Problems when withdrawing corticosteroids

Abstract

Prolonged treatment with a corticosteroid, unless to replace hormone deficiency, carries well recognised risks which include hypertension, hyperglycaemia, osteoporosis and cushingoid appearance. Moreover, doses above 5–7.5mg prednisolone daily can suppress the hypothalamo-pituitary-adrenal (HPA) axis. Needlessly high doses should therefore be avoided and treatment should be withdrawn when it is no longer needed. Many unwanted effects then disappear or cease to progress - though osteoporosis may persist and the child whose growth has been suppressed may not fully catch up. Disease relapse is the commonest difficulty during or following withdrawal of corticosteroid treatment. This article discusses some other problems that may arise.