{"id":78250,"date":"2024-10-02T09:07:17","date_gmt":"2024-10-02T15:07:17","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=78250"},"modified":"2024-10-02T09:07:17","modified_gmt":"2024-10-02T15:07:17","slug":"understanding-steroid-use-and-potential-side-effects","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/understanding-steroid-use-and-potential-side-effects\/","title":{"rendered":"Understanding the ups and downs of steroid use and potential side effects"},"content":{"rendered":"
<\/div>
\"And
Working closely with a physician to manage the use of steroids is key. Corticosteroids are powerful anti-inflammatory medications that can play a critical role in treating and managing a host of diseases. Photo: Getty Images.<\/figcaption><\/figure>\n

From skin rashes to sinusitis, corticosteroids are regularly prescribed to address a range of health issues.<\/p>\n

But while these steroids may bring much-needed relief, they can cause a host of side effects, such as osteoporosis, weight gain, eye issues, and even heart disease and diabetes.<\/p>\n

Dr. Nicole Cotter<\/a>, a rheumatologist at UCHealth Rheumatology Clinic in Steamboat Springs<\/a>, outlines what you need to know about steroid use below.<\/p>\n

How do steroids work?<\/strong><\/h2>\n

Corticosteroids are medications that act like cortisol, a hormone naturally released by the adrenal gland when you\u2019re injured or stressed. Similar to cortisol, corticosteroids such as prednisone and methylprednisolone can slow or stop immune system processes that trigger inflammation.<\/p>\n

Corticosteroids aren\u2019t the same as anabolic steroids, which are a synthetic form of testosterone that may be taken to increase muscle mass.<\/p>\n

What are the uses for steroids?<\/strong><\/h2>\n

\u201cIn rheumatology, we treat inflammation and the diseases that cause it, and steroids are potent anti-inflammatory drugs,\u201d Cotter said. \u201cWe\u2019ll often use them to decrease inflammation with the idea of inducing remission.\u201d<\/p>\n

Steroids are helpful in a range of conditions, such as rheumatoid arthritis, lupus, multiple sclerosis, asthma and skin conditions.<\/p>\n

A short course of steroids may be prescribed to calm joint inflammation, while higher doses of steroids may be given over longer periods of time to manage more critical illnesses, such as systemic vasculitis.<\/p>\n

In many cases, steroids are necessary, for instance if inflammation has increased enough to damage a patient\u2019s organs.<\/p>\n

\u201cWhen a disease is dangerous and potentially organ-threatening, we use steroids to knock it out,\u201d Cotter said.<\/p>\n

What are common side effects of steroid medications?<\/strong><\/h2>\n

While steroids are powerful medications, those benefits can come at a price.<\/p>\n

\u201cThe side effect profile of steroids is one of the most alarming of any medication, in part because the side effects of steroids are guaranteed,\u201d Cotter said. \u201cThe list of side effects goes on and on. They\u2019re not good long-term medications.\u201d<\/p>\n

Patients may be surprised and frustrated by immediate side effects, such as weight gain, puffiness, insomnia and mood changes. If steroids are used for a long period, additional side effects may arise. For instance, a patient may suddenly break a hip and learn that they have osteoporosis.<\/p>\n

Steroids require an endgame<\/strong><\/h2>\n

With any steroid usage, it\u2019s critical to begin with the end in mind.<\/p>\n

\u201cWhenever I prescribe steroids, we\u2019re talking about the endgame and what the plan is for getting someone off steroids,\u201d Cotter said. \u201cI will tell people from the very beginning about steroid withdrawal, so they\u2019re not caught off guard.\u201d<\/p>\n

It\u2019s of top importance to taper down steroid usage when the prescribed course is ending.<\/p>\n

\u201cSteroids make people feel good. If you\u2019ve been on them for a long period of time, then you have to taper them down,\u201d Cotter said. \u201cIf you stop steroids abruptly, that\u2019s when you can get sick and go through withdrawal.\u201d<\/p>\n

While tapering down steroid dosages, patients may find issues such as arthritis pain resurface. That can require some careful sleuthing to determine treatment.<\/p>\n

\u201cThe arthritis pain is unmasked, and people think the disease is flaring up,\u201d Cotter said. \u201cWe have to tease out what truly is the disease flaring versus steroid withdrawal and determine if we need to re-up the steroid usage or put something else in place.\u201d<\/p>\n

Steroids should be used only when necessary<\/strong><\/h2>\n

In all instances, it\u2019s important to use steroids only when necessary, and to opt for the lowest dose required for as short of a period of time as possible.<\/p>\n

\u201cJust as we talk about stewardship with antibiotics, we should be using steroids judiciously,\u201d Cotter said. \u201cThere are times you absolutely need them and should take them, and we know there are side effects, and we will monitor for them, but we\u2019re not just using them because they can make people feel better.\u201d<\/p>\n

