From the Guidelines
Glucocorticoids are affected by various factors, including dose, duration, and individual patient characteristics.
Key Factors Affecting Glucocorticoids
- Dose: A daily glucocorticoid dose equivalent to prednisolone ≥ 5 mg, for longer than 1 month, represents an adrenal suppressive dose in a proportion of adults 1.
- Duration: The highest rate of bone loss occurs within the first 3–6 months of glucocorticoid treatment, and a slower decline continues with persistent use 1.
- Individual patient characteristics: Factors such as age, sex, and concomitant risk factors for osteoporosis can influence the effects of glucocorticoids on bone density and fracture risk 1.
Clinical Considerations
- Stress dosing: Patients receiving oral glucocorticoids (>5 mg/day prednisone equivalent) are at risk of developing adrenal suppression, and stress dosing may be necessary in certain clinical scenarios 1.
- Hyperglycemia: Glucocorticoid therapy can induce hyperglycemia in 56–86% of individuals with and without preexisting diabetes, and appropriate insulin treatments should be considered 1.
- Infection risk: Glucocorticoids may increase the risk of secondary infection and delay viral clearance, particularly in patients with COVID-19 1.
From the Research
Factors Affecting Glucocorticoids
- The hypothalamic-pituitary-adrenal (HPA) axis affects glucocorticoids, as it governs the normal stress response in humans and raises blood levels of the glucocorticoid hormone cortisol 2
- Glucocorticoid sensitivity and biologic responses can vary across tissues, with considerable heterogeneity in their effects 3
- The classic glucocorticoid receptor (GR) and its isoforms, such as GRα and GRβ, play a crucial role in mediating the actions of glucocorticoids 3, 2
- Sexually dimorphic responses to glucocorticoids can occur, with women tend to have a more hyperresponsive HPA axis than men 2
- Chronic glucocorticoid therapy can lead to a glucocorticoid-resistant state, resulting in noticeable side effects such as weight gain, adiposity, and diabetes 2, 4
- Acute increases in glucocorticoids can interfere with other neurotransmitter systems, such as the noradrenergic and 5HT systems 5
- The achievement of behavioral goals can reduce glucocorticoid production, highlighting the adaptive nature of glucocorticoid effects 5
Physiological Processes Affected by Glucocorticoids
- Glucose homeostasis, including gluconeogenesis, glycogen metabolism, and insulin response 6
- Pancreatic α and β cell function, regulating the secretion of glucagon and insulin 6
- Inflammatory and autoimmune disorders, as glucocorticoids are a mainstay treatment for these conditions 4
- Metabolic conditions, such as hyperglycaemia, which can be affected by short-term systemic glucocorticoid administration 4