Efeitos sistêmicos e síndrome de retirada em tomadores crônicos de corticosteróides

Faiçal, S.; Uehara, Marcelo Hiroshi

doi:10.1590/s0104-42301998000100014

Cited by 10 publications

(11 citation statements)

References 43 publications

(48 reference statements)

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“…insuficiência adrenal secundária (supressão do eixo HHA), sín-drome de retirada ou deprivação dos corticóides e reativação da doença de base para a qual eles foram introduzidos 5, [18][19][20] .…”

Section: Síndromes Associadas à Retirada Dos Corticóidesunclassified

Withdrawal from glucocorticosteroid therapy: clinical practice recommendations

Alves¹,

Robazzi²,

Mendonça³

2008

J Pediatr (Rio J)

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ResumoObjetivo: Apresentar uma revisão atualizada e prática sobre como efetuar de forma segura a retirada da corticoterapia. Fontes dos dados:Revisão da literatura utilizando os bancos de dados MEDLINE e LILACS (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007), selecionando os artigos mais atuais e representativos do tema. Síntese dos dados:Três situações clínicas podem ocorrer durante a retirada da corticoterapia prolongada: insuficiência adrenal secundária à supressão do eixo hipotálamo-hipófise-adrenal, síndrome de retirada ou deprivação dos corticóides e reativação da doença de base. Embora não exista consenso sobre o melhor esquema para descontinuar a terapia prolongada com corticóides, existe concordância quanto ao fato desta retirada ser gradual. Este artigo atualiza o pediatra quanto ao reconhecimento desses problemas e fornece orientações para a suspensão do tratamento prolongado com corticóide. Uma breve revisão da farmacologia dos corticóides também é descrita. Conclusão:Não existe teste com bom valor preditivo para antecipar o risco de insuficiência adrenal nos pacientes que receberam terapia crônica com corticóide. São necessários estudos prospectivos para avaliar a real incidência desse problema e assim propor estratégias racionais para sua prevenção. No momento, a menos que a integridade do eixo hipotálamo-hipófise-adrenal esteja estabelecida por testes dinâmicos, recomenda-se a administração de corticóide em situações de estresse nos pacientes que fizeram uso de corticoterapia crônica e/ou em doses elevadas.J Pediatr (Rio J). 2008;84(3):192-202: Insuficiência adrenal; síndrome de Cushing; síndrome de retirada dos corticóides; corticóides. AbstractObjective: To present an up-to-date and practical review of how to safely withdraw glucocorticosteroid therapy.Sources: A review of the published literature identified by searching the MEDLINE and LILACS databases (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007), selecting the most representative articles on the subject. Summary of the findings:Three clinical situations may occur during glucocorticoid withdrawal: adrenal insufficiency secondary to negative feedback on the hypothalamic-pituitary adrenal (HPA) axis, steroid withdrawal syndrome and relapse of the disease for which the glucocorticoids were prescribed. Although there is no consensus on how to best discontinue prolonged glucocorticosteroid therapy, there is agreement that this withdrawal should be gradual. This article updates pediatricians on how to recognize these problems and provides recommendations on how to safely suspend glucocorticosteroid therapy. A brief review of the pharmacology of glucocorticoids is also presented. Conclusion:There is no good predictive test for predicting the risk of adrenal insufficiency in patients who have been on corticosteroid therapy chronically. There is a need for prospective studies to assess the true incidence of this problem and to propose rational strategies for preventing it. The current recommendation is that patie...

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Section: Síndromes Associadas à Retirada Dos Corticóidesunclassified

Withdrawal from glucocorticosteroid therapy: clinical practice recommendations

Alves¹,

Robazzi²,

Mendonça³

2008

J Pediatr (Rio J)

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“…De acordo com a dose administrada e tempo de tratamento os glicocorticóides geram efeitos colaterais por ação na maior parte das glândulas do corpo, alterando consequentemente o metabolismo orgânico [7][8][9][10][11][12] . A alteração metabólica pode causar síndrome de Cushing iatrogênica, acúmulo de gordura centripetamente, redução da tolerância a carboidratos, fragilidade vascular e cutânea, miopatias, fraqueza muscular, hipertensão arterial, osteoporose, maior suscetibilidade a infecções, alterações psiquiátricas, até mesmo hipertensão arterial e, ocasionalmente, hipocalemia e hirsutismo e/ou virilização 13 . Por sua vez, as alterações na qualidade de vida do paciente, bem como afastamento do trabalho e do convívio social, podem ser geradas tanto pelos efeitos colaterais dos medicamentos como pelas características da doença 13,14 .…”

