HORMONE HIRIT – The use and abuse of steroids

HORMONE HIRIT – The use and abuse of steroids
Patricia B. Gatbonton, MD, FPCp, FPSEM

Steroids are amongst the most commonly used, and abused drugs. Every so often, you will hear or read of athletes accused of using these performance enhancing drugs, including our pound-for-pound, Pambansang Kamao, Manny Pacquiao. An accusation Manny vehemently denies.

Doctors prescribe steroids occasionally, judiciously and most important, temporarily in most cases for problems ranging from allergy to asthma to arthritic inflammations. Unfortunately, some doctors prescribe it indiscriminately, often for lack of anything better to give.

Here in the Philippines, steroids are available over the counter, which is dangerous and can lead to all sorts of problems. The common perception among lay persons is that steroids are the magic pill ‘cure-all’ and because it is an anti-inflammatory and can produce euphoria, makes them feel better.

The usual scenario is that the patients will continue the prescription without physician supervision and worse,

Normally, our adrenals, which are paired glands above each of our kidneys, provide the steroids our body needs by stimulation from the pituitary hormone, Adrenocorticotropin hormone (ACTH).

recommend it to friends and neighbours . One of the most common uses of steroids is as a “vitamin supplement” for weight gain. I’ve heard patients tell me that others have told them to take it “pang pataba.” Unfortunately, the resulting appetite stimulation and weight gain leads to an abnormal and unhealthy fat deposition in the abdomen with other undesirable consequences.

Normally, our adrenals, which are paired glands above each of our kidneys, provide the steroids our body needs by stimulation from the pituitary hormone, Adrenocorticotropin hormone (ACTH). Infrequently, the primary problem is a pituitary tumour causing excess production of steroids from the adrenal glands.

More commonly, excess steroid medication intake results in Cushing’s syndrome, with very typical and striking physical symptoms. These manifestations reflect the known effects of steroids on different organs causing metabolic and physical abnormalities.

These included abnormal fat deposition in characteristic places causing a moon face, buffalo hump at neck, large belly with purple stretch marks and thin skin which easily bruises. Other effects include hypertension, impaired glucose tolerance, reproductive dysfunction, thin bones (osteoporosis), forearm and thigh muscle weakness and swelling of the lower legs (edema).

A typical example is a patient of mine, C.D., a 44 year old male with gouty arthritis. An internist referred him to my clinic on after seeing him for hypertension, abnormal sugar levels, and almost daily intake of methylprednisolone (Medrol) 16 mg for several years. His weight was 180 Ib, his blood pressure was 150/90 on two antihypertensives, and his blood sugar was 126 mmol/L, with abnormal cholesterol profile. His waist circumference measured 110 cm and he allowed me to photograph his stomach. We did an ACTH stimulation test which confirmed that his adrenals were not producing enough steroids because of the large volume of imported steroids. We first switched his steroid from long acting to a shorter acting steroid (prednisone) and began to lower the dose slowly over the next 8 months.

Occasionally, we would have to go back up because of flare ups of his arthritis and slow down the withdrawal.

Many of his physical symptoms improved. His facial puffiness, redness, acne have receded. His had weight had dropped 142 Ibs. His blood pressure is now 130/70 with only one drug. His blood sugar was 92 mg% and cholesterol levels have improved. His waist circumference is now 91 cm with disappearance of the large, raised stretch marks. He is now off medication and we are waiting to repeat his test to confirm restoration of normal adrenal function.
CD’s is a happy ending. There is a real potential though, for many bad things to happen, because patients do not understand how much they can hurt themselves by taking medication without proper physician supervision. Drugs have good and bad effects, and that those bad effects may be permanent.

By educating the public, we hope that we can avoid serious problems for other patients who are thinking of taking steroids, and that those who already are, will seek help to help wean them of their steroid dependency.


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What is PCEDM?

The PCEDM is a sub-specialty society of the Philippine College of Physicians, a founding member of the ASEAN Federation of Endocrine Societies, and a member of the International Society of Endocrinology.

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