Iatrogenic Complications of Steroid Treatments Flashcards
What are some iatrogenic complications of glucocorticoid therapy?
Cushingoid syndrome Adrenal suppression Immunosuppression Peptic ulcers Osteoporosis Inhibition of linear growth in children
Why do you get adrenal suppression with glucocorticoid therapy?
Cortisol not released > cells atrophy > can’t produce cortisol anymore
Does everyone with Addison’s disease get a tan in the absence of sunlight?
No
Can also just get patchy discolouration
Why are people who present with cortisol deficiency often missed?
Nebulous symptoms
Gradual onset
Each patient present differently
What also occurs with a cortisol deficiency in primary adrenal hypofunction?
Mineralocorticoid deficiency
What does a mineralocorticoid deficiency present as?
Hyperkalaemia
Hyponatraemia
Acidosis
Dehydration
Why is it so important to diagnose Addison’s disease promptly?
Death follows quickly
What are the options for cortisol replacement?
Hydrocortisone
Cortisone acetate
Prednisolone
How is replacement cortisol dosed?
Divide dose to mimic physiological time course
- Large dose in morning
- Smaller dose during day
When are extra doses of replacement cortisol taken?
Infections
Periods of stress
What must be done for patients when they’re put on cortisol replacement therapy?
Have to be educated to adjust dose themselves
Why is extra cortisol needed during infections?
Stop over-activation of immune system
Does everyone with Addison’s disease require fludrocortisone?
No, but most do
What is the bioavailability of oral cortisone?
A little less than cortisol’s
Are there any side effects with cortisol replacements?
No, if it’s well-managed physiological replacement
Why do some patients prefer to use prednisolone rather than hydrocortisone or cortisone?
Prednisolone has longer half life
What happens to cortisol in the kidneys?
Quickly converted to cortisone
Why is cortisol so quickly inactivated in the kidneys?
Prevent it acting on mineralocorticoid receptor
What happens to cortisone in the liver?
Reconverted to cortisol via same enzyme as that in kidney
What is the half life of prednisolone?
Prednisone’s half life = 1 hour
Converted to prednisolone
Prednisolone’s half life = 3-4 hours
When do cortisol peaks occur?
With meal times
Why don’t patients take cortisol with each meal?
Can’t mimic short lived peaks
Therefore take big dose in morning and smaller dose later in evening
What is the major complication of glucocorticoid therapy?
Adrenal suppression
What is adrenal suppression because glucocorticoid therapy related to?
Dose and duration
- Varies between drugs
- Affected by dosing regime
