An example of an acute hepatitis-like syndrome arising after pulse methylprednisolone therapy. These episodes arise typically 2 to 4 weeks after a third or fourth cycle of pulse therapy, and range in severity from an asymptomatic and transient rise in serum aminotransferase levels to an acute hepatitis and even fulminant hepatic failure. In this instance, the marked and persistent rise in serum enzymes coupled with liver histology suggesting chronic hepatitis led to a diagnosis of new-onset autoimmune hepatitis, despite the absence of serum autoantibodies or hypergammaglobulinemia. Autoimmune hepatitis may initially present in this fashion, without the typical pattern of serum autoantibodies during the early, anicteric phase. The diagnosis was further supported by the prompt improvements in serum enzymes with prednisone therapy. The acute hepatitis-like syndrome that can occur after pulses of methylprednisolone is best explained as a triggering of an underlying chronic autoimmune hepatitis caused by the sudden and profound immunosuppression followed by rapid withdrawal. This syndrome can be severe, and fatal instances have been reported. Whether reinitiation of corticosteroid therapy with gradual tapering and withdrawal is effective in ameliorating the course of illness is unclear, but anecdotal reports such as this one suggest that they are beneficial and should be initiated promptly on appearance of this syndrome. Long term follow up of such cases is also necessary to document that the autoimmune hepatitis does not relapse once corticosteroids are withdrawn again.
Los suplementos de calcio y vitamina D definitivamente son benéficos para combatir la osteoporosis común; además, existe una buena evidencia de que estos también protegen contra la osteoporosis provocada por los corticosteroides. 1 Una revisión de cinco pruebas que reclutaron a un total de 274 participantes descubrió que la complementación de calcio y vitamina D previno de manera significativa la pérdida ósea en la espina lumbar y el antebrazo en individuos tratados con corticosteroides. 2 Por ejemplo, en un estudio de 2 años del tipo doble ciego controlado por placebo con 130 individuos, la complementación con 1,000 mg de calcio y 500 IU de vitamina D diariamente en realidad revirtió la pérdida ósea provocada por esteroides, provocando una ganancia ósea neta. 3
Some parents worry that children who use inhaled corticosteroids may not grow as tall as other children. A very small difference in height and growth was found in children who were using inhaled corticosteroids compared to children not using them. 3 And one study showed a very small difference in height [about in. ( cm) ] in adults who used inhaled corticosteroids as children compared to adults who did not use inhaled corticosteroids. 4 But the use of inhaled corticosteroids has important health benefits for children who have asthma. If you are worried about the effects of asthma medicines on your child, talk with your doctor.