Corticosteroid induced disorders – An overview
Corresponding Author(s) : Koppula Shilpa
koppulashilpa108@gmail.com
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 2 No. 2 (2014): 2014 Volume 2- Issue -2
Abstract
Glucocorticoids are important in the treatment of many inflammatory, allergic, immunologic, and malignant disorders, and the toxicity of glucocorticoids is one of the commonest causes of iatrogenic illness associated with chronic inflammatory disease.Glucocorticoid-induced muscle atrophy is characterized by fast-twitch or type II muscle fiber atrophy. Corticosteroid (CS) therapy is widely used in the treatment of rheumatic diseases.Osteoporosis remains one of its major complications.Steroid induced glaucoma is a form of open angle glaucoma occurring as an adverse effect of corticosteroid therapy. Glucocorticoids induce hepatic and extrahepatic insulin resistance.Glucocorticoid treatment impairs both glucose transport in fat and muscle cells. Corticosteroid-induced psychosis represents a spectrum of psychological changes that can occur at any time during treatment. Cushing’s syndrome describes the signs and symptoms associated with prolonged exposure to inappropriately high levels of the hormone cortisol. Physicians must be aware of these adverse effects and be equipped to manage them.
Keywords
corticosteroids
myopathy
osteoporosis
glaucoma
diabetes mellitus
psychosis
cushing’s syndrome
1.
Koppula Shilpa. Corticosteroid induced disorders – An overview. Int. J. of Allied Med. Sci. and Clin. Res. [Internet]. 2020 Jul. 31 [cited 2025 Jul. 13];2(2):102-11. Available from: https://ijamscr.com/ijamscr/article/view/61
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References
-
1)Goodman Gilman, A., Rall, T.W., Nies, A.I.S. and Taylor, P. Goodman and Gilman’s The
pharmacological Basis of therapeutics. 9th Ed, 1996. Publisher Mc Graw Hill, Pergamon press.
2)Tripathi, K. D. Essentials of medical pharmacology. 4th Ed, 1999. Publisher: Jaypee, Delhi.
3)O Schakman, H Gilson and J P ThissenMechanisms of glucocorticoid-induced myopathy, J Endocrinol April 1, 2008 197 1-10
4) Tomas FM,Munro HN & Young VR,1979Effect of glucocorticoid administration on the rate of muscle protein breakdown in vivo in rats, as measured by urinary excretion of N tau-methylhistidine. Biochemical Journal178139–146
5) Goldberg AL, Tischler M, DeMartino G &Griffin G,1980Hormonal regulation of protein degradation and synthesis in skeletal muscle. Federation Proceedings3931–36.
6)Lofberg E, Gutierrez A, Wernerman J, Anderstam B,Mitch WE, Price SR,Bergstrom J & Alvestrand A ,2002Effects of high doses of glucocorticoids on free amino acids, ribosomes and protein turnover in human muscle. European Journal of Clinical Investigation32345–353.
7)Dardevet D,Sornet C, Savary I, Debras E, Patureau-Mirand P &Grizard J,1998Glucocorticoid effects on insulin- and IGF-I-regulated muscle protein metabolism during aging. Journal of Endocrinology15683–89.
8)Kostyo JL & Redmond AF,1966Role of protein synthesis in the inhibitory action of adrenal steroid hormones on amino acid transport by muscle.Endocrinology79531–540.
9)Shah OJ, Kimball SR & Jefferson LS,2000bAmong translational effectors, p70S6k is uniquely sensitive to inhibition by glucocorticoids. Biochemical Journal347389–397.
10)Liu ZQ,Jahn LA, Long W, Fryburg DA,Wei LP & Barrett EJ,2001Branched chain amino acids activate messenger ribonucleic acid translation regulatory proteins in human skeletal muscle, and glucocorticoids blunt this action.Journal of Clinical Endocrinology and Metabolism862136–2143.
11)Deval D, Mordier S, Obled C, Bechet D, Combaret L, Attaix D &Ferrara M,2001Identification of cathepsin L as a differentially expressed message associated with skeletal muscle wasting. Biochemical Journal360143–150.
