Glucocorticoid - Side Effects

Side Effects

Glucocorticoid drugs currently being used act nonselectively, so in the long run they may impair many healthy anabolic processes. To prevent this, much research has been focused recently on the elaboration of selectively acting glucocorticoid drugs. Side effects include:

• immunodeficiency (see separate section below)
• hyperglycemia due to increased gluconeogenesis, insulin resistance, and impaired glucose tolerance ("steroid diabetes"); caution in those with diabetes mellitus
• increased skin fragility, easy bruising
• negative calcium balance due to reduced intestinal calcium absorption
• steroid-induced osteoporosis: reduced bone density (osteoporosis, osteonecrosis, higher fracture risk, slower fracture repair)
• weight gain due to increased visceral and truncal fat deposition (central obesity) and appetite stimulation
• adrenal insufficiency (if used for long time and stopped suddenly without a taper)
• muscle breakdown (proteolysis), weakness, reduced muscle mass and repair
• expansion of malar fat pads and dilation of small blood vessels in skin
• anovulation, irregularity of menstrual periods
• growth failure, delayed puberty
• increased plasma amino acids, increased urea formation, negative nitrogen balance
• excitatory effect on central nervous system (euphoria, psychosis)
• glaucoma due to increased cranial pressure
• cataracts

In high doses, hydrocortisone (cortisol) and those glucocorticoids with appreciable mineralocorticoid potency can exert a mineralocorticoid effect as well, although in physiologic doses this is prevented by rapid degradation of cortisol by 11β-hydroxysteroid dehydrogenase isoenzyme 2 (11β-HSD2) in mineralocorticoid target tissues. Mineralocorticoid effects can include salt and water retention, extracellular fluid volume expansion, hypertension, potassium depletion, and metabolic alkalosis.

The combination of clinical problems produced by prolonged, excess glucocorticoids, whether synthetic or endogenous, is termed Cushing's syndrome.