Systemic Corticosteroid Safety

Prednisone and other systemic corticosteroids reduce inflammation by suppressing immune and inflammatory signaling throughout the body. That broad effect can be therapeutic during an asthma exacerbation, autoimmune flare, or severe inflammatory condition. It also explains why the same medication can raise glucose, retain sodium and water, lower potassium, weaken bone, increase eye pressure, and reduce the body’s ability to mount a visible response to infection. A patient receiving prednisone may become seriously infected without developing the fever or dramatic inflammatory findings expected in an untreated infection. New cough, dysuria, purulent drainage, focal redness, sore throat, or a change in mental status may be more meaningful than temperature alone. Corticosteroids also mimic some effects of cortisol, the hormone the adrenal glands normally release during stress. With sustained therapy, the hypothalamic-pituitary-adrenal (HPA) axis reduces its own cortisol production. Abruptly stopping the drug can leave the patient unable to produce enough cortisol for ordinary physiologic stress, much less surgery or severe infection.