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Chow, Renee W. Y., David J. Handelsman, and Martin K. C. Ng. "Minireview: Rapid Actions of Sex Steroids in the Endothelium." Endocrinology 151, no. 6 (April 14, 2010): 2411–22. http://dx.doi.org/10.1210/en.2009-1456.
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The endothelium is a dynamic interface between the blood vessel and the circulating blood that plays a pivotal role in vascular homeostasis. As such, studies on sex steroid regulation of endothelial function are critical to understanding the role of sex steroids in cardiovascular health and disease. The classical model of steroid action involves liganded steroid receptors binding to specific response elements on target genes to regulate gene transcription. In whole organisms, the time lag between steroid administration and observable effects produced by newly synthesized protein is typically in the order of hours to days. And yet, some effects of steroids, such as vasodilatation, occur within seconds to minutes of steroid administration. Studies in multiple cell types have also shown that steroids can cause the rapid initiation of multiple signaling cascades and second messenger systems, prompting investigations into alternate, transcription independent mechanisms of steroid action. Studies of the endothelium over the past two decades have revealed fundamental mechanisms in rapid sex steroid signaling. In particular, endothelium-dependent vasodilatation by estradiol-induced activation of endothelial nitric oxide synthase has proven to be an uniquely informative model to study sex steroid signaling via classical sex steroid receptors localized to the cell membrane. Despite the complexity of feedback and cross talk between rapid sex steroid signaling and other modes of steroid action, recent studies in this field are facilitating the development of steroidal drugs that selectively target the ability of sex steroids to initiate signaling cascades.
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Hammond, Geoffrey L. "Plasma steroid-binding proteins: primary gatekeepers of steroid hormone action." Journal of Endocrinology 230, no. 1 (July 2016): R13—R25. http://dx.doi.org/10.1530/joe-16-0070.
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Biologically active steroids are transported in the blood by albumin, sex hormone-binding globulin (SHBG), and corticosteroid-binding globulin (CBG). These plasma proteins also regulate the non-protein-bound or ‘free’ fractions of circulating steroid hormones that are considered to be biologically active; as such, they can be viewed as the ‘primary gatekeepers of steroid action’. Albumin binds steroids with limited specificity and low affinity, but its high concentration in blood buffers major fluctuations in steroid concentrations and their free fractions. By contrast, SHBG and CBG play much more dynamic roles in controlling steroid access to target tissues and cells. They bind steroids with high (~nM) affinity and specificity, with SHBG binding androgens and estrogens and CBG binding glucocorticoids and progesterone. Both are glycoproteins that are structurally unrelated, and they function in different ways that extend beyond their transportation or buffering functions in the blood. Plasma SHBG and CBG production by the liver varies during development and different physiological or pathophysiological conditions, and abnormalities in the plasma levels of SHBG and CBG or their abilities to bind steroids are associated with a variety of pathologies. Understanding how the unique structures of SHBG and CBG determine their specialized functions, how changes in their plasma levels are controlled, and how they function outside the blood circulation provides insight into how they control the freedom of steroids to act in health and disease.
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Kim, D. H., H. S. Kim, E. S. Kim, S. H. Park, S. J. Kim, K. O. Kim, Y. J. Lee, E. M. Song, and D. S. Kim. "P176 Clinical features of acute severe ulcerative colitis according to steroid dependency: A KASID multicenter study." Journal of Crohn's and Colitis 17, Supplement_1 (January 30, 2023): i329—i330. http://dx.doi.org/10.1093/ecco-jcc/jjac190.0306.
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Abstract Background Intravenous steroid therapy is the main initial treatment for acute severe ulcerative colitis (ASUC). However, steroid dependence in patients who were treated with intravenous steroid therapy for ASUC is not fully evaluated. We aimed to determine the prevalence and risk factors of corticosteroid dependence after treatment of ASUC. Methods Adult patients who were admitted for the treatment of ASUC satisfying Truelove-Witts criteria from January 2015 to December 2020 were included in the study. Steroid dependence was defined as a failure to taper steroids below 10 mg within 3 months from initiating intravenous therapy or relapse within 3 months after steroid discontinuation. Results Among a total of 140 patients who received intravenous steroids as initial treatment for ASUC, 105 (75.0%) showed a response while 35 (25.0%) were refractory to steroids. Of 105 patients who responded to intravenous steroid therapy, 21 (20.0%) showed steroid dependence during the follow-period. Demographic and clinical variables were not significantly different between steroid-dependent and steroid response groups. However, initial C-reactive protein (CRP) levels in steroid-dependent groups were numerically lower compared with those in the steroid response group with statistical significance (4.4 ± 4.6 mg/dL versus 7.0 ± 6.4 mg/dL, p = 0.04). Conclusion A total of 20.0% of responders to intravenous steroid treatment for ASUC had a steroid dependency during follow-up. The demographic and clinical features of ASUC according to the presence or absence of steroid dependency were similar. Initial CRP levels were low in patients with steroid dependence.
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Singh, Dheerendra, Nupur Sharma, and Rahul Agarwal. "Prevalence of steroid-induced glaucoma among patients suffering from vernal kerato-conjunctivitis in central India." Indian Journal of Clinical and Experimental Ophthalmology 8, no. 3 (October 15, 2022): 363–67. http://dx.doi.org/10.18231/j.ijceo.2022.074.
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The present study is aimed to assess the prevalence of steroid-induced glaucoma in vernal kerato-conjunctivitis patients treated with topical steroids and to determine the association between different types of topical steroids and the presence of steroid-induced glaucoma. This study was conducted as a hospital-based cross-sectional study on patients belonging to the age range of 8 years to18 years who were already diagnosed with vernal kerato-conjunctivitis and were using topical steroids as treatment. Detailed clinical history and ophthalmologic examination were done. Depending upon the potency of steroids and their intra-ocular pressure raising potential, patients were categorized into one of the 4 groups (A, B, C, D). Intra-ocular pressure levels were raised in 32.9% of the patients managed with topical corticosteroids. Steroid-induced glaucoma was observed in 15 (6.1%) of the patients with vernal kerato-conjunctivitis. Steroid-induced glaucoma was significantly associated with prolonged duration of corticosteroids and high potency corticosteroid use (p<0.05). Steroid-induced glaucoma is one of the common complications of injudicious and long-term use of topical corticosteroids particularly high potency steroids. Approximately one-third of the patients on treatment for vernal kerato-conjunctivitis are corticosteroid responders. High potency steroids and prolonged use of steroids are factors associated with steroid-induced glaucoma.