12)Schakman O, Gilson H, de C V, Lause P, Verniers J, Havaux X, Ketelslegers JM & Thissen JP,2005Insulin-like growth factor-I gene transfer by electroporation prevents skeletal muscle atrophy in glucocorticoid-treated rats. Endocrinology1461789–1797.
13)Kanda F, Takatani K, Okuda S, Matsushita T & Chihara K,1999Preventive effects of insulinlike growth factor-I on steroid- induced muscle atrophy.Muscle and Nerve22213–217.
14)Gilson H, Schakman O, Combaret L, Lause P, Grobet L, Attaix D,Ketelslegers JM & Thissen JP,2007Myostatin gene deletion prevents glucocorticoid-induced muscle atrophy. Endocrinology148452–460.
15)Kimball SR & Jefferson LS,2006Signaling pathways and molecular mechanisms through which branched-chain amino acids mediate translational control of protein synthesis. Journal of Nutrition136227S–231S.
16)Campos AR, Serafini LN, Sobreira C, Menezes LG & Martinez JA,2006Creatine intake attenuates corticosteroid-induced impairment of voluntary running in hamsters. Applied Physiology, Nutrition, and Metabolism31490–494.
17)Lukert BP, Raisz LG. Glucocorticoid induced osteoporosis: pathogenesis and management. Ann Intern Med 1990;112:352–64.
18)Prummel MF, Wiersinga WM, Lips P, Sanders GTB, Sauerwein HP. The course of biochemical parameters of bone turnover during treatment with corticosteroids. J Clin Endocrinol Metab 1991;72:382–6.
19)Cosman F, Nieves J, Herbert J, Shen V, Lindsay R. High dose corticosteroid in multiple sclerosis patients exerts direct effects on the kidney and skeleton. J Bone Miner Res 1994;9:1097–105.
20)Morrison NA, Shine J, Fragonas J?C, Verkest V, McMenemy L, Eisman JA. 1,25?dihydroxyvitamin D?responsive element and glucocorticoid repression in the osteocalcin gene. Science 1989;246:1158–61.
21)Ali NJ, Capewell S, Ward MJ. Bone turnover during high dose inhaled corticosteroid treatment. Thorax 1991;46:160–4.
22)Morrison D, Ali NJ, Routledge PA, Capewell S. Bone turnover during short course prednisolone treatment in patients with chronic obstructive airways disease. Thorax1992;47:418–20.
23)Aaron JE, Francis RM, Peacock M, Makins NB. Contrasting microanatomy of idiopathic and corticosteroid?induced osteoporosis. Clin Orthop 1989;243:294–305.
24)Daens S, Peretz A, de Maertelaer V, Moris M, Bergmann P. Efficiency of quantitative ultrasound measurements as compared to dual?energy X?ray absorptiometry in the assessment of corticosteroid?induced bone impairment.Osteoporosis Int 1999;10:278–83.
25)Eastell R, Reid DM, Compston J et al. A UK Consensus Group on management of glucocorticoid?induced osteoporosis: an update. J Intern Med 1998;244:271–92.
26)Tinetti ME, Baker DI, McAvay G et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med1994;331:821–7.
27)Hall GM, Daniels M, Doyle DV, Spector TD. Effect of hormone replacement therapy on bone mass in rheumatoid arthritis patients treated with and without steroids. Arthritis Rheum 1994;37:1499–505.
28)Reid IR, Wattie DJ, Evans MC, Stapleton JP. Testosterone therapy in glucocorticoid?treated men. Arch Intern Med 1996;156:1173–7.
29)Tobias JH. Management of steroid?induced osteoporosis: what is the current state of play? Rheumatology 1999;38:198–201.
30)Renfro L, Snow JS. Ocular effects of topical and systemic steroids.Dermatol Clin 1992; 10: 505–510.
31)Wordinger RJ, Clark AF. Effects of glucocorticoids on the trabecular meshwork: towards a better understanding of glaucoma. Prog Retina Eye Res 1999; 18: 629–667.
