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Glucose metabolism usually returns to normal after stopping steroids. Usually apparent only with prolonged courses; One study identified no increased risk of infection with less than 700 mg of prednisone or a daily dose less than 10 mg/day. Decreased bone density/ avascular necrosis (most commonly in head of femur) Retrospective study of 1352 patients treated with corticosteroids for neurosurgical problems identified 4 cases of avascular necrosis (0. Most report at least 10 mg daily for at least a year before developing cataracts (ref Carnahan MC 2000) 37 out of 80 (46%) on a mean dose of 31 mg of prednisone over three months developed hirsutism, spontaneous bruising or altered wound healing (ref Fardet 2007) Although patients using prednisone more commonly complain of peptic-ulcer-type symptoms, meta-analysis of 93 randomized trials found no association between ulcer development and prednisone use (ref Conn 1994) Suppression of adrenal glands. May require gradual tapering of dose; the normal, non-stressed adult adrenal gland secretes 10-20 mg of cortisol per day (equivalent to 5-7 mg of prednisone per day) (ref Asare 2007) Atrophy of proximal limb muscles. Usually resolves after 1-4 months following cessation; rarely involves muscles other than proximal limbs – identified by difficulty climbing stairs (ref Bowyer 1985) Potential increased risk of heart attack. Observational studies from the U. Usually dose dependent and reversible with stopping medications (ref Warrington 2006) An older study (ref The Boston Collaborative 1972) reported a 1, buy test-prop 100 mg injectable steroids testosterone propionate. Poetker DM, Reh DD. A comprehensive review of the adverse effects of systemic corticosteroids. Otolaryngol Clin North Am 2010;43:753-76. Poetker DM, Smith: What Rhinologists and Allergists Should Know About the Medico-Legal Implications of Corticosteroid Use: A Review of the Literature. Int Forum Allergy Rhinol. Wong GK, Poon WS and Chiu KH: Steroird- induced avascular necrosis of the hip in neurosurgical patients: epidemiological Study. ANZ J Surg 2005;75:409-10. Carnahan MC, Goldstein DA. Ocular complications of topical, peri-ocular, and systemic corticosteroids. Curr Opin Ophthalmol 2000;11:478-83. Fardet L, Flahault A, Kettaneh A et al Corticosteroid-induced clinical adverse events: freuqncy, risk factors and patients’s opinion Br J Dermatol 2007; 157:142-8. Conn HO and Poynard T. Corticosteroids and peptic ulcer: metaanalysis of adverse events during steroid therapy J Intern Med 1994;236:619-32. Diagnosis and treatment of adrenal insufficiency in the critically ill patient. Bowyer SL, LaMothe MP, Hollister JR. Steroid myoplathy: incidence and detection in a population with asthma. J Allergy Clin Immunol 1985;76:234-42.
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