Steroids are hormones which are indispensable for physiological functions. In naturally occurring conditions of deficiency of these hormones, the treatment of choice is replacement in required doses.
Steroids have also anti-inflammatory actions at supra-physiological doses. The bulk of indications of steroids are attributed to their anti-inflammatory action. Steroids do not alter the causative factor but provides symptomatic relief by suppressing inflammation.
So, while the hormone replacement therapy is used for adreno-cortical insufficiency and congenital adrenal hyperplasia, the list of indications of the anti-inflammatory use of steroids is ‘endless’.
Adverse effects with replacement therapy are rare because they are simply the replacement of the physiological requirements with the right dose. Side effects which are dose dependent may occur during dose adjustment or lack of proper monitoring.
On the other hand, anti-inflammatory doses which are supra physiological are very commonly associated with adverse effects. The incidence of adverse effects increases with the dose and duration of therapy. While hyperglycaemia, fluid retention, delayed wound healing, secondary infections can occur immediately after steroid initiation, fat redistribution, osteoporosis, myopathy, peptic ulcer and cataract can occur in the long run.
An inevitable consequence of long term steroid therapy is suppression of the hypothalamus-pituitary adrenal axis. It is generally innocuous during ongoing steroid therapy, but if abruptly stopped, will land the patient in acute adrenal crisis. The condition is life threatening. So any steroid therapy which is continued for more than two weeks is gradually tapered with decrease in the daily dose every week allowing time for the HPA axis to regain its normal functioning.
In the end, we can say that steroids are life saving drugs (Manna’s dew) providing relief and solace to the suffering millions but if used improperly can turn the Manna’s dew into the ‘devil’s bait’.
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