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• Credits

  • Section Writer: Dr. Om J Lakhani
  • Section Editor: Dr. Om J Lakhani

• Also see

  • Glucocorticoid induced osteoporosis (GIO)

• Q. Which Glucocorticoids side effects are irreversible?

  • Atherosclerotic risk
  • Bone loss
  • Cataract

• Q. What are skin changes due to glucocorticoids?

  • Strain
  • Purpura
  • Acne
  • Hirsutism
  • Hypertrichosis
  • Alopecia
  • Non-melanotic skin cancers

• Q. What is the relation between Glucocorticoids use and skin cancer?

  • Increased risk of non-melanotic skin cancers like Squamous cell carcinoma and basal cell carcinoma has been reported with prolonged glucocorticoid use

• Q. is the weight gain and Cushingoid effect dependent on the dose of glucocorticoids?

  • Yes
  • Weight gain and Cushingoid effect is generally seen with doses >7.5 mg and less common in doses <5 mg

• Q. How soon after starting treatment does the Cushingoid appearance start?

  • 2  months after starting treatment

• Q. Do patients with Glucocorticoids have increased appetite?

  • Yes
  • This is a common side effect

• **Eye involvement **

• Q. What are the features of cataracts seen with Glucocorticoids?

  • Posterior subcapsular in location
  • More in children than adults
  • Slowly developing
  • Bilateral

• Q. What does produces a cataract?

  • Any dose can produce
  • However, in general, prednisolone >10 mg for >1 year - they have more risk

• Q. What are the clinical features of these cataracts?

  • Glare
  • Difficulty in seeing in bright light
  • Diminution of vision

• Q. How is the diagnosis of the Posterior subcapsular cataract made?

  • By examination and looking for red reflex
  • Visual acuity testing
  • In some cases, ocular ultrasound look at the posterior segment of the eye

• Q. Do all Glucocorticoid patients develop glaucoma?

  • No
  • There is increase Intraocular pressure but no all develop glaucoma
  • Those who are predisposed are more likely to develop glaucoma
  • Steroid eye drops also increase the risk of glaucoma

• Q. Which is the other common ophthalmic complication pertaining to appearance?

  • Exophthalmos

• Q. Name another serious ophthalmic complication of iatrogenic Cushing’s?

  • Central serous chorioretinopathy

• **CARDIOVASCULAR DISEASE **

• Q. Are Glucocorticoids associated with increased risk of Coronary artrey disease?

  • Yes

• Q. Is this dose-dependent?

  • Yes
  • Dose of prednisolone >7.5 mg /day – more risk

• Q. What about heart failure?

  • Risk of heart failure also increased

• Q. What type of arrhythmia risk is increased with glucocorticoid use?

  • Increased risk of Atrial fibrillation and flutter

• **Gastrointestinal tract (GI tract) **

• Q. Enlist the effects of Glucocorticoids on the GI tract?

  • Increased risk of
    • Gastritis
    • Peptic ulcer
    • GI bleeding
    • Pancreatitis
    • Steatohepatitis
    • Visceral perforation

• Q. Should prophylaxis for GI  bleeding be prescribed to the patient on Glucocorticoids?

  • Glucocorticoids alone – not required
  • Glucocorticoids + NSAID- advised

• Q. Do Glucocorticoids cause pancreatitis?

  • It is uncertain
  • It is believed that Glucocorticoids may not be the cause, and the underlying disease may be the cause

• Q. When does pancreatitis develop after starting Glucocorticoids?

  • Mainly after 4-14 days of starting Glucocorticoids
  • Risk reduces after 2 weeks

• RENAL INVOLVEMENT*

• Q. Do Glucocorticoids cause fluid retention?

  • Yes
  • But it is a problem only in patients with renal or CV disease
  • This is because normal patients have an aldosterone escape mechanism that prevents fluid retention

• Q. Does it produce hypokalemia ?

  • Yes, often acutely
  • But significant chronic hypokalemia is generally not seen

• **Musculoskeletal **

• Q. Does it affect stature in children?

  • Yes
  • Even inhaled steroids affect stature

• Q. What are the lowest doses of glucocorticoids that can affect linear growth in children?

  • Doses as low as
    • 0.075 mg/kg of prednisolone
    • 0.3 mg/kg of hydrocortisone

• Q. What is the role of Glucocorticoids in causing Critical illness-associated myopathy?

  • It increases the risk of critical illness myopathy in critically ill patient, especially when used with neuromuscular blocking agents

• **CNS INVOLVEMENT **

• Q. What is Akathisia?

  • Motor restlessness
  • This is common in Glucocorticoids patients

• Q. What is the effect of Glucocorticoids on Mood?

  • It is biphasic
  • Initially, there is euphoria and even mania
  • Chronic use produces depression

• Q. Does it produce psychosis?

  • Yes
  • Especially with prednisolone dose >20 mg or more
  • More in patients with low albumin
  • Problem in Lupus because CNS lupus also produces similar psychosis

• Q. Does it affect memory?

  • Yes
  • Especially in older people
  • Some develop steroid-induced dementia

• Q. What about suicide?

  • There is increased suicidal tendencies for patients on Glucocorticoids

• Q. Can it produced raised ICT?

  • Yes
  • Often self-limiting

• **Glucose metabolism **

• Separate notes on the topic - COMING SOON

• Q. What is the relative risk of developing new-onset diabetes after Glucocorticoid use?

  • It is dose-dependent
  • Relative risk of 1.8 with 10mg dose increasing to 10.8 with 30 mg dose

• INFECTION

• Q. What is the effect of Glucocorticoids on WBC count?

  • It increases the WBC count
  • Mainly by it increasing the neutrophils
  • There is a shift of neutrophils from endothelium to the circulation

• Q. Which patients on Glucocorticoids can take live vaccines?

  • The following group can take live vaccines
    • Glucocorticoids dose <20 mg for <2 weeks
    • On physiological Glucocorticoids replacement
    • Nonsystemic administration of Glucocorticoids

• OTHER SIDE EFFECTS

• Q. What are the effects of Glucocorticoids on the Reproductive tract?

  • Menstrual irregularity
  • Reduced libido
  • Reduced fertility

• Q. Does the use of Glucocorticoids produce fetal adrenal insufficiency?

  • No

• Q. Does it increase the risk of teratogenicity?

  • Some suggest there is an increased risk of cleft palate

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