Further investigation is required to determine the appropriate use and benefits of steroid therapy when the patient has concomitant life-threatening infections and when the patient has already received more than three days of anti-pneumocystis therapy and has developed significant hypoxia.
Hyperthyroidism is a common disease affecting around 2 percent of women and 0. The amount of benefit and the effect on patient outcome in this circumstance is not yet known. Graves' eye disease is treated by first normalizing the thyroid function and then administering diuretics and systemic glucocorticoids. Other causes of hyperthyroidism that may be treated with corticosteroids are subacute thyroiditis and thyroid storm. Hyperthyroid disease related to thyroiditis is usually mild and self-limited.
Beta blockers may be used to treat symptoms. In subacute thyroiditis, non-steroidal anti-inflammatory drugs or corticosteroids can be used to relieve thyroid pain and tenderness. Thyroid storm is a life-threatening condition of the hyperthyroid state. Corticosteroids are used as adjuvant analgesics for pain in cancer patients and patients with neuropathic pain such as herpes zoster—related neuropathy, spinal cord compression and pain following oral surgery. Prednisone, at a dosage of 7.
Patients with nerve compression pain or pain resulting from increased intracranial pressure showed a better response when compared with patients with other pain syndromes. Perioperative use of corticosteroids has been advocated to reduce pain and decrease edema and trismus following oral surgical procedures. The most significant improvement occurs in the treatment of postoperative edema.
Dosages of prednisone between 40 and 80 mg per day can be used. Maximal benefit has been achieved after third-molar extraction, although some benefit has been reported after other surgeries. Some evidence indicates that combining corticosteroids with acyclovir Zovirax will decrease the duration of zoster-associated pain. Systemic treatment with corticosteroids such as prednisone, at 40 mg per day for three weeks, decreases the proportion of patients affected by postherpetic neuralgia, especially pain occurring six to 12 weeks after onset.
Alcoholic hepatitis is a chronic, progressive and often fatal disease. Treatment has generally been supportive. Meta-analysis of studies from to supports the finding that patients with acute severe alcoholic hepatitis and hepatic encephalopathy, without gastrointestinal bleeding, benefit from a trial of corticosteroid therapy. Further clinical trials were recommended to clarify the role of steroids in the treatment of alcoholic hepatitis. Bacterial meningitis is a serious disease that may result in death or permanent neurologic complications such as seizures, paralysis or sensorineural hearing loss.
These produce inflammatory components such as cytokines, which lead to meningeal inflammation and increased intracranial pressure. Studies show that potent corticosteroids, such as dexamethasone, combined with appropriate antibiotics reduce the risk of acquired sensorineural deafness and the incidence of other neurologic sequelae in meningitis caused by Haemophilus influenzae.
The drug was administered in a dosage of 0. Corticosteroids may also be used in the treatment of tuberculous meningitis. In one randomized, controlled study 55 involving 47 patients in India, dexamethasone was found to be useful as an adjunct treatment in cases of tuberculous meningitis, especially in patients with severe disease.
A more recent randomized trial 56 using prednisone in children with tuberculous meningitis showed that prednisone in a dosage of 2 to 4 mg per kg per day for one month improved survival rate and intellectual outcome. Table 4 57 lists other unlabeled uses of corticosteroids.
Dexamethasone, 0. Methylprednisolone, given intravenously within 8 hours of injury, to improve neurologic function. Prednisolone, 0. Adapted with permission from Drug facts and comparisons. Louis: Facts and Comparisons, b. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Zoorob is a graduate of the American University of Beirut and completed residency training in family practice at Anderson S. Memorial Hospital. Chandler Medical Center, Lexington.
Address correspondence to Roger J. Zoorob, M. Reprints are not available from the authors. Drug facts and comparisons. Bethesda, Md. Gregerman RI. Metabolic and endocrine problems. In: Barker LR, ed. Principles of ambulatory medicine. American College of Rheumatology. Task Force on Osteoporosis Guidelines.
Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Rheum. Safely withdrawing patients from chronic glucocorticoid therapy. Am Fam Physician. Skolnik N. J Fam Pract. Baugh R, Gilmore BB. Infectious croup: a critical review. Otolaryngol Head Neck Surg. Corticosteroid and croup.
Controlled double-blind study. Steroid treatment of laryngotracheitis: a meta-analysis of the evidence of randomized trials. Nebulized budenoside for children with mild to moderate croup. N Engl J Med. Treatment of croup with nebulized steroid, a double blind, placebo controlled study. Arch Dis Child. Use of dexa-methasone in the outpatient management of acute laryngotracheitis. Kovas JA. Diagnosis, treatment, and prevention of Pneumocystis carinii pneumonia in HIV-infected patients.
AIDS: etiology, diagnosis, treatment and prevention update. Philadelphia: Lippincott, ;— Suddenly stopping the medication can be dangerous, so continue taking your regular dose and see your doctor if you are troubled by side effects.
Some of the more common side effects of cortisol-like drugs include:. Corticosteroids can cause a loss of bone density in men and women, particularly among postmenopausal women. The bones of the spine are the most vulnerable to fracturing in this setting.
Corticosteroids interfere with the proper functioning of bone cells and prevent the intestine from properly absorbing calcium, which also affects the bones. Symptoms of osteoporosis can include:. When a person stops taking high-dose corticosteroids, they may experience cortisol insufficiency.
Symptoms of cortisol insufficiency can include:. Other causes include tumours of the pituitary and adrenal glands, and tumours in other areas of the body. In these cases the body itself is producing too much cortisol. Symptoms of Cushing's syndrome may include:. This page has been produced in consultation with and approved by:.
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Cortisone is biologically inactive and is rapidly converted to cortisol by the liver so that it can exert its effects. Hydrocortisone and cortisone acetate are both short-acting glucocorticoids.
These are the only circumstances in which I prescribe hydrocortisone, and I do not use cortisone acetate. Prednisone and dexamethasone are also synthetic glucocorticoids. Prednisone is 4 to 5 times more potent than hydrocortisone and has a longer duration of action, perhaps 12 hours or more.
Dexamethasone is 40 to 50 times more potent than hydrocortisone and even longer-acting, 18 to 24 hours. Both of these glucocorticoids are given when a prolonged action is desired.
This can be a contributing…. Betamethasone is an inflammation-reducing corticosteroid that helps treat a range of skin conditions. Learn about the types, uses, and side effects of…. Prednisone is a drug that contains synthetic cortisol. When a person takes prednisone, the body stops making enough cortisol on its own. This can lead…. What to know about corticosteroids. Uses Types Side effects How they work Risks Managing side effects Summary Corticosteroids, such as prednisone and cortisone, are a class of drugs that can effectively reduce inflammation.
Share on Pinterest Corticosteroids may help treat asthma, allergies, and eczema. Types and drug list. Side effects. How corticosteroids work. Coping with side effects. Exposure to air pollutants may amplify risk for depression in healthy individuals. Costs associated with obesity may account for 3.
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