Steroid Hormones

Information for patients who take Steroid Hormones:

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Steroid hormones (more precisely corticosteroids) are life-sustaining hormones made naturally in the body by the adrenal glands. More of the natural hormone is made in the body in the early hours of the morning, less in the afternoon, and very little in the late evening. The natural hormone is called cortisol, and probably the best known man made corticosteroids are prednisone (Medrol) and dexamethasone (Decadron). The body normally makes about 30 mg of cortisol per day, which is approximately equivalent to 0.75 mg of dexamethasone and 7.5 mg of prednisone (the man made hormones are much stronger).

Doctors sometimes use steroids as a treatment for a variety of conditions such as rheumatoid arthritis and asthma. When used as a treatment, doses of steroids much higher than the body would usually make are often prescribed (20 - 100 mg of prednisone per day, for instance). These doses of corticosteroids taken for weeks, months, and years do have significant well-known side effects. However, doses of corticosteroids that are similar to the amount usually made by the body cannot and do not have side effects. Furthermore, even very large doses of corticosteroids taken for less than one month have no significant long-term side effects, as a rule.

The body does on occassion make increased amounts of cortisol per day. The amount of the hormone produced increases during stress such as an illness, an injury, surgery, or even emotional stress. Without this increase, a person would not survive such challenges. Production of up to 300 mg of cortisol per day has been noted in otherwise healthy patients undergoing major surgery. This is the reason cortisol is sometimes referred to as a "stress hormone."

A person can be deficient in cortisol for one of two reasons. Rarely the adrenal glands simply stop working, known as Addison's Disease, or the pituitary gland, which tells the adrenals what to do, is not working. A more common situation is when a person takes steroids as a treatment for a prolonged period of time, usually two months or longer. In that case, the adrenal glands "forget" how to make cortisol. That is not a problem, as long as the person continues to take their steroid treatment, but drugs such as prednisone and dexamethasone must not be stopped abruptly.

If the body is deficient in cortisol, a person becomes weak, tired, loses appetite, can develop nausea and diarrhea, and often loses weight. This is serious, but the situation is even more serious when a person who cannot make stress amounts of cortisol is exposed to stress (illness, injury or surgery); in that setting, even death can result from cortisol insufficiency.

What to do and not to do if you take steroid hormones:

If you take steroids as a treatment

  1. Never miss doses, and wear a medical alert bracelet or necklace. That way if you are in an accident, the medical personnel attending you can know that you take steroids and can give you "stress doses" of steroids. However, if you take steroids as a treatment, you usually do not need to adjust the dose for minor stress.

If you have Addison's Disease or insufficient cortisol production due to pituitary disease

  1. You will be prescribed cortisol replacement - usually hydrocortisone pills - to be taken twice each day.
  2. The larger dose should be taken as soon as you wake up and the smaller dose at around 4:00 pm (adjusted if you wake up very early or late).
  3. The usual dose should be doubled for minor stress (flu or cold with a fever, but not just the "sniffles," death in the family, losing your job, etc.) just for the few days that the stress lasts.
  4. Never miss doses, and wear a medical alert bracelet or necklace. That way if you are in an accident, the medical personnel attending you can know that you take steroids and can give you "stress doses" of steroids.
  5. If you cannot keep the steroid pills down because of vomiting, you will either have an injection at home to use, or you must go to the nearest medical facility to get an injection.



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