Glukokortikoid Kullanan Hastanın Yönetimi

Yıl 2018, Cilt: 10 Sayı: 1, 30 - 34, 30.01.2018

Sefika Yasemin Akdeniz Hamide Pişkinpaşa1 Ayşe Esen Pınar Karakaya Sema Çiftçi Doğanşen Yıldız Okuturlar Meral Mert

Öz

Günümüzde glukokortikoidler çok sayıda otoimmun ve inflamatuar hastalıkların tedavisinde

yaygın olarak kullanılmaktadır. Adrenal yetmezlik tedavisinde tedavi dozu fizyolojik

olmakla birlikte bazı romatolojik, oftalmolojik, hematolojik, pulmoner ve gastrointestinal

sistem hastalıklarında suprafizyolojik dozlarda kullanılmaktadır. Yararlı etkilerinin

yanı sıra oral veya parenteral uzun süreli sistemik glukokortikoid kullanımı başta

osteoporoz ve kırıklar, adrenal baskılanma, kan şekeri regulasyonunun bozulması, kilo

alımı, kardiyovasküler hastalık, dislipidemi, psikiyatrik bozukluklar, gastrointestinal sistem

şikayetleri olmak üzere pek çok yan etki yapabilir. Yan etkiler arasında hiperglisemi,

hiperlipidemi, peptik ülser ve psikolojik değişiklikler daha çok doz bağımlı iken, osteoporoz,

cushingoid görünüm, kan basıncı yüksekliği, fırsatçı enfeksiyonlar daha çok

kullanım süresi ile ilişkilidir. Bu yan etkilerin çoğu hastaların dikkatli ve yakın izlemi,

altta yatan hastalığı kontrol edecek en düşük dozun kullanılması gibi koruyucu önlemlerin

alınması ile azaltılabilir.