32)Cantrill HL, Palmberg, Zink HA, Waltman SR, Podos SM, Becker B. Comparison of in vitro potency of corticosteroids with ability to raise intraocular pressure. Am J Ophthalmol 1975; 79: 1012–1017.
33)Herschler J. Increased intraocular pressure induced by repository corticosteroids. Am J Ophthalmol 1976; 82: 90–93.
34)Weinreb RN, Polansky JR, Kramer SG, BaxterJD. Acute effects of dexamethasone on intraocular pressure in glaucoma. Invest Ophthalmol Vis Sci 1985; 26(2): 170–175.
35) Goldberg I. Ocular inflammatory and steroid-induced glaucoma. In: Yanoff M, Duker JS (eds) Ophthalmology, 2nd edn. Mosby: St Louis, MO, 2004, pp 1512–1517.
36)Scherer WJ, Hauber FA. Effect of latanoprost on intraocular pressure in steroid induced glaucoma. J Glaucoma 2000; 9: 179–182
37)Smith SL, Pruitt CA, Sine CS, Hudgins AC, Stewart WC. Latanoprost 0.005% and anterior segment uveitis. Acta Ophthalmol Scand 1999; 77: 668–672.
38)Warwar RE, Bullock JD, Ballal D. Cystoid macular edema and anterior uveitis associated with latanoprost use. Experience and incidence in a retrospective review of 94 patients. Ophthalmology 1998; 105: 263–268.
39)Tanuj dada, et al - Steroid induced glaucoma;J of current Glaucoma practice,May-Aug 2009;3(2):33-38
40)Panthakalam S,Bhatnagar D,Klimiuk P,The prevalence and management of hyperglycaemia in patients with rheumatoid arthritis on corticosteroid therapy. Scott Med J 2004; 49:139–141.
41)Uzu T,Harada T,Sakaguchi M,et al. Glucocorticoid-induced diabetes mellitus: prevalence and risk factors in primary renal diseases. Nephron Clin Pract 2007; 105:c54–c57.
42)Gurwitz JH,Bohn RL,Glynn RJ, Monane M, Mogun H, Avorn J.Glucocorticoids and the risk for initiation of hypoglycemic therapy.Arch Intern Med 1994; 154:97–101.
43)Bevier WC, Zisser HC, Jovanovic L,et al. Use of continuous glucose monitoring to estimate insulin requirements in patients with type 1 diabetes mellitus during a short course of prednisone. J Diabetes Sci Technol 2008; 2:578–583
44). Warrington TP, Bostwick JM. Psychiatric adverse effect of corticosteroids. Mayo Clin Proc. 2006;81(10):1361-1367.
45) Brown ES, Chamberlain W, Dhanani N, et al. An open-label trial of olanzapine for corticosteroid-induced mood symptoms. J Affect Disord. 2004;83:277-281.
46)Falk WE, Mahnke MW, Poskanzer DC. Lithium prophylaxis of corticotropin-induced psychosis. JAMA. 1979;241:1011-1012.
47)Brown ES, Stuard G, Liggin JD, et al. Effect of phenytoin on mood and declarative memory during prescription corticosteroid therapy. Bio Psychiatry. 2005;57:543-548.
48) Brown ES, Frol AB, Khan DA, et al. Impact of levetiracetam on mood and cognition during prednisone therapy. Eur Psychiatry. 2007;22:448-452.
49) Brown ES, Frol A, Bobadilla L, et al. Effect of lamotrigine on mood and cognition in patients receiving chronic exogenous corticosteroids. Psychosomatics. 2003;44(3):204-208.
50). Naber D, Sand P, Heigl B. Psychopathological and neuropsychological effects of 8-days’ corticosteroid treatment. A prospective study. Psychoneuroendocrinology. 1996;21(1):25-31.
51). Brown ES, Woolston DJ, Frol A, et al. Hippocampal volume, spectroscopy, cognition, and mood in patients receiving corticosteroid therapy. Biol Psychiatry. 2004;55:538-545.
