Síndrome de Cushing exógena e retirada de glicocorticóides

Abstract

RESUMOGlicocorticóides são amplamente utilizados na prática clínica para o controle da atividade de doenças auto-imunes, inflamatórias, alérgicas e outras entidades nosológicas. Doses terapêuticas de glicocorticóides são muita vezes administradas inapropriadamente e isto é um problema particular, pois a terapia crônica tem muitos efeitos colaterais que se estendem desde a supressão do eixo hipotálamo-hipofisário-adrenal e síndrome de Cushing até infecções e alterações do status mental. Fatores que influenciam tanto nos efeitos adversos quanto nos terapêuticos dos glicocorticóides incluem propriedades farmacocinéticas do glicocorticóide, dose diária, diferenças individuais no metabolismo esteróide e duração do tratamento. Quando utilizados para o controle da atividade destas doenças, quatro aspectos da retirada de glicocorticóide merecem atenção especial. Primeiro, a doença tratada pelo esteróide pode recorrer. Segundo, o eixo hipotálamo-hipó-fise-adrenal pode permanecer suprimido por um longo período. Terceiro, muitas vezes desenvolve-se dependência psicológica a esses hormônios. Quarto, uma síndrome de retirada inespecífica pode desenvolver mesmo enquanto os pacientes estão recebendo doses de reposição fisiológica de glicocorticóides. A gravidade da síndrome de retirada depende da fase e o grau de dependência e inclui sintomas tais como anorexia, náusea, vômitos, perda de peso, fadiga, mialgias, artralgias, cefaléia, dor abdominal, letargia, hipotensão postural, febre e descamação da pele. ABSTRACT Exogenous Cushing's Syndrome and Glucocorticoid Withdrawal.Glucocorticoids are widely used in clinical practice to control the activity of autoimmune, inflammatory, allergic diseases and other nosological entities. Therapeutic doses of glucocorticoids are often administered inappropriately and it is a particular problem because chronic therapy has many side effects, ranging from suppression of the hypothalamic-pituitary-adrenal axis and Cushing's syndrome to infections and changes in mental status. Factors influencing both the therapeutic and adverse effects of glucocorticoids include the pharmacokinetic properties of the glucocorticoid, daily dosage, individual differences in steroid metabolism and the duration of treatment. When used to control the activity of these diseases, four aspects of glucocorticoid withdrawal deserve special attention. First, the illness treated by steroids may relapse. Second, the hypothalamic-pituitary-adrenal axis may remain suppressed for a long time. Third, psychological dependence to these hormones often develops. Fourth, a nonspecific withdrawal syndrome may develop even while patients are receiving physiological replacement doses of glucocorticoids. The severity of the withdrawal syndrome depends on the phase and degree of dependence and includes many symptoms as anorexia, nausea, emesis, weight loss, fatigue, myalgias, arthralgias, headache, abdominal pain, lethargy, postural hypotension, fever, and skin desquamation.

Allogeneic mesenchymal stem cells and xenogenic platelet rich plasma, associated or not, in the repair of bone failures in rabbits with secondary osteoporosis

“…Three aliquots of 1x10 4 MSC were maintained in complete F12 DMEM medium, together with a 3 mm sample of sterile hemostatic sponge of hydrolyzed collagen, in a six-well culture plate, incubated at 37°C, 5% CO 2 and 95% moisture 16 .…”

“…According to these authors, glucocorticoids can induce parathyroid hyperplasia, with subsequent serum increase in parathyroid hormone levels (PTH), stimulating calcium reabsorption and release of calcium and phosphorus ions into the extracellular environment 4 .…”

Prednisolone Induced Cushing Syndrome: A Case Report

“…The pharmacokinetic properties of the glucocorticoids, individual difference in steroid metabo lism, daily dosage and the duration of treatment are the factors influencing therapeutic and adverse effect of glucocorticoids. 4 Before initiating steroid therapy, patients should be well informed about the possible side effects of steroids. Otherwise it may leads to severe systemic side effects including Cushing's syndrome, hypertension, dyslipidemia, suppression of hypothalamicpituitaryadrenal axis, striae, glaucoma, skin atrophy, cataract and predisposition to lifethreatening infections.…”

Case Report on Steroid Induced Cushing Syndrome

“…A 30 yrs old female patient presented in the general medicine department with a episode of fever since 2 days vomiting of one episode and joint pains .there was unintentional weight gain with puffy face [4] . The patient was found to be very weak; she was anaemic with shortness o f breath and present complaints of cough and pedal edema.…”