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Okihara, Masaaki, Hironori Takeuchi, Yukiko Kikuchi, Isao Akashi, Yu Kihara, Osamu Konno, Hitoshi Iwamoto, et al. "Individual Lymphocyte Sensitivity to Steroids as a Reliable Biomarker for Clinical Outcome after Steroid Withdrawal in Japanese Renal Transplantation." Journal of Clinical Medicine 10, no. 8 (April 13, 2021): 1670. http://dx.doi.org/10.3390/jcm10081670.
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Recently, steroid reduction/withdrawal regimens have been attempted to minimize the side effects of steroids in renal transplantation. However, some recipients have experienced an increase/resumption of steroid administrations and acute graft rejection (AR). Therefore, we investigated the relationship between the individual lymphocyte sensitivity to steroids and the clinical outcome after steroid reduction/withdrawal. We cultured peripheral blood mononuclear cells (PBMCs) isolated from 24 recipients with concanavalin A (Con A) in the presence of methylprednisolone (MPSL) or cortisol (COR) for four days, and the 50% of PBMC proliferation (IC50) values and the PBMC sensitivity to steroids were calculated. Regarding the experience of steroid increase/resumption and incidence of AR within one year of steroid reduction/withdrawal, the IC50 values of these drugs before transplantation in the clinical event group were significantly higher than those in the event-free group. The cumulative incidence of steroid increase/resumption and AR in the PBMC high-sensitivity groups to these drugs before transplantation were significantly lower than those in the low-sensitivity groups. These observations suggested that an individual’s lymphocyte sensitivity to steroids could be a reliable biomarker to predict the clinical outcome after steroid reduction/withdrawal and to select the patients whose dose of steroids can be decreased and/or withdrawn after transplantation.
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Blue, Jeffrey G., and John A. Lombardo. "STEROIDS AND STEROID-LIKE COMPOUNDS." Clinics in Sports Medicine 18, no. 3 (July 1999): 667–89. http://dx.doi.org/10.1016/s0278-5919(05)70175-7.
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Wiseman, Helen, and Rosanna Duffy. "Steroids, steroid receptors and disease." Trends in Molecular Medicine 7, no. 4 (April 2001): 146–47. http://dx.doi.org/10.1016/s1471-4914(01)01978-5.
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Lin, Kenny, Claire Stewart, Philip Steig, Cameron Brennan, Philip Gutin, and Samuel Selesnick. "Incidence of Prolonged Systemic Steroid Treatment after Surgery for Acoustic Neuroma and Its Implications." Journal of Neurological Surgery Part B: Skull Base 79, no. 06 (April 13, 2018): 559–68. http://dx.doi.org/10.1055/s-0038-1641752.
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Objectives To determine the incidence of prolonged postoperative systemic corticosteroid therapy after surgery for acoustic neuroma as well as the indications and associated risk factors that could lead to prolonged steroid administration, and the incidence of steroid-related adverse effects. Study Designs Retrospective chart review. Methods Retrospective chart review of patients undergoing resection of acoustic neuroma between 2010 and 2017 at two tertiary care medical centers. Patient and tumor characteristics, operative approach, hospital length of stay, initial postoperative taper length, number of discrete postoperative steroid courses, and postoperative complications were analyzed. Results There were 220 patients (99 male, 121 female) with an average age of 49.4 (range 16–78). There were 124 left-sided tumors and 96 right-sided tumors. Within the group, 191 tumors were operated through a retrosigmoid approach, 25 tumors through a translabyrinthine approach, and 4 tumors with a combined retrosigmoid–translabyrinthine approach under the same anesthetic. In total, 35 (15.9%) patients received an extended initial course of postoperative systemic steroids, defined as a taper longer than 18 days. Twenty six (11.8%) patients received additional courses of systemic steroids after the initial postoperative taper. There were 5 (2.3%) patients who required an extended initial taper as well as additional courses of steroids. Aseptic meningitis, often manifested as headache, was the most common indication for additional steroids (14 cases of prolonged taper and 17 cases of additional courses). None of the patient or tumor factors including age, gender, side, size, and approach were statistically significantly associated with either a prolonged initial steroid taper or additional courses of steroids. An extended hospital length of stay was associated with a prolonged initial steroid taper (p = 0.03), though the initial taper length was not predictive of additional courses of steroids. The cumulative number of days on steroids was associated with need for additional procedures (p < 0.01) as well as steroid-related side effects (p = 0.05). The administration of steroids was not found to significantly improve outcomes in postoperative facial paresis. Steroid-related complications were uncommon, seen in 9.26% of patients receiving steroids, with the most common being psychiatric side effects such as agitation, anxiety, and mood lability. Conclusions Systemic corticosteroids are routinely administered postoperatively for patients undergoing craniotomy for the resection of acoustic neuromas. In a review of 220 patients operated by a single neurotologist, no patient or tumor factors were predictive of requiring prolonged initial steroid taper or additional courses of steroids. The cumulative number of days on systemic steroids was associated with undergoing additional procedures and steroid-related side effects. The most common indications for prolonged or additional steroids were aseptic meningitis, cerebrospinal fluid leak, and facial paresis. Additional steroids for postoperative facial paresis did not significantly improve outcomes. Patient-reported steroid-related complications were infrequent and were most commonly psychiatric including agitation, anxiety, and mood lability.
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Corbin, Charles B., Steven A. Feyrer-Melk, Craig Phelps, and Lisa Lewis. "Anabolic Steroids: A Study of High School Athletes." Pediatric Exercise Science 6, no. 2 (May 1994): 149–58. http://dx.doi.org/10.1123/pes.6.2.149.
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A group of 1,680 high school athletes were studied to determine factors associated with anabolic steroid use. A questionnaire assessed personal factors and steroid use, behavior of others and steroid use, and availability of anabolic steroids. Use rates were 1.1% for females and 2.4% for males. Steroids were more readily available to males, who also reported knowing more steroid users than did females. Older athletes were more likely to consider steroid use, but differences in use rate were not significant from Grade 8 to 12. Using discriminant analysis, significant differences (p < .001) were found for profiles of steroid users and nonusers for both males and females. For both males and females, personal factors such as having considered steroid use, a willingness to use them if they were legal, and a willingness to use them if they could insure success in sports were the most useful in classifying athletes as steroid users versus nonusers.
