Glucocorticoids

The Healthcare Cost and Utilization Project identified corticosteroids as the most common specific cause of drug-related adverse events, resulting in 141,000 hospital stays in the United States in 2004. Glucocorticoids can cause osteoporotic fractures, coronary artery disease, cataracts, hypertension, avascular necrosis, psychosis and stroke. These complications are usually due to long term steroid therapy (ie rheumatologic diseases). Interestingly, infection is likely not significantly increased in patients taking a mean dose of less than 10 mg/day of prednisone or a cumulative dose of less than 700 mg.

A major concern is suppression of the hypothalamic-pituitary-adrenal (HPA) axis. Some authors believe that glucocorticoid courses of < 3 weeks duration will not lead to axis suppression, no matter what the steroid dose. Others believe that at relatively high doses, significant HPA suppression can occur after as little as 5 days, although adrenal suppression is unlikely to cause adrenal insufficiency in patients who are treated for 1 week or less. Physiologic doses are caonsidered to be 5-7.5 mg/day of prednisone, 15-20 mg/day of hydrocortisone, or the equivalent and are unlikely to cause adrenal insufficiency if the patient is treated for less than 1 month.

Krasner AS. Glucocorticoid-induced adrenal insufficiency. JAMA. 1999 Aug 18;282(7):671-6.
Sarnes E, et al. Incidence and US costs of corticosteroid-associated adverse events: a systematic literature review. Clin Ther. 2011 Oct;33(10):1413-32. Epub 2011 Oct 13.
Huscher D, et al.  Dose-related patterns of glucocorticoid-induced side effects. Ann Rheum Dis. 2009 Jul;68(7):1119-24. Epub 2008 Aug 6.
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