Glucocorticoids are an important weapon for clinicians, especially in the treatment of medical diseases, and have created the possibility of remission and cure for many diseases. However, it also has many side effects, which may cause a lot of pain and distress to patients and make people fearful of talking about hormones. How to use this double-edged sword well also becomes a basic, mandatory lesson for every doctor. Understanding the possible side effects of hormones can help patients to detect abnormal conditions in a timely manner, and can also remove any doubts in their minds. The commonly used intravenous glucocorticoids include hydrocortisone succinate injection, methylprednisolone injection and dexamethasone injection; the oral ones include prednisone acetate (prednisone), prednisolone, methylprednisolone tablets, dexamethasone tablets, etc.
The side effects of glucocorticoids mainly include the following.
1. Inducing or aggravating infection
Glucocorticosteroids can suppress the immune function of the body, so long-term application can induce infection or aggravate infection, spread latent infection foci in the body or rekindle static infection foci, especially for those with reduced resistance, such as patients with nephrotic syndrome, tuberculosis, aplastic anemia, etc. Since patients often feel good about themselves when using glucocorticosteroids, masking the symptoms of progressive infection, latent infection should be ruled out before deciding to adopt a long course of treatment, and vigilance should be exercised during the application process, which should be applied with effective antibacterial drugs when necessary, and extra attention should be paid to the prevention and treatment of latent TB foci.
PS: Patients taking hormone therapy should go to a regular hospital promptly once symptoms of infection appear and provide the receiving physician with a history of hormone use. Many patients with symptoms of infection are not prominent, especially pulmonary infections caused by some specific pathogenic bacteria, which often only manifest as weakness, chest tightness and dry cough, resulting in the infection not being diagnosed and treated in a timely manner.
2. Disorders of substance metabolism and water and salt metabolism
Long-term application of glucocorticoids can cause disorders of substance metabolism and water and salt metabolism, resulting in hyperadrenocorticism syndrome, such as swelling, hypokalemia, hypertension, diabetes, thinning skin, full-moon face, buffalo back, centripetal obesity, hirsutism, acne, muscle weakness and myasthenia gravis, etc. Generally, no extra treatment is needed, and the symptoms can subside on their own after stopping the drug. However, muscle weakness recovery is slow and incomplete. Low-salt, low-sugar, high-protein diet (to be avoided in kidney-preserving patients) and additional potassium chloride can reduce these symptoms. In addition, glucocorticoids may delay wound healing in trauma patients due to inhibition of protein synthesis. In children, it can cause negative nitrogen balance due to the inhibition of growth hormone secretion, which can affect growth and development.
PS: Once hormone-related skin damage occurs, the use of various applications on the damaged skin surface should be avoided, and special attention should be paid to avoid damaging the integrity of the skin, otherwise it will easily lead to skin infection.
3. Cardiovascular system complications
Long-term application of glucocorticosteroids may lead to hypertension and atherosclerosis due to sodium and water retention and elevated blood lipids.
4. Digestive system complications
Glucocorticoids can stimulate the secretion of gastric acid and pepsin and inhibit the secretion of gastric mucus, reducing the resistance of the gastric mucosa, thus inducing or aggravating peptic ulcers. Glucocorticoids can also mask the initial symptoms of ulcers, resulting in serious complications such as sudden bleeding and perforation. Long-term use can aggravate gastric or duodenal ulcers. This side effect is more likely to occur when other drugs with gastric irritation (e.g. aspirin, indomethacin) are used. In a small number of patients, it can induce pancreatitis or fatty liver.
5. Cataract and glaucoma
Glucocorticoids can induce cataracts, which can occur with systemic or local administration. The production of cataracts may be related to the inhibition of lens epithelial Na+-K+ pump function by glucocorticoids, resulting in crystal fiber water accumulation and protein agglutination. Glucocorticoids can also increase intraocular pressure and induce glaucoma or worsen glaucoma, which can occur with either systemic or topical administration. The reason for the increase in intraocular pressure may be due to the swelling of collagen bundles in the trabecular network structure of the anterior chamber angle caused by glucocorticoids, which impedes the flow of atrial water.
PS: If blurred vision, eye swelling and pain occur during the use of hormones, promptly consult an ophthalmologist, see a slit lamp and measure intraocular pressure.
6. Osteoporosis and vertebral compression fracture
Osteoporosis and vertebral compression fractures are serious comorbidities in patients of all ages treated with glucocorticoids. Ribs and and vertebrae with a highly beamed structure are usually the most severely affected. This may be related to the inhibition of osteoblast activity by glucocorticoids, increased calcium and phosphorus excretion, inhibition of intestinal calcium uptake, and increased sensitivity of osteocytes to parathyroid hormone. If osteoporosis occurs, the drug must be discontinued. To prevent osteoporosis, it is advisable to take vitamin D (vitamin D), calcium salts and protein supplements.
D), calcium salts and anabolic hormones, etc.
PS: Femoral head necrosis is a serious complication caused by hormones. If hip pain occurs during the use of hormones, seek orthopedic consultation in a timely manner. Once femoral head necrosis occurs, avoid weight-bearing on the hip joint (bed rest, walking with crutches) to reduce the secondary damage to the hip joint. Early stage femoral head necrosis can be considered for interventional treatment.
7. Neuropsychiatric abnormalities
Glucocorticoids can cause many forms of behavioral abnormalities. For example, euphoria can often mask the symptoms of certain diseases and misdiagnose them. Another example is hypersensitivity, agitation, insomnia, emotional changes or even obvious psychotic symptoms. Some patients may also be suicidal. In addition, glucocorticoids may trigger seizures.
Once hormone-related side effects occur, promptly seek medical help and aggressive treatment.