Preterm infants who are treated with glucocorticoids could be at a growing risk for damage to the cerebellum in the brain, according to a recent study by scientists from the University of California.

Glucocorticoids are usually administered to premature infants to facilitate lung maturation and normalization of breathing and blood pressure.

From Healthjockey.com:

Emily Tam, MD, a child neurologist in the Neurological Intensive Care Nursery at the UCSF Benioff Children’s Hospital and lead author of the study, remarked, “This study provides new evidence that these drugs, even at low doses, are associated with impaired cerebellar development when given to babies after birth.”

Initial studies have linked smaller cerebellum volumes of premature children to cognitive and motor disorders as they reach young adulthood. In order to test the effects of glucocorticoids, nearly 172 premature babies were examined. Around 85% of them had received betamethasone before birth and almost 20% of them were given hydrocortisone or dexamethasone after birth.

The study, ‘Preterm Cerebellar Growth Impairment After Postnatal Exposure to Glucocorticoids’, is published in the journal Science Translational Medicine.

Tags: betamethasone, dexamethasone, glucocorticoids, hydrocortisone

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Dr. Djillali Annane said at the 12th International Congress on Infectious Diseases that a consensus has emerged that corticosteroids provide major benefits in patients with severe sepsis or septic shock.

Dr. Annane of the University of Versailles, France, said these benefits only with low doses of corticosteroids administered for at least 5 days, and only in the sizable patient subsets having adrenal insufficiency or refractory septic shock.

From Internalmedicinenews.com:

Much of the lengthy controversy in this field was the result of great heterogeneity in clinical trials, particularly those done before 1992. For example, steroids for septic shock fell into disfavor all through the 1980s and 1990s because multiple trials before 1992 showed no benefit. That’s because these negative studies used short-course, high-dose corticosteroids, Dr. Annane explained. Today, with the benefit of hindsight, it can be emphatically stated that no evidence supports the use of such therapy, he said at the congress, which was sponsored by the International Society for Infectious Diseases.

Dr. Annane was first author of a 2006 Cochrane Collaboration systematic review of corticosteroids for treatment of severe sepsis and septic shock (Cochrane Library ISSN 1464-780X).

In 15 randomized trials totaling more than 2,000 children and adults included in the analysis, steroid therapy didn’t change 28-day all-cause mortality. But the results varied with dosing strategy. In nine trials of replacement-dose corticosteroids—the equivalent of hydrocortisone at 200–300 mg/day intravenously for 5 days or longer—there was a highly significant 20% reduction in the relative risk of 28-day mortality compared with placebo, along with a greater proportion of patients experiencing shock reversal by day 7. In contrast, patients on high-dose, short-course corticosteroids didn’t benefit.

The benefits, as shown in multiple randomized placebo-controlled trials, are enhanced 28-day mortality, shorter shock duration, improved hemodynamics, reduced organ dysfunction, and less systemic inflammation.

Tags: corticosteroids, hydrocortisone, steroids

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Researchers at the University of Bristol are looking for volunteers to find out if hydrocortisone, a drug affecting stress system of the body, could help people with depression and not responding to present forms of treatment.

It is believed that Severe or recurrent depression affects 3-5 percent of the population and 10-30 percent of this population do not respond to the present-day treatment options.

From News-Medical.Net:

Evidence from UK and US studies suggests that a short course of steroids, such as hydrocortisone, may be sufficient to trigger a beneficial response in people who have TRD who are on ‘standard’ antidepressant treatment.  If this were to be confirmed, it would be a significant advance as it may enable a restoration of response to conventional treatments in these individuals.  A further advantage is that such an intervention is inexpensive, relatively simple and could be carried out in outpatient or even appropriate primary care settings.

The researchers are looking for patients with depression who have failed to respond to two antidepressant medications and who would like to be assessed for entry into the study.

Dr Andrea Malizia leading the team of Bristol researchers has a long-standing clinical and research interest in treatment resistant depression and spearheads a specialist outpatient service at the Bristol Royal Infirmary.

Tags: depression, hydrocortisone, steroids

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If you are a diabetic and there is a need for you to undergo steroid therapy, your doctor should advise you on adjusting your diabetes therapy.

Steroids, particularly glucocorticoids can affect the glucose level in a person’s bloodstream. Glucocorticoids include hydrocortisone, prednisone, prednisolone, dexamethasone and betamethasone.

Since insulin is the only hormone that could overcome this effect, increase in insulin doses may be needed. The diabetic may also need to plan his meals or control his food intake since steroid can increase hunger.

Steroids can also make a non-diabetic increase their blood sugar levels. Steroids can make the liver produce sugar from substances such as proteins and fats. Steroids can also inhibit insulin release from the pancreas and its action in our body tissues.

The type of steroids and the form of administration can have various effects on sugar levels. Generally, inhaled and topical steroids have less effect on blood sugar levels compared to other types and routes of delivery.

Dosages also affect sugar levels. If steroids are given in low doses, it may have no effect on sugar levels, while moderate to higher doses can increase sugar levels significantly.

Fortunately, this effect is reversible. Once steroid therapy is stopped, blood sugar levels usually returns to normal.

From Caller:

CORPUS CHRISTI — The word steroids has become synonymous with sports and medicine. But these two associations could not be more different. The family of anabolic steroids abused by athletes is quite different than the family of glucocorticoid steroids that patients get.

