syndrome of hypoadrenalism, called Addison’s disease, is lethal if not treated. The
symptoms of this disease are weakness, anemia, nausea, hypotension, depression, and
abnormal skin pigmentation. Hyperadrenalism is the opposite of Addison’s disease and
is produced by an excessive circulating amount of glucocorticoids. Hyperadrenalism, or
Cushing’s syndrome,may result from adrenal tumors, which secrete glucocorticoid
steroids, or from increased ACTH levels secreted by a tumor (microadenoma) of the
pituitary gland that produces a specific clinical subtype of Cushing’s syndrome, called
Cushing’s disease. Patients who have been taking therapeutic glucocorticoid treatment
for inflammatory diseases for a prolonged period of time develop a similar medical
problem, called Cushingoid syndrome.The symptoms of Cushing’s syndrome,
Cushing’s disease, and Cushingoid syndrome are all essentially identical and consist of
facial fattening (“mooning”), facial cheeks becoming red, acne, osteoporosis (with sus-
ceptibility to deterioration [“aseptic necrosis”] of the head of the femur), hypertension,
weight gain, body mass redistribution (thin legs with a fat, pendulous abdomen), fat col-
lection over the upper back (“buffalo hump”), reddish-purple striae over the skin
(“stretch marks”), thinning of the skin with poor wound healing, and decreased resis-
tance to infection.
As has been emphasized, the therapeutic administration of glucocorticoids is associ-
ated with side effects and complications. In addition to the Cushingoid syndrome
described above, there are many other side effects of steroid use. These include loss of
blood glucose control in a known diabetic, initiation of diabetes in a previously well
person, worsening of infections (especially bacterial or fungal infections), psychiatric
problems (psychosis, hypomania, or depression), peptic ulcers, hypokalemia(i.e.,
decreased concentration of K+in the blood, which could predispose to cardiac arrhyth-
mias), and cataracts in the posterior subcapsular region of the lens within the eye. If
used for less than two weeks, the likelihood of these side effects is uncommon.
However, if used for a prolonged period of time, the possibility of side effects becomes
increasingly common. Another problem that can occur if corticosteroids are used for
more than two weeks is adrenal suppression.If a person is receiving steroids for an
anti-inflammatory indication, the administration of the exogenous steroids may sup-
press the body’s capacity to produce its own endogenous steroids, resulting in iatro-
genic(i.e., “treatment induced”) hypoadrenalism. Therefore, if corticosteroids have
been administered for a prolonged time, they must be tapered off (using a gradually
decreasing dose) rather than abruptly stopped.
5.12.4 Glucocorticoids: Inflammation versus InfectionThe use of anti-inflammatory steroids also demands an appreciation of the differences
between the processes of infectionandinflammation. An infection is a pathological
process whereby an exogenous agent (fungus, bacterium, virus, prion) invades the
body, either locally or systemically, causing some form of injurious dysfunction.
Inflammation, on the other hand, is the body’s physiological endogenous response to an
injury, be it caused by an infective agent or some other process (trauma, chemical).
Although inflammation is a normal physiological response, it may become pathological
under certain circumstances; for example, inflammation of the bronchi in the lungs due
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