Adverse reactions, associated with prolonged systemic glucocorticoid therapy, are unlikely when high doses are administered over a short period of time. Nevertheless, gastric and duodenal ulceration, with possible perforation and haemorrhage, may occasionally occur.
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.