52). Schatzberg AF, Rothschild AJ, Langlais PJ, et al. A corticosteroid/dopamine hypothesis for psychotic depression and related states. J Psychiat Res. 1985;19(1):57-64.
53)Stratakis CA. Cushing syndrome in pediatrics. Endocrinology Metabolism Clinics of North America. 2012;41:793.
54)Wein AJ, et al. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.mdconsult.com/das/book/body/208746819-6/0/1445/0.html. Accessed Jan. 2, 2013.
55)Guaraldi F, et al. Cushing syndrome: Maybe not so uncommon of an endocrine disease. Journal of the American Board of Family Medicine. 2012;25:199.
56)Mazziotti G, et al. Diabetes in Cushing syndrome: Basic and clinical aspects. Trends in Endocrinology and Metabolism. 2011;22:499.
57)Nieman LK. Overview of the treatment of Cushing's syndrome.. Accessed Jan. 1, 2013.
58)Kliegman RM, et al. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa.: Saunders Elsevier; 2011.. Accessed Jan. 2, 2013.
59)Cushing's syndrome. National Institute of Diabetes and Digestive and Kidney Diseases.
60)Nieman LK. Causes and pathophysiology of Cushing's syndrome.. Accessed Jan. 1, 2013.
61)The Surgeon General's report on bone health and osteoporosis: What it means to you. National Institute of Arthritis and Musculoskeletal and Skisn Diseases. Accessed Jan. 2, 2013.
62)Nippoldt TB (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 24, 2013.
63)FDA approves Korlym for patients with endogenous Cushing's syndrome. U.S. Food and Drug Administration.. Accessed Jan. 25, 2013.
64)Kumar, Abbas, Fausto. Robbins and Cotran Pathologic Basis of Disease, 7th ed. Elsevier-Saunders; New York, 2005
References
1)Goodman Gilman, A., Rall, T.W., Nies, A.I.S. and Taylor, P. Goodman and Gilman’s The
pharmacological Basis of therapeutics. 9th Ed, 1996. Publisher Mc Graw Hill, Pergamon press.
2)Tripathi, K. D. Essentials of medical pharmacology. 4th Ed, 1999. Publisher: Jaypee, Delhi.
3)O Schakman, H Gilson and J P ThissenMechanisms of glucocorticoid-induced myopathy, J Endocrinol April 1, 2008 197 1-10
4) Tomas FM,Munro HN & Young VR,1979Effect of glucocorticoid administration on the rate of muscle protein breakdown in vivo in rats, as measured by urinary excretion of N tau-methylhistidine. Biochemical Journal178139–146
5) Goldberg AL, Tischler M, DeMartino G &Griffin G,1980Hormonal regulation of protein degradation and synthesis in skeletal muscle. Federation Proceedings3931–36.
6)Lofberg E, Gutierrez A, Wernerman J, Anderstam B,Mitch WE, Price SR,Bergstrom J & Alvestrand A ,2002Effects of high doses of glucocorticoids on free amino acids, ribosomes and protein turnover in human muscle. European Journal of Clinical Investigation32345–353.
7)Dardevet D,Sornet C, Savary I, Debras E, Patureau-Mirand P &Grizard J,1998Glucocorticoid effects on insulin- and IGF-I-regulated muscle protein metabolism during aging. Journal of Endocrinology15683–89.
8)Kostyo JL & Redmond AF,1966Role of protein synthesis in the inhibitory action of adrenal steroid hormones on amino acid transport by muscle.Endocrinology79531–540.
9)Shah OJ, Kimball SR & Jefferson LS,2000bAmong translational effectors, p70S6k is uniquely sensitive to inhibition by glucocorticoids. Biochemical Journal347389–397.
10)Liu ZQ,Jahn LA, Long W, Fryburg DA,Wei LP & Barrett EJ,2001Branched chain amino acids activate messenger ribonucleic acid translation regulatory proteins in human skeletal muscle, and glucocorticoids blunt this action.Journal of Clinical Endocrinology and Metabolism862136–2143.
