Chronic Steroid Use
Most people are familiar with the term cortisone, which is 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 useful medication. Because of this property, cortisol has been synthetically improved so as to provide an entire family of glucocorticoid hormones that 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 rivaled 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
A pet taking 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 that can be serious.
Should the above issues become problematic, adjusting to a lower dose of medication generally 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 that require long-term suppression of the immune system. Glucocorticoid doses generally include an anti-inflammatory dose that is lower and an immune suppressive dose that is higher; when used long enough, lower doses will suppress the immune system. 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
- Hard plaques of diseased skin called calcinosis cutis. These plaques represent deposited calcium in the skin.
- Predisposition to infection of any kind, weakening of immune defenses
- Development of Cushing's syndrome
All of the above listed effects can be seen and can 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 medications is not appropriate. Periodic urine cultures, checkups and even blood testing is part of responsible on-going corticosteroid use. For details on what tests are best for your pet, consult your veterinarian.
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