title: The effect of local injection of methylprednisolone acetate on the hypothalamic-pituitary-adrenal axis among patients with greater trochanteric pain syndrome.
abstract: Greater trochanteric pain syndrome (GTPS) is a common clinical entity for which the most effective treatment is local corticosteroid injection (LCI). There are no studies on the effect of LCI among patients with GTPS on the hypothalamic-pituitary-adrenal axis. The present study recruited nonselected patients diagnosed with GTPS. After consenting, participants received low dose (1 μg) of adrenocorticotropin hormone (ACTH) stimulation test at 09:00. Immediately following the test, participants received a LCI of 80 mg of methylprednisolone acetate at the greater trochanteric region. The ACTH stimulation test was repeated 1, 2, 4, and 6 weeks following the LCI. Cortisol samples were obtained at just prior to (basal) and 30 min (post-stimulation) following every ACTH stimulation test. Serum cortisol levels of <500 μmol/l obtained 30 min following the ACTH stimulation test were considered evidence of secondary adrenal insufficiency. The study enrolled 22 patients, 21 of whom completed participation. There were 19 female participants (~90%), and mean age of all the participants was 55.2 ± 8.6 years. Four participants showed evidence of secondary adrenal insufficiency, which was observed only at weeks 1 and 2 following the LCI. Mean serum cortisol level among these four participants 30 min following the ACTH stimulation test was 354 μmol/l, with a range of 268-430 μmol/l. LCI of 80 mg of methylprednisolone acetate in the greater trochanteric area among patients with GTPS was associated with transient secondary adrenal insufficiency in ~20% of the patients, mainly 1 week following the injection.
authors.affiliation: Rheumatology Unit, Laniado Hospital, 42150, Netanya, Israel. gshabib@gmail.com.|Netanya and Rheumatology Clinic, Nazareth Hospital, Nazareth, Israel. gshabib@gmail.com.|Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel. gshabib@gmail.com.
authors.forename: George
authors.initials: G
authors.lastname: Habib
authors.affiliation: Department of Medicine, Carmel Medical Center, Haifa, Israel.
authors.forename: Shada
authors.initials: S
authors.lastname: Elias
authors.affiliation: Department of Medicine, Carmel Medical Center, Haifa, Israel.
authors.forename: Muhanned
authors.initials: M
authors.lastname: Abu-Elhaija
authors.affiliation: Department of Pediatrics, Rambam Medical Center, Haifa, Israel.
authors.forename: Fahed
authors.initials: F
authors.lastname: Sakas
authors.affiliation: Department of Orthopedics, Carmel Medical Center, Haifa, Israel.
authors.forename: Fadi
authors.initials: F
authors.lastname: Khazin
authors.affiliation: Department of Radiology, Nazareth Hospital, Nazareth, Israel.|Gallile Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel.
authors.forename: Suheil
authors.initials: S
authors.lastname: Artul
authors.affiliation: Central Lab, Nazareth Hospital, Nazareth, Israel.
authors.forename: Adel
authors.initials: A
authors.lastname: Jabbour
authors.affiliation: Ophthalmology Unit, Poryia Medical Center, Gallile Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel.
authors.forename: Haneen
authors.initials: H
authors.lastname: Jabaly-Habib
mesh_terms: D000309:Adrenal Insufficiency / Q000453:epidemiology* / Q000209:etiology; D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage; D005260:Female; D005269:Femur / Q000503:physiopathology*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects; D007267:Injections; D007557:Israel; D016015:Logistic Models; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D000077555:Methylprednisolone Acetate; D008875:Middle Aged; D015999:Multivariate Analysis; D010913:Pituitary-Adrenal System / Q000187:drug effects; D011446:Prospective Studies; D013001:Somatoform Disorders / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000077555:Methylprednisolone Acetate; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone; D008775:Methylprednisolone
keywords: Greater trochanteric pain syndrome; Hypothalamic-pituitary-adrenal axis; Local corticosteroid injection; Methylprednisolone acetate; Secondary adrenal insufficiency