11)Deval D, Mordier S, Obled C, Bechet D, Combaret L, Attaix D &Ferrara M,2001Identification of cathepsin L as a differentially expressed message associated with skeletal muscle wasting. Biochemical Journal360143–150.
12)Schakman O, Gilson H, de C V, Lause P, Verniers J, Havaux X, Ketelslegers JM & Thissen JP,2005Insulin-like growth factor-I gene transfer by electroporation prevents skeletal muscle atrophy in glucocorticoid-treated rats. Endocrinology1461789–1797.
13)Kanda F, Takatani K, Okuda S, Matsushita T & Chihara K,1999Preventive effects of insulinlike growth factor-I on steroid- induced muscle atrophy.Muscle and Nerve22213–217.
14)Gilson H, Schakman O, Combaret L, Lause P, Grobet L, Attaix D,Ketelslegers JM & Thissen JP,2007Myostatin gene deletion prevents glucocorticoid-induced muscle atrophy. Endocrinology148452–460.
15)Kimball SR & Jefferson LS,2006Signaling pathways and molecular mechanisms through which branched-chain amino acids mediate translational control of protein synthesis. Journal of Nutrition136227S–231S.
16)Campos AR, Serafini LN, Sobreira C, Menezes LG & Martinez JA,2006Creatine intake attenuates corticosteroid-induced impairment of voluntary running in hamsters. Applied Physiology, Nutrition, and Metabolism31490–494.
17)Lukert BP, Raisz LG. Glucocorticoid induced osteoporosis: pathogenesis and management. Ann Intern Med 1990;112:352–64.
18)Prummel MF, Wiersinga WM, Lips P, Sanders GTB, Sauerwein HP. The course of biochemical parameters of bone turnover during treatment with corticosteroids. J Clin Endocrinol Metab 1991;72:382–6.
19)Cosman F, Nieves J, Herbert J, Shen V, Lindsay R. High dose corticosteroid in multiple sclerosis patients exerts direct effects on the kidney and skeleton. J Bone Miner Res 1994;9:1097–105.
20)Morrison NA, Shine J, Fragonas J?C, Verkest V, McMenemy L, Eisman JA. 1,25?dihydroxyvitamin D?responsive element and glucocorticoid repression in the osteocalcin gene. Science 1989;246:1158–61.
21)Ali NJ, Capewell S, Ward MJ. Bone turnover during high dose inhaled corticosteroid treatment. Thorax 1991;46:160–4.
22)Morrison D, Ali NJ, Routledge PA, Capewell S. Bone turnover during short course prednisolone treatment in patients with chronic obstructive airways disease. Thorax1992;47:418–20.
23)Aaron JE, Francis RM, Peacock M, Makins NB. Contrasting microanatomy of idiopathic and corticosteroid?induced osteoporosis. Clin Orthop 1989;243:294–305.
24)Daens S, Peretz A, de Maertelaer V, Moris M, Bergmann P. Efficiency of quantitative ultrasound measurements as compared to dual?energy X?ray absorptiometry in the assessment of corticosteroid?induced bone impairment.Osteoporosis Int 1999;10:278–83.
25)Eastell R, Reid DM, Compston J et al. A UK Consensus Group on management of glucocorticoid?induced osteoporosis: an update. J Intern Med 1998;244:271–92.
26)Tinetti ME, Baker DI, McAvay G et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med1994;331:821–7.
27)Hall GM, Daniels M, Doyle DV, Spector TD. Effect of hormone replacement therapy on bone mass in rheumatoid arthritis patients treated with and without steroids. Arthritis Rheum 1994;37:1499–505.
28)Reid IR, Wattie DJ, Evans MC, Stapleton JP. Testosterone therapy in glucocorticoid?treated men. Arch Intern Med 1996;156:1173–7.
29)Tobias JH. Management of steroid?induced osteoporosis: what is the current state of play? Rheumatology 1999;38:198–201.