Anahtar Kelimeler

Glukokortikoid, osteoporoz, cushing hastalığı, adrenal yetmezlik

Kaynakça

• 1. Dora Liu, Alexandra Ahmet et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013; 9(1): 30. 2. Huscher D, Thiele K, Gromnica-Ihle E, et al. Dose-related patterns of glucocorticoid-induced side effects. Ann Rheum Dis 2009; 68:1119. 3. Saag KG, Koehnke R, Caldwell JR, et al. Low dose long-term corticosteroid therapy in rheumatoid arthritis: an analysis of serious adverse events. Am J Med 1994; 96:115. 4. McDougall R, Sibley J, Haga M, Russell A. Outcome in patients with rheumatoid arthritis receiving prednisone compared to matched controls. J Rheumatol 1994; 21:1207. 5. Cauley JA, Hochberg MC, Lui LY, et al. Long-term risk of incident vertebral fractures. JAMA 2007; 298:2761. 6. Kanis JA, Johnell O, De Laet C, et al. A meta-analysis of previous fracture and subsequent fracture risk. Bone 2004; 35:375. 7. Kanis JA, Johansson H, Oden A, McCloskey EV. Guidance for the adjustment of FRAX according to the dose of glucocorticoids. Osteoporos Int 2011; 22:809. 8. Buckley L, Guyatt G, Fink HA, et al. 2017 American Colle34 www.kliniktipdergisi.com ge of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. Arthritis Rheumatol 2017; 69:1521. 9. Ahmet A, Kim H, Spier S. Adrenal suppression: A practical guide to the screening and management of this under-recognized complication of inhaled corticosteroid therapy. Allergy Asthma Clin Immunol. 2011;7:13. doi: 10.1186/1710-1492-7-13. 10. Hägg E, Asplund K, Lithner F Value of basal plasma cortisol assays in the assessment of pituitary-adrenal insufficiency. Clin Endocrinol (Oxf) 1987;26(2):221. 11. Finucane FM, Liew A, Thornton E, Rogers B, Tormey W, Agha A. Clinical insights into the safety and utility of the insulin tolerance test (ITT) in the assessment of the hypothalamo-pituitary- adrenal axis. Clin Endocrinol (Oxf) 2008;69(4):603. 12. Tordjman K, Jaffe A, Grazas N, Apter C, Stern N. The role of the low dose (1 microgram) adrenocorticotropin test in the evaluation of patients with pituitary diseases. J Clin Endocrinol Metab.1995;80:1301–1305. doi: 10.1210/jc.80.4.1301 13. Kazlauskaite R, Evans AT, Villabona CV, Abdu TA, Ambrosi B, Atkinson AB, Choi CH, Clayton RN, Courtney CH, Gonc EN, Maghnie M, Rose SR, Soule SG, Tordjman K. Consortium for Evaluation of Corticotropin Test in Hypothalamic-Pituitary Adrenal Insufficiency. Corticotropin tests for hypothalamic-pituitary- adrenal insufficiency: a meta-analysis. J Clin Endocrinol Metab.2008;93:4245–4253. doi: 10.1210/jc.2008-0710. 14. Türkiye Endokrinoloji ve Metabolizma Derneği Adrenal ve Gonadal Hastalıklar Kılavuzu 2017 15. Canada 125 Anderson TJ, Grégoire J, Hegele RA, Couture P, Mancini GB, McPherson R, Francis GA, Poirier P, Lau DC, Grover S, Genest J Jr, Carpentier AC, Dufour R, Gupta M, Ward R, Leiter LA, Lonn E, Ng DS, Pearson GJ, Yates GM, Stone JA, Ur E. 2012 update of the Canadian cardiovascular society guidelines for the diagnosis and treatment of dyslipidemia for the prevention of cardiovascular disease in the adult. Can J Cardiol. 2013;29:151–167. doi: 10.1016/j.cjca.2012.11. 032. 16. Wei L, MacDonald TM, Walker BR. Taking glucocorticoids by prescription is associated with subsequent cardiovascular disease. Ann Intern Med 2004; 141:764. 17. Olefsky JM, Kimmerling G. Effects of glucocorticoids on carbohydrate metabolism. Am J Med Sci 18. Gurwitz JH, Bohn RL, Glynn RJ, et al. Glucocorticoids and the risk for initiation of hypoglycemic therapy. Arch Intern Med 1994; 154:97. 19. Miller Se, Meılson Jm. Clınıcal features of the dıabetıc syndrome appearıng after steroıd therapy. postgrad mej 1964; 40:660.76; 271:202. 20. Türkiye Endokrinoloji ve Metabolizma Derneği Diyabetes Mellitus ve Komplikasyonlarının Tanı Tedavi ve İzlem Kılavuzu 2017 21. Black Rl, Oglesby Rb, Von Sallmann l, Bunım Jj Posterior subcapsular cataracts induced by corticosteroids in patients with rheumatoid arthritis. JAMA. 1960;174:166. 22. Piper JM, Ray WA, Daugherty JR, Griffin MR. Corticosteroid use and peptic ulcer disease: role of nonsteroidal anti-inflammatory drugs. Ann Intern Med 1991; 114:735. 23. Gabriel SE, Jaakkimainen L, Bombardier C. Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. A meta-analysis. Ann Intern Med 1991; 115:787. 24. Wolkowitz OM, Burke H, Epel ES, Reus VI. Glucocorticoids. Mood, memory, and mechanisms. Ann N Y Acad Sci 2009; 1179:19. 25. Brown ES, Chandler PA. Mood and Cognitive Changes During Systemic Corticosteroid Therapy. Prim Care Companion J Clin Psychiatry 2001; 3:17. 26. Fardet L, Petersen I, Nazareth I. Suicidal behavior and severe neuropsychiatric disorders following glucocorticoid therapy in primary care. Am J Psychiatry 2012; 169:491. 27. Migita K, Arai T, Ishizuka N, et al. Rates of serious intracellular infections in autoimmune disease patients receiving initial glucocorticoid therapy. PLoS One 2013; 8:e78699.