Glucocorticoid Medication Research Articles

Prednisolone in the management of patients with Crohn’s disease

Glucocorticoids, a type of steroid hormone, are widely used in the treatment of inflammatory bowel disease (IBD) in patients with Crohn's disease or ulcerative colitis. Many patients with these conditions are managed conservatively outside hospital, with continued support from their gastroenterologist and occasional glucocorticoid medication. However, glucocorticoids are not a long-term solution for anyone with IBD, since they carry many unwanted side-effects, and can damage body parts and function years after ingestion, particularly if the dose was high and for longer than 6 months. In the short-term, glucocorticoids can produce some very impressive results, but patients need to know the facts about them and what they should and could expect from taking this medication. This article gives an outline of one of these drugs--prednisolone--what it is used for, and the side-effects that may arise.

Failure to perceive increased risk of fracture in women 55 years and older: the Global Longitudinal Study of Osteoporosis in Women (GLOW)

SummaryWe compared self-perception of fracture risk with actual risk among 60,393 postmenopausal women aged ≥55 years, using data from the Global Longitudinal Study of Osteoporosis in Women (GLOW). Most postmenopausal women with risk factors failed to appreciate their actual risk for fracture. Improved education about osteoporosis risk factors is needed.IntroductionThis study seeks to compare self-perception of fracture risk with actual risk among postmenopausal women using data from GLOW.MethodsGLOW is an international, observational, cohort study involving 723 physician practices in 17 sites in ten countries in Europe, North America, and Australia. Participants included 60,393 women ≥55 years attended by their physician during the previous 24 months. The sample was enriched so that two thirds were ≥65 years. Baseline surveys were mailed October 2006 to February 2008. Main outcome measures were self-perception of fracture risk in women with elevated risk vs women of the same age and frequency of risk factors for fragility fracture.ResultsIn the overall study population, 19% (10,951/58,434) of women rated their risk of fracture as a little/much higher than that of women of the same age; 46% (27,138/58,434) said it was similar; 35% (20,345/58,434) believed it to be a little/much lower. Among women whose actual risk was increased based on the presence of any one of seven risk factors for fracture, the proportion who recognized their increased risk ranged from 19% for smokers to 39% for current users of glucocorticoid medication. Only 33% (4,185/12,612) of those with ≥2 risk factors perceived themselves as being at higher risk. Among women reporting a diagnosis of osteopenia or osteoporosis, only 25% and 43%, respectively, thought their risk was increased.ConclusionIn this international, observational study, most postmenopausal women with risk factors failed to appreciate their actual risk for fracture.

Sarcoidosis Following Cushing's Syndrome: A Report of Two Cases and Review of the Literature

Cushing's syndrome is characterized by excessive elevation of glucocorticoid concentrations. In rare cases, the treatment of Cushing's syndrome may result in unmasking or aggravation of diseases responsive to glucocorticoid medication. We report two cases of sarcoidosis following Cushing's syndrome. A 43 year-old male developed cutaneous sarcoidosis and mediastinal lymphadenopathy after resection of an ACTH-secreting pituitary microadenoma. A 32 year-old female showed cutaneous sarcoidosis, arthralgia, mediastinal lymphadenopathy and elevation of angiotensin-converting enzyme and interleukin 2-receptor concentrations after traumatic adrenal bleeding, which ceased formerly undiagnosed hypercortisolism caused by an adrenal adenoma. Sarcoidosis seems to be a rare sequel following the treatment of hypercortisolism. Skin affections were present and suggestive for the diagnosis in all reported cases. As some cases are probably missed when skin affections are lacking, a more frequent evaluation of patients after Cushing's syndrome for the possible diagnosis of sarcoidosis might be necessary.

Use of budesonide in the treatment of microscopic colitis

Collagenous colitis and lymphocytic colitis, the two types of microscopic colitis, cause watery diarrhea. Budesonide, a glucocorticoid medication with limited systemic availability, is commonly used to treat these illnesses. Budesonide has proven efficacy in the induction of clinical remission in both collagenous colitis and lymphocytic colitis. Budesonide is effective as a maintenance drug for patients with collagenous colitis, but has not been studied for this indication in patients with lymphocytic colitis. This drug improves quality of life in patients while causing few mild adverse events. Budesonide is an effective treatment of microscopic colitis that is safe and well tolerated.