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Kayes, Mohammad Imrul. "Recent Update in The Management of Childhood Nephrotic Syndrome." Journal of Bangladesh College of Physicians and Surgeons 34, no. 1 (August 8, 2016): 26–32. http://dx.doi.org/10.3329/jbcps.v34i1.29119.
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Nephrotic Syndrome (NS) is a common renal disease seen in children. Children who go into complete remission following treatment with corticosteroids are classified as having steroid sensitive NS. In developed countries over 80% of children with idiopathic NS have steroid sensitive disease. The exact pathogenesis of this condition remains elusive. Podocyte injury and proteinuria are the two main issues in the pathogenesis. Recent studies suggest release of cytokines by T-cells as well as a strong contribution of Bcell immunity. Genetic studies have reported human leucocyte antigen (HLA) class II antigens DR and DQ associations linked to steroid sensitive NS. Most children with steroid sensitive NS have multiple relapses and a significant percentage also develop steroid dependent NS. Diuretic- resistant edema also a clinical problem to manage these patients. These children receive multiple courses of steroids and are at high risk of developing steroid toxicity. Patient with frequent relapses who develop steroid dependency thus require alternative treatment. Steroid resistant NS considers when failure to response within 8 weeks of steroid therapy. Steroids sparing agents used include levamisole, cyclophosphamide, mycophenolate mofetil (MMF), calcineurin inhibitors (cyclosporine and tacrolimus), rituximab and vincristine; these agents have greatly reduced the adverse effects seen with long-term use of steroids; so therapy needs to be individualized to achieve optimal care of each child.J Bangladesh Coll Phys Surg 2016; 34(1): 26-32
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Pandav, SS, Savleen Kaur, Sushmita Kaushik, and Sonia Phulke. "Steroid-induced Glaucoma: An Avoidable Irreversible Blindness." Journal of Current Glaucoma Practice 11, no. 2 (2017): 67–72. http://dx.doi.org/10.5005/jp-journals-10028-1226.
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ABSTRACT Steroids are a group of anti-inflammatory drugs, commonly used to treat ocular and systemic conditions. Unmonitored use of steroids especially in eye drop formulations is common in situations when it is easily available over-the-counter, resulting in undesirable side effects. Among the ocular side effects, cataract and glaucoma are common. Steroid-induced ocular hypertension was reported in 1950, when long-term use of systemic steroid was shown to increase the intraocular pressure (IOP). Chronic administration of steroids in any form with raised IOP can cause optic neuropathy resulting in steroid-induced glaucoma. This review describes the pathophysiology and epidemiology of steroid-induced glaucoma, recognition of side effects, and principles of management. The purpose is to familiarize all clinicians with the potential dangers of administering steroids without monitoring the eye and the dangers of irreversible blindness in some instances of habitual self-prescription by patients. How to cite this article Phulke S, Kaushik S, Kaur S, Pandav SS. Steroid-induced Glaucoma: An Avoidable Irreversible Blindness. J Curr Glaucoma Pract 2017;11(2):67-72.
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Guillemette, C., D. W. Hum, and A. Belanger. "Levels of plasma C19 steroids and 5 alpha-reduced C19 steroid glucuronides in primates, rodents, and domestic animals." American Journal of Physiology-Endocrinology and Metabolism 271, no. 2 (August 1, 1996): E348—E353. http://dx.doi.org/10.1152/ajpendo.1996.271.2.e348.
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In this study, a comparison of circulating levels of androsterone glucuronide and androstane-3 alpha, 17 beta-diol glucuronide in the male and female of several mammalian species was performed. Glucuronidated steroids were not detected in the circulation of the dog, bovine, swine, and rodent. High levels of circulating glucuronidated steroids were measured in the cynomolgus monkey and found to be 10-fold higher than in humans. The determination of tissue levels of unconjugated and conjugated C19 steroids was then performed in intact and castrated rats treated with androgens. Steroid glucuronides were not detected in the plasma, skin, prostate, or liver of either intact or treated rats, although the levels of unconjugated steroids in the plasma and tissues were increased after steroid treatments. Significant levels were detected in the bile, thus suggesting hepatic formation of steroid glucuronides in the rat. It is suggested that the monkey represents the best animal model to date to study the contribution of diphosphoglucuronosyltransferases present in steroid target peripheral tissues to circulating levels of steroid glucuronides.
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Marcinkowska, Ewa, and Antoni Wiedłocha. "Steroid signal transduction activated at the cell membrane: from plants to animals." Acta Biochimica Polonica 49, no. 3 (September 30, 2002): 735–45. http://dx.doi.org/10.18388/abp.2002_3782.
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Steroid hormones in plants and in animals are very important for physiological and developmental regulation. In animals steroid hormones are recognized by nuclear receptors, which transcriptionally regulate specific target genes following binding of the ligand. In addition, numerous rapid effects generated by steroids appear to be mediated by a mechanism not depending on the activation of nuclear receptors. Although the existence of separate membrane receptors was postulated many years ago and hundreds of reports supporting this hypothesis have been published, no animal membrane steroid receptor has been cloned to date. Meanwhile, a plant steroid receptor from Arabidopsis thaliana has been identified and cloned. It is a transmembrane protein which specifically recognizes plant steroids (brassinosteroids) at the cell surface and has a serine/threonine protein kinase activity. It seems that plants have no intracellular steroid receptors, since there are no genes homologous to the family of animal nuclear steroid receptors in the genome of A. thaliana. Since the reason of the rapid responses to steroid hormones in animal cells still remains obscure we show in this article two possible explanations of this phenomenon. Using 1,25-dihydroxyvitamin D(3) as an example of animal steroid hormone, we review results of our and of other groups concordant with the hypothesis of membrane steroid receptors. We also review the results of experiments performed with ovarian hormones, that led their authors to the hypothesis explaining rapid steroid actions without distinct membrane steroid receptors. Finally, examples of polypeptide growth factor that similarly to steroids exhibit a dual mode of action, activating not only cell surface receptors, but also intracellular targets, are discussed.
