Schott S, Schnauder G, Müssig K
Abteilung für Endokrinologie, Diabetes, Angiologie, Nephrologie und Klinische Chemie, Medizinische Klinik, Universitätsklinikum Tübingen.
Dtsch Med Wochenschr. 2009 Feb;134(7):298-301. doi: 10.1055/s-0028-1123995. Epub 2009 Feb 5.
Two women, aged 74 and 57 years, were admitted for endocrinological work-up. The 74-year-old women had clinical signs of adrenal insufficiency after she had been given one triamcinolone acetonide intra-articular injection 3 months before. The 57-year-old women who had over several years been repeatedly received local triamcinolone acetonide injections for degenerative changes in her cervical spine for several years and needed reoperative investigation. Physical examination was unremarkable in both patients: they had no signs of Cushing's syndrome.
Serum cortisol and plasma adrenocorticotropic hormone (ACTH) were reduced in both patients. Endocrinological tests in the 74-year-old patient showed reduced free cortisol excretion in the urine, normal cortisol response in the ACTH test and subnormal cortisol stimulation during the corticotropin-releasing-hormone test and the insulin tolerance test. Magnetic resonance imaging of the sella was normal. The 57-year-old patient had a reduced cortisol response.
DIAGNOSIS, TREATMENT AND COURSE: The results of endocrinological tests in both patients were consistent with secondary adrenal insufficiency after local injection of triamcinolone acetonide. In the 74-year-old patient substitution treatment with hydrocortisone was started and resulted in rapid improvement of the symptoms. Perioperative intravenous substitution was advised for the 57-year-old patient .
Locally administered synthetic glucocorticoids can be associated with systemic adverse effects, such as secondary adrenal insufficiency. Clinically significant secondary adrenal failure can be produced not only by long-term administration of triamcinolone acetonide, but possibly also if it is injected just once.
两名女性患者，年龄分别为74岁和57岁，因内分泌检查入院。74岁女性在3个月前接受了一次关节腔内注射曲安奈德后出现肾上腺功能不全的临床症状。57岁女性因颈椎退行性变多年来反复接受局部曲安奈德注射，需要再次进行手术检查。两名患者的体格检查均无异常：均无库欣综合征的体征。
两名患者的血清皮质醇和血浆促肾上腺皮质激素（ACTH）均降低。74岁患者的内分泌检查显示尿中游离皮质醇排泄减少，ACTH试验中皮质醇反应正常，促肾上腺皮质激素释放激素试验和胰岛素耐量试验中皮质醇刺激低于正常。蝶鞍磁共振成像正常。57岁患者的皮质醇反应降低。
诊断、治疗与病程：两名患者的内分泌检查结果均符合局部注射曲安奈德后继发性肾上腺功能不全。74岁患者开始使用氢化可的松替代治疗，症状迅速改善。建议57岁患者围手术期进行静脉替代治疗。
局部应用合成糖皮质激素可能会引起全身不良反应，如继发性肾上腺功能不全。不仅长期使用曲安奈德可导致具有临床意义的继发性肾上腺功能衰竭，单次注射也可能导致。