Insulin und Diabetes mellitus Typ 2

Worldwide an increasing number of persons suffers from type 2 diabetes. Often treatment with oral hypoglycemic agents is not sufficient for adequate glycemic control and additional insulin treatment is necessary. Treatment with insulin is recommended if HbA1c levels below 7% cannot be achieved despite lifestyle measures and the proper use of oral hypoglycemic agents. In addition, pregnancy, periods pre and post major operations, treatment in intensive care units, glucocorticoid medication, severe peripheral neuropathy as well as contraindications of oral hypoglycaemic agents may be indications for insulin therapy irrespective of the actual glycemic control. The choice of the appropriate insulin regimen depends on the daily blood glucose profiles and patient needs.

Effects of Glucocorticoid Immunosuppression on Serum Cystatin C Levels

Effects of Glucocorticoid Immunosuppression on Serum Cystatin C LevelsThe aim of the present study is to describe the influence of glucocorticoid immunosuppression on serum cystatin C concentration in renal transplant patients. To evaluate the influence of immunosuppressive regimens, especially glucocorticoids, on serum cystatin C level, 38 clinically stable patients on immunosuppression therapy with low-dose glucocorticoids were compared to 30 clinically stable patients receiving cyclosporin A alone, and 18 clinically stable patients receiving cyclosporin A together with azathioprine. Clinical stability was defined as the absence of acute rejection, febrile infection, and cyclosporin A toxicity, as well as stability of creatinine clearance as estimated by the formula of Cockroft and Gault. All groups were compared for estimated creatinine clearance (CrCl) values and had comparable gender, age and time since transplantation. The group receiving short-course, high-dose methylprednisolone was analyzed at four time points: a) before methylprednisolone commencement (median, 15 days); b) the day methylprednisolone was introduced (before medication); c) after 3 days of methylprednisolone therapy; and d) on a follow-up 9-10 days after the last dose. Intravenous administration of high-dose methylprednisolone led to significant differences in cystatin C levels at different time points (before administration, after three doses, and 8 days after discontinuation). Glucocorticoid medication in adult renal transplant patients is associated in a dose-de pendent manner with increased cystatin C, leading to systematic under estimation of GFR. Moreover, our data illustrate the need for specific reference intervals in patients on glucocorticoid therapy. In clinical routine settings, as well as in future clinical studies, it is important to take glucocorticoid medication into account when interpreting serum cystatin C concentrations in renal transplant patients presumably, as well as in other patient groups.

Attenuation of a rocuronium‐induced neuromuscular block in patients receiving prednisolone

This study tested the influence of continuous medication (more than 4 weeks) with prednisolone on a rocuronium-induced neuromuscular block. The time course of a rocuronium-induced neuromuscular blockade (0.3 mg/kg) was investigated in 40 patients with chronic inflammatory bowel disease undergoing elective abdominal surgery. The primary end point was the time from the start of injection of rocuronium until recovery of the TOF ratio to 0.9. Twenty patients received continuous medication with prednisolone (group A), and 20 were without glucocorticoid medication (group B). Additionally, another 20 patients without inflammatory bowel disease and without glucocorticoid medication served as control (group C). The onset time was prolonged in group A [253 (51.2) s] compared with group B [187 (61.3) s]. Twitch height at the onset of the block was higher in group A [16.5 (0-61)%] than that in group B [5.0 (0-33)%]. The duration to 25% twitch height was shorter in group A [12.6 (0-20.7) min] compared with group B [16.7 (0-25.3) min] and group C [16.9 (0-29.3) min]. The recovery to a train-of-four ratio of 0.9 was reduced in group A [25.7 (23-34.3) min] compared with group B [34.7 (32.7-44.2) min] and group C [36.5 (31.7-42.3) min]. Prednisolone treatment in patients with inflammatory bowel disease is associated with a delayed onset and a shorter duration of action of rocuronium. The presence of an inflammatory bowel disease did not influence the neuromuscular block.

