Side effects caused by corticosteroids
1. Long-term use of large doses of corticosteroids can cause disorders of water, salt, sugar, protein and fat metabolism
The symptoms are centripetal obesity, full-moon face, hirsutism, weakness, hypokalemia, edema, hypertension and diabetes, which are clinically called Cushing’s syndrome. These symptoms can be treated without special treatment, and will usually gradually subside on their own after stopping the drug, and can return to normal after several months or a longer period of time. If necessary, antihypertensive and hypoglycemic drugs can be prescribed, and symptomatic treatment such as low salt, low sugar, high protein diet and potassium supplementation can be given. Therefore, patients with hypertension, arteriosclerosis, renal insufficiency and diabetes mellitus should take appropriate vitamin D and calcium supplements, and corticosteroids should be applied with caution.
2. Inducing or aggravating infection
Corticosteroids have anti-inflammatory effects, but they do not have antibacterial effects, and they can reduce the body’s ability to resist infection, making the body’s resistance to disease decrease and facilitating the growth, reproduction and spread of bacteria. Therefore, long-term application of corticosteroids may induce infection or cause the expansion or spread of potential infection foci in the body, and may also cause the spread of previously quiescent tuberculosis foci. In the process of medication, we should pay attention to the changes of the disease and whether there is induced infection, and give anti-infection treatment at the same time.
3. Induce or aggravate peptic ulcer
In addition to hindering tissue repair and delaying tissue healing, glucocorticoids can increase secretion of gastric acid and pepsin, reduce secretion of gastric mucus and lower resistance of gastric mucosa, which can induce or aggravate bleeding of gastric and duodenal ulcers and even cause perforation of the peptic tract.
4.Nervous symptoms
Agitation and insomnia can occur, individual patients can induce psychosis, and epileptic patients can induce seizures. Therefore, patients with psychotic tendencies, psychiatric patients and epileptics should be prohibited.
5. Adrenal cortical atrophy or insufficiency
The long-term application of these drugs, because the body glucocorticoid level is higher than normal for a long time, can cause a negative feedback effect, and affect the hypothalamus and anterior pituitary secretion of adrenocorticotropic hormone, so that the endogenous glucocorticoid secretion is reduced or lead to adrenocorticotropic hormone insufficiency. In case of stress, such as bleeding or infection, dizziness, nausea, vomiting, hypotension, hypoglycemia or hypoglycemic coma may occur.
6. Rebound phenomenon and withdrawal symptoms
Long-term application of hormone drugs, the symptoms are basically controlled, if the dose is reduced too much or suddenly stop, the original symptoms can quickly appear or aggravate, this phenomenon is called rebound phenomenon. This is because the patient is dependent on the hormone or the symptoms have not been completely controlled. The treatment measure is to resume the hormone dosage and then slowly reduce the dosage after the symptoms are under control. Side effects of glucocorticoids.
Long-term application of large amounts of glucocorticoids can cause a series of adverse reactions, and the side effects of glucocorticoids mainly include the following.
1. Disorders of substance metabolism and water and salt metabolism
Long-term application of glucocorticosteroids in large quantities 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 special treatment is needed, and the symptoms can subside on their own after stopping the drug. However, muscle weakness recovery is slow and incomplete. Measures such as low salt, low sugar, high protein diet and the addition of potassium chloride can reduce these symptoms. In addition, glucocorticoids can delay wound healing in trauma patients because they inhibit protein synthesis. In children, it can inhibit the secretion of growth hormone and cause negative nitrogen balance, so that growth and development are affected.
2. Inducing or aggravating infection
Glucocorticoids can inhibit the immune function of the body and have no antibacterial effect, so long-term application can often induce infection or aggravate infection, which can cause the spread of potential infection foci in the body or rekindle the static infection foci, especially for those with reduced resistance, such as patients with nephrotic syndrome, tuberculosis and aplastic anemia. Since patients often feel good about themselves when using glucocorticosteroids and conceal the symptoms of infection development, physical examination should be conducted to exclude potential infection before deciding to use long course treatment, and it is also advisable to raise vigilance during application, and to combine with effective antibacterial drugs when necessary, paying special attention to the prevention and treatment of potential tuberculosis lesions.
3.Gastrointestinal complications
Gucocorticoid can stimulate the secretion of gastric acid and pepsin and inhibit the secretion of gastric mucus, which reduces the resistance of gastric mucosa, therefore, it can induce or aggravate peptic ulcer. Long-term use may aggravate gastric or duodenal ulcers. This side effect is more likely to occur when other drugs with gastric irritation (e.g. aspirin, indometacin, butazolidin) are used in combination. In a few patients, pancreatitis or fatty liver can be induced.
4.Complications of cardiovascular system
Long-term application of glucocorticosteroids can lead to hypertension and atherosclerosis due to sodium and water retention and elevated blood lipids.
5.Osteoporosis and vertebral compression fracture
Osteoporosis and vertebral compression fractures are serious comorbidities in patients of all ages treated with glucocorticoids. Ribs and vertebrae with a high degree of beam 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 absorption, and increased sensitivity of osteocytes to parathyroid hormone. If osteoporosis occurs, the drug must be discontinued. To prevent osteoporosis, it is advisable to supplement with vitamin D (vitamin
D), calcium salts and anabolic hormones, etc.
6.Neuropsychiatric abnormalities
Glucocorticoids can cause many forms of behavioral abnormalities. For example, euphoria can often conceal the symptoms of certain diseases and lead to misdiagnosis. Another example is hypersensitivity, agitation, insomnia, emotional changes or even obvious psychotic symptoms. Some patients may also be suicidal. In addition, glucocorticoids may induce seizures.
7. 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 systemic or topical administration. The reason for the increase in intraocular pressure may be due to glucocorticoids swelling the collagen bundles of the trabecular network structure in the anterior chamber angle of the eye and obstructing the flow of atrial water.