The major adverse effect of glucocorticoids especially in children is -
Ans. is 'd' i.e., Posterior subcapsular cataract Adverse effects glucocorticoids1) Cushing's habitus: characteristic appearance with rounded face, narrow mouth, supraclavicular hump, obesity of trunk with relatively thin limbs.2) Fragile skinf purple striae-- typically on thighs and lower abdomen, easy bruising, telangiectasis, hirsutism. Cutaneous atrophy localized to the site occurs with topical application as well.3) Hyperglycaemia, may be glycosuria, precipitation of diabetes.4) Muscular weakness: proximal (shoulder, arm, pelvis, thigh) muscles are primarily affected. Myopathy occurs occasionally, warrants withdrawal of the corticoids.5) Susceptibility to infection: this is nonspecific for all types of pathogenic organisms. Latent tuberculosis may flare; opportunistic infections with low grade pathogens (Candida, etc.) set in. Delayed healing: of wounds and surgical incisions.6) Peptic ulceration: risk is doubled; bleeding and silent perforation of ulcers may occur. Dyspeptic symptoms are frequent with high dose therapy.7 Osteoporosis: especially involving vertebrae and other flat spongy bones. Compression fractures of vertebrae and spontaneous fracture of long bones can occur, especially in the elderly.8) Posterior subcapsular cataract may develop after several years of use, especially in children.9) Glaucoma: may develop in susceptible individuals after prolonged topical therapy.10) Growth retardation: in children occurs even with small doses if given for long periods. Large doses do inhibit GH secretion, but growth retardation may, in addition, be a direct cellular effect of corticoids. Recombinant GH given concurrently can prevent growth retardation, but risk/benefit of such use is not known.11) Foetal abnormalities: Cleft palate and other defects are produced in animals, but have not been encountered on clinical use in pregnant women. The risk of abortion, stillbirth or neonatal death is not increased, but intrauterine growth retardation can occur after prolonged therapy, and neurological/ behavioral disturbances in the offspring are feared. Prolonged corticosteroid therapy during pregnancy increases the risk of gestational diabetes, pregnancy induced hypertension and preeclampsia.12) Psychiatric disturbances: mild euphoria frequently accompanies high dose steroid treatment.13) Suppression of hypothalamo-pituitary-adrenal (HPA) axis: occurs depending both on dose and duration of therapy. In time, adrenal cortex atrophies and stoppage of exogenous steroid precipitates withdrawal syndrome consisting of malaise, fever, anorexia, nausea, postural hypotension, electrolyte imbalance, weakness, pain in muscles and joints and reactivation of the disease for which they were used. Subjected to stress, these patients may go into acute adrenal insufficiency leading to cardiovascular collapse.
Hyperkalemia
Hypoglycemia
Muscular weakness
Posterior subcapsular cataract
Endocrinology