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• Allergic responses are suppressed. The antigen-antibody interaction is unaffected, but its injurious inflammatory consequences do not follow.

• Antibody production is reduced by heavy doses.

• Lymphoid tissue is reduced (including leukaemic lymphocytes).

• Renal excretion of urate is increased.

• Blood eosinophils are reduced in number.

• Euphoria or psychotic states may occur, perhaps due to CNS electrolyte changes.

• Anti-vitamin D action, see calciferol (p. 738).

• Reduction ofhypercalaemia chiefly where this is due to excessive absorption of calcium from the gut (sarcoidosis, vitamin D intoxication).

• Urinary calcium excretion is increased and renal stones may form.

• Growth reduction where new cells are being added (growth in children), but not where they are replacing cells as in adult tissues.

• Suppression of hypothalamic/pituitary/adrenocortical feedback system (with delayed recovery) occurs with chronic use, so that abrupt withdrawal leaves the patient in a state of adrenocortical insufficiency.

Normal daily secretion of hydrocortisone is 10-30 mg. The exogenous daily dose that completely suppresses the cortex is hydrocortisone 40-80 mg, or prednisolone 10-20 mg, or its equivalent of other agents. Recovery of function is quick after a few days' use; but when used over months recovery takes months. A steroid-suppressed adrenal continues to secrete aldosterone.

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