30)Renfro L, Snow JS. Ocular effects of topical and systemic steroids.Dermatol Clin 1992; 10: 505–510.
31)Wordinger RJ, Clark AF. Effects of glucocorticoids on the trabecular meshwork: towards a better understanding of glaucoma. Prog Retina Eye Res 1999; 18: 629–667.
32)Cantrill HL, Palmberg, Zink HA, Waltman SR, Podos SM, Becker B. Comparison of in vitro potency of corticosteroids with ability to raise intraocular pressure. Am J Ophthalmol 1975; 79: 1012–1017.
33)Herschler J. Increased intraocular pressure induced by repository corticosteroids. Am J Ophthalmol 1976; 82: 90–93.
34)Weinreb RN, Polansky JR, Kramer SG, BaxterJD. Acute effects of dexamethasone on intraocular pressure in glaucoma. Invest Ophthalmol Vis Sci 1985; 26(2): 170–175.
35) Goldberg I. Ocular inflammatory and steroid-induced glaucoma. In: Yanoff M, Duker JS (eds) Ophthalmology, 2nd edn. Mosby: St Louis, MO, 2004, pp 1512–1517.
36)Scherer WJ, Hauber FA. Effect of latanoprost on intraocular pressure in steroid induced glaucoma. J Glaucoma 2000; 9: 179–182
37)Smith SL, Pruitt CA, Sine CS, Hudgins AC, Stewart WC. Latanoprost 0.005% and anterior segment uveitis. Acta Ophthalmol Scand 1999; 77: 668–672.
38)Warwar RE, Bullock JD, Ballal D. Cystoid macular edema and anterior uveitis associated with latanoprost use. Experience and incidence in a retrospective review of 94 patients. Ophthalmology 1998; 105: 263–268.
39)Tanuj dada, et al - Steroid induced glaucoma;J of current Glaucoma practice,May-Aug 2009;3(2):33-38
40)Panthakalam S,Bhatnagar D,Klimiuk P,The prevalence and management of hyperglycaemia in patients with rheumatoid arthritis on corticosteroid therapy. Scott Med J 2004; 49:139–141.
41)Uzu T,Harada T,Sakaguchi M,et al. Glucocorticoid-induced diabetes mellitus: prevalence and risk factors in primary renal diseases. Nephron Clin Pract 2007; 105:c54–c57.
42)Gurwitz JH,Bohn RL,Glynn RJ, Monane M, Mogun H, Avorn J.Glucocorticoids and the risk for initiation of hypoglycemic therapy.Arch Intern Med 1994; 154:97–101.
43)Bevier WC, Zisser HC, Jovanovic L,et al. Use of continuous glucose monitoring to estimate insulin requirements in patients with type 1 diabetes mellitus during a short course of prednisone. J Diabetes Sci Technol 2008; 2:578–583
44). Warrington TP, Bostwick JM. Psychiatric adverse effect of corticosteroids. Mayo Clin Proc. 2006;81(10):1361-1367.
45) Brown ES, Chamberlain W, Dhanani N, et al. An open-label trial of olanzapine for corticosteroid-induced mood symptoms. J Affect Disord. 2004;83:277-281.
46)Falk WE, Mahnke MW, Poskanzer DC. Lithium prophylaxis of corticotropin-induced psychosis. JAMA. 1979;241:1011-1012.
47)Brown ES, Stuard G, Liggin JD, et al. Effect of phenytoin on mood and declarative memory during prescription corticosteroid therapy. Bio Psychiatry. 2005;57:543-548.
48) Brown ES, Frol AB, Khan DA, et al. Impact of levetiracetam on mood and cognition during prednisone therapy. Eur Psychiatry. 2007;22:448-452.
49) Brown ES, Frol A, Bobadilla L, et al. Effect of lamotrigine on mood and cognition in patients receiving chronic exogenous corticosteroids. Psychosomatics. 2003;44(3):204-208.
