An overview of the adverse reactions to adrenal corticosteroids

Glucocorticoids are amongst the most potent immunosuppressant drugs available and are widely used in many inflammatory and autoimmune conditions such as asthma and systemic lupus erythematosus. These agents are, however, associated with potentially substantial systemic side effects including electrolyte disturbances, cardiovascular effects, diabetes mellitus and loss of bone density and osteoporosis with concomitant vertebral fracture. The clinical utility of these agents should be tempered by the use of a minimum effective dose and, where possible, by the administration of alternate daily or pulse steroids which may have some impact on reducing the prevalence of these adverse effects. Moreover, recent evidence suggests that calcium and vitamin D co-administration may offset the chronic effects of glucocorticoids in inducing bone loss. A greater understanding of the molecular and cellular basis of glucocorticoid action, particularly as it relates to bone loss, is necessary to optimize efficacy and safety and to utilize therapies which may minimize the long-term effects of glucocorticoids. Furthermore, there is a need to develop newer glucocorticoids which have lesser effects on bone and other sites of adverse events, whilst retaining their immunosuppressive and anti-inflammatory action.