Pharmacology · patient case question
Which is a recognised adverse effect of long-term systemic corticosteroid therapy?
Patient case: Choosing and stopping drugs
demo: Series of prescribing decisions
chief: Several patients seen in one session raise questions about antibiotic choice, analgesia and anticoagulation.
history: One patient has a spreading odontogenic infection unresponsive to five days of empirical antibiotics. Another takes rivaroxaban for atrial fibrillation. A third developed a widespread blistering rash and mucosal ulceration a week after starting a new medication.
meds: Varies by patient.
findings: Not applicable.
Show answer and explanation
Correct answer: B. Cataract formation
- A. Corticosteroids cause hyperglycaemia, not hypoglycaemia, by stimulating gluconeogenesis and antagonising insulin. This is why they can unmask or worsen diabetes.
- B. Correct. Posterior subcapsular cataract and raised intraocular pressure are established complications of prolonged corticosteroid use. The wider list includes adrenal suppression, osteoporosis, hyperglycaemia, immunosuppression, thin fragile skin, poor wound healing, peptic ulceration and the cushingoid habitus.
- C. Weight gain with central redistribution of fat is characteristic, not weight loss.
- D. Steroids do cause hirsutism, but the distribution is generalised and it is a minor feature next to the ocular, skeletal and metabolic effects.