Rapid Rx Quiz: Corticosteroids

Mary L. Windle, PharmD


July 14, 2022

Fluid retention is among the most commonly reported adverse effects of hydrocortisone, which can aggravate hypertension and congestive heart failure. It is also associated with:

Fluid and electrolyte disturbances

  • Sodium retention

  • Fluid retention

  • Potassium loss

  • Hypokalemic alkalosis

Cardiovascular effects

  • Congestive heart failure in susceptible patients

  • Increased blood pressure

Musculoskeletal effects

  • Muscle weakness

  • Steroid myopathy

  • Loss of muscle mass

  • Osteoporosis

  • Tendon rupture, particularly of the Achilles tendon

  • Vertebral compression fractures

  • Aseptic necrosis of femoral and humeral heads

  • Pathologic fracture of long bones

Gastrointestinal effects

  • Peptic ulcer with possible perforation and hemorrhage

  • Pancreatitis

  • Abdominal distention

  • Ulcerative esophagitis

  • Increased alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase levels

Dermatologic effects

  • Impaired wound healing

  • Thin, fragile skin

  • Petechiae and ecchymoses

  • Facial erythema

  • Increased sweating

  • May suppress reactions to skin tests

Neurological effects

  • Increased intracranial pressure with papilledema (pseudotumor cerebri), usually after treatment

  • Convulsions

  • Vertigo

  • Headache

  • Epidural lipomatosis

  • Behavioral and mood changes

Endocrine effects

  • Increased appetite and weight gain

  • Development of Cushingoid state

  • Suppression of growth in children

  • Secondary adrenocortical and pituitary unresponsiveness, particularly in times of stress, as in trauma, surgery or illness

  • Menstrual irregularities

  • Decreased carbohydrate tolerance

  • Manifestations of latent diabetes mellitus

  • Increased requirements for insulin or oral hypoglycemic agents in diabetic patients

Ophthalmic effects

  • Central serous chorioretinopathy

  • Posterior subcapsular cataracts

  • Increased intraocular pressure

  • Glaucoma

  • Exophthalmos

Metabolic effects

  • Negative nitrogen balance due to protein catabolism

Blood and lymphatic system disorders

  • Leukocytosis

Learn more about hydrocortisone.


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