Glukokortikoid Kullanan Hastanın Yönetimi
Günümüzde glukokortikoidler çok sayıda otoimmun ve inflamatuar hastalıkların tedavisindeyaygın olarak kullanılmaktadır. Adrenal yetmezlik tedavisinde tedavi dozu fizyolojikolmakla birlikte bazı romatolojik, oftalmolojik, hematolojik, pulmoner ve gastrointestinalsistem hastalıklarında suprafizyolojik dozlarda kullanılmaktadır. Yararlı etkilerininyanı sıra oral veya parenteral uzun süreli sistemik glukokortikoid kullanımı baştaosteoporoz ve kırıklar, adrenal baskılanma, kan şekeri regulasyonunun bozulması, kiloalımı, kardiyovasküler hastalık, dislipidemi, psikiyatrik bozukluklar, gastrointestinal sistemşikayetleri olmak üzere pek çok yan etki yapabilir. Yan etkiler arasında hiperglisemi,hiperlipidemi, peptik ülser ve psikolojik değişiklikler daha çok doz bağımlı iken, osteoporoz,cushingoid görünüm, kan basıncı yüksekliği, fırsatçı enfeksiyonlar daha çokkullanım süresi ile ilişkilidir. Bu yan etkilerin çoğu hastaların dikkatli ve yakın izlemi,altta yatan hastalığı kontrol edecek en düşük dozun kullanılması gibi koruyucu önlemlerinalınması ile azaltılabilir.
___
- 1. Dora Liu, Alexandra Ahmet et al. A practical guide to the monitoring
and management of the complications of systemic corticosteroid
therapy. Allergy Asthma Clin Immunol. 2013; 9(1): 30.
2. Huscher D, Thiele K, Gromnica-Ihle E, et al. Dose-related patterns
of glucocorticoid-induced side effects. Ann Rheum Dis
2009; 68:1119.
3. Saag KG, Koehnke R, Caldwell JR, et al. Low dose long-term
corticosteroid therapy in rheumatoid arthritis: an analysis of
serious adverse events. Am J Med 1994; 96:115.
4. McDougall R, Sibley J, Haga M, Russell A. Outcome in patients
with rheumatoid arthritis receiving prednisone compared
to matched controls. J Rheumatol 1994; 21:1207.
5. Cauley JA, Hochberg MC, Lui LY, et al. Long-term risk of incident
vertebral fractures. JAMA 2007; 298:2761.
6. Kanis JA, Johnell O, De Laet C, et al. A meta-analysis of previous
fracture and subsequent fracture risk. Bone 2004; 35:375.
7. Kanis JA, Johansson H, Oden A, McCloskey EV. Guidance for
the adjustment of FRAX according to the dose of glucocorticoids.
Osteoporos Int 2011; 22:809.
8. Buckley L, Guyatt G, Fink HA, et al. 2017 American Colle34
www.kliniktipdergisi.com
ge of Rheumatology Guideline for the Prevention and Treatment
of Glucocorticoid-Induced Osteoporosis. Arthritis Rheumatol
2017; 69:1521.
9. Ahmet A, Kim H, Spier S. Adrenal suppression: A practical guide
to the screening and management of this under-recognized
complication of inhaled corticosteroid therapy. Allergy Asthma
Clin Immunol. 2011;7:13. doi: 10.1186/1710-1492-7-13.
10. Hägg E, Asplund K, Lithner F Value of basal plasma cortisol
assays in the assessment of pituitary-adrenal insufficiency.
Clin Endocrinol (Oxf) 1987;26(2):221.
11. Finucane FM, Liew A, Thornton E, Rogers B, Tormey W, Agha
A. Clinical insights into the safety and utility of the insulin tolerance
test (ITT) in the assessment of the hypothalamo-pituitary-
adrenal axis. Clin Endocrinol (Oxf) 2008;69(4):603.
