Vol. 5 Num 923 Sun. December 31, 2006  
Star Health

Steroid overuse is harmful

Steroids (usually corticosteroids) are powerful drugs which can improve symptoms and provoke incredible results. There are potential consequences to their use though. The power of corticosteroids should not be feared, but must be respected.

Serious side effects
Steroids can lead to serious side effects, including liver cancer, kidney disease and bad acne.

For men, steroids can shrink testicles, lower sperm count, raise prostate cancer risk and cause infertility and baldness. For women, they can cause facial hair growth, male-pattern baldness, menstrual problems and a deeper voice. They can stunt the growth of adolescents.

Researchers also have seen among steroid abusers extreme mood swings, impulsiveness, depression, paranoid jealousy, extreme irritability, delusions and impaired judgment.

The potent effect of corticosteroids can result in serious side effects which mimic Cushing's disease, a malfunction of the adrenal glands resulting in an overproduction of cortisol. The list of potential side effects is long and includes increased appetite and weight gain, deposits of fat in chest, face, upper back, and stomach, water and salt retention leading to swelling and edema, high blood pressure, diabetes, black and blue marks, slowed healing of wounds, osteoporosis, cataracts, acne, muscle weakness, thinning of the skin, increased susceptibility to infection, stomach ulcers, increased sweating, mood swings, psychological problems such as depression, adrenal suppression and crisis.

Ways to cope with the adverse effects
Side effects can be minimised by following doctor's orders and keeping to the lowest dose possible. It is also important to avoid self regulation of the dosage, either by adding more or stopping the medication without a schedule.

When used as a short-term treatment, prednisone is usually prescribed at a moderate dose and reduced or "tapered" over a one or two week period. The purpose is to achieve a sudden improvement in symptoms. Long-term therapy is usually reserved for severe cases of rheumatoid arthritis or related diseases.

High-dose steroids are given occasionally for the most rare, most severe cases of inflammatory disease. In such cases the steroids are "tapered" as soon as possible. To reduce potential side effects, the lowest dose of corticosteroid possible, still yielding a positive impact, should be given.

Corticosteroids: How do I stop taking the drugs?
Corticosteroids must be gradually reduced so as to permit the adrenal glands to resume natural cortisol production. Eliminating doses too quickly can result in adrenal crisis (a life-threatening state caused by insufficient levels of cortisol).

In cases where corticosteroids were taken in low doses for long periods of time, tapering can continue for months or years. When steroids are taken for shorter periods of time, tapering is more rapid and decreases in dosage can be larger.

Another possible complication to coming off steroids is steroid withdrawal syndrome, or rebound effect, which is the body's exaggerated response to removal of the drug. Rebound effect can result in fever, muscle pain, and joint pain making it hard for the physician to differentiate between withdrawal symptoms and a flare of the disease itself.

The bottom line
Steroids have a wide variety of use which provide immense benefit to the patients. But exploiting this advantage can be dangerous in some cases.

So the drug should be used rationally after the prescription of a physician. And the physicians should be responsible enough about the use of the drug.

The writer is the a Professor and Head, Department of Orthopeadics and Trauma Surgery of Dhaka Medical College Hospital, Dhaka.