Prednisone Health Dictionary

The generic term for the group of hormones produced by the ADRENAL GLANDS, with a profound e?ect on mineral and glucose metabolism.

Many modi?cations have been devised of the basic steroid molecule in an attempt to keep useful therapeutic effects and minimise unwanted side-effects. The main corticosteroid hormones currently available are CORTISONE, HYDROCORTISONE, PREDNISONE, PREDNISOLONE, methyl prednisolone, triamcinolone, dexamethasone, betamethasone, paramethasone and de?azacort.

They are used clinically in three quite distinct circumstances. First they constitute replacement therapy where a patient is unable to produce their own steroids – for example, in adrenocortical insu?ciency or hypopituitarism. In this situation the dose is physiological – namely, the equivalent of the normal adrenal output under similar circumstances – and is not associated with any side-effects. Secondly, steroids are used to depress activity of the adrenal cortex in conditions where this is abnormally high or where the adrenal cortex is producing abnormal hormones, as occurs in some hirsute women.

The third application for corticosteroids is in suppressing the manifestations of disease in a wide variety of in?ammatory and allergic conditions, and in reducing antibody production in a number of AUTOIMMUNE DISORDERS. The in?ammatory reaction is normally part of the body’s defence mechanism and is to be encouraged rather than inhibited. However, in the case of those diseases in which the body’s reaction is disproportionate to the o?ending agent, such that it causes unpleasant symptoms or frank illness, the steroid hormones can inhibit this undesirable response. Although the underlying condition is not cured as a result, it may resolve spontaneously. When corticosteroids are used for their anti-in?ammatory properties, the dose is pharmacological; that is, higher – often much higher – than the normal physiological requirement. Indeed, the necessary dose may exceed the normal maximum output of the healthy adrenal gland, which is about 250–300 mg cortisol per day. When doses of this order are used there are inevitable risks and side-effects: a drug-induced CUSHING’S SYNDROME will result.

Corticosteroid treatment of short duration, as in angioneurotic OEDEMA of the larynx or other allergic crises, may at the same time be life-saving and without signi?cant risk (see URTICARIA). Prolonged therapy of such connective-tissue disorders, such as POLYARTERITIS NODOSA with its attendant hazards, is generally accepted because there are no other agents of therapeutic value. Similarly the absence of alternative medical treatment for such conditions as autoimmune haemolytic ANAEMIA establishes steroid therapy as the treatment of choice which few would dispute. The use of steroids in such chronic conditions as RHEUMATOID ARTHRITIS, ASTHMA and DERMATITIS needs careful assessment and monitoring.

Although there is a risk of ill-effects, these should be set against the misery and danger of unrelieved chronic asthma or the incapacity, frustration and psychological trauma of rheumatoid arthritis. Patients should carry cards giving details of their dosage and possible complications.

The incidence and severity of side-effects are related to the dose and duration of treatment. Prolonged daily treatment with 15 mg of prednisolone, or more, will cause hypercortisonism; less than 10 mg prednisolone a day may be tolerated by most patients inde?nitely. Inhaled steroids rarely produce any ill-e?ect apart from a propensity to oral thrush (CANDIDA infection) unless given in excessive doses.

General side-effects may include weight gain, fat distribution of the cushingoid type, ACNE and HIRSUTISM, AMENORRHOEA, striae and increased bruising tendency. The more serious complications which can occur during long-term treatment include HYPERTENSION, oedema, DIABETES MELLITUS, psychosis, infection, DYSPEPSIA and peptic ulceration, gastrointestinal haemorrhage, adrenal suppression, osteoporosis (see BONE, DISORDERS OF), myopathy (see MUSCLES, DISORDERS OF), sodium retention and potassium depletion.... corticosteroids

Also known as laryngo-tracheo-bronchitis, croup is a household term for a group of diseases characterised by swelling and partial blockage of the entrance to the LARYNX, occurring in children and characterised by crowing inspiration. There are various causes but by far the commonest is acute laryngo-tracheobronchitis (see under LARYNX, DISORDERS OF). Croup tends to occur in epidemics, particularly in autumn and early spring, and is almost exclusively viral in origin – commonly due to parain?uenza or other respiratory viruses. It is nearly always mild and sufferers recover spontaneously; however, it can be dangerous, particularly in young children and infants, in whom the relatively small laryngeal airway may easily be blocked, leading to su?ocation.

Symptoms Attacks generally come on at night, following a cold caught during the previous couple of days. The breathing is hoarse and croaking (croup), with a barking cough and harsh respiratory noise. The natural tendency for the laryngeal airway to collapse is increased by the child’s desperate attempts to overcome the obstruction. Parental anxiety, added to that of the child, only exacerbates the situation. After struggling for up to several hours, the child ?nally falls asleep. The condition may recur.

Treatment Most children with croup should be looked after at home if the environment is suitable. Severe episodes may require hospital observation, with treatment by oxygen if needed and usually with a single dose of inhaled steroid or oral PREDNISONE. For the very few children whose illness progresses to respiratory obstruction, intubation and ventilation may be needed for a few days. There is little evidence that putting the child in a mist tent or giving antibiotics is of any value. Of greater importance is the reassurance of the child, and careful observation for signs of deterioration, together with the exclusion of other causes such as foreign-body inhalation and bacterial tracheitis.... croup

One of the CORTICOSTEROIDS with a potency equivalent to that of PREDNISONE, but less likely to cause retention of sodium. It is used for the suppression of in?ammatory and allergic disorders, and is used particularly for treating the skin and joints by local injection.... triamcinolone