Objectives: To determine if a single intra- or peri-articular injection of corticosteroid for post-traumatic or microtraumatic skeleton injuries in healthy young subjects would induce a suppression of hypothalamo-pituitary-adrenal axis activity and reactivity.
Methods: 10 young healthy male sportsmen (28.8±2.5 years) received a single intra- or peri-articular injection of either cortivazol or betamethasone for post-traumatic or microtraumatic skeleton injuries. Morning cortisol levels were measured on 4 occasions: the first day immediately before steroid injection (D0) & 2d (D2), 7d (D7) and 14d (D14) later. On D2, a ACTH test (1 μg) was performed.
Results: On D2, adrenal insufficiency (cortisol levels <100 nmol/l and/or blunted peak cortisol after stimulation with ACTH 1 μg) occurred in 9 out of 10 subjects.
On D7, cortisol levels were still decreased in all subjects (48.2±7.3% of D0 levels). Only one subject displayed a normal adrenal function (cortisol level >500 nmol/l).
On D14, cortisol levels remained significantly decreased compared to pre-injection levels (P=0.02) and averaged 77.3±8.3% of D0 levels. Only 3 participants out of 10 displayed a normal adrenal function. The magnitude of the adrenal suppression was correlated with the injected dose.
Conclusions: Some sportsmen are exposed to a high risk of traumatism which can potentially lead to an acute adrenal crisis should the HPA axis be non reactive. Thus, it is important to provide them some advice about the clinical signs that should lead to consult a physician after an intra or peri-articular corticosteroid injection.