Chronic Steroid Use

Most people are familiar with the term “cortisone” which is really an old fashioned word for “cortisol,” the hormone produced by the adrenal cortex in times of stress. In higher doses, cortisol has potent anti-inflammatory properties making it a very useful medication. Because of this property, cortisol has been synthetically improved so as to provide an entire family of “glucocorticoid” hormones which include such familiar medications as:

  • Prednisone and Prednisolone
     
  • Dexamethasone (Azium®)
     
  • Trimacinolone (Vetalog®)
     
  • Methylprednisolone (Medrol®)

These medications last longer than natural cortisol and are stronger. In fact, there are so many therapeutic steroids that a doctor may choose the strength as well as duration of activity.

THERE HAS NEVER BEEN A CLASS OF DRUG
THAT HAS MORE APPLICATION IN DISEASE TREATMENT
THAN THE GLUCOCORTICOID CLASS.

INDEED, THIS GROUP IS RIVALLED ONLY
BY ANTIBIOTICS IN LIVES SAVED.

That said, side effects from the glucocorticoid group are numerous and can be classified into those seen with short term use and those seen in long term use.

SHORT TERM SIDE EFFECTS

The pet on glucocorticoids is likely to experience the following:

  • Increased hunger
     
  • Increased thirst
    (and possibly urinary incontinence if there is inadequate access to an area for appropriate urination).
     
  • Panting (dogs)
     
  • General loss of energy
     
  • Recrudescence of latent infection (hidden infection being unmasked)

Further, pre-diabetic animals may be “tipped over” into a diabetic state with steroid use. Often in these cases, the diabetes resolves once the steroid wears off. Sensitive individuals may experience upset stomach which can be serious.

Should the above issues become problematic, generally adjusting to a lower dose of medication will solve the problem. The goal with glucocorticoids is always to find the lowest dose of medication that is still effective. Sometimes changing to another steroid solves the problem.

LONG TERM SIDE EFFECTS

There are many conditions which require long term suppression of the immune system. Glucocorticoid doses generally include an “anti-inflammatory” dose which is lower and an “immune suppressive” dose which is higher, though with long enough term use, lower doses will become immune suppressive. When steroid use stretches out for more than four months, a new set of side effects (in addition to those listed above) becomes of concern:

  • Latent Urinary Tract Infections in up to 30% of patients
    Monitoring for these is necessary with periodic urine cultures. The patient will not have the usual symptoms of urinary infection as the steroid will suppress the inflammation associated with the infection.
     Culture may be the only way to detect the infection.
     
  • Development of Thin Skin, Blackheads, and Poor Ability to Heal Wounds or Grow Hair
     
  • Development of Obesity and Muscle Weakness

    calcinosis cutis small

  • Hard Plaques of Diseased Skin called “Calcinosis cutis”
    These plaques actually represent the deposition of calcium in the skin.



     
  • Predisposition to Infection of Any Kind/Weakening of Immune Defenses
     
  • The Development of Cushing's Syndrome

All of the above listed effects can be seen and be considered symptoms of this syndrome.

When long term therapy is needed, monitoring tests become especially important; requesting refill after refill without regard for the potency of these medication is not appropriate. Periodic urine cultures, check ups and even blood testing is part of responsible on-going corticosteroid use. For details on what tests are best for your pet, please consult your veterinarian.
 

Page last updated: 5/18/2011