Consequences Of Glucocorticoid Therapy Research Articles

Chronic constrictive pericarditis: a rare cardiac involvement in primary Sjögren’s syndrome

BackgroundConstrictive pericarditis represents a chronic condition and systemic inflammatory diseases are a known, yet uncommon, cause. Pericardial involvement is seldom reported in primary Sjögren’s syndrome, usually occurring in association with pericardial effusion or pericarditis.We report a case of constrictive pericarditis with an insidious course and unusual evolution associated with primary Sjögren’s syndrome. Due to the challenging nature of the diagnosis, clinical suspicion and multimodality imaging are essential for early identification and prompt initiation of treatment. Long-term outcomes remain uncertain.To the best of our knowledge, no other cases linking this autoimmune disease to constrictive pericarditis have been reported.Case presentationWe present the case of a 48-year-old male patient with moderate alcohol habits and a history of two prior hospitalizations. On the first, the patient was diagnosed with primary Sjögren’s syndrome after presenting with pleural effusion and ascites, and empirical corticosteroid regiment was initiated. On the second, two-years later, he was readmitted with complaints of dyspnea and abdominal distension. Thoracic computed tomography revealed a localized pericardial thickening and a thin pericardial effusion, both of which were attributed to his rheumatic disease. A liver biopsy showed hepatic peliosis, which was considered to be a consequence of glucocorticoid therapy. Diuretic therapy was adjusted to symptom-relief, and a tapering corticosteroid regimen was adopted.Four years after the initial diagnosis, the patient was admitted again with recurrent dyspnea, orthopnea and ascites. At this time, constrictive pericarditis was diagnosed and a partial pericardiectomy was performed.Although not completely asymptomatic, the patient reported clinical improvement since the surgery, but still with a need for baseline diuretic therapy.ConclusionAlbeit uncommon, connective tissue disorders, such as primary Sjögren’s syndrome, should be considered as a potential cause of constrictive pericarditis, especially in young patients with no other classical risk factors for constriction.In this case, after excluding possible infectious, neoplastic and autoimmune conditions, a primary Sjögren´s syndrome in association with constrictive pericarditis was assumed. This case presents an interesting and challenging clinical scenario, highlighting the importance of clinical awareness and the use of multimodal cardiac imaging for early recognition and treatment.

Glucocorticoid Induced Hypothalamic-Pituitary Axis Alterations Associated with Hypogonadotropic Hypogonadism

Since the existence of cortisol in 1930 to current multiple formulations of glucocorticoids, it has been one of the most widespread medications to use for the treatment of simple to serious maladies. Glucocorticoids have gained unprecedented importance in treating autoimmune and inflammatory diseases, with one study conducted between 1998-2008 signifying that 1.2% of Americans over the age of 20 were at one point on glucocorticoid therapy, accounting for approximately 2.5 million Americans over the course of a decade. In this brief review, we focused on consequences of glucocorticoid therapy on alteration of sex steroids mainly in men with subsequent low libido, fatigue, erectile dysfunction, loss of muscle mass, increasing adipose tissue and osteoporosis. Effects of glucocorticoids appraised, based on current and available evidence at the level of the hypothalamus and pituitary, could cause alteration on the adipocyte-kisspeptin-gonadotropin-releasing hormone (GnRH)-luteinizing hormone (LH)-follicle-stimulating hormone (FSH) axis, especially with long-term use. The resultant hypogonadism occurs by suppression of GnRH-receptors, GnRH, LH, and FSH. Hypogonadism in patients with rheumatological diseases has multiple reasons, one of which is functional due to current illness and alteration in cytokines and inflammatory markers, and the other is a consequence of glucocorticoid therapy, which in either situation treatment of hypogonadism may improve quality of life and prevent complications of hypogonadism.

Prevention of cortisone-induced osteoporosis

Osteoporosis and fractures are the frequent consequences of glucocorticoid therapy. Cancellous bone is primarily affected with a decrease of bone formation and an increase of bone resorption. Prevention of corticosteroid-induced osteoporosis is based upon general measures such as calcium and vitamine D supplementation, adequate protein intake, regular physical exercise, and upon specific therapies like those used in primary osteoporosis. Bisphosphonates which are potent bone resorption inhibitors have been shown to reduce bone mineral density and to decrease vertebral fracture rate. Therefore, they appear to be a first choice in the prevention of corticosteroid-induced osteoporosis.

The effect of long-term glucocorticoid therapy on pituitary-adrenal responses to exogenous corticotropin-releasing hormone

Abstract Background. Suppression of pituitary--adrenal function is a well-known consequence of glucocorticoid therapy, manifested principally by decreased corticotropin secretion. To determine the degree of suppression of pituitary—adrenal function in patients treated with different doses of synthetic glucocorticoid medication for different periods, we measured the pituitary—adrenal response to the administration of exogenous human corticotropin-releasing hormone (CRH). Methods. We studied 279 patients who were receiving daily therapy with 5 to 30 mg of prednisone or its equivalent to treat various chronic diseases, principally collagen vascular disorders, and 50 normal subjects. Therapy ranged in duration from 1 week to 15 years. Stimulation tests using 100 μg of CRH as a bolus injection were performed in the morning, 24 hours after the most recent dose of glucocorticoids. In 61 patients an insulin hypoglycemia test, thought by many to be the reference standard, was also performed to assess the reliabili...