Some Facts about Glucocorticoid & Major side effects

Facts about Glucocorticoid & Hypermineralocorticoidism Major side effects

Definition :

[Gr. gleukos, sweet (new wine), + L. cortex, + Gr. eidos, form, shape] A general classification of adrenalLABORATORY TESTS FOR ADRENAL FUNCTIONS. Read more ... » cortical hormones that are primarily active in protecting against stress and in affecting protein and carbohydrate metabolismGlycogen Storage Diseases von Gierke disease, Andersen's disease, McArdle's disease. Read more ... ». The most important glucocorticoid is cortisol (hydrocortisone).

Isolated glucocorticoid deficiency

  • It is a rare autosomal recessive disease secondary to a mutation of ACTH receptor.

Adrenoleucodystrophy

Ad renomyeloneu ropathy

Glucocorticoid

Facts about Glucocorticoid & Hypermineralocorticoidism


Hypermineralocorticoidism

  • There may be low plasma renin activity with hyper­tension and hypokalemia which can be corrected by glucocort;icoids.

There may be high plasma renin activity called:

Facts to remember when using glucocorticoids ::

  • n tuberculosis or other chronicChronic Hepatitis Classification viral hepatitis Clinical features and Treatment. Read more ... » infections, steroids must be given under antitubercular or antibacterial cover.
  • Diabetes mellitus can worsen when steroids are given. OsteoporosisTeriparatide. Read more ... » can occur especially in post menopausal patient.
  • Peptic ulcer, gastritis, oesophagitis can occur or worsen.
  • Hypertension can occur and become refractory. There may be psychological disorders with steroids. Weight gain may occur.
  • Sodium intake must be restricted to prevent edema, hypertension and potassium loss.
  • Potassium supplements may be given.
  • H2 receptor antagonist, antacids should be given.
  • Steroid should be gradually tapered or patients put on alternate day regime when requirement is only 20 mg / day.
  • It should be stopped when dose of 5 mg/ day is reached.
  • For patients on long-term steroids the dose is in­creased at times of stress.
  • Calcium intake should be high 1200 mg/day plus Vi­tamin D supplements.
  • For high-risk patients of osteopenia biphosphonates may be given.

Glucocorticoid & Hypermineralocorticoidism Table ::

Glucocorticoid preparations

Glucocorticoid potency

Mineralocorticoid potency

Short acting
Hydrocortisone 1 1
Cortisone 0.8 0.8
Intermediate acting
Prednisone 4 0.25
Prednisolone 4 0.25
Methyl prednisolone 5 0.01
Triamcinolone 5 0.01
Long acting
Beta methasone 25 0.01
Dexamethasone 30 0.01

Major side effects associated with corticosteroid therapy

Dermatologic and soft tissue

Skin thinning and purpura
Cushingoid appearance
Alopecia
Acne
Hirsutism
Striae
Hypertrichosis

Eye

Posterior subcapsular cataract
Elevated intraocular pressure/glaucoma
Exophthalmos

Cardiovascular

Hypertension
Perturbations of serum lipoproteins
Premature atherosclerotic disease
Arrhythmias with pulse infusions

Gastrointestinal

Gastritis
Peptic ulcer disease
Pancreatitis
Steatohepatitis
Visceral perforation

Renal

Hypokalemia
Fluid volume shifts
Genitourinary and reproductive
Amenorrhea/infertility
Intrauterine growth retardation

Bone

OsteoporosisTeriparatide. Read more ... »
Avascular necrosis
Muscle
Myopathy

Neuropsychiatric

Euphoria
Dysphoria/depression
Insomnia/akathisia
Psychosis
Pseudo tumor cerebri

Endocrine

Diabetes mellitus
Hypothalamic-pituitary-adrenalLABORATORY TESTS FOR ADRENAL FUNCTIONS. Read more ... » insufficiency
Infectious disease
Heightened risk of typical infections
Opportunistic infections
Herpes zoster
  • Thus, when examining studies of glucocorticoid associated AEs, it is necessary to carefully account for the initial indication for steroid use, since such patients are generally “sicker” than those with similar conditions who are not treated with glucocorticoids.