Park JungHyun, Kwak Jueun, Chung Sukyung, Hong Hyo Ju, Chon Jin Young, Moon Ho Sik
Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
J Pain Res. 2020 Jun 24;13:1505-1514. doi: 10.2147/JPR.S252278. eCollection 2020.
Endocrinological complications of an epidural steroid injection (ESI) are rare but dangerous. Nevertheless, despite the associated risks, repeated long-term ESIs are indispensable in some clinical situations. However, only a few reports to date have assessed the safety of this procedure. In this study, we evaluate the incidence of adrenal insufficiency (AI) and Cushing's syndrome after long-term ESIs.
This clinical observational study enrolled herniated nucleus pulposus or spinal stenosis patients who had received ESIs over a period of six months or longer. The adrenocorticotropic hormone (ACTH) stimulation test was performed to confirm AI and the late-night salivary cortisol (LNSC) test was performed to diagnose Cushing's syndrome. To evaluate the hypothalamus pituitary adrenal axis suppression, salivary cortisol (SC) levels were measured on days 0, 1, 7, 21, 28, 35, and 42.
This study included 17 patients. Among these, two patients (11.8%) developed AI, but no cases of Cushing's syndrome were reported. There was no predictor for the development of AI. The SC levels tended to increase with time after an ESI (β = 0.003). The slope of the mixed effect model between the AI and non-AI groups showed a significant difference (p value = 0.015). However, the differences in mean SC levels at each time point between the two groups were not significant (adjusted p value = 0.053).
Long-term ESI use may be associated with AI development. An unexpected adrenal crisis due to AI could be life threatening. Therefore, regular monitoring of adrenal function in patients who have received long-term ESIs may be prudent.
硬膜外类固醇注射（ESI）的内分泌并发症罕见但危险。然而，尽管存在相关风险，但在某些临床情况下，重复进行长期ESI是必不可少的。然而，迄今为止，只有少数报告评估了该手术的安全性。在本研究中，我们评估长期ESI后肾上腺功能不全（AI）和库欣综合征的发生率。
本临床观察性研究纳入了接受ESI治疗六个月或更长时间的腰椎间盘突出症或椎管狭窄患者。进行促肾上腺皮质激素（ACTH）刺激试验以确认AI，并进行午夜唾液皮质醇（LNSC）试验以诊断库欣综合征。为了评估下丘脑-垂体-肾上腺轴抑制情况，在第0、1、7、21、28、35和42天测量唾液皮质醇（SC）水平。
本研究包括17名患者。其中，两名患者（11.8%）发生了AI，但未报告库欣综合征病例。没有AI发生的预测因素。ESI后SC水平倾向于随时间增加（β = 0.003）。AI组和非AI组之间混合效应模型的斜率显示出显著差异（p值 = 0.015）。然而，两组在每个时间点的平均SC水平差异不显著（校正p值 = 0.053）。
长期使用ESI可能与AI的发生有关。由AI引起的意外肾上腺危象可能危及生命。因此，对接受长期ESI治疗的患者定期监测肾上腺功能可能是谨慎的做法。