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Schreiber, S. W., R. Cross, R. Panaccione, G. D’Haens, P. Bossuyt, J. F. Colombel, E. Louis, et al. "DOP82 Achievement of steroid-free remission in patients with moderately to severely active Crohn’s Disease during treatment with risankizumab." Journal of Crohn's and Colitis 16, Supplement_1 (January 1, 2022): i125—i126. http://dx.doi.org/10.1093/ecco-jcc/jjab232.121.
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Abstract Background The efficacy and safety of risankizumab (RZB) as induction and maintenance therapy for patients with moderately to severely active Crohn’s disease (CD) has been documented. Steroid-free clinical remission is an important additional treatment goal in CD. The efficacy of RZB by baseline steroid use during induction and steroid-free outcomes during maintenance was examined. Methods In ADVANCE (NCT03105128) and MOTIVATE (NCT03104413), patients with moderately to severely active CD received intravenous (IV) RZB induction therapy or placebo (PBO) for 12 weeks. Patients with clinical response to RZB were re-randomised in a 52-week maintenance study (FORTIFY; NCT03105102) to subcutaneous (SC) RZB or PBO (ie, withdrawal). Patients receiving steroids (maximum prednisone or equivalent ≤ 20 mg/day; budesonide ≤ 9 mg/day) at baseline of the induction studies maintained stable doses for the 12-week study duration. A mandatory steroid taper per protocol was initiated at the beginning of maintenance for patients receiving steroids during induction. Patients losing clinical response (per investigator assessment) after initiation of taper could have their steroid dose increased up to the induction baseline dose. This analysis included patients who received RZB 600 mg IV in ADVANCE or MOTIVATE and patients who received RZB 360 mg SC in FORTIFY. Endpoints reported included clinical remission (defined by CD Activity Index [CDAI] or stool frequency/abdominal pain score [SF/APS] criteria) at week 12 of induction by baseline steroid use, steroid-free clinical remission (CDAI or SF/APS), steroid-free endoscopic response, and steroid-free endoscopic remission at week 52 of maintenance. Steroid discontinuation rates over 52 weeks of maintenance were also assessed. Results Induction of clinical remission at week 12 with RZB 600 mg IV in ADVANCE or MOTIVATE was independent from baseline steroid use (Figure 1).Clinical remission rates (CDAI or SF/APS) at week 12 were similar for patients using steroids vs those who were not (33.8%–42.0% vs 34.9%–46.6%; Figure 1). Steroid use decreased over time in FORTIFY, with a greater proportion of patients receiving RZB 360 mg SC discontinuing steroids at week 52 vs withdrawal (PBO SC; Figure 2A). Rates of steroid-free clinical remission (P ≤ .012), steroid-free endoscopic response (P < .001), and steroid-free endoscopic remission (P < .001) were significantly higher with RZB 360 mg SC vs withdrawal (PBO SC) at week 52 of maintenance (Figure 2B–2C). Conclusion Efficacy of RZB induction therapy was independent of baseline steroid use. RZB maintenance promotes high rates of steroid-free clinical and endoscopic outcomes, demonstrating a benefit of RZB treatment in CD.
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Johnson, Mimi D., M. Susan Jay, Brad Shoup, and Vaughn I. Rickert. "Anabolic Steroid Use by Male Adolescents." Pediatrics 83, no. 6 (June 1, 1989): 921–24. http://dx.doi.org/10.1542/peds.83.6.921.
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Anabolic steroids have recently been used by professional and college athletes to improve athletic ability by increasing muscle size and strength. A study was done to determine the extent of steroid use and knowledge about these drugs in a population of high school male adolescents in a southern state. A self-report questionnaire, which allowed multiple answers for each question, was administered to 853 male students in six high schools. Results indicated that an average of 11% had used or were using anabolic steroids. The following were assessed: the reasons for steroid use, the sources from which the students received information about steroids, their familiarity with the physiologic effects and complications of steroid use, and the extent of their involvement in sports. The results suggest that a segment of male adolescents are using anabolic steroids without fully understanding the risks of such behavior. Health care providers need to become knowledgeable about steroids so that they may better educate adolescents about the potential deleterious effects of these agents.
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Thierry, A., G. Mourad, M. Büchler, G. Choukroun, O. Toupance, N. Kamar, F. Villemain, et al. "Three-Year Outcomes in Kidney Transplant Patients Randomized to Steroid-Free Immunosuppression or Steroid Withdrawal, with Enteric-Coated Mycophenolate Sodium and Cyclosporine: The Infinity Study." Journal of Transplantation 2014 (2014): 1–8. http://dx.doi.org/10.1155/2014/171898.
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In a six-month, multicenter, open-label trial,de novokidney transplant recipients at low immunological risk were randomized to steroid avoidance or steroid withdrawal with IL-2 receptor antibody (IL-2RA) induction, enteric-coated mycophenolate sodium (EC-MPS: 2160 mg/day to week 6, 1440 mg/day thereafter), and cyclosporine. Results from a 30-month observational follow-up study are presented. Of 166 patients who completed the core study on treatment, 131 entered the follow-up study (70 steroid avoidance, 61 steroid withdrawal). The primary efficacy endpoint of treatment failure (clinical biopsy-proven acute rejection (BPAR) graft loss, death, or loss to follow-up) occurred in 21.4% (95% CI 11.8–31.0%) of steroid avoidance patients and 16.4% (95% CI 7.1–25.7%) of steroid withdrawal patients by month 36 (P=0.46). BPAR had occurred in 20.0% and 11.5%, respectively (P=0.19). The incidence of adverse events with a suspected relation to steroids during months 6–36 was 22.9% versus 37.1% (P=0.062). By month 36, 32.4% and 51.7% of patients in the steroid avoidance and steroid withdrawal groups, respectively, were receiving oral steroids. In conclusion, IL-2RA induction with early intensified EC-MPS dosing and CNI therapy inde novokidney transplant patients at low immunological risk may achieve similar three-year efficacy regardless of whether oral steroids are withheld for at least three months.
