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Steroid-Related Risks

Glucocorticoids (GCs), often referred to as corticosteroids, systemic steroids, or steroids, primarily are synthetic, biologically active derivatives of the cortisol secreted by the adrenal cortex. They should not be confused with muscle-building anabolic steroids (eg, testosterone). The effects of GCs are widespread and include alterations in carbohydrates (increased blood glucose levels), stimulation of amino acid release, maintenance of fluid and electrolyte balance, preservation of normal cardiovascular system function, immune system suppression, and decreased bone formation.

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Articles of Interest

A Different Look at Corticosteroids

Corticosteroids were first used in clinical practice in 1949 for the treatment of rheumatoid arthritis. Indications since then have spanned multiple specialties and organ systems, including dermatology, rheumatology, immunology and oncology... If physicians understand the composition and physiologic effects of corticosteroid agents, appropriate drug selection can be made and inappropriate or problematic uses can be avoided. Corticosteroid agents mimic the endogenous steroid hormones produced in the adrenal cortex—mineralocorticoid (aldosterone) and glucocorticoid (cortisol). Mineralocorticoids are primarily regulated by the renin-angiotensin system and possess salt-retaining properties. Glucocorticoids are primarily regulated by corticotropin (ACTH) and can have anti-inflammatory effects, as well as several metabolic and immunogenic effects, on the body.

Corticosteroid Adverse Effects

Given the diversity in the mechanism of action of glucocorticoids, they can cause a wide array of adverse effects ranging from mild to severe, some of which are unavoidable. Of all the factors influencing the adverse effects of glucocorticoids, dose and duration of therapy are the most important independent and well-documented risk factors.

Corticosteroid Medication

Corticosteroids are synthetic analogs of the natural steroid hormones produced by the adrenal cortex and include glucocorticoids and mineralocorticoids. The synthetic hormones have varying degrees of glucocorticoid and mineralocorticoid properties. Glucocorticoids are predominantly involved in metabolism and have immunosuppressive, anti-inflammatory, and vasoconstrictive effects. Corticosteroid drugs (including cortisone, hydrocortisone and prednisone) are useful in treating many conditions, such as rashes, inflammatory bowel disease and asthma. However these drugs also carry a risk of various side effects.

In brief: Using steroids correctly and avoiding side effects

The term "steroids" is often used to describe medications belonging to a group of drugs known as glucocorticoids. These include betamethasone, mometasone, and prednisolone. Glucocorticoids are hormones that occur naturally in the body, but they can also be made artificially and then used as medication. Medications containing steroids (glucocorticoids) have been available for over 50 years. At first, little was known about their side effects and how to use them correctly. So they were often used wrongly in the years after they were developed – either at too high a dose or for too long. As a result, many people had side effects, some of which were severe.

Itchy Hives? A Steroid May Not Be Needed

Doctors often prescribe an oral corticosteroid, like prednisone, along with an antihistamine to treat mild itchy rashes. But steroids, which carry risks, even in the short term, may not be needed.

My topical steroid withdrawal: ‘Water felt like acid, my body was ablaze and I shed skin like a snake’

I was prescribed steroid cream for my eczema – but when I stopped using it I ended up in A&E. Much more research is needed into this debilitating condition.

Psychiatric Adverse Effects of Corticosteroids

Psychiatric adverse effects during systemic corticosteroid therapy are common. Two large meta-analyses found that severe reactions occurred in nearly 6% of patients, and mild to moderate reactions occurred in about 28%. Although disturbances of mood, cognition, sleep, and behavior as well as frank delirium or even psychosis are possible, the most common adverse effects of short-term corticosteroid therapy are euphoria and hypomania.

Steroid Shots Do Little for Knee Pain of Arthritis

Doctors often prescribe steroid injections for the pain of knee arthritis, but a rigorous trial has found they work no better than a placebo. Researchers randomly assigned 140 men and women over 45 with painful knee osteoarthritis to injections of either a corticosteroid or a saline placebo. The subjects were injected every three months for two years, with neither the patients nor the people who gave the shots knowing who got the placebo. The study is in JAMA.

Steroid Side Effects

Steroid medications, which are prescribed in many different forms for many different conditions, have a multitude of side effects. Corticosteroid medications—often just called steroids by clinicians and patients—are used to reduce inflammation and inhibit the immune system. They are also associated with many side effects. Corticosteroid medications are synthetic versions of the human steroid hormone cortisol, which is produced in the adrenal glands. These are different from the synthetic versions of the human steroid hormone testosterone used by some athletes (anabolic steroids) or the synthetic versions of the human steroid hormone estrogen used by some women after menopause (hormone therapy).

Steroid Wars: New Drugs Challenge Old Habits

Here’s how novel delivery systems and updated formulations may one day overcome the current challenges inherent in topical steroid prescribing.

Steroids May Be Risky Even in the Short Term

The dangers of long-term use of corticosteroids like prednisone and cortisone are well known, but a new study suggests that even short-term use can have serious side effects.

Steroids’ Miracle Comes With a Caveat

Steroids, corticosteroids, that is, synthetic versions of the natural hormone produced by the adrenal glands are indeed miracle drugs, capable of restoring the health and saving the lives of countless people with a wide spectrum of serious ailments. Prednisone may be the best known, but there are scores of others, some tailor-made to counter specific ailments.

The Effects of Alternate-Day Corticosteroids in Autoimmune Disease Patients

Several studies demonstrated that the use of alternate-day corticosteroid therapy maintains control of autoimmune diseases due to the prolongation of their therapeutic effect beyond their metabolic effect, with a significant decrease in side effects in patients. For this reason, the current recommendation for the use of these medications is in a short cycle to avoid adverse effects when used frequently and for prolonged periods of time.

The Risks of Using Steroids for Respiratory Infections

Doctors often prescribe them for sore throats and the common cold, even though evidence of benefit is sorely lacking.

Resources

StatPearls

Since their discovery, corticosteroids have been used in almost all areas of medicine and by nearly every route. Corticosteroids are synthetic analogs of the natural steroid hormones produced by the adrenal cortex and include glucocorticoids and mineralocorticoids. The synthetic hormones have varying degrees of glucocorticoid and mineralocorticoid properties. Glucocorticoids are predominantly involved in metabolism and have immunosuppressive, anti-inflammatory, and vasoconstrictive effects. While mineralocorticoids regulate electrolytes and water balance by affecting ion transport in the epithelial cells of the renal tubules. The term corticosteroids in practice, however, is generally used to refer to the glucocorticoid effect.