China
Africa
Explore chapters and articles related to this topic
What are the side effects of corticosteroids?
Published in Nathaniel Knox Cartwright, Petros Carvounis, Short Answer Questions for the MRCOphth Part 1, 2018
Nathaniel Knox Cartwright, Petros Carvounis
Adrenal suppression is a particularly important side effect of long-term steroid treatment. Any patient treated with systemic steroids for more than three weeks should be warned of the dangers of sudden cessation. To prevent this, all patients on long-term treatment should carry a steroid treatment card and doses must be increased at times of stress and peri-operatively.
Endocrine system
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
Brian J Pollard, Gareth Kitchen
The degree of adrenal suppression correlates with dose and duration of the glucocorticoid therapy. This is difficult to assess and is usually not attempted prior to surgery. Confusion exists with regard to the duration of administration and dose of glucocorticoid that suppresses adrenal cortical function to an extent relevant to surgery and anaesthesia. In general, short-term use (less than 1 month) and doses of less than the equivalent of 7.5 mg prednisolone per day carry little risk of suppressing the hypothalamic–pituitary–adrenal axis (Table 6.8). Suppression may occur after topical, oral, parenteral, nebulised or inhaled preparations, but less consistently.
Hip disorders
Published in Maneesh Bhatia, Tim Jennings, An Orthopaedics Guide for Today's GP, 2017
The risk of hyperglycaemia in patients with diabetes is very small and transient, even for longer acting corticosteroid preparations. Adrenal suppression from intra-articular corticosteroids has been described but usually lasts less than 2 weeks when it occurs. Other potential risks include skin hypopigmentation, fat atrophy, tendon rupture and facial flushing.
Corticosteroid-eluting implants for the management of chronic rhinosinusitis with or without nasal polyps
Published in Expert Review of Clinical Immunology, 2023
Dafna Gershnabel Milk, Kent K. Lam, Joseph K. Han
The first pilot study was published in 2011 and included 43 CRS patients with and without nasal polyposis who underwent bilateral primary or revision ESS [6]. In this intrapatient-controlled study, all patients served as their own control to compare the clinical benefit of the Propel implant following ESS versus non-drug-eluting implants. At day 60, the Propel implants showed significant reduction in polyp formation (7 of 38 sinuses in the treatment group versus 14 of 38 sinuses in the control group), adhesions (2 of 38 sinuses versus 8 of 38 sinuses), and inflammation (endoscopic score mean differences of −12, −11.2, and −8.8 on days 21, 30, and 45, respectively). Five of the cohort population underwent blood sampling of plasma MF concentrations. The results were below the lower limit of quantification (LLOQ) at all time points. All patients’ mean cortisol concentrations at baseline and at follow-up time points were within normal limits and indicated no evidence of adrenal suppression.
Safety review of current systemic treatments for severe chronic rhinosinusitis with nasal polyps and future directions
Published in Expert Opinion on Drug Safety, 2021
The placement of corticosteroid-eluting implants in patients with recurrent polyposis after sinus surgery has been reported to significantly reduce nasal obstruction and the need for further surgery [1]. A number of studies have compared the efficacy and safety of steroid-eluting stents in the ethmoid sinuses of patients with recurrent polyposis after sinus surgery [35–38]. Three studies evaluated ocular safety and none showed a significant increase in intraocular pressure or changes in lens opacity [35–37]. One study evaluated the serum cortisol levels at baseline and at days 7, 14, 21, and 30 postoperatively and reported no evidence of adrenal suppression [38]. Local adverse events were limited and not reported more frequently in the drug-eluting stent group than the placebo group. To the author’s knowledge, there are no long-term studies evaluating the safety of drug-eluting stents in CRSwNP patients.
A safety evaluation of budesonide MMX for the treatment of ulcerative colitis
Published in Expert Opinion on Drug Safety, 2018
Cristina Bezzio, Stefano Festa, Giulia Zerboni, Claudio Papi, Gianpiero Manes, Simone Saibeni
In induction trials, a reduction in plasma cortisol levels is frequently observed in UC patients treated with budesonide-MMX compared with those treated with 5-ASA or placebo. It is true that they were often within normal values in the majority of patients, but it is also true that the measurement of basal plasma cortisol concentrations has limitations as an indicator of pituitary-adrenal function [40]. Indeed, when corticotropin stimulation tests have been performed, they showed that a higher proportion of IBD patients treated with budesonide-MMX (compared with those treated with 5-ASA and placebo) had impaired adrenal function both during short- and long-term therapy [22,26,29]. This appears in agreement with the findings that when budesonide is used as a maintenance therapy for CD, abnormal adrenocorticoid stimulation tests were seen more frequently in patients receiving both 6 mg daily (RR 2.88; 95% CI 1.72 to 4.82) and 3 mg daily (RR 2.73; 95% CI 1.34 to 5.57) compared with placebo [41]. Then, treatment with budesonide-MMX appears to have a minimal effect on the hypothalamic-pituitary-adrenal axis, consistently with its pharmacodynamic activity. The clinical relevance of hypothalamic-pituitary-adrenal suppression appears to be modest and likely inferior to that expected from long-term administration of conventional corticosteroids.