What are some additional side effects of steroid use?<\/strong><\/h2>\n

Corticosteroids can play a critical role in treating and managing a host of diseases, but they can result in a range of side effects, including steroid-induced adrenal insufficiency.<\/p>\n

\u201cIf you take a corticosteroid for long enough at a high enough dose, your body thinks, \u2018I don\u2019t need to make my own steroid,\u2019\u201d said Dr. Jessica Devin<\/a>, an endocrinologist at UCHealth Endocrinology Clinic<\/a> in Steamboat Springs. \u201cThere\u2019s reduced signaling from the pituitary gland to the adrenal gland, and over time, the adrenal gland makes less.\u201d<\/p>\n

Adrenal insufficiency may occur when patients take steroid dosages that reach the level the body naturally makes, such as 10 mg or higher of prednisone. While past research suggested adrenal insufficiency wasn\u2019t usually an issue until after steroids were used for several months, newer research suggests the condition can crop up sooner.<\/p>\n

\u201cSome of the more recent data says we need to start thinking about adrenal insufficiency even after a month,\u201d Devin said.<\/p>\n

Taking steroids for longer periods at higher doses, or using long-lasting steroids, can be more likely to cause steroid-induced adrenal efficiency, but some people experience impacts after a shorter course of lower-dose steroids.<\/p>\n

\u201cThere are all sorts of genetic and clinical modifiers, many of which we don\u2019t completely understand,\u201d Devin said. \u201cSome people can hop on and off these medications and be fine, while other people run into a problem even when they haven\u2019t been on them as long.\u201d<\/p>\n

Symptoms of steroid-induced adrenal insufficiency can be general and diffuse, and include nausea, fatigue and an overall feeling of achiness.<\/p>\n

Because symptoms are so general, some patients only learn they have the condition when they\u2019re in the hospital for another issue. For instance, someone who has used steroids for asthma may go to the hospital for a surgery, then learn they have low blood pressure. A quick check of the patient\u2019s cortisol level may reveal steroid-induced adrenal insufficiency.<\/p>\n

If symptoms of the condition arise in people who have a history of steroid use, Devin recommends checking morning cortisol levels. If the value is less than 10, a treatment plan is created, and cortisol levels are re-checked.<\/p>\n

If the cortisol level is persistently low, Devin recommends seeing an endocrinologist for further evaluation.<\/p>\n

Tapering steroid usage is critical in preventing and addressing steroid-induced adrenal insufficiency.<\/p>\n

\u201cYou want to taper off of it, as that enables the pituitary gland and adrenal gland to acclimate and start waking up with the signaling of hormones,\u201d Devin said.<\/p>\n

While steroid-induced adrenal insufficiency can be frustrating, the good news is that it can be treated. Often in treatment, a patient is prescribed another course of a steroid, but this time a shorter-acting steroid such as hydrocortisone may be used. Then, the steroid can be slowly tapered, sometimes over several months.<\/p>\n

With all steroid usage, it\u2019s important not to self-dose. It\u2019s common to experience symptoms of steroid-withdrawal when reducing steroid usage, but eventually those symptoms resolve. Staying on steroids may help someone avoid symptoms of withdrawal, but it ultimately prolongs recovery.<\/p>\n

\u201cOne of the main frustrations for patients is there\u2019s no treatment for steroid withdrawal,\u201d Devin said. \u201cBut we can acknowledge that at least we have a label and an explanation for it. It\u2019s not a forever thing. It\u2019ll get better. But unfortunately, you\u2019ve got to stick it out.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

From skin rashes to sinusitis, corticosteroids are regularly prescribed to address a range of health issues. But while these steroids may bring much-needed relief, they can cause a host of side effects, such as osteoporosis, weight gain, eye issues, and even heart disease and diabetes. Dr. Nicole Cotter, a rheumatologist at UCHealth Rheumatology Clinic in […]<\/p>\n","protected":false},"author":2163,"featured_media":78254,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[6],"tags":[338,988,848,3512,3357,183,65,102,395,551],"class_list":["post-78250","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-healthy-living","tag-allergy-care-and-immunology","tag-diabetes-endocrinology-care","tag-eye-care-ophthalmology","tag-heart-and-vascular-care-cardiovascular","tag-lung-and-respiratory-care-pulmonology","tag-orthopedics","tag-pain-care-and-management","tag-rheumatology","tag-sports-medicine","tag-weight-and-metabolism"],"acf":[],"yoast_head":"\nUnderstanding steroid use and potential side effects - UCHealth Today<\/title>\n<meta name=\"description\" content=\"Steroids play a critical role in treating and managing diseases. 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