The following adverse reactions have been associated with prolonged systemic glucocorticoid therapy.
Endocrine and Metabolic Disturbances: Cushing-like syndrome, hirsutism, menstrual irregularities, premature epiphyseal closure, secondary adrenal-cortical and pituitary unresponsiveness, decreased glucose tolerance, negative nitrogen and calcium balance.
Fluid and Electrolyte Disturbances: Sodium and fluid retention, hypertension, potassium loss, hypokalaemic alkalosis.
Musculoskeletal Effects: Myopathy, abdominal distension, osteoporosis, aseptic necrosis of femoral and humeral heads.
Gastrointestinal Effects: Gastric and duodenal ulceration, perforation and haemorrhage.
Dermatologic Effects: Impaired wound healing, skin atrophy, striae, petechiae and ecchymoses, bruising, facial erythema, increased sweating, acne.
CNS Effects: Psychic disturbances ranging from euphoria to frank psychotic manifestations, convulsions; in children, pseudo-tumour cerebri (benign intra-cranial hypertension) with vomiting and papilloedema.
Ophthalmic Effects: Glaucoma, increase in intra-ocular pressure, posterior sub-capsular cataracts.
lmmunosuppressive Effects: Increased susceptibility to infections, decreased responsiveness to vaccination and skin tests. Hypersensitivity reactions may occasionally occur. Local adverse reactions include post-injection flare and a painless destruction of the joint reminiscent of Charcot's arthropathy, especially with repeated intra-articular injections.
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