50). Naber D, Sand P, Heigl B. Psychopathological and neuropsychological effects of 8-days’ corticosteroid treatment. A prospective study. Psychoneuroendocrinology. 1996;21(1):25-31.
51). Brown ES, Woolston DJ, Frol A, et al. Hippocampal volume, spectroscopy, cognition, and mood in patients receiving corticosteroid therapy. Biol Psychiatry. 2004;55:538-545.
52). Schatzberg AF, Rothschild AJ, Langlais PJ, et al. A corticosteroid/dopamine hypothesis for psychotic depression and related states. J Psychiat Res. 1985;19(1):57-64.
53)Stratakis CA. Cushing syndrome in pediatrics. Endocrinology Metabolism Clinics of North America. 2012;41:793.
54)Wein AJ, et al. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.mdconsult.com/das/book/body/208746819-6/0/1445/0.html. Accessed Jan. 2, 2013.
55)Guaraldi F, et al. Cushing syndrome: Maybe not so uncommon of an endocrine disease. Journal of the American Board of Family Medicine. 2012;25:199.
56)Mazziotti G, et al. Diabetes in Cushing syndrome: Basic and clinical aspects. Trends in Endocrinology and Metabolism. 2011;22:499.
57)Nieman LK. Overview of the treatment of Cushing's syndrome.. Accessed Jan. 1, 2013.
58)Kliegman RM, et al. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa.: Saunders Elsevier; 2011.. Accessed Jan. 2, 2013.
59)Cushing's syndrome. National Institute of Diabetes and Digestive and Kidney Diseases.
60)Nieman LK. Causes and pathophysiology of Cushing's syndrome.. Accessed Jan. 1, 2013.
61)The Surgeon General's report on bone health and osteoporosis: What it means to you. National Institute of Arthritis and Musculoskeletal and Skisn Diseases. Accessed Jan. 2, 2013.
62)Nippoldt TB (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 24, 2013.
63)FDA approves Korlym for patients with endogenous Cushing's syndrome. U.S. Food and Drug Administration.. Accessed Jan. 25, 2013.
64)Kumar, Abbas, Fausto. Robbins and Cotran Pathologic Basis of Disease, 7th ed. Elsevier-Saunders; New York, 2005
pharmacological Basis of therapeutics. 9th Ed, 1996. Publisher Mc Graw Hill, Pergamon press.
2)Tripathi, K. D. Essentials of medical pharmacology. 4th Ed, 1999. Publisher: Jaypee, Delhi.
3)O Schakman, H Gilson and J P ThissenMechanisms of glucocorticoid-induced myopathy, J Endocrinol April 1, 2008 197 1-10
4) Tomas FM,Munro HN & Young VR,1979Effect of glucocorticoid administration on the rate of muscle protein breakdown in vivo in rats, as measured by urinary excretion of N tau-methylhistidine. Biochemical Journal178139–146
5) Goldberg AL, Tischler M, DeMartino G &Griffin G,1980Hormonal regulation of protein degradation and synthesis in skeletal muscle. Federation Proceedings3931–36.
6)Lofberg E, Gutierrez A, Wernerman J, Anderstam B,Mitch WE, Price SR,Bergstrom J & Alvestrand A ,2002Effects of high doses of glucocorticoids on free amino acids, ribosomes and protein turnover in human muscle. European Journal of Clinical Investigation32345–353.
7)Dardevet D,Sornet C, Savary I, Debras E, Patureau-Mirand P &Grizard J,1998Glucocorticoid effects on insulin- and IGF-I-regulated muscle protein metabolism during aging. Journal of Endocrinology15683–89.
8)Kostyo JL & Redmond AF,1966Role of protein synthesis in the inhibitory action of adrenal steroid hormones on amino acid transport by muscle.Endocrinology79531–540.
9)Shah OJ, Kimball SR & Jefferson LS,2000bAmong translational effectors, p70S6k is uniquely sensitive to inhibition by glucocorticoids. Biochemical Journal347389–397.
