title: Hypothalamic-pituitary-adrenal axis function following intravitreal triamcinolone acetonide injection.
abstract: To evaluate the pituitary-adrenal axis function by means of the adrenocorticotropic hormone (ACTH) stimulation test following a single intravitreal injection of triamcinolone acetonide (IVTA). Prospective comparative clinical interventional study. Twenty-eight patients (28 eyes) received a single IVTA (4 mg in 0.1 ml) for macular edema. The basal cortisol level and the response to 1 μg adrenocorticotropic hormone stimulation were determined on the morning before IVTA injection and at 1 day and 1, 2, and 4 weeks after IVTA injection. Results were compared with those obtained from a control group of 50 healthy subjects. All patients in the study had normal basal cortisol and normal response to ACTH challenge before receiving IVTA. 1 day following IVTA, basal cortisol was suppressed in one patient in the study group. Fasting serum cortisol levels at 1, 2, and 4 weeks after IVTA injection were normal in all patients in the study group. 1 day following IVTA, the peak response to ACTH at 30 min was blunted in four patients (14.3 % of the study group, p = 0.05) and the cortisol response at 60 min was suppressed (p = 0.009). 1 week following IVTA, the response to ACTH challenge was blunted in only one patient. A single IVTA injection may be associated with impaired hypothalamic-pituitary-adrenal function in some patients during the first 24 h following IVTA.
authors.affiliation: Department of Ophthalmology, Ha'Emek Medical Center, 18101, Afula, Israel. karen_charrach@hotmail.com
authors.forename: Maoz D
authors.initials: MD
authors.lastname: Amiran
authors.forename: Sonia N
authors.initials: SN
authors.lastname: Yeung
authors.forename: Yaron
authors.initials: Y
authors.lastname: Lang
authors.forename: Gil
authors.initials: G
authors.lastname: Sartani
authors.forename: Avraham
authors.initials: A
authors.lastname: Ishay
authors.forename: Rafael
authors.initials: R
authors.lastname: Luboshitzky
mesh_terms: D000324:Adrenocorticotropic Hormone; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006728:Hormones; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects* / Q000502:physiology; D058449:Intravitreal Injections; D008269:Macular Edema / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000187:drug effects* / Q000502:physiology; D011446:Prospective Studies; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*
chemical_list: D005938:Glucocorticoids; D006728:Hormones; D000324:Adrenocorticotropic Hormone; D014222:Triamcinolone Acetonide; D006854:Hydrocortisone