Corticosteroids — Adverse Effects
A patient on prednisone for two weeks now has a blood glucose of 248 mg/dL and no diabetes history. Corticosteroids mimic Cushing syndrome — and every side effect traces back to that single idea.
Core Concept
Corticosteroids (prednisone, dexamethasone, hydrocortisone) suppress inflammation by flooding the body with exogenous glucocorticoid. The adverse effects mirror Cushing syndrome because that is exactly what you are pharmacologically creating. Metabolic effects hit first: hyperglycemia from gluconeogenesis, fluid retention and hypokalemia from mineralocorticoid activity, and weight gain with redistribution (moon face, buffalo hump, truncal obesity). Immune suppression raises infection risk — monitor for subtle signs because the drug masks fever and inflammation. Bone loss (osteoporosis) occurs with long-term use; calcium, vitamin D, and baseline DEXA scans matter. GI irritation increases peptic ulcer risk, especially combined with NSAIDs. Psychiatric effects range from euphoria to psychosis. Adrenal suppression is the most dangerous long-term consequence: the HPA axis downregulates, so abrupt discontinuation triggers adrenal crisis (hypotension, shock, cardiovascular collapse). Taper — never stop suddenly after more than 7-10 days of use. Monitor blood glucose, electrolytes (especially potassium), weight, blood pressure, and signs of infection at every visit.
Watch Out For
Don't confuse corticosteroid-induced hyperglycemia with new-onset diabetes — the glucose elevation is drug-driven and may resolve after tapering. Students often think infection risk means the patient gets more infections; the real danger is that signs of infection are masked by the drug's anti-inflammatory action. Adrenal crisis from abrupt withdrawal is not a side effect of taking the drug — it is a side effect of stopping it.
Clinical Pearl
Think "Cushing in a bottle." If you can picture moon face, high glucose, thin skin, and a suppressed immune system, you already know every major corticosteroid adverse effect.
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