10)Liu ZQ,Jahn LA, Long W, Fryburg DA,Wei LP & Barrett EJ,2001Branched chain amino acids activate messenger ribonucleic acid translation regulatory proteins in human skeletal muscle, and glucocorticoids blunt this action.Journal of Clinical Endocrinology and Metabolism862136–2143.
11)Deval D, Mordier S, Obled C, Bechet D, Combaret L, Attaix D &Ferrara M,2001Identification of cathepsin L as a differentially expressed message associated with skeletal muscle wasting. Biochemical Journal360143–150.
12)Schakman O, Gilson H, de C V, Lause P, Verniers J, Havaux X, Ketelslegers JM & Thissen JP,2005Insulin-like growth factor-I gene transfer by electroporation prevents skeletal muscle atrophy in glucocorticoid-treated rats. Endocrinology1461789–1797.
13)Kanda F, Takatani K, Okuda S, Matsushita T & Chihara K,1999Preventive effects of insulinlike growth factor-I on steroid- induced muscle atrophy.Muscle and Nerve22213–217.
14)Gilson H, Schakman O, Combaret L, Lause P, Grobet L, Attaix D,Ketelslegers JM & Thissen JP,2007Myostatin gene deletion prevents glucocorticoid-induced muscle atrophy. Endocrinology148452–460.
15)Kimball SR & Jefferson LS,2006Signaling pathways and molecular mechanisms through which branched-chain amino acids mediate translational control of protein synthesis. Journal of Nutrition136227S–231S.
16)Campos AR, Serafini LN, Sobreira C, Menezes LG & Martinez JA,2006Creatine intake attenuates corticosteroid-induced impairment of voluntary running in hamsters. Applied Physiology, Nutrition, and Metabolism31490–494.
17)Lukert BP, Raisz LG. Glucocorticoid induced osteoporosis: pathogenesis and management. Ann Intern Med 1990;112:352–64.
18)Prummel MF, Wiersinga WM, Lips P, Sanders GTB, Sauerwein HP. The course of biochemical parameters of bone turnover during treatment with corticosteroids. J Clin Endocrinol Metab 1991;72:382–6.
19)Cosman F, Nieves J, Herbert J, Shen V, Lindsay R. High dose corticosteroid in multiple sclerosis patients exerts direct effects on the kidney and skeleton. J Bone Miner Res 1994;9:1097–105.
20)Morrison NA, Shine J, Fragonas J?C, Verkest V, McMenemy L, Eisman JA. 1,25?dihydroxyvitamin D?responsive element and glucocorticoid repression in the osteocalcin gene. Science 1989;246:1158–61.
21)Ali NJ, Capewell S, Ward MJ. Bone turnover during high dose inhaled corticosteroid treatment. Thorax 1991;46:160–4.
22)Morrison D, Ali NJ, Routledge PA, Capewell S. Bone turnover during short course prednisolone treatment in patients with chronic obstructive airways disease. Thorax1992;47:418–20.
23)Aaron JE, Francis RM, Peacock M, Makins NB. Contrasting microanatomy of idiopathic and corticosteroid?induced osteoporosis. Clin Orthop 1989;243:294–305.
24)Daens S, Peretz A, de Maertelaer V, Moris M, Bergmann P. Efficiency of quantitative ultrasound measurements as compared to dual?energy X?ray absorptiometry in the assessment of corticosteroid?induced bone impairment.Osteoporosis Int 1999;10:278–83.
25)Eastell R, Reid DM, Compston J et al. A UK Consensus Group on management of glucocorticoid?induced osteoporosis: an update. J Intern Med 1998;244:271–92.
26)Tinetti ME, Baker DI, McAvay G et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med1994;331:821–7.
27)Hall GM, Daniels M, Doyle DV, Spector TD. Effect of hormone replacement therapy on bone mass in rheumatoid arthritis patients treated with and without steroids. Arthritis Rheum 1994;37:1499–505.
28)Reid IR, Wattie DJ, Evans MC, Stapleton JP. Testosterone therapy in glucocorticoid?treated men. Arch Intern Med 1996;156:1173–7.
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