Management of patients on chronic glucocorticoid therapy: an endocrine perspective.

Glucocorticoids continue to be a potent therapeutic tool for various medical conditions; however, their medication side effects pose challenges. Steroid diabetes is treated primarily with prandial insulin, either regular or the rapid insulins (lispro or aspart). Intermediate insulin is indicated less frequently, for fasting hyperglycemia. Osteoporosis is the most debilitating of potential glucocorticoid side effects, with bisphosphonates the mainstay of prevention and treatment. Dyslipidemia can range from mild to significant, but it responds to therapy similar to that of nonglucocorticoid-induced lipid disorders. Glucocorticoid-induced adrenal withdrawal syndrome can occur even with short courses of longer-acting glucocorticoid therapy, but it responds to adjustment of glucocorticoid dose. When tapering down to near-physiologic dose, pituitary-adrenal axis responsiveness should be checked before discontinuing steroid use.