1155/2022/4798466 |
| spellingShingle | Jia Wei Tan Sachin K. Majumdar Development and Resolution of Secondary Adrenal Insufficiency after an Intra-Articular Steroid Injection Case Reports in Endocrinology |
| title | Development and Resolution of Secondary Adrenal Insufficiency after an Intra-Articular Steroid Injection |
| title_full | Development and Resolution of Secondary Adrenal Insufficiency after an Intra-Articular Steroid Injection |
| title_fullStr | Development and Resolution of Secondary Adrenal Insufficiency after an Intra-Articular Steroid Injection |
| title_full_unstemmed | Development and Resolution of Secondary Adrenal Insufficiency after an Intra-Articular Steroid Injection |
| title_short | Development and Resolution of Secondary Adrenal Insufficiency after an Intra-Articular Steroid Injection |
| title_sort | development and resolution of secondary adrenal insufficiency after an intra articular steroid injection |
| url | http://dx.doi.org/10.1155/2022/4798466 |
| work_keys_str_mv | AT jiaweitan developmentandresolutionofsecondaryadrenalinsufficiencyafteranintraarticularsteroidinjection AT sachinkmajumdar developmentandresolutionofsecondaryadrenalinsufficiencyafteranintraarticularsteroidinjection |