Glucocorticoid epidural for sciatica: metabolic and endocrine sequelae.
OBJECTIVE
The study was designed to investigate the effect of epidural administration of glucocorticoid on insulin sensitivity.


METHODS
Ten healthy individuals with sciatica underwent a short insulin tolerance test before and twice following (at 24 h and 1 week) a caudal epidural containing 80 mg triamcinolone. Fasting glucose, insulin and cortisol concentrations were also measured.


RESULTS
The rate of glucose disappearance after insulin administration (k(ITT)) fell from 3.6%/min before the epidural to 1.9%/min 24 h afterwards (P=0.001) and returned to pretreatment values by 1 week. Significantly raised fasting insulin and glucose levels also reflected impaired insulin sensitivity immediately after the epidural. Morning cortisol levels were suppressed after the epidural (49 nmol/l at 24 h and 95 nmol/l at 1 week vs 352 nmol/l at baseline; P<0.01).


CONCLUSIONS
Epidural administration of glucocorticoid results in potent suppression of insulin action and this should be taken into account when patients with diabetes require treatment for sciatica.
Ward
A
A
Bournemouth Diabetes and Endocrine Centre, Royal Bournemouth Hospital, Castle Lane East, Bournemouth BH7 7DW, UK.
Watson
J
J
Wood
P
P
Dunne
C
C
Kerr
D
D
D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D005951:Glucose Tolerance Test; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007268:Injections, Epidural; D007328:Insulin / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010865:Pilot Projects; D011336:Probability; D012585:Sciatica / Q000175:diagnosis / Q000188:drug therapy*; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D001786:Blood Glucose; D005938:Glucocorticoids; D007328:Insulin; D006854:Hydrocortisone