Side effects (SE) of GC are both dose- & duration-related.

 

 

Major side effects of systemic glucocorticoids (GC)

Side effects (SE) of GC are both dose- & duration-related. They are mediated via cytosolic GC receptors resulting from both genomic & non-genomic pathways that have also a role in therapeutic action of these medications. Genetic polymorphism in GC receptor & GC metabolism may denotes heterogeneity in GC-related hazards.  

GC have SE on multiple organ systems. SE range from non-serious but displeasing to the ptns (e.g., Cushingoid texture) to the life-threatening (e.g., devastating infections). Some SE, e.g. fastened reduction in BMD (bone mineral density) & early cataract, may be commonly asymptomatic until delayed manifestations evolve requiring medical intervention (e.g., sudden vertebral collapse, cataract with need for surgical removal). Organ systems could be affected by systemic GC include:

·         Dermatologic & body appearance  

·         Ophthalmologic hazards  

·         CVS involvment  

·         GIT side effects  

·         Bone & muscle impacts  

·         Neuropsychiatric effects  

·         Metabolic & endocrine seqeulea  

·         Immune system effects

·         Hematological effects  

 

In a trial to reduce the SE of GC by the following maneuvers can be considered:

1)    Consider the lowest dose for the shortest duration to achieve your goals

2)    Manage comorbid disorders that may augment risk if GC are indicated

3)    Monitor ptns under ttt for SE to benefit from added intervention

Further considerations before long-term plans with systemic GC include proper immunization plan, anti-opportunistic infection & osteoporosis precautions.

 

 

  

Dermatologic effects & appearance: Many clinically relevant SE of GC involving the skin & appearance that have been reported even at low doses include skin thinning & ecchymosis, Cushingoid feature, acne, WG (weight gain), hirsutism, erythema face, and body striae.  

1)    Skin thinning & ecchymosis: Of most common toxicities attributed to GC are skin thinning & ecchymosis, even at lower doses.  Ecchymosis or purpura related to GC usually involve the sun-exposed parts of hand dorsum & forearm & not associated by palpable swelling.  

2)    Cushingoid feature: evolution of Cushingoid appearance (redistributed body fat + truncal obesity, buffalo hump, + moon face) & WG are dose- & duration-related and may be seen within the 1^st 2 mo of ttt. The Cushingoid feature can be very troubling to ptns and can be seen even with low-doses; however, it’s uncommon at doses < physiologic GC- range. Factors contributing to augment weight may include good appetite, a common SE of GC, and increased food consumption to relief in ptns with gastropathic disease or peptic ulceration.  

Weight gain: Several reports have evaluating the frequency of Cushingoid appearance & weight gain. WG was more observed in ptns ttt with at least 5 mg/d of  Prd or equivalent for at least 6 mo.