PMC:4134656 / 10511-13534
Annnotations
{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/4134656","sourcedb":"PMC","sourceid":"4134656","source_url":"https://www.ncbi.nlm.nih.gov/pmc/4134656","text":"Long term steroid use is associated with many side effects. Boon et al., in their study of complications of systemic corticosteroid therapy for haemangiomas, identified cushingoid facies in 44 of 62 children which began 1 to 2 months after starting at a dose of 2-3 mg/kg/day.[22] Although it was not statistically significant the authors observed that the cushingoid facies was higher in children who received therapy for more than 6 months. The cushingoid facies resolved spontaneously during the final few months of tapering steroids. Twenty-two (35%) children slipped off their growth curve for weight during the treatment, and 91% of these children returned to their baseline within 2 weeks to 16 months (mean, 7 months; median, 4 months) after treatment. They also observed a transient decrease in weight gain in 26 children (42%). Of these, 23 children returned to their pre-treatment weight curve within 2 years after therapy (mean, 7.4 months; median, 6 months). Three children remained at a lower percentile for a longer period of time. Children who received treatment for more than 6 months or who received the therapy during the first 3 months of life were found to be more likely to have this transient slowdown of gain in height. Personality changes such as irritability, depressed mood, euphoria, insomnia and restlessness was reported in 29% of their cases, appeared within 2 weeks of therapy and resolved immediately after stopping the drug. The other side effects reported were gastric irritation (21%, n = 13), oral and/or perineal candidiasis (6%, n = 4) and steroid myopathy (n = 1). The overall risk of bacterial infection was not increased. Serious complications such as aseptic necrosis of femoral head, osteoporosis and cataracts were not seen in any patient.[22] George et al., in a retrospective review, found that 16 (73%) of 22 children treated with systemic steroids had irritability, fussiness or insomnia. Hypertension was observed in 10 patients (45%), while abnormal morning cortisol levels were found in 13 of the 15 patients (87%) tested. In addition, low-dose corticotropin stimulation test results were abnormal in 2 of the 3 infants tested.[23] In a prospective study on 16 infants with haemangiomas treated with prednisolone at doses 2-3 mg/kg/day for 4 weeks followed by a tapering period (mean duration of steroid therapy 7.2 months), only one case (6%) was found to have adrenal insufficiency (on corticotropin stimulation test) after therapy completion, which normalised 3 months later. The authors concluded that there is a low risk of adrenal insufficiency following completion of steroid therapy in infants with haemangiomas. The authors commented that measuring morning serum cortisol levels, which is less specific than corticotropin stimulation test for assessing the HPA axis suppression, and measuring the cortisol levels while the patient is still on corticosteroid therapy could explain the higher incidence of adrenal insufficiency reported in the earlier studies.[24]","tracks":[{"project":"2_test","denotations":[{"id":"25136206-10541160-58659542","span":{"begin":277,"end":279},"obj":"10541160"},{"id":"25136206-10541160-58659543","span":{"begin":1785,"end":1787},"obj":"10541160"},{"id":"25136206-15313812-58659544","span":{"begin":2180,"end":2182},"obj":"15313812"},{"id":"25136206-19289754-58659545","span":{"begin":3020,"end":3022},"obj":"19289754"}],"attributes":[{"subj":"25136206-10541160-58659542","pred":"source","obj":"2_test"},{"subj":"25136206-10541160-58659543","pred":"source","obj":"2_test"},{"subj":"25136206-15313812-58659544","pred":"source","obj":"2_test"},{"subj":"25136206-19289754-58659545","pred":"source","obj":"2_test"}]}],"config":{"attribute types":[{"pred":"source","value type":"selection","values":[{"id":"2_test","color":"#ec93d3","default":true}]}]}}