[Corticosteroid therapy]

Synthetic corticosteroids have variable glucocorticoid and mineralocorticoid potencies. Depending on their galenic form they can be administered either by intravenous, oral, intraarticular, intramuscular, inhalative or topic route. A local application is preferable over a systemic administration to avoid side effects. An initially high dose should always be tapered to the lowest possible effective dose. Among the side effects some have substantial clinical implications: Osteoporosis (to be treated during any long-term steroid application with calcium, vitamin D and eventually bis-phosphonates), immunodeficiency and a risk for often atypical infections, diabetes mellitus and psychiatric disorders such a depression and psychosis. A long-term glucocorticoid treatment can lead to a permanent adrenal insufficiency (M. Addison), which must be recognized and properly managed.