Precautions During Chronic Adrenal Steroid Therapy

The most important precaution during replacement and pharmacotherapy is to see the patient regularly with an awareness of the possibilities of adverse effects including fluid retention (weight gain), hypertension, glycosuria, hypokalemia (potassium supplement may be necessary) and back pain (osteoporosis); and of the serious hazard of patient noncompliance.

Mild withdrawal symptoms (iatrogenic cortical insufficiency) include conjunctivitis, rhinitis, weight loss, arthralgia and itchy skin nodules.

Patients must always

• carry a card giving details of therapy

• be impressed with the importance of compliance

• know what to do if they develop an intercurrent illness or other severe stress: double their next dose and to tell their doctor. If a patient omits a dose then it should be made up as soon as possible so that the total daily intake is maintained, because every patient should be taking the minimum dose necessary to control the disease.

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