Bone health in ambulatory individuals with multiple sclerosis: Impact of physical activity, glucocorticoid use, and body composition

This study examined the relationships among physical activity, glucocorticoid use, body composition, and bone health in ambulatory women with multiple sclerosis (MS). Twenty-nine white women (mean +/- standard deviation: age 45.1 +/- 9.0 yr, Expanded Disability Status Scale 2.9 +/- 1.2) diagnosed with MS were assessed for whole body (WB), proximal femur (PF) and lumbar spine (LS) bone status (bone mineral content [BMC], bone mineral density [BMD], and quantitative ultrasound index [QUI] by calcaneal quantitative ultrasound) and body composition by dual energy X-ray absorptiometry; for physical activity by pedometer and accelerometer; and for glucocorticoid medication exposure by self-report. Accelerometer counts were related to PF BMC (r = 0.50, p = 0.010) when we controlled for age, fat and lean mass, MS disease duration, and glucocorticoid use. Glucocorticoid use was not associated with bone measures. When we controlled for age and fat mass, lean mass was associated with WB BMC (r = 0.41, p = 0.04), PF BMC (r = 0.61, p = 0.001), and speed of sound (SOS) (r = 0.44, p = 0.02), whereas fat mass was associated with SOS and QUI (r =0.43, p = 0.03, and r = 0.44, p = 0.02, respectively). Lean mass was an independent predictor of WB BMC ( p = 0.04) and PF BMC ( p = 0.001), whereas fat mass was an independent predictor of LS BMD (p = 0.05). In conclusion, physical activity and lean mass are associated with femoral bone mass in women with MS who are ambulatory.

Short-term glucocorticoid administration in patients with protracted and chronic gout arthritis. Part 2 — comparison of different medication forms efficacy

Система комплексной поддержки и сопровождения научного журнала Elpub позволяет запустить двуязычный сайт журнала со встроенной системой электронной редакции в соответствии с лучшими издательскими практиками, а так же предусматривает техническую и методическую поддержку со стороны специалистов НЭИКОН.

An adrenal rest tumour in the perirenal region in a patient with congenital adrenal hyperplasia due to congenital 3β-hydroxysteroid dehydrogenase deficiency

In contrast to the high incidence of testicular adrenal rest tumours (TART) in adult male patients with congenital adrenal hyperplasia (CAH), ovarian adrenal rest tumours in female CAH patients are very rare and other locations of adrenal rest tumours have never been reported. Here, we report on an adult patient with CAH due to 3beta-hydroxysteroid dehydrogenase (HSD) deficiency with bilateral TART and additionally a large perirenal adrenal rest tumour. The patient was known with CAH due to 3beta-HSD deficiency and treated with hydrocortisone and fludrocortisone since the neonatal period. In puberty, there was lack of compliance with consequently high POMC concentrations. At the age of 16 years, bilateral TART were detected by scrotal ultrasound. Intensifying glucocorticoid medication did not result in decrease in POMC concentrations and shrinkage of size of the tumours. At the age of 23 years, abdominal ultrasound was performed because of abdominal complaints, showing a round inhomogeneous structure with a diameter of 4 cm near the left renal hilus. A computer tomography scan showed a multinodular lesion in the retroperitoneal region beside the left kidney. Histological investigation after removal of the tumour showed sheets of large polygonal cells with abundant eosinophilic cytoplasm, separated by dense fibrous tissue strands. The histological and immunohistochemical profile resulted in a diagnosis of an adrenal rest tumour. In adult CAH patients, ectopic adrenal rest tumours can be present outside the testicular region. Further investigations are necessary to determine whether regularly screening for these tumours is useful.

