- Volume 18 Issue 2
Background: This study measured the rate of adrenal insufficiency among rotator cuff tear patients, and determined the roles of steroid treatment and herbal medicine as specific risk factors of adrenal insufficiency. Methods: We prospectively evaluated the 53 patients who agreed to participate in the study and underwent arthroscopic rotator cuff repair due to a chronic full-thickness tear from March 2012 to September 2013. The diagnosis of adrenal insufficieny was made by rapid adrenocortical hormone test before the operation. We collected information regarding their history of steroid and herbal medicine treatment within the last 12 months. Results: The rate of adrenal insufficiency among the rotator cuff tear patients in our study was 18.9% (10 of 53 patients). Steroid treatment (p=0.034), frequency of local steroid injection (p=0.008), and herbal medicine treatment (p=0.02) showed significant association with the risk of adrenal insufficiency. Conclusions: In this study, careful taking of a patient's medical history, such as the use of steroids and herbal medicine, is important when investigating adrenal function before surgery.
Intra-articular steroid injection;Herbal medicine;Adrenal insufficiency;Rotator cuff tear
- Matsen FA, Titelman RM, Lippitt SB, et al. Rotator cuff. In: Rockwood CA, Matsen FA, Matsen FA III, Wirth MA, Lippitt SB, Fehringer EV, eds. The shoulder. Philadelphia: WB Saunders;2004. 795-878.
- Neer CS 2nd. Impingement lesions. Clin Orthop Relat Res. 1983;(173):70-7.
- Bokor DJ, Hawkins RJ, Huckell GH, Angelo RL, Schickendantz MS. Results of nonoperative management of full-thickness tears of the rotator cuff. Clin Orthop Relat Res. 1993;(294):103-10.
- Wong MW, Tang YN, Fu SC, Lee KM, Chan KM. Triamcinolone suppresses human tenocyte cellular activity and collagen synthesis. Clin Orthop Relat Res. 2004;(421):277-81.
- Hugate R, Pennypacker J, Saunders M, Juliano P. The effects of intratendinous and retrocalcaneal intrabursal injections of corticosteroid on the biomechanical properties of rabbit Achilles tendons. J Bone Joint Surg Am. 2004;86(4):794-801. https://doi.org/10.2106/00004623-200404000-00019
- Sacre K, Dehoux M, Chauveheid MP, et al. Pituitary-adrenal function after prolonged glucocorticoid therapy for systemic inflammatory disorders: an observational study. J Clin Endocrinol Metab. 2013;98(8):3199-205. https://doi.org/10.1210/jc.2013-1394
- Habib G, Artul S, Chernin M, Hakim G, Jabbour A. The effect of intra-articular injection of betamethasone acetate/betamethasone sodium phosphate at the knee joint on the hypothalamic-pituitary-adrenal axis: a case-controlled study. J Investig Med. 2013;61(7):1104-7. https://doi.org/10.2310/JIM.0b013e3182a67871
- Mader R, Lavi I, Luboshitzky R. Evaluation of the pituitaryadrenal axis function following single intraarticular injection of methylprednisolone. Arthritis Rheum. 2005;52(3):924-8. https://doi.org/10.1002/art.20884
- Arlt W, Allolio B. Adrenal insufficiency. Lancet. 2003;361(9372):1881-93. https://doi.org/10.1016/S0140-6736(03)13492-7
- Oelkers W. Adrenal insufficiency. N Engl J Med. 1996;335(16):1206-12. https://doi.org/10.1056/NEJM199610173351607
- Bornstein SR. Predisposing factors for adrenal insufficiency. N Engl J Med. 2009;360(22):2328-39. https://doi.org/10.1056/NEJMra0804635
- Habib GS. Systemic effects of intra-articular corticosteroids. Clin Rheumatol. 2009;28(7):749-56. https://doi.org/10.1007/s10067-009-1135-x
- Lazarevic MB, Skosey JL, Djordjevic-Denic G, Swedler WI, Zgradic I, Myones BL. Reduction of cortisol levels after single intra-articular and intramuscular steroid injection. Am J Med. 1995;99(4):370-3. https://doi.org/10.1016/S0002-9343(99)80183-1
- Duclos M, Guinot M, Colsy M, et al. High risk of adrenal insufficiency after a single articular steroid injection in athletes. Med Sci Sports Exerc. 2007;39(7):1036-43. https://doi.org/10.1249/mss.0b013e31805468d6
- Rispler DT, Sara J. The impact of complementary and alternative treatment modalities on the care of orthopaedic patients. J Am Acad Orthop Surg. 2011;19(10):634-43. https://doi.org/10.5435/00124635-201110000-00007
- Armanini D, Fiore C, Mattarello MJ, Bielenberg J, Palermo M. History of the endocrine effects of licorice. Exp Clin Endocrinol Diabetes. 2002;110:257-61. https://doi.org/10.1055/s-2002-34587
- Matsuda S, Oda K, Kawaguchi M, Hayashi H. Histochemical studies on the effect of glycyrrhizin on corticoid metabolism. Nisshin Igaku Jpn J Med Prog. 1962;49:465-81.
- van Staa TP, Leufkens HG, Abenhaim L, Begaud B, Zhang B, Cooper C. Use of oral corticosteroids in the United Kingdom. QJM. 2000;93(2):105-11. https://doi.org/10.1093/qjmed/93.2.105