Posted by Jonathan on November 13, 1998 at 09:40:14:
While reading through some medical journals I found this inf. This made me feel happy to have found a reason for my mood swings and depression etc. but it also made me angry that my GP was happy to keep on prescribing me the medicine for so long without consideration of the possible consequences. Anyhow, I thought you might all like a read of this. It tells you all about the wonder drug steroids, so commonly used to treat our condition.
"Disadvantages of Corticosteroids.
Overdose or prolonged use may exaggerate some of the normal physiological actions of corticosteroids. Miniralocorticoid effects include hypertension, sodium and water retention, potassium loss, and muscle weakness. Glucocorticoid effects include diabetes and osteoporosis which is a danger, particularly in the elderly, as it may result in vertebral collapse. Mental disturbances may occur; a serious paranoid state or depression with risk of suicide, may be induced, particularly in patients with a history of mental disorder. Euphoria is frequently observed. Peptic ulceration is a recognised complication which may result in haemorrhage or perforation. Mineralcorticoid effects are most marked with fludrocortisone and deoxycortone, but are significant with cortisone, hydrocortisone, corticotrophin, and tetracosactrin. Mineralcorticoid effects are negligible with the high potency glucocorticoids betamethasone, dexamethasone, methylprednisolone, and triamcinolone and occur only slightly with prednisolone and prednisone. In children, administration of corticosteroids may result in suppression of growth. Corticosteroids given in high dosage during pregnancy may affect adrenal development in the child.
Spread of infection. Suppression of clinical signs may allow septicaemia or tuberculosis to reach an advanced stage before being recognised. Systemic corticosteroid therapy should be avoided in patients with psoriasis, as subsequent reduction in dose is commonly followed by severe and persistent exacerbation.
Adrenal Suppression: The administration of exogenous corticosteroids suppresses the secretion of corticotrophin and may lead to adrenal atrophy which can persist for years after stopping prolonged corticosteroid therapy; any illness or surgical emergency may then require further corticosteroid therapy to compensate for lack of sufficient adrenocortical response. High doses of corticosteroids may cause Cushing's syndrome, with moon face striae, and acne; it us usually reversible on withdrawal of treatment, but this must always be gradually tapered to avoid symptoms of acute adrenal insufficiency"
"CUSHING SYNDROME:
A hormonal disorder caused by an abnormally high level of corticosteroid hormones in the bloodstream. The excess may be caused by overactivity of the adrenal glands, which normally produce corticosteroid hormones, or by prolonged administration of corticosteroid drugs. Cushing syndrome can occur at any age, but is most common in middle age.
Causes and Incidence:
Most cases of Cushing's syndrome today are caused by prolonged use of corticosteroid drugs, which are widely used to treat inflammatory conditions such as rheumatoid arthritis, inflammatory bowel disease, and asthma. Such cases are usually mild; the patient is often described as having cushingoid features rather than Cushing's syndrome. Cushing's syndrome is sometimes produced directly by an adrenal tumour that causes excessive secretion of corticosteroids. The condition may also be caused indirectly by overactivity of the pituitary gland, often due to a pituitary tumour. The pituitary gland controls the activity of the adrenal glands by producing a hormone called ACTH. (Adrenocorticotrophic hormone)l this stimulates the cortex (outer part) or the adrenal glands to grow and secrete excess corticosteroids. Cases caused by pituitary overactivity (sometimes called Cushing's disease) are much more common in women. Some lung cancers and various other tumours may also lead to Cushing's syndrome by secreting ACTH and thus leading to excess secretion of corticosteroids by the adrenal glands. This is more common in men.
Symptoms:
People with Cushing's Syndrome have a characteristic appearance. The face appears round ("moon-faced") and red, the trunk tends to become obese with a humped upper back, and the limbs become wasted. Acne develops and purple stretch marks may appear on the abdomen, thighs, and breasts. The skin is thin and bruises easily. The bones become weakened by osteoporosis and are more likely to fracture. Women may become increasingly hairy. Affected people are more susceptible to infection and may suffer from peptic ulcers. Mental changes often occur, causing depression, paranoia, or sometimes euphoria. Insomnia may be a problem. Patients may develop hypertension (high blood pressure) and oedema one fifth of patients develop diabetes mellitus. In children, Cushhing's syndrome may suppress growth.
Diagnosis:
Anyone suspected of having Cushing's syndrome should be examined by and endocrinologist. Confirmation of the diagnoses may require measurement of ACTH levels in the blood and of corticosteroid levels in the blood and urine. CT scanning or MRI of the adrenal and pituitary glands may be performed to look for abnormalities.
Treatment:
If corticosteroid drugs are the cause, Cushing's syndrome will usually disappear if the dose of drugs is gradually reduced. If the cause is shown to be a tumour or overgrowth of an adrenal gland, the gland is removed surgically. If the cause is a pituitary tumour, the gland is removed surgically or the tumour is shrunk by arradiation and medication. Patients subsequently need hormone replacement therapy to compensate for lack of production of adrenal and pituitary hormones."