Relation of Adult-Onset Asthma to Coronary Heart Disease and Stroke

Asthma was associated with atherosclerotic disease in several studies, with evidence that this association may be limited to women. However, most previous studies failed to account for the heterogeneity of asthma subtypes. We previously reported increased carotid intima-medial thickness in women with adult-onset asthma. In this study, the association of adult- and child-onset asthma with incident coronary heart disease (CHD) and stroke were examined. Subjects were classified according to self-report of physician-diagnosed asthma and age of asthma onset. Cox proportional hazards models were used to test the association of adult- and child-onset asthma with incident CHD and stroke, testing for gender interaction. Subanalysis was also performed using only never smokers. Women with adult-onset asthma experienced a 2-fold increase in incident CHD and stroke that was independent of other risk factors, including smoking, body mass index, and physical activity, and persisted when analysis was restricted to never smokers. No significant association was found in women with child-onset asthma or in men. In conclusion, adult-onset asthma may be a significant risk factor for CHD and stroke in women, but not men.

Central serous chorioretinopathy

Central serous chorioretinopathy (CSC) is a disease of the retina characterized by serous detachment of the neurosensory retina secondary to one or more focal lesions of the retinal pigment epithelium (RPE). CSC occurs most frequently in mid-life and more often in men than in women. Major symptoms are blurred vision, usually in one eye only and perceived typically by the patient as a dark spot in the centre of the visual field with associated micropsia and metamorphopsia. Normal vision often recurs spontaneously within a few months. The condition can be precipitated by psychosocial stress and hypercortisolism. Ophthalmoscopic signs of CSC range from mono- or paucifocal RPE lesions with prominent elevation of the neurosensory retina by clear fluid - typical of cases of recent onset - to shallow detachments overlying large patches of irregularly depigmented RPE. The spectrum of lesions includes RPE detachments. Granular or fibrinous material may accumulate in the subretinal cavity. Serous detachment often resolves spontaneously. From first contact, counselling about the potential relation to stress and glucocorticoid medication is warranted. After 3 months without resolution of acute CSC or in chronic CSC, treatment should be considered. Resolution of detachment can usually be achieved in acute CSC by focal photocoagulation of leaking RPE lesions or, in chronic CSC, by photodynamic therapy. The effect of therapy on long-term visual outcome is insufficiently documented. Reattachment within 4 months of onset is considered a relevant therapeutic target because prolonged detachment is associated with photoreceptor atrophy. This suggests that the value of treatment depends upon proper selection of cases that will not resolve without therapy. Chronic CSC may be difficult to differentiate from occult choroidal neovascularization secondary to CSC. Patients with chronic CSC who receive glucocorticoid treatment for systemic disease can often be managed without having to discontinue this medication.

Morbus Crohn - Infliximab, Adalimumab und Certolizumab-Pegol - Was bringen die neuen Gegenspieler des TNF-α?

Therapeutic antibodies against TNF-alpha are an important therapeutic innovation in recent years in treating complicated Crohn's disease. Chimeric infliximab fully human produced Adalimumab and Certolizumab-Pegol, a humanized, PEGylated anti-TNF-alpha antibody Fab'fragment, are therapeutic antibodies against TNF. All three antibodies have a rapid onset of action, with two thirds of the patients with refractory Crohn's disease showing an initial clinical response to the anti-TNFalpha treatment and only 20-30 % develops a lasting remission. Clinical benefits include closure of draining fistulas and reduction of chronic glucocorticoid medication. When considering an anti TNF-alpha therapy a long term strategy is needed and a systematic maintenance treatment should be developed. The antibodies recognize different epitopes but have a complementary mode of action. Does one antibody fail, especially after an initial clinical response, a second antibody can still show an effect. More recent anti TNF-alpha antibodies can be applied without an azathioprine comedication. Severe side effects like an increase risk of infection and malignancies are a class effect and closely linked to the mode of action. When patients are properly selected, the clinical benefit outweighs the side effects. Before starting an immunosuppressive therapy or an anti-TNF-alpha therapy screening for latent tuberculosis is mandatory. An abscess has to be excluded. Due to the high risk of infection any symptoms which might be a sign of complications during therapy should result in a thorough diagnostic examination. Patients should be documented in registries.