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Intervenção fisioterapêutica promove melhora na qualidade de vida de indivíduos com pênfigo

Timóteo

Marques

Bertoncello

2010

Rev. Soc. Bras. Med. Trop.

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Introduction:Pemphigus is an autoimmune disease characterized by bullae, in which its chronicity and clinical manifestations generate alterations in the quality of life. In Brazil, the disease prevails in the states of the Midwest and Southeast. The study aimed to evaluate the profile and quality of life of patients with pemphigus in a Brazilian city, for the purposes of physiotherapeutic intervention. Methods: The medical records of 15 institutionalized patients were analyzed, though only 7 volunteers underwent the initial and final interviews using the quality of life questionnaire SF-36. Between data collections, physical therapy exercises were applied over a four-month period. After this predetermined period the data were compared and analyzed quantitatively using the Med Calc E and the Student t test. Results: The 15 patients in treatment had a mean age of 40 years-old; 53.3% were melanoderm; 80% were men; 60% had contact with rural areas and 80% were from the southern region. The 7 patients who participated in the intervention showed a tendency for improvement in the areas assessed by the SF-36, except for vitality and social aspects. Conclusions: The profile of the population of this hospital is in agreement with the literature. According to the SF-36 collected before and after the physical therapy intervention, general improvement in the quality of life of these patients was verified. This research suggests that physiotherapeutic intervention promotes diverse benefits for patients with pemphigus.

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“…18,19,30 Clinical status is characterized by physical or psychological dependence. 31 Physical dependence is characterized by anorexia, nausea, vomiting, weight loss, asthenia, headache, myalgia, arthralgia, postural hypotension, tachycardia, fever and flaky skin.…”

Section: Steroid Withdrawal or Deprivation Syndromementioning

confidence: 99%

Retirada da corticoterapia: recomendações para a prática clínica

Alves¹,

Robazzi²,

Mendonça³

2008

J. Pediatr. (Rio J.)

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Objective: To present an up-to-date and practical review of how to safely withdraw glucocorticosteroid therapy.Sources: A review of the published literature identified by searching the MEDLINE and LILACS databases (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007), selecting the most representative articles on the subject. Summary of the findings:Three clinical situations may occur during glucocorticoid withdrawal: adrenal insufficiency secondary to negative feedback on the hypothalamic-pituitary adrenal (HPA) axis, steroid withdrawal syndrome and relapse of the disease for which the glucocorticoids were prescribed. Although there is no consensus on how to best discontinue prolonged glucocorticosteroid therapy, there is agreement that this withdrawal should be gradual.This article updates pediatricians on how to recognize these problems and provides recommendations on how to safely suspend glucocorticosteroid therapy. A brief review of the pharmacology of glucocorticoids is also presented. Conclusion:There is no good predictive test for predicting the risk of adrenal insufficiency in patients who have been on corticosteroid therapy chronically. There is a need for prospective studies to assess the true incidence of this problem and to propose rational strategies for preventing it. The current recommendation is that patients who have been on chronic and/or high dose glucocorticoids should be administered glucocorticoids during stress situations unless the integrity of the HPA axis has been established by dynamic tests. (Rio J). 2008;84(3):192-202: Adrenal insufficiency, Cushing's syndrome, steroid withdrawal therapy, corticosteroid. J Pediatr

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Efeitos sistêmicos e síndrome de retirada em tomadores crônicos de corticosteróides

Cited by 10 publications

References 43 publications

Withdrawal from glucocorticosteroid therapy: clinical practice recommendations

Withdrawal from glucocorticosteroid therapy: clinical practice recommendations

Intervenção fisioterapêutica promove melhora na qualidade de vida de indivíduos com pênfigo

Retirada da corticoterapia: recomendações para a prática clínica

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