Transient suppression of endogenous cortisol production after intraarticular steroid therapy for chronic arthritis in children.
OBJECTIVE
To assess the effect on endogenous cortisol production of administration of intraarticular steroids for chronic arthritis in children and adolescents.


METHODS
We examined 22 children with chronic arthritis who received intraarticular steroid injection. The morning peak cortisol concentration was measured in saliva before and several days to weeks after steroid injection. In 7 children cortisol concentrations were measured at 4 pm and 8 pm as well. In one girl the hypothalamic-pituitary-adrenal axis was tested using the corticotropin releasing hormone stimulation test.


RESULTS
After steroid injection there was suppression of endogenous cortisol production that lasted 10 to 30 days. During this period the circadian rhythm of cortisol production and the hypothalamic-pituitary-adrenal axis were disturbed.


CONCLUSIONS
After intraarticular steroid injection children show transient suppression of endogenous cortisol production. It is not known whether this might place them at risk from stress induced acute adrenal insufficiency.
Huppertz
H I
HI
Children's Hospital, University of Würzburg, Germany.
Pfüller
H
H
D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy* / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003346:Corticotropin-Releasing Hormone / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007223:Infant; D007270:Injections, Intra-Articular; D012463:Saliva / Q000378:metabolism; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000627:therapeutic use*
D000893:Anti-Inflammatory Agents; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D014222:Triamcinolone Acetonide; D006854:Hydrocortisone