The “Steroid Dementia Syndrome”: A Possible Model of Human Glucocorticoid Neurotoxicity

Glucocorticoid medications cause neurotoxicity in animals under certain circumstances, but it is not known if this occurs in humans. We present the case of a 10-year-old boy with no prior psychiatric history and no prior exposure to glucocorticoid medication who received a single 5-week course of glucocorticoids for an acute asthma flare. Beginning during steroid treatment, and persisting for over 3 years after stopping treatment, he showed a significant decline from his pre-morbid academic performance and estimated IQ, verified by longitudinally administered testing and school records. Neuropsychological tests that are sensitive to glucocorticoid-induced cognitive impairments revealed global cognitive deficits consistent with primary hippocampal and prefrontal cortical dysfunction. The patient has a fraternal twin brother, who had previously achieved academic milestones in parallel with him; the patient began falling behind his twin in academic, developmental and social areas shortly after the steroid treatment. In the 3 years since stopping steroid medication, the patient has shown gradual but possibly incomplete resolution of his cognitive deficits. Quantitative brain magnetic resonance imaging (MRI), performed 38 months after steroid exposure revealed no gross abnormalities, but the patient's hippocampal volume was 19.5% smaller than that of his twin, despite the patient having a larger overall intracranial volume. Single photon emission computed tomography (SPECT) imaging, performed at the same time, suggested subtly decreased activity in the left posterior frontal and left parietal lobes. This case, along with others reported in the literature, suggests that certain individuals develop a “steroid dementia syndrome” after glucocorticoid treatment. Although this syndrome is uncommon, it is consistent with evolving theories of the neurotoxic or neuroendangering potential of glucocorticoids in some situations.

A case of acute pericarditis with hemophagocytic syndrome, cytomegalovirus infection and systemic lupus erythematosus

Hemophagocytic syndrome, cytomegalovirus infection and systemic lupus erythematosus (SLE) would each be critical diseases separately. Viral infections, autoimmune diseases or malignancies can complicate the Hemophagocytic syndrome. Cytomegalovirus infection is known to be prevalent in immune compromised hosts, and can exacerbate the symptoms of systemic lupus erythematosus. A 25-year-old man presented with fever and acute pericarditis with the hemophagocytic syndrome, cytomegalovirus infection and systemic lupus erythematosus; all developed concurrently at the onset of illness. With treatment, using ganciclovir and glucocorticoid medication the patient improved. Here we report this rare case and review the medical literature.

Repeated successful induction of fertility after replacing hydrocortisone with dexamethasone in a patient with congenital adrenal hyperplasia and testicular adrenal rest tumors

To report repeated successful induction of fertility in an adult male patient with congenital adrenal hyperplasia (CAH) and testicular adrenal rest tumors (TART). Case report. Radboud University Nijmegen Medical Centre. A 23-year-old male CAH patient with bilateral TART and azoospermia. Changing glucocorticoid medication from 30 mg of hydrocortisone to 0.75 mg of dexamethasone (DXM) daily. Improved semen analysis. With the use of ultrasound screening, TART were detected in the 23-year-old patient. The semen analysis showed azoospermia. In an attempt to decrease tumor size and improve testicular function, his glucocorticoid medication was changed from hydrocortisone to an equivalent dosage of DXM. The azoospermia was quickly reversed, and his partner conceived within 7 months of stopping oral contraceptives. Due to his progressive weight gain and striae, his medication was changed back to hydrocortisone, and he again developed again azoospermia. Two years later, the patient started again with DXM at the same dosage. His sperm concentration increased with progressive weight gain. Seven months later his partner became pregnant for the second time; afterward, the DXM treatment was changed back to hydrocortisone. In male CAH patients with testicular adrenal rest tumors, infertility may be reversible by replacing hydrocortisone with short courses of an equivalent dosage of DXM.

