Major side-effects of glucocorticoids in japan

Abstract

Major side-effects of glucocorticoids (GC) in Japan were investigated statistically. 1. Severe infectious complications, severe complications of digestive canals, disorders of the central nervous system, shock or acute adrenal crisis due to iatrogenic adrenal insufficiency, thrombophlebitis or embolism, diabetes mellitus (excluding slight steroid glucosuria) and pathologic fractures due to severe osteoporosis, etc. were major side-effects with GC. 2. Among 212 cases of these major side-effects, severe infections and gastrointestinal complications occupied the overwhelming majority and high mortality. Shock due to iatrogenic adrenal insufficiency also resulted in a high mortality. Disorders of the central nervous system were observed frequently, but their mortality was low. 3. These major side-effects were mainly observed in such diseases as rheumatoid arthritis, blood diseases, nephrotic syndrome, systemic lupus erythematosus (S. L. E.), rheumatic fever and bronchial asthma in which GC therapy played a major role. Especially these side-effects tended to occur in such diseases that were treated with massive dose of GC, e.g. acute leukemia and S. L. E. 4. Severe infectious complications mainly consisted of mycosis, tuberculosis, sepsis and pulmonary abscess. Almost all cases of mycosis, miliary tuberculosis and sepsis were fatal. It should be always kept in mind that fungi-infections can be caused by long-term treatments with GC and antibiotics. 5. Complications of digestive canals mainly consisted of steroid ulcer, which tended to cause a sudden massive bleeding or perforation. Disseminated petechial bleedings on the mucosa, as well as steroid ulcer, were also seen. It was observed that these complications of digestive canals occurred at a rather early period of GC administration. 6. Among various disorders of the central nervous system, depression, mania, schizophrenic symptoms, pseud-cranial tumor symptoms were frequently observed. These side-effects were mainly observed in younger subjects. 7. Shock due to iatrogenic adrenal insufficiency often occurred immediately after the withdrawal of the GC in patients who had been treated for a long time. The shock was frequently observed in patients with bronchial asthma. 8. These results seem to be almost agree well with those in Europe and the United States, except for the lower frequency of cataract in Japan due to some unknown reasons. 9. In most cases of these major side-effects, the continuation of GC therapy becomes impossible and some treatment should be made immediately. It was therefore suggested that major side-effects should be definitely distinguished from minor ones in which further administration of GC can be continued. 10. It is believed that the present report can give an outline of the major side-effects of GC and contributes to the adequate clinical application of GC. © 1965, The Japan Endocrine Society. All rights reserved.