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Micallef, Jacob V., Margaret M. Hayes, Abdul Latif, Rukhsana Ahsan, and Saulat B. Sufi. "Serum Binding of Steroid Tracers and its Possible Effects on Direct Steroid Immunoassay." Annals of Clinical Biochemistry: International Journal of Laboratory Medicine 32, no. 6 (November 1995): 566–74. http://dx.doi.org/10.1177/000456329503200609.
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We studied the serum protein binding of 3H-labelled progesterone, oestradiol and testosterone, and five 125I-labelled analogues of these steroids. All tracers investigated appeared to be bound by proteins in every serum sample tested. The addition of blocking agents caused a substantial reduction in serum protein binding of 3H-labelled steroids, but had relatively little effect on the binding of analogue steroid tracers. Use of analogue steroid tracers in conventional direct immunoassays for oestradiol and progesterone produced anomalous results for some patient samples when compared to extraction radioimmunoassays, but assays where tracer binding to serum constituents was prevented by adoption of two-step procedures appeared to avoid anomalous results. The results suggest that serum protein binding of steroid analogue tracers may be a source of interference in some direct steroid immunoassays.
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Baker, ME. "Recent insights into the origins of adrenal and sex steroid receptors." Journal of Molecular Endocrinology 28, no. 3 (June 1, 2002): 149–52. http://dx.doi.org/10.1677/jme.0.0280149.
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The recent cloning by Thornton (2001) of estrogen, progesterone and corticoid receptors from lamprey provides important insights into the early evolution of adrenal and sex steroid receptors and an opportunity to elucidate the ancient steroids that regulated gene transcription. Inclusion of lamprey sequences in a steroid receptor phylogeny indicates that the estrogen receptor is the most ancient of these receptors, followed by the progesterone receptor and the corticoid receptor. Thornton proposed that estradiol was the earliest of the steroids to activate a steroid receptor. An alternative hypothesis is that a steroid in the Delta(5) pathway activated the ancestral estrogen receptor.
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Falkenstein, Elisabeth, Anthony W. Norman, and Martin Wehling. "Mannheim Classification of Nongenomically Initiated (Rapid) Steroid Action(s)." Journal of Clinical Endocrinology & Metabolism 85, no. 5 (May 1, 2000): 2072–75. http://dx.doi.org/10.1210/jcem.85.5.6516.
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Abstract There is increasing evidence for rapid effects of steroids that are incompatible with the classical model of genomic steroid action. To address the diversity of mechanisms for rapid steroid signaling described over the past years, a classification of rapid steroid effects has been proposed to promote the discussion and understanding of nongenomic steroid action.
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Braughler, J. Mark, and Edward D. Hall. "Current application of “high-dose” steroid therapy for CNS injury." Journal of Neurosurgery 62, no. 6 (June 1985): 806–10. http://dx.doi.org/10.3171/jns.1985.62.6.0806.
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✓ Although administration of glucocorticoid steroids is one of the most widely used therapeutic modalities for the clinical management of acute trauma of the central nervous system (CNS), controversy continues regarding their effectiveness. In essence, two viewpoints concerning their use exist. Some believe that despite their poor clinical record, the steroids nevertheless have a place in the treatment of human CNS trauma. In general, this group of clinical investigators uses the steroids primarily out of tradition, feeling that steroid therapy may be of some benefit. Unfortunately, confusion remains as to what constitutes an appropriate dose or regimen. In this regard, it has been suggested that the steroid dose be increased and the regimen intensified. Others believe that steroids should not be used. They contend that in view of their poor clinical record, it is unlikely that increasing the steroid dose or changing the dosing regimen will improve clinical efficacy, since steroids have already failed at what may be considered huge doses by glucocorticoid standards. Furthermore, it is contended that the side effects associated with large steroid doses reduce the margin of safety so as to make the steroids unsafe. Complicating these arguments is a body of experimental evidence that by and large strongly supports the utility of steroids for the acute treatment of CNS trauma. The intent of this article is to evaluate the current use of steroid therapy for CNS trauma from a purely pharmacological perspective, and to compare the steroids' experimental use with their clinical application.
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Prasad, G. Lakshmi. "Steroids for delayed cerebral edema after traumatic brain injury." Surgical Neurology International 12 (February 10, 2021): 46. http://dx.doi.org/10.25259/sni_756_2020.
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Background: Brain edema is a common phenomenon after traumatic brain injury (TBI) resulting in increased intracranial pressure and subsequent neurological deterioration. Experimental studies have proven that brain edema is biphasic (cytotoxic followed by vasogenic). Till date, all studies, including the corticosteroid randomization after significant head injury (HI) trial, have used high-dose steroids in the acute period during which the edema is essentially cytotoxic in nature. No clinical data exist pertaining to delayed cerebral edema (vasogenic) and steroids. Methods: Patients who had received steroids for delayed cerebral edema after TBI were retrospectively analyzed over a 2-year period. Steroid dose, timing of steroid prescription, time to improvement of symptoms, and complications were noted. Results: There were six males and three females. Mean age was 41.1 years. There were no severe HI cases. All subjects had cerebral contusions on imaging. Dexamethasone was the preferred steroid starting with 12 mg/day and tapered in 5–7 days. The mean interval to steroid administration after trauma was 7 days. The mean duration of steroid prescription was 6.3 days. All patients had complete symptomatic improvement. The mean time to symptom resolution was 3.8 days. No patients experienced any complications pertinent to steroid usage. Conclusion: This is the first study to document efficacy of steroids for delayed cerebral edema after TBI, at least in mild/moderate head injuries. The timing of steroid usage and dose of steroids is key aspects that might determine its efficacy in TBI which was the drawbacks of the previous studies. Future prospective trials with the above factors in consideration may confirm/refute above findings.
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Hricik, D. E., W. L. Kupin, and M. R. First. "Steroid-free immunosuppression after renal transplantation." Journal of the American Society of Nephrology 4, no. 8 (February 1994): S10. http://dx.doi.org/10.1681/asn.v48s10.
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Concerns about the side effects of chronic steroid therapy have prompted increasing interest in steroid-free immunosuppression for renal transplant recipients who are maintained on cyclosporine-based regimens. Studies to date suggest that at least 50% of cyclosporine-treated patients can be managed without steroid therapy. Reported benefits of avoiding or withdrawing steroid therapy have included improvements in hyperlipidemia, hypertension, and glucose intolerance and accelerated growth in children. Whether these effects will increase patient or allograft survival remains to be proved. Furthermore, the benefits of steroid-free immunosuppression must be weighed against the risk of precipitating allograft rejection. Although the elimination of steroids clearly increases the short-term risk of acute rejection, further studies are needed to determine the effects of steroid-free immunosuppression on long-term allograft function and to identify clinical or immunologic factors that can predict a successful outcome after the elimination of steroids.
