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M. Amiran, Y. Lang, G. Sartani, I. Avraham, R. Luboshitzky; Evaluation of the Pituitary-Adrenal Axis Function Following Intravitreal Triamcinolone Acetonide Injection. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5608.
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To determine the effects of a single 4mg/0.1ml intravitreal Triamcinolone Acetonide injection (IVTA) on the function of the pituitary-adrenal axis.
Nineteen patients suffering from macular edema were treated with single IVTA injection. The basal cortisol level and the response to 1µg adrenocoticotropic hormone (ACTH) simulation were determined on the morning before treatment and at 1 day, 1-, 2-, and 4- weeks after IVTA injection. Results were compared with those obtained from a control-group of 19 healthy subjects.
Before treatment, all patients had basal (381 ± 110 nmol/L) and peak (676 ± 135 nmoles/liter) cortisol responses to ACTH at 30 minutes, which were similar to those in controls (395 ±130 nmoles/liter and 712 ±119 nmoles/liter, respectively). Blunted peak cortisol response (<585 nmoles/liter) at 30 minutes was observed in 7 out of 19 patients (36.8%) after 1 day, in 5 patients (26.3%) after 1 week, and in 4 patients (21%) 2 weeks after IVTA injection. In 2 of the 19 patients (10.5%) blunted cortisol was observed 4 weeks after IVTA.
Single IVTA injection is associated with adrenocortical suppression presumably due systemic absorption of Triamcinolone.Maximal adrenocortical suppression may be observed during the first 2 weeks after IVTA.While recovery is expected in most patients within 4 weeks, some patients may exhibit adrenocortical suppression for over than 4 weeks after IVTA injection.
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