Endocrine Abstracts

Introduction: Pain in the groin area is frequently encountered in football players, the cause being a sport hernia, muscle tears, avulsions, sacroiliac joint pathology, etc. Local corticosteroid injections (LCIs) are often used as one of the first-line treatments in the conservative management because of their ease of delivery, low cost and efficacy.

Case presentation: A 32-year-old amateur futsal player (goalkeeper) diagnosed with type 1 diabetes at the age of 18, complicated by mild peripheral polyneuropathy, treated with aspart insulin through an insulin pump (basal rate=25.7 IU/day and boluses=35 IU/day) was admitted to the Clinical Recovery Hospital for an intense pain in the left groin area (9/10 on VAS), located profound and aggravated by any physical activity. The patient was previously treated with Celecoxib 90 mg/day in 2 cycles of 7 days at one month’s interval. At admission: BMI=26 kg/m², BP=120/80 mmHg, Pulse=70/min, flat feet, bilateral hallux valgus, cracking sounds on knees mobilization, lipohypertrophy due to insulin therapy under umbilical area. Labs exams revealed: Gl=173 mg/dl, A₁c=6.7% and negative inflammatory markers. The X-rays displayed an avulsion of the antero-inferior iliac spine (AIIS) confirmed by CT scan which also revealed the preservation of the muscle tendon insertion and a partial tear of the left rectus femoris. Under treatment with Celecoxib (30 mg/day), Tramadol + Acetaminophen 37.5/325 mg (bid) and local Ketoprofenum 2.5% applications the pain intensity decreased slightly (6/10 on VAS). In order to optimize the pain management a Betamethasone injection 1 ml (7 mg) in the groin area was administered in the 4th day of hospitalization. In order to maintain an optimal glycemic control significant increases of both basal rate (120% - 140% - 160%) and prandial boluses (with 2, 4 and 5 IU) were necessary. The highest glycemic value was 456 mg/dl and was documented in the 4th day after LCI. The patient returned to his initial insulin doses in the 9th day after LCI. The improvement in pain symptoms lasted for almost 6 months.

Conclusions: This case report demonstrated that a single injection of Betamethasone can cause a significant rise in the average daily insulin requirements needed to control blood glucose levels. The medical practitioners should warn type 1 diabetic patients about this possible side effect and must advise a more frequent monitoring in order to detect and correct the hyperglycemic events.