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Kahn, SM, DJ Hryb, AM Nakhla, NA Romas, and W. Rosner. "Sex hormone-binding globulin is synthesized in target cells." Journal of Endocrinology 175, no. 1 (October 1, 2002): 113–20. http://dx.doi.org/10.1677/joe.0.1750113.
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Sex hormone-binding globulin (SHBG) is a multifunctional protein that acts in humans to regulate the response to steroids at several junctures. It was originally described as a hepatically secreted protein that is the major binding protein for sex steroids in plasma, thereby regulating the availability of free steroids to hormone-responsive tissues. SHBG also functions as part of a novel steroid-signaling system that is independent of the classical intracellular steroid receptors. Unlike the intracellular steroid receptors that are ligand-activated transcription factors, SHBG mediates androgen and estrogen signaling at the cell membrane by way of cAMP. We have reviewed the current state of knowledge on the SHBG gene and the role of SHBG in steroid signaling (we shall not address its function as a plasma-binding protein).
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KWASMAN, ALAN. "Steroid Abuse by Adolescents." Pediatrics 78, no. 1 (July 1, 1986): 186. http://dx.doi.org/10.1542/peds.78.1.186.
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To the Editor.— I would like to call attention to my suspicion that there is significant steroid abuse among adolescents and offer a short case report. I have been surprised at the number of adolescent boys who come in for physical examinations and ask about steroids. None of these patients have asked for steroids, but they openly state that they can get them from "friends." All of them appear concerned about the side effects. I would like to present the salient features of one case of steroid abuse.
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Nagornova, A. M., A. V. Seleznеv, I. A. Bulakh, A. Yu Brezhnev, and A. V. Kuroyedov. "Steroid glaucoma." Clinical Medicine (Russian Journal) 99, no. 7-8 (January 4, 2022): 420–28. http://dx.doi.org/10.30629/0023-2149-2021-99-7-8-420-428.
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Glucocorticosteroids are widely used in clinical and ophthalmic practice, but their unjustifi ed and uncontrollable use is unacceptable. Prescription of steroids has to be controlled strictly and the level of intraocular pressure must be diagnosed, because one of the signifi cant side eff ect of steroids is increased intraocular pressure level and, as a result, the development of glaucomatous optic neuropathy. This review deals with the pathogenesis of an increase in the level of intraocular pressure against various forms of glucocorticosteroids intake, describes the time and duration of their ocular-hypertensive eff ect. The available data on the features of the clinical picture of steroid glaucoma, depending on the routes of their entry, have been studied in detail. The tactics of treating patients with ocular hypertension or a proven case of steroid glaucoma are described.
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Denham, Bryan E. "The Third Time Is a Charm: News Media, Policy Dynamics, and the Designer Anabolic Steroid Control Act." International Journal of Sport Communication 10, no. 2 (June 2017): 141–52. http://dx.doi.org/10.1123/ijsc.2017-0017.
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Designer steroids contain chemical structures “derived from, or substantially similar to” anabolic steroids, which became Schedule III controlled substances in the United States in 1990. Chemists create designer steroids by reverse engineering existing drugs, altering their chemical structures, and creating new compounds. Seeking to help curtail problems with steroid-spiked dietary supplements, the Designer Anabolic Steroid Control Act of 2014 classified 25 designer steroids, many contained in supplements, as controlled substances. Previous versions of the 2014 legislation, introduced in 2010 and 2012, had failed to become law despite consistent news accounts of supplements contaminated with conventional and designer steroids, as well as steroid precursors. Guided conceptually by a streams-of-influence model, the present article examines regulatory processes involving designer steroids and discusses limitations on the capacity of news outlets to build policy agendas.
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Wendler, Alexandra, Elisabetta Baldi, Brian J. Harvey, Angel Nadal, Anthony Norman, and Martin Wehling. "Position Paper: Rapid responses to steroids: current status and future prospects." European Journal of Endocrinology 162, no. 5 (May 2010): 825–30. http://dx.doi.org/10.1530/eje-09-1072.
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Steroids exert their actions through several pathways. The classical genomic pathway, which involves binding of steroids to receptors and subsequent modulation of gene expression, is well characterized. Besides this, rapid actions of steroids have been shown to exist. Since 30 years, research on rapid actions of steroids is an emerging field of science. Today, rapid effects of steroids are well established, and are shown to exist for every type of steroid. The classical steroid receptors have been shown to be involved in rapid actions, but there is also strong evidence that unrelated structures mediate these rapid effects. Despite increasing knowledge about the mechanisms and structures which mediate these actions, there is still no unanimous acceptance of this category. This article briefly reviews the history of the field including current controversies and challenges. It is not meant as a broad review of literature, but should increase the awareness of the endocrinology society for rapid responses to steroids. As members of the organizing committee of the VI International Meeting on Rapid Responses to Steroid Hormones 2009, we propose a research agenda focusing on the identification of new receptoral structures and the identification of mechanisms of actions at physiological steroid concentrations. Additionally, efforts for the propagation of translational studies, which should finally lead to clinical benefit in the area of rapid steroid action research, should be intensified.
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Adams, Rebecca W., Robin L. Chapman, and Gregory A. Smallwood. "Steroid Withdrawal in Liver Transplant Recipients." Progress in Transplantation 11, no. 3 (September 2001): 217–23. http://dx.doi.org/10.1177/152692480101100312.
