Corticosteroid side effects during pregnancy

Corticosteroid injections are used as a nonoperative modality to combat acute inflammation when conservative treatments fail. As female patients are regularly seen by orthopedic physicians, it is essential to identify and understand potential sex-related side effects. The aim of this article is to examine available literature for sex-related side effects of orthopedic-related corticosteroid injections. Although the incidence is low, sex-related side effects, such as abnormal menstruation, lactation disturbances, facial flushing, and hirsutism, are associated with corticosteroid injections. Physicians should be aware of these female-specific side effects and relay this information as part of the informed consent process. [Orthopedics. 2017; 40(2):e211-e215.].

An example of an acute hepatitis-like syndrome arising after pulse methylprednisolone therapy.  These episodes arise typically 2 to 4 weeks after a third or fourth cycle of pulse therapy, and range in severity from an asymptomatic and transient rise in serum aminotransferase levels to an acute hepatitis and even fulminant hepatic failure.  In this instance, the marked and persistent rise in serum enzymes coupled with liver histology suggesting chronic hepatitis led to a diagnosis of new-onset autoimmune hepatitis, despite the absence of serum autoantibodies or hypergammaglobulinemia.  Autoimmune hepatitis may initially present in this fashion, without the typical pattern of serum autoantibodies during the early, anicteric phase.  The diagnosis was further supported by the prompt improvements in serum enzymes with prednisone therapy.  The acute hepatitis-like syndrome that can occur after pulses of methylprednisolone is best explained as a triggering of an underlying chronic autoimmune hepatitis caused by the sudden and profound immunosuppression followed by rapid withdrawal.  This syndrome can be severe, and fatal instances have been reported.  Whether reinitiation of corticosteroid therapy with gradual tapering and withdrawal is effective in ameliorating the course of illness is unclear, but anecdotal reports such as this one suggest that they are beneficial and should be initiated promptly on appearance of this syndrome.  Long term follow up of such cases is also necessary to document that the autoimmune hepatitis does not relapse once corticosteroids are withdrawn again.

Dr. Shiel: Fortunately, the rounding of the face, which occurs because of cortisone medications, is often times reversible. This usually occurs because of a re-distribution of fatty tissue and enlargement of fat in and around the face so that what is commonly referred to as a "moon face" can occur with prolonged cortisone use. This often times is a temporary phenomenon. There are a limited number of patients who unfortunately, this is not reverse in, but most often does reverse over time after the medicines are discontinued.

Poor Growth: While poor growth can result from ICS, poorly controlled asthma can also lead to poor growth in children. In general, low and medium doses of ICS are potentially associated with small, non-progressive but reversible declines in growth of children. As a result, you and your asthma provider should not only carefully monitor growth, but try to use the lowest possible dose that gets good control of your child's asthma. You must weigh the potential benefits of good asthma control with the small but real possible side effect of slowed growth.

Corticosteroid side effects during pregnancy

corticosteroid side effects during pregnancy

Poor Growth: While poor growth can result from ICS, poorly controlled asthma can also lead to poor growth in children. In general, low and medium doses of ICS are potentially associated with small, non-progressive but reversible declines in growth of children. As a result, you and your asthma provider should not only carefully monitor growth, but try to use the lowest possible dose that gets good control of your child's asthma. You must weigh the potential benefits of good asthma control with the small but real possible side effect of slowed growth.

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