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What we usually call hormones refers to glucocorticoids, which are secreted by the adrenal cortex as a class of steroid hormones (cortisol), which have multiple biological effects such as anti-inflammatory, immunosuppressive, anti-toxic, anti-allergic, anti-shock, etc., and are the most widely used and effective anti-inflammatory drugs and immunosuppressants in clinical practice, and are the trump card weapons for dealing with rheumatic immune diseases and allergic diseases. At the same time, it is a double-edged sword, and if used incorrectly, it can also lead to many side effects, some of which are very serious. In this regard, it is necessary to fully understand and pay attention to prevent its side effects.
1. Induce infection
Mechanism of occurrence: Hormones can reduce the body's immunity and easily induce infection, and after infection, hormones will also inhibit symptoms such as fever and cough, making infection not easy to be detected early, often causing delays in diagnosis.
Countermeasures: During the period of medication, pay attention to observe whether there are signs of infection in the respiratory tract, digestive tract, urinary tract, biliary tract and other parts, regularly monitor blood routine, C-reactive protein (CRP) and other indicators, and immunoglobulin can be used in immunocompromised patients to enhance non-specific immune function.
2. Drug-induced "Cushing syndrome"
Mechanism of occurrence: Long-term use of glucocorticoids in large doses can cause "exogenous Cushing syndrome", in which patients present with centripetal obesity moon face, buffalo shoulders, slender limbs, acne, hirsutism, etc.
Countermeasures: It can disappear on its own after stopping the drug, generally without special treatment, and can be treated symptomatically if necessary, such as diuretic drugs.
3. Cause peptic ulcers and bleeding
Mechanism of occurrence: Stimulates the secretion of gastric acid and protease, induces or aggravates peptic ulcers and bleeding.
Countermeasures: Glucocorticoids should be used with caution or contraindicated in patients with a history of peptic ulcer, not combined with non-steroidal anti-inflammatory drugs, and gastrointestinal mucosal protective drugs, such as proton pump inhibitors (PPIs), can be routinely added during hormone therapy.
4. Elevated blood sugar
Mechanism of occurrence: Inhibition of glucose uptake and utilization in peripheral tissues, promotion of gluconeogenesis, resulting in "glucose metabolism disorder". Patients with pre-existing "diabetes" or "impaired glucose tolerance" will have a further increase in blood glucose after taking glucocorticoids, and patients with normal blood sugar may develop "glucose metabolism disorders" after taking corticosteroids, called "steroid diabetes", and blood glucose may return to normal after stopping the drug.
Response: Monitor blood glucose around the clock (especially after meals), and adjust or add hypoglycemic drugs as appropriate according to the results of blood glucose tests to maintain euglycemia.
5. High blood pressure
Mechanism of development: Glucocorticoids can cause sodium and water retention and increase the responsiveness of the vascular wall to angiotensin II and catecholamines, resulting in an increase in blood pressure.
Countermeasures: During the use of corticosteroids, pay attention to monitoring blood pressure, adjust or add antihypertensive drugs in time.
6. Osteoporosis
Mechanism of occurrence: Glucocorticoids can reduce intestinal calcium absorption and promote urinary calcium excretion. In addition, glucocorticoids can also enhance the activity of osteoclasts and induce osteoblast apoptosis. Long-term use of hormones in large quantities can lead to severe osteoporosis and even necrosis of the femoral head.
Countermeasures: All patients on long-term hormone therapy need to monitor bone mineral density regularly (about half a year), supplement calcium and active vitamin D (such as alfacalciferol, calcitriol, etc.), and give anti-osteoporosis therapy with dicates if necessary.
7. Mental abnormalities
Mechanism of occurrence: Glucocorticoids can increase the excitability of the central nervous system, manifested as euphoria, agitation, restlessness, insomnia, and depression in a very small number of patients.
Countermeasures: Once psychiatric symptoms appear, the drug should be stopped in time, sedatives should be used at the same time, and psychological counseling and monitoring should be strengthened.
8. Drug withdrawal syndrome
Mechanism of occurrence: Long-term use of glucocorticoids inhibits the "hypothalamic-pituitary-adrenal (HPA) axis", which can lead to adrenal hypofunction crises if the drug is abruptly discontinued or rapidly tapered.
For example, the initial therapeutic dose of prednisone is 60mg/d, which can be directly reduced to 40mg/d, and then reduced by 10% or 5mg of the original dose every 1~2 weeks, and the side effects are relatively small when the dose is < 7.5mg/d, and it can be maintained for a long time.
9. Water and electrolyte disorders
Mechanism of occurrence: Glucocorticoids have the effects of sodium preservation, potassium excretion, and reduction of calcium absorption, and long-term use may lead to water and sodium retention, low potassium and low calcium.
Countermeasures: Pay attention to monitoring electrolytes during medication, and give potassium and calcium supplementation if necessary.
Hormones have a wide range of clinical uses, and many diseases are inseparable from the treatment of hormones. However, hormones also have certain side effects, which must be used correctly and reasonably, and necessary precautions should be taken for hormone side effects, so as to maximize the therapeutic effect of hormones and reduce or avoid hormone adverse reactions.
In short, hormones are a "double-edged sword", neither abused nor fearful, and the rational use of the pharmacological effects of glucocorticoids is king.