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Because of troublesome side effects associated with steroid use, many transplant centers have tried to withdraw steroids from stable, solid organ transplant recipients. The objective of this study was to evaluate the ability to wean liver transplant recipients off steroids, depending on both their primary immunosuppressive regimen and their primary disease state. This was a retrospective, single-center review of steroid weaning in adult orthotopic liver transplant recipients. Based on primary immunosuppression, patients could be weaned off steroids similarly if they were taking cyclosporine or tacrolimus (53.9% vs 61.4%). When triple immunosuppressive regimens were compared with dual regimens, a difference was found in ability to wean patients off steroids (52.4% vs 74.5%, P=.001). When steroid weaning was stratified for primary immunosuppression and primary disease state, patients with autoimmune-mediated diseases (autoimmune hepatitis, sclerosing cholangitis, and primary biliary cirrhosis) were less likely to be weaned if they were receiving cyclosporine-based immunosuppressants (36.8% vs 62.2%, P=.03). In conclusion, it appears that a large number of liver transplant recipients can safely be tapered off steroids.
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Lee, C.-S., H. W. Pyun, E. Y. Chae, K.-K. Kim, S. C. Rhim, and D. C. Suh. "Reversible Aggravation of Neurological Deficits after Steroid Medication in Patients with Venous Congestive Myelopathy Caused by Spinal Arteriovenous Malformation." Interventional Neuroradiology 15, no. 3 (September 2009): 325–29. http://dx.doi.org/10.1177/159101990901500310.
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Steroids are empirically used to medicate patients with myelopathy of unknown etiology. We report the reversible aggravation of neurological status after steroid administration in a patient with venous congestive myelopathy (VCM). We retrospectively evaluated 36 patients with angio-graphically confirmed spinal arteriovenous malformation (SAVM) from a prospectively collected neurointerventional database. We evaluated steroid medication and neurological aggravation using Aminoff grading and analyzed using Fisher's exact test whether steroid medication is related to neurological aggravation and spinal cord edema as demonstrated on MR T2-WI. Among 26 patients who had been treated with steroids, ten had aggravated neurological deficits. The aggravation in these ten patients was related to the steroid medication (P = 0.039 in all patients) and only marginally to VCM with spinal cord edema as seen on T2-WI (P = 0.074). Aggravation caused by using a high intravenous dose (250–1000 mg) of methylprednisolone or dexamethasone at 8–20 mg/day slowly decreased after stopping the steroid medication. Steroids were reversibly detrimental in patients with VCM caused by SAVM. A history of neurological aggravation after the use of steroids may suggest the diagnosis of SAVM associated with VCM.
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Woolcock, AJ. "Steroid resistant asthma: what is the clinical definition?" European Respiratory Journal 6, no. 5 (May 1, 1993): 743–47. http://dx.doi.org/10.1183/09031936.93.06050743.
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Asthma is usually a steroid responsive disease. A few patients respond poorly to these drugs, and others need such high doses to control the disease that side-effects become a serious problem. The term steroid resistant asthma is used for both groups. In some patients, factors may be operating to make the asthma worse and, thus, to increase the requirement for steroids. In order to make a clinical diagnosis of steroid resistant asthma, it is therefore necessary to investigate the factors that could be operating to prevent a "normal" response to steroids. These factors include wrong diagnosis, insufficient steroid reaching the airway mucosa, continuing exposure to sensitizing agents, unrecognized aggravating agents, excessive use of beta-agonist aerosols, and failure to undertake regular management according to a strict management plan. Using a strict clinical definition of steroid resistant asthma leads to better investigation and treatment of individual patients, allows steroids to be stopped when they are not indicated, allows other anti-inflammatory drugs to be used with confidence, and provides a well-defined group of patients for further research relating to the mechanisms of action of steroids.
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Taylor, David R., Lea Ghataore, Lewis Couchman, Royce P. Vincent, Ben Whitelaw, Dylan Lewis, Salvador Diaz-Cano, et al. "A 13-Steroid Serum Panel Based on LC-MS/MS: Use in Detection of Adrenocortical Carcinoma." Clinical Chemistry 63, no. 12 (December 1, 2017): 1836–46. http://dx.doi.org/10.1373/clinchem.2017.277624.
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Abstract BACKGROUND Adrenocortical carcinoma (ACC) is a rare malignancy, with an annual incidence of 1 or 2 cases per million. Biochemical diagnosis is challenging because up to two-thirds of the carcinomas are biochemically silent, resulting from de facto enzyme deficiencies in steroid hormone biosynthesis. Urine steroid profiling by GC-MS is an effective diagnostic test for ACC because of its capacity to detect and quantify the increased metabolites of steroid pathway synthetic intermediates. Corresponding serum assays for most steroid pathway intermediates are usually unavailable because of low demand or lack of immunoassay specificity. Serum steroid analysis by LC-MS/MS is increasingly replacing immunoassay, in particular for steroids most subject to cross-reaction. METHODS We developed an LC-MS/MS method for the measurement of serum androstenedione, corticosterone, cortisol, cortisone, 11-deoxycorticosterone, 11-deoxycortisol, 21-deoxycortisol, dehydroepiandrosterone sulfate, pregnenolone, 17-hydroxypregnenolone, progesterone, 17-hydroxyprogesterone, and testosterone. Assay value in discriminating ACC from other adrenal lesions (phaeochromocytoma/paraganglioma, cortisol-producing adenoma, and lesions demonstrating no hormonal excess) was then investigated. RESULTS In ACC cases, between 4 and 7 steroids were increased (median = 6), and in the non-ACC groups, up to 2 steroids were increased. 11-Deoxycortisol was markedly increased in all cases of ACC. All steroids except testosterone in males and corticosterone and cortisone in both sexes were of use in discriminating ACC from non-ACC adrenal lesions. CONCLUSIONS Serum steroid paneling by LC-MS/MS is useful for diagnosing ACC by combining the measurement of steroid hormones and their precursors in a single analysis.
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Shore, L. S., and M. Shemesh. "Naturally produced steroid hormones and their release into the environment." Pure and Applied Chemistry 75, no. 11-12 (January 1, 2003): 1859–71. http://dx.doi.org/10.1351/pac200375111859.
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Steroidal hormones produced by humans and animals are constantly excreted into the environment in their active forms. The primary steroid hormones are progesterone, estrone, estradiol, testosterone, and cortisol, all of which are lipophilic and poorly soluble in water. The steroids of major concern are estrone and estradiol-17β, since they exert their physiological effects at a lower concentration than other steroids and can be found in the environment in concentrations above their LOEL for fish and plants (10 ng/l). The steroid hormones can be readily measured in run-off, soil, and groundwater, but each steroid has its distinct pathway of transport. Since the major source of steroids in the environment appears to be cattle and chickens, the hormonal steroid input into the environment could be drastically reduced by well-established techniques such as buffer strips and composting.
