Corticosteroid medications, often just called steroids by clinicians and patients, are used to reduce inflammation and suppress the immune system. They are associated with many side effects, some of them serious. Corticosteroids are the synthetic version of cortisol, which is produced by the adrenal glands (the adrenal glands are located on top of both kidneys). These steroids are different from synthetic versions of the human steroid testosterone, which are called anabolic steroids and are used by some athletes, and the human steroid hormone estrogen, which is used by some women after menopause.
Steroids can be given orally for rashes and asthma attacks or intravenously (IV) for flares of autoimmune diseases like inflammatory bowel disease or rheumatoid arthritis. To minimize the side effects of oral or IV steroids, steroid treatments that are given locally were developed. These include topical skin creams, nasal inhalation for allergies, lung inhalation for asthma, joint injections, and eye drops to reduce swelling after eye surgery. Some patients find steroids difficult to take because of their side effects, while others like how steroids make them feel. Side effects are most common with oral and IV steroids, especially with prolonged use, although some locally used steroids may be absorbed into the body and cause side effects. Serious, potentially life-threatening side effects include infections, especially unusual ones, which occur because of immune system suppression. Cortisol, produced by the adrenal glands, has many effects throughout the body including regulating blood pressure. Systemic steroids (oral and IV), especially if taken for a prolonged period, cause adrenal suppression, meaning the adrenals stop producing cortisol. If systemic steroids are suddenly stopped, it can cause an adrenal crisis, which has many symptoms including dangerously low blood pressure. This is why long-term steroids cannot just be stopped but must be tapered to zero over time. This allows the adrenals to “wake up” and start producing cortisol again.
Side effects of short-term steroids include increased appetite, weight gain, unusual fat distribution around the waist and upper back (buffalo hump), upset stomach, and insomnia, confusion, and either euphoria or depression. Long-term use side effects include a round face (moonface), elevated blood pressure and blood sugar, infections, cataracts and glaucoma, osteoporosis (bone thinning) and fractures, thinning skin, bruising, stretch marks, poor wound healing, and muscle weakness. Because of side effects, healthcare practitioners are cautious in prescribing them. If they are necessary, they must be prescribed for the shortest possible amount of time and, if possible, local steroids are preferred over systemic ones. If your doctor must prescribe steroids, be sure that you fully understand the risks and benefits associated with their use. Also, if long-term steroids are necessary, for example to treat certain autoimmune diseases, frequent monitoring of the patient is necessary to look for side effects.
For more information, go to the U.S. National Library of Medicine at: medlineplus.gov/steroids.html