steroids by any other name

Monday, July 9, 2012

Trying to explain physiology, disease and treatment to patients at the bedside is difficult enough but it gets much harder when words get in the way. This is especially true when the drug used has a namesake that routinely makes nasty headlines. The Olympics are on the horizon, the Tour de France is in its first stages and baseball seems to always be battling the image that steroids are being abused. Imagine, then, what a patient must think when I come into the room and want to prescribe steroids to treat their wheezing or migraine headache. How should they know that more than one type of steroid exists within their body.

Corticosteroids get a bad rap. They are the chemicals that are responsible for some of the major bodily controls. They help with blood pressure and electrolyte balance. They are part of the stress response in the body and decrease inflammation. They help metabolize the fats, carbohydrates and proteins in our diet. Yet mention steroids and a patient’s gut response beings with body builders injecting themselves and continues to include baseball, football and Olympics athletes failing drug tests. Those players are using anabolic androgenic steroids that mimic the effect of testosterone in the body and those are totally different chemicals than the corticosteroids that he body manufactures to help it get through times of crisis. It’s too bad that they share the same name.

Cortisol is produced in the adrenal glands and the body does a good job of making extra when it gets stressed and needs a boost to the immune system. Sometimes, though, the body needs some help and the ability to add a little extra to decrease inflammation is a good thing. Prescribing a few days of prednisone can help prevent a relapse of an asthma attack or a flare of COPD. Injecting it into an injured joint may help decrease inflammation and speed healing.

Some diseases have ongoing inflammation and corticosteroids are often prescribed on a daily basis to control symptoms. Patients with autoimmune diseases, like rheumatoid arthritis, scleroderma or lupus, often take prednisone long term to suppress immunity and to prevent the body from, in effect, attacking itself. Long term use of these drugs can lead to major complications and it may be another reason patients balk when I use the word and is also a reminder that there is no perfect drug. A few side effects include increasing blood sugar and blood pressure, decreasing bone density and causing osteoporosis and decreasing muscle strength. As well, there are the cosmetic issues when the face becomes very round and a buffalo hump forms on the back. As with any treatment, the benefits have to be balanced with the risks.

On the other hand, there are very few indications for prescribing anabolic steroids. In kids, they are used to treat those who born lacking the ability to manufacture testosterone or who are of very short stature. In adults, the ability for anabolic steroids to increase muscle mass is used to treat patients who are cachectic, and whose body has lost the ability to maintain muscle because it is fighting a major infection or injury. Think of patients with liver or kidney failure, major burn or wound victims or those with cancer.

Fortunately, my two minute talk about why I want to prescribe a five day course of prednisone usually will convince my patient (and sometimes a parent) that the steroid for asthma isn’t the same one that costs a weightlifter a gold medal. Had the powers that be had the foresight to name chemicals differently, it would have made my life a lot easier. And perhaps patients wouldn’t have to listen to me ramble.

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