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Hypothalamic–pituitary–adrenal axis function following intravitreal triamcinolone acetonide injection

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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.

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Authors and Affiliations

  1. Department of Ophthalmology, Ha’Emek Medical Center, 18101, Afula, Israel

    Maoz D. Amiran, Yaron Lang & Gil Sartani

  2. The Bruce Rappaport Faculty of Medicine, Technion, The Israeli Institute of Technology, Haifa, Israel

    Maoz D. Amiran, Yaron Lang, Gil Sartani, Avraham Ishay & Rafael Luboshitzky

  3. Department of Ophthalmology and Visual Sciences, Eye Care Centre, Vancouver Hospital, University of British Columbia, Vancouver, BC, Canada

    Sonia N. Yeung

  4. Endocrine Institute, Ha’Emek Medical Center, Afula, Israel

    Avraham Ishay & Rafael Luboshitzky

Authors
  1. Maoz D. Amiran
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  2. Sonia N. Yeung
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  3. Yaron Lang
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  4. Gil Sartani
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  5. Avraham Ishay
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Correspondence to Sonia N. Yeung.

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Amiran, M.D., Yeung, S.N., Lang, Y. et al. Hypothalamic–pituitary–adrenal axis function following intravitreal triamcinolone acetonide injection. Int Ophthalmol 33, 211–216 (2013). https://doi.org/10.1007/s10792-012-9659-5

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  • DOI: https://doi.org/10.1007/s10792-012-9659-5

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