Vasculature deprivation – induced osteonecrosis of the rat femoral head as a model for therapeutic trials

Experimental OsteonecrosisThe authors' experience with experimentally produced femoral capital osteonecrosis in rats is reviewed: incising the periosteum at the base of the neck of the femur and cutting the ligamentum teres leads to coagulation necrosis of the epiphysis. The necrotic debris is substituted by fibrous tissue concomitantly with resorption of the dead soft and hard tissues by macrophages and osteoclasts, respectively. Progressively, the formerly necrotic epiphysis is repopulated by hematopoietic-fatty tissue, and replaced by architecturally abnormal and biomechanically weak bone. The femoral heads lose their smooth-surfaced hemispherical shape in the wake of the load transfer through the hip joint such that, together with regressive changes of the joint cartilage and inflammatory-hyperplastic changes of the articular membrane, an osteoarthritis-like disorder ensues.Therapeutic ChoicesDiverse therapeutic options are studied to satisfy the different opinions concerning the significance of diverse etiological and pathogenic mechanisms: 1. Exposure to hyperbaric oxygen. 2. Exposure to hyperbaric oxygen and non-weight bearing on the operated hip. 3. Medication with enoxaparin. 4. Reduction of intraosseous hypertension, putting to use a procedure aimed at core decompression, namely drilling a channel through the femoral head. 5. Medication with vascular endothelial growth factor with a view to accelerating revascularization. 6. Medication with zoledronic acid to decrease osteoclastic productivity such that the remodeling of the femoral head is slowed.Glucocorticoid-related osteonecrosis appears to be apoptosis-related, thus differing from the vessel-deprivation-induced tissue coagulation found in idiopathic osteonecrosis. The quantities of TNF-α, RANK-ligand and osteoprotegerin are raised in glucocorticoid-treated osteoblasts so that the differentiation of osteoclasts is blocked. Moreover, the osteoblasts and osteocytes of the femoral cortex mostly undergo apoptosis after a lengthy period of glucocorticoid medication.

Therapy for ROD and measurement of the bone mass

The kidney deeply takes part in phosphorus and vitamin D metabolism. The chronic kidney disease patients usually suffer from serious bone disease. They are prescribed the glucocorticoid medication for primary kidney disease, as nephrotic syndrome and collagen renal disease, with aging. The end of therapeutic target is normal bone structure with normal bone turnover in CKD patients. The control of serum Ca and phosphorus level is important step and also another target. This issue describes the problem and the advancement of treatment and the measurement of the bone mass from this viewpoint.

Use of stereotactic intensity-modulated radiotherapy in thyroid-related ophthalmopathy

✓ Thyroid-related ophthalmopathy (TRO), a debilitating condition involving a range of visual and orbital symptoms, occurs in up to 40% of patients with Graves disease. The goals of treatment include correcting thyroid dysfunction, relieving ocular pain, preserving vision, and improving cosmetic appearance. Options for therapy include symptomatic treatment, glucocorticoid medication, radiation therapy, and surgery. Traditional radiation treatment uses small opposed bilateral fields consisting of retrobulbar volumes and customized blocks to shield periorbital structures. The combination of intensity-modulated radiotherapy (IMRT) and stereotactic technology facilitates the administration of radiation to patients suffering from TRO and provides greater safety and efficacy than traditional treatment. The authors present the case of a patient with severe TRO whose symptoms resolved rapidly after treatment with stereotactic IMRT. The outcome in this case supports stereotactic IMRT as an effective treatment option for patients with TRO who also undergo radiation therapy.

Use of stereotactic intensity-modulated radiotherapy in thyroid-related ophthalmopathy

✓ Thyroid-related ophthalmopathy (TRO), a debilitating condition involving a range of visual and orbital symptoms, occurs in up to 40% of patients with Graves disease. The goals of treatment include correcting thyroid dysfunction, relieving ocular pain, preserving vision, and improving cosmetic appearance. Options for therapy include symptomatic treatment, glucocorticoid medication, radiation therapy, and surgery. Traditional radiation treatment uses small opposed bilateral fields consisting of retrobulbar volumes and customized blocks to shield periorbital structures. The combination of intensity-modulated radiotherapy (IMRT) and stereotactic technology facilitates the administration of radiation to patients suffering from TRO and provides greater safety and efficacy than traditional treatment. The authors present the case of a patient with severe TRO whose symptoms resolved rapidly after treatment with stereotactic IMRT. The outcome in this case supports stereotactic IMRT as an effective treatment option for patients with TRO who also undergo radiation therapy.