Side effects of corticosteroid treatment

Side effects of corticosteroid treatment include:

• Musculoskeletal 
• Osteoporosis 
• Fractures – 12% 
• Avascular necrosis of femoral head (high doses) 
• Proximal myopathy
• Gastrointestinal 
• Peptic ulceration
• Acute pancreatitis 
• Endocrine 
• Weight gain
• Diabetes 
• Adrenal suppression 
• Hypercholesterolaemia/hyperlipidaemia 
• Menstrual disturbances 
• Skin 
• Acne 
• Skin bruising/thinning 
• Hirsutism 
• Other 
• Sleep disturbance 
• Mood disturbance 
• Cataracts -15% 
• Glaucoma 
• Hypertension
• Increased susceptibility to infection 

Adrenal suppression may occur after just 5 days of high dose steroids, and can occur even at low doses after prolonged use. 

Significance of adrenal suppression: 

• When stopping dose should be tapered rather than abruptly stopped 
• Increased dose is required during illness 
• Dose required during induction for surgery and increased dose afterwards

References

British National Formulary. 2011. Available at www.bnf.org 

Curtis, J. et al. Population-based assessment of adverse events associated with long-term glucocorticoid use. Arthritis Rheum. 2006; 55(3): 420-426. 

Peacey, S. et al. Corticosteroid therapy and intercurrent illness: the need for continuing patient education. Postgrad Med J. 1993; 69(810): 282-284. 

Pisu, M. et al. The cost of glucocorticoid-associated adverse events in rheumatoid arthritis. Rheumatology (Oxford). 2005; 44(6): 781-788.

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