Doses Of Oral Glucocorticoids Research Articles

Risk of ocular hypertension or open-angle glaucoma in elderly patients on oral glucocorticoids

Ocular hypertension and open-angle glaucoma are well-known side-effects of treatment with topical ophthalmic glucocorticoids. There is uncertainty about the risk of these disorders with oral glucocorticoid therapy. Data from the Quebec universal health insurance programme for the elderly were used to identify 9793 patients with a new diagnosis of ocular hypertension or open-angle glaucoma, or on newly prescribed treatment for these disorders (cases). 38,325 controls were randomly selected from ophthalmology patients seen in the same month and year as the case (index date). Current use of oral glucocorticoids was defined as that within 14 days of the index date. All glucocorticoid doses were converted to the equivalent amount of hydrocortisone. The case-control analysis was done by conditional logistic regression and adjusted for age, sex, systemic hypertension, diabetes mellitus, ophthalmic glucocorticoids, glucocorticoid injections, and variables related to general health. The mean ages of cases and controls were similar (74.9 [SD 6.3] vs 74.7 [6.4]). The adjusted odds ratio of ocular hypertension or open-angle glaucoma for current users of oral glucocorticoids compared with non-users was 1.41 (95% CI 1.22-1.63). There was a dose-related increase in the adjusted odds ratios for current users: 1.26 (1.01-1.56) for less than 40 mg per day of hydrocortisone, 1.37 (1.06-1.76) for patients on 40-79 mg per day, and 1.88 (1.40-2.53) for patients on 80 mg or more per day. The odds ratios also increased with the duration of treatment over the first 11 months of exposure. The use of oral glucocorticoids increases the risk of ocular hypertension or open-angle glaucoma in elderly patients. In patients in this age-group who need long-term treatment with high doses of oral glucocorticoids, monitoring of intraocular pressure may be justified.

Glucocorticoid resistance in asthma.

"Glucocorticoid Resistance in Asthma." American Journal of Respiratory and Critical Care Medicine, 152(6_pt_2), pp. S125–S140

Intact parathyroid hormone levels are not elevated in glucocorticoid-treated subjects

To assess whether chronic glucocorticoid therapy results in a compensatory increase in parathyroid hormone (PTH), we measured intact PTH levels and other indices of mineral metabolism in 13 postmenopausal glucocorticoid-treated women and 16 normal age-matched controls. The glucocorticoid-treated women received a mean prednisone dose of 15.8 +/- 3.1 mg/day for 12.9 +/- 3.1 years. A linear regression analysis between intact PTH levels and a wide range of prednisone doses in these 13 glucocorticoid-treated women and 26 additional male and female subjects receiving chronic glucocorticoid therapy for a variety of rheumatic and pulmonary disorders (n = 39) was also performed. Intact PTH levels using the sensitive immunoradiometric assay (IRMA, Nichols Institute, San Juan Capistrano, CA) were comparable in the glucocorticoid-treated and normal control women (35.3 +/- 4.4 vs 31.3 +/- 3.2 ng/l, respectively) as wee the total calcium concentrations (9.67 +/- 0.12 vs 9.52 +/- 0.11 mg/dl). In the glucocorticoid-treated women, the 25-hydroxyvitamin D levels, measured by competitive protein assay were similar to those of the control subjects (29.2 +/- 2.8 vs 29.1 +/- 2.3 mg/ml), and no patient was treated with vitamin D in excess of 400 IU daily. In the combined 39 male and female patients, there were also no significant regression relationships between daily prednisone dose and intact PTH levels. Thus, secondary hyperparathyroidism does not accompany chronic oral glucocorticoid therapy in women on low to moderate doses of oral glucocorticoids. The lack of an elevation in intact PTH levels in the presence of chronic glucocorticoid therapy may represent an increased sensitivity of bone to PTH, or an alteration in the relationship between calcium and PTH, or both.

The Effect of Long Acting Glucocorticoids on Menstrual Abnormalities in Patients with Virilizing Congenital Adrenal Hyperplasia

Amenorrhea or oligomenorrhea occurs in more than 25% of young women with virilizing congenital adrenal hyperplasia due to 21-hydroxylase deficiency who are treated with conventional glucocorticoid therapy. In four such patients, we studied the variation in plasma concentration of ACTH, 17-hydroxyprogesterone (17-OHP), estradiol (E2), estrone, testosterone (T), dehydroepiandrosterone and its sulfate, androstenedione, and progesterone before and at frequent intervals after the administration of the patients' usual dose of oral glucocorticoids. We found that plasma ACTH, 17-OHP, and T were usually increased above the normal range early in the morning before the first daily dose of medication; plasma dehydroepiandrosterone and its sulfate were decreased below the normal range for the patient's pubertal stage; and androstenedione, estrone, and E2 were within the normal range. Two of the four patients had low basal plasma LH and impaired LH response to LRF. Administration of a long acting glucocorticoid (dexame...

The Effect of Long Acting Glucocorticoids on Menstrual Abnormalities in Patients with Virilizing Congenital Adrenal Hyperplasia*

Amenorrhea or oligomenorrhea occurs in more than 25% of young women with virilizing congenital adrenal hyperplasia due to 21-hydroxylase deficiency who are treated with conventional glucocorticoid therapy. In four such patients, we studied the variation in plasma concentration of ACTH, 17-hydroxyprogesterone (17-OHP), estradiol (E2), estrone, testosterone (T), dehydroepiandrosterone and its sulfate, androstenedione, and progesterone before and at frequent intervals after the administration of the patients' usual dose of oral glucocorticoids. We found that plasma ACTH, 17-OHP, and T were usually increased above the normal range early in the morning before the first daily dose of medication; plasma dehydroepiandrosterone and its sulfate were decreased below the normal range for the patient's pubertal stage; and androstenedione, estrone, and E2 were within the normal range. Two of the four patients had low basal plasma LH and impaired LH response to LRF. Administration of a long acting glucocorticoid (dexamethasone) to three patients, and methylprednisolone to one, resulted in continuous suppression of T into the normal range in all patients, in spite of continued abnormally increased concentration of ACTH and 17-OHP in two patients. In three patients, E2 concentrations were increased when a long acting glucocorticoid was given. In all four patients, menses began or became more regular during treatment with the long acting glucocorticoid. We conclude that a long acting glucocorticoid is useful in the management of menstrual abnormalities in adolescent patients with congenital adrenal hyperplasia who have attained their adult height, and that monitoring the concentration of serum T in them is a valuable but not infallible procedure for assessing the effectiveness of therapy.