Tags: betamethasone, dexamethasone, diabetes, glucocorticoids, hydrocortisone, prednisolone, Prednisone

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Low doses of hydrocortisone (steroid) can bring slight improvements in some chronic fatigue syndrome (CFS) symptoms but that will pose a risk to induce adrenal suppression, as per researchers from the National Institute of Allergy and Infectious Diseases.

Stephen E. Straus, M.D., Chief of the Laboratory of Clinical Investigation at NIAID and Senior Author on the study commented that the kind of suppression in context of the steroid is justified for CFS treatment.

From News.Bio-Medicine.Org:

“The data show that about half the people on placebo and two-thirds of those taking hydrocortisone reported some improvement in well-being,” comments Stephen E. Straus, M.D., chief of the Laboratory of Clinical Investigation at NIAID and senior author on the study. “The greater benefit seen in the hydrocortisone group, however, was modest, and there was clear evidence of adrenal suppression by the drug.” Twelve of 33 patients on the therapy developed laboratory evidence of adrenal insufficiency. “It was manageable and completely reversible,” says Dr. Straus, “but it’s the kind of suppression that in the context of minimal improvement afforded by the drug cannot, in our minds, justify using this treatment for CFS.

Though the side-effects were found to be risky, there have been perceptions in the medical world that this may be just the perfect launchpad for treating patients with chronic fatigue syndrome symptoms.

Strauss commented that his team is further testing fludrocortisone in 100 patients with CFS and neurally mediated hypotension so that even the risk of adrenal suppression is eliminated.

Tags: chronic fatigue syndrome, fludrocortisone, hydrocortisone, national institute of allergy and infectious diseases, steroid

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Patients who have low levels of adrenal are supposed to be weaned off early from ICU if they are given a supplement of hydrocortisone before extubation is attempted.

Study was conducted on 93 critically ill patients, 91.4% of the 70 with relative adrenal insufficiency who received hydrocortisone infusions were successfully weaned from a ventilator, compared with 68.8% of those who received a saline placebo.

This stress dose corticosteroid supplementation with adrenal insufficiency led to a significantly higher success rate for ventilator weaning. Functional adrenal insufficiency was related to subnormal corticosteroid production during critical illness, particularly septic shock, in the absence of structural defects in the hypothalamic-pituitary-adrenal axis.

From med page today:

ICU patients with adrenal insufficiency stand a better chance of being weaned off a ventilator more rapidly if they are treated with hydrocortisone before extubation is attempted.

“In this study, stress dose corticosteroid supplementation before extubation of patients with adrenal insufficiency led to a significantly higher success rate for ventilator weaning and a shorter weaning duration than in the placebo group,” they wrote.

“The successful ventilator weaning percentage was significantly higher (p = 0.035) in the adequate adrenal reserve group (88.4%) and in the stress dose hydrocortisone treatment group (91.4%) than in the placebo group (68.6%),” the authors wrote.

The patients were given regular corticosteroids before or during the admission. Patients with adrenal insufficiency were given 50 mg intravenous hydrocortisone every six hours during the weaning period. Studies showed that 32 of 35 patients taking hydrocortisone were successfully taken off ventilators, compared with 24 of 35 in the control group. Among the 20 patients with adequate adrenal reserves, 20 of 20 patients were taken off ventilator, but three failed after extubation.

Studies conclude that the weaning period was shorter in the hydrocortisone treatment group than in the placebo group. They also noted that “No significant adverse effects were observed in the corticosteroid treatment group.”

Tags: corticosteroid, extubation, hydrocortisone, hypothalamic-pituitary-adrenal axis, ventilator

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Jari Halonen, M.D., of Kuopio University Hospital, and colleagues reported “Atrial fibrillation occurrence generally ranges from 20% to 40% after a coronary artery bypass graft and is even higher after valve and combined valve and bypass surgery”, in the April 11 issue of Journal of the American Medical Association.

This was taken in account and findings emerged that the rate of atrial fibrillation after cardiac surgery, with its increased likelihood of stroke, fell from 48% to 30%, a reduced relative risk of 37%, when 241 patients were randomized to receive 100-mg hydrocortisone. In addition, patients received oral metoprolol titrated to heart rate too.

From medpage today:

Intravenous hydrocortisone after cardiac surgery had a 37% lower relative risk of post-op atrial fibrillation compared with placebo, researchers here reported.

The rate of atrial fibrillation after cardiac surgery, with its increased likelihood of stroke, fell from 48% to 30%, a reduced relative risk of 37%, when 241 patients were randomized to receive 100-mg hydrocortisone or matching placebo on the evening of the operative day, and then one dose every eight hours for three days.

Afib occurrence generally ranges from 20% to 40% after a coronary artery bypass graft and is even higher after valve and combined valve and bypass surgery, Jari Halonen, M.D., of Kuopio University Hospital, and colleagues reported in the April 11 issue of Journal of the American Medical Association.

When we compared with the placebo patients, we found that the steroid patients did not have higher rates of post-op infections or other complications such as mediastinitis, stroke, myocardial infarction, conduction disturbances, or re-sternotomy caused by bleeding or any psychotic disorders occurred in either group.

Large trials were needed to confirm that corticosteroid treatment was a much beneficial method to keep a check on atrial fibrillation since they has an anti inflammatory activity.

Intravenous Hydrocortisone therapy for patients having cardiac surgery was effective and well tolerated in this study.

Tags: Atrial fibrillations, bypass surgery, coronary artery, hydrocortisone, metoprolol, psychotic disorders

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