The timing and amount of glucocorticoid secretion under physiological condition.
The adrenal glands of normal people secrete about 10-20mg of glucocorticoids, also known as cortisol, every day, and show a pulsatile release with a circadian rhythm. The concentration of cortisol in the blood is lowest at night, and the secretion starts to increase 3-5 hours after going to sleep, reaches its peak in the early morning after waking up, and tends to decline thereafter.
The principle of glucocorticoid treatment of diseases is to regulate immunosuppression and anti-inflammatory effects, to regulate the metabolism of sugar, fat and protein, to promote the role of fetal growth and maturation, to promote the sensitivity of peripheral blood vessels to vasoactive substances, and to regulate the permeability of vascular endothelium. It regulates central nervous function and plays an important role in memory, mood, etc.
Some studies have shown that even the long-term application of physiological doses of hormones can bring about many side effects, not to mention that the doses of hormones used to treat diseases often greatly exceed the physiological doses. Therefore, we should pay attention to the side effects of hormones and prevent them in advance.
The side effects of long-term glucocorticoid use include
1. Changes in skin and body shape due to protein metabolism disorders, skin thinning, acne, purple lines, hair loss, petechiae, hairiness, delayed wound healing, pigmentation, hair follicle keratinization and sun purpura. At the same time the body fat redistribution, the patient full moon face, chest abdomen neck back fat accumulation, limb muscle wasting, that is, centripetal obesity.
2, infection long-term application can often induce a variety of infections including bacteria, fungi, viruses, etc., and can make the original infection, including respiratory system infection, urinary system infection, blood system infection, can make the body latent infection foci spread or static infection foci rekindle, so before the application of hormones, need to exclude infection, especially those who have a history of tuberculosis infection, hepatitis B virus infection, need to pay great attention. In addition, hormones can suppress fever and other symptoms of toxicity, so that the infection is not easily detected and treatment is delayed.
3. Water and sodium retention, hypertension and hyperlipidemia Long-term application of hormones can lead to water and sodium retention, resulting in volume-dependent hypertension, and hormones can cause hyperlipidemia and increase the occurrence of atherosclerosis.
4, venous thrombosis hormone can blood coagulability and stimulate platelet production, can occur venous thrombosis. If combined with infection, it is more likely to form venous thrombosis.
5, peptic ulcer and upper gastrointestinal bleeding long-term application of hormones, resulting in nausea, bloating, belching, epigastric pain and other digestive disorders, and stimulate the secretion of gastric acid and pepsin, inhibit the secretion of gastric mucus, reduce the defense ability of the gastric mucosa, induce or aggravate peptic ulcer. Especially in the simultaneous application of aspirin and other non-steroidal anti-inflammatory drugs, the incidence further increases.
6, elevated blood sugar long-term application of hormones, can make the normal glucose metabolism induced by elevated blood sugar, namely steroidal diabetes. And further increase the blood sugar of those with hyperglycemia and abnormal glucose tolerance.
7. Neuropsychiatric abnormalities Long-term application of hormones may cause euphoria, insomnia, anxiety, hypersensitivity, agitation, hallucinations, delusions, and emotional changes, and very few patients may become depressed. In children, epilepsy can be induced.
8, osteoporosis a large number of hormones long-term application, inhibit osteoblast production, promote osteoclast differentiation, reduce intestinal calcium absorption, so that osteoporosis, femoral head necrosis, fracture incidence increased.
9, cataract and glaucoma hormone can induce cataract, also can make the intraocular pressure rise, induce glaucoma or make glaucoma worse, systemic or local administration can occur.
10. Leukocytosis hormone causes more neutrophils to enter the blood circulation, which can cause a mild increase in white blood cells. If the leukocytes in the blood exceed 15×109/L, the possibility of potential infection should be noted.
11.Sexual dysfunction hormone inhibits the secretion of pituitary gonadotropin, causing menstrual disorders in women, sodium masculinization in women and malformation of fetal development, while men have reduced libido and softened testicles, etc.
12.Renal complications make glomerular nodular sclerosis, and amyloid kidney and kidney stone may occur.
13, exogenous hormone withdrawal syndrome long-term application of hormones, if suddenly stop, will produce joint pain, muscle pain, general weakness, emotional depression, etc., this is the withdrawal syndrome.
14, rebound phenomenon long-term application of hormones, the symptoms are basically controlled, if the reduction is too large or suddenly stop, the original symptoms can quickly relapse or aggravate, this is the rebound phenomenon.