12. Tordjman K, Jaffe A, Grazas N, Apter C, Stern N. The role
of the low dose (1 microgram) adrenocorticotropin test in the
evaluation of patients with pituitary diseases. J Clin Endocrinol
Metab.1995;80:1301–1305. doi: 10.1210/jc.80.4.1301
13. Kazlauskaite R, Evans AT, Villabona CV, Abdu TA, Ambrosi
B, Atkinson AB, Choi CH, Clayton RN, Courtney CH, Gonc EN,
Maghnie M, Rose SR, Soule SG, Tordjman K. Consortium for
Evaluation of Corticotropin Test in Hypothalamic-Pituitary Adrenal
Insufficiency. Corticotropin tests for hypothalamic-pituitary-
adrenal insufficiency: a meta-analysis. J Clin Endocrinol
Metab.2008;93:4245–4253. doi: 10.1210/jc.2008-0710.
14. Türkiye Endokrinoloji ve Metabolizma Derneği Adrenal ve Gonadal
Hastalıklar Kılavuzu 2017
15. Canada 125 Anderson TJ, Grégoire J, Hegele RA, Couture P,
Mancini GB, McPherson R, Francis GA, Poirier P, Lau DC,
Grover S, Genest J Jr, Carpentier AC, Dufour R, Gupta M, Ward
R, Leiter LA, Lonn E, Ng DS, Pearson GJ, Yates GM, Stone JA,
Ur E. 2012 update of the Canadian cardiovascular society guidelines
for the diagnosis and treatment of dyslipidemia for the
prevention of cardiovascular disease in the adult. Can J Cardiol.
2013;29:151–167. doi: 10.1016/j.cjca.2012.11. 032.
16. Wei L, MacDonald TM, Walker BR. Taking glucocorticoids
by prescription is associated with subsequent cardiovascular
disease. Ann Intern Med 2004; 141:764.
17. Olefsky JM, Kimmerling G. Effects of glucocorticoids on carbohydrate
metabolism. Am J Med Sci
18. Gurwitz JH, Bohn RL, Glynn RJ, et al. Glucocorticoids and
the risk for initiation of hypoglycemic therapy. Arch Intern Med
1994; 154:97.
19. Miller Se, Meılson Jm. Clınıcal features of the dıabetıc syndrome
appearıng after steroıd therapy. postgrad mej 1964;
40:660.76; 271:202.
20. Türkiye Endokrinoloji ve Metabolizma Derneği Diyabetes Mellitus
ve Komplikasyonlarının Tanı Tedavi ve İzlem Kılavuzu
2017
21. Black Rl, Oglesby Rb, Von Sallmann l, Bunım Jj Posterior subcapsular
cataracts induced by corticosteroids in patients with
rheumatoid arthritis. JAMA. 1960;174:166.
22. Piper JM, Ray WA, Daugherty JR, Griffin MR. Corticosteroid
use and peptic ulcer disease: role of nonsteroidal anti-inflammatory
drugs. Ann Intern Med 1991; 114:735.
23. Gabriel SE, Jaakkimainen L, Bombardier C. Risk for serious
gastrointestinal complications related to use of nonsteroidal
anti-inflammatory drugs. A meta-analysis. Ann Intern Med
1991; 115:787.
24. Wolkowitz OM, Burke H, Epel ES, Reus VI. Glucocorticoids.
Mood, memory, and mechanisms. Ann N Y Acad Sci 2009;
1179:19.
25. Brown ES, Chandler PA. Mood and Cognitive Changes During
Systemic Corticosteroid Therapy. Prim Care Companion
J Clin Psychiatry 2001; 3:17.
26. Fardet L, Petersen I, Nazareth I. Suicidal behavior and severe
neuropsychiatric disorders following glucocorticoid
therapy in primary care. Am J Psychiatry 2012; 169:491.
27. Migita K, Arai T, Ishizuka N, et al. Rates of serious intracellular
infections in autoimmune disease patients receiving initial
glucocorticoid therapy. PLoS One 2013; 8:e78699.