Question: Are those that are cured from Cushing’s more apt to get Cushing’s symptoms after a steroid injection in a joint? I thought that with injections, the medication was supposed to stay localized, but I had a systemic reaction. 

Answer: There is no information on whether or not patients in remission from Cushing’s are more apt to have a return of Cushing’s symptoms compared with patients who did not have Cushing’s. However, there should be no difference because this is what is called an “exogenous” steroid (not produced by the normal adrenal gland). The bottom line: most steroid injections (joint or muscle injections) involve the most potent steroid available (triamcinolone, trade names: Aristacort,  Kenalog, Aristospan) that has a long lasting effect, especially with repeated injections. This steroid is released over time and repeated injections can definitely cause symptoms of Cushing’s in anyone. A single injection is unlikely to cause symptoms of Cushing’s, but repeated injections may cause Cushing’s symptoms.  Most orthopedic and pain centers usually limit the number of these injections to 3 over several months. It is important to know that while a steroid injection may provide temporary relief from pain, this most likely is only a temporary “fix”, not a cure, for the symptoms of joint or muscle problems.

A steroid injection will suppress the normal pituitary ACTH production and cortisol production by the adrenal glands; this is usually temporary unless there are repeated and frequent injections. Before agreeing to steroid injections, patients should ask if the injection contains a steroid, how many injections there will be and how often these injections are recommended. The patient also needs to understand that injections may provide temporary improvement, but usually, this is not a cure.

Yes, the steroid injections do cause a systemic effect and they can have a long lasting effect.

 By Dr. Mary Lee Vance, Univ. of Virginia, Charlottesville, Winter, 2014