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Bicikova, M., M. Hill, L. Sosvorova, D. Ripova, and P. Mohr. "Neuroactive steroids, steroid metabolism and schizophrenia." International Clinical Psychopharmacology 28 (December 2012): e33-e34. http://dx.doi.org/10.1097/01.yic.0000423295.54788.9b.
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Shackleton, C. H. L. "Profiling steroid hormones and urinary steroids." Journal of Chromatography B: Biomedical Sciences and Applications 379 (June 1986): 91–156. http://dx.doi.org/10.1016/s0378-4347(00)80683-0.
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Gray, Sofia L., Cecilia Jalabert, Chunqi Ma, and Kiran K. Soma. "Measurement of Steroid Fatty Acyl Esters in Blood and Brain." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A811—A812. http://dx.doi.org/10.1210/jendso/bvab048.1652.
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Abstract Steroid fatty acyl esters (FAEs) are a class of steroid conjugates that are abundant in circulation, have long half-lives, and are stored in lipid-rich tissues. Steroid-FAEs are present in many species, but their functions are poorly understood. They can be metabolized to active, unconjugated steroids and therefore may act as a reservoir of steroids. Dehydroepiandrosterone (DHEA) is an androgen precursor that can be conjugated to various fatty acids. DHEA also modulates aggression in several species, including songbirds, rodents and humans. Recent studies suggest that DHEA-FAEs might be present in songbird blood and/or brain, in part, to regulate aggression. Here, we (1) investigated the abundance of multiple fatty acids in songbird blood and (2) developed an indirect method to measure DHEA-FAEs in songbird blood and brain. First, preliminary work demonstrated high circulating levels of total (esterified and non-esterified) fatty acids, especially oleic, linoleic, and palmitic acids. These data, in conjunction with previous research, suggest that these fatty acids might be conjugated to steroids, including DHEA. Second, we successfully developed a saponification technique to indirectly measure DHEA-FAEs. Saponification cleaves the bond between the steroid molecule and the fatty acid, and we then measure the unconjugated steroid. DHEA-FAEs were incubated in 0.5M potassium hydroxide in ethanol for 30 min at room temperature, and steroids were subsequently extracted twice with dichloromethane. Unconjugated DHEA was quantified using liquid chromatography-tandem mass spectrometry (LC-MS/MS), the gold standard in steroid measurement. DHEA recovery was 88% using reference standards in neat solution. We validated this method with song sparrow plasma and chicken serum and obtained recoveries of 94-105% with intra-assay variation of 2.6%. Future research will directly measure specific DHEA-FAEs (e.g. DHEA-oleate) in blood and brain using LC-MS/MS. This research will elucidate the possible roles of steroid-FAEs in brain function and the regulation of steroid-dependent behavior. This work may also clarify the identities, levels and functions of steroid-FAEs in other species, including rodent models and humans. These data have implications for basic and clinical neuroendocrinology, offering insights into a possible storage system for steroids that may influence social behaviour.
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Taqiyyah, Masyalia Hasna. "Penggunaan Steroid Sistemik pada Henoch Schonlein Purpura." Cermin Dunia Kedokteran 48, no. 11 (November 1, 2021): 377. http://dx.doi.org/10.55175/cdk.v48i11.1562.
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<p>Steroid umum digunakan pada HSP mengingat efek antiinflamasinya. Namun, di lain pihak beberapa kasus HSP dapat sembuh sendiri hanya dengan terapi simtomatik ataupun suportif. Penelitian terkini menunjukkan bahwa steroid hanya bermanfaat pada beberapa kasus HSP. Penggunaan steroid harus dipertimbangkan berdasarkan indikasi dan tidak untuk setiap kasus HSP.</p><p> </p>Steroids are commonly used in all cases of HSP because of its anti-inflammatory effect. However, some HSP cases are self-limiting and only necessitate symptomatic or supportive therapy. Recent research has shown that steroids are beneficial in only a few cases of HSP. Steroid should be used as indicated and considered in every case of HSP.
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Stoll, Anna, Michele Iannone, Giuseppina De Gregorio, Xavier de la Torre, Francesco Molaioni, Francesco Botrè, and Maria Kristina Parr. "Influence of Pain Killers on the Urinary Anabolic Steroid Profile." Journal of Analytical Toxicology 44, no. 8 (May 9, 2020): 871–79. http://dx.doi.org/10.1093/jat/bkaa049.
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Abstract Anabolic androgenic steroids (AAS) are prohibited as performance-enhancing drugs in sports. Among them, testosterone and its precursors are often referred to as “pseudoendogenous” AAS, that is, endogenous steroids that are prohibited when administered exogenously. To detect their misuse, among other methods, the World Anti-Doping Agency-accredited laboratories monitor the steroid profile (concentrations and concentration ratios of endogenous steroids, precursors and metabolites) in urine samples collected from athletes in and out of competition. Alterations in steroid profile markers are used as indicators for misuse of anabolic steroids in sports. Therefore, especially their metabolic pathways with possible interactions are crucial to elucidate. As steroid metabolism is very complex, and many enzymes are involved, certain non-prohibited drugs may influence steroid metabolite excretion. One important group of steroid-metabolizing enzymes is aldo–keto reductases (AKRs). An inhibition of them by non-steroidal anti-inflammatory drugs (NSAIDs), which are neither prohibited nor monitored, but frequently used drugs in sports, was demonstrated in vitro. Thus, this work aims to investigate the influence of NSAID intake on the urinary steroid profile. Kinetic and inhibitory studies were performed using 5α-dihydrotestosterone as substrate. The results obtained from in vitro experiments show that ibuprofen inhibits AKR1C2 and thus influences steroid biotransformation. For in vivo investigations, urine samples prior, during and postadministration of ibuprofen were analyzed using routine methods to monitor the steroid profile. Changes in markers of the steroid profile of volunteers were observed. The combination of in vitro and in vivo results suggests that monitoring of ibuprofen may be useful in doping control analysis. The presented work illustrates the importance to consider co-administration of (non-prohibited) drugs during antidoping analysis. Intake of multiple substances is likely leading to interfering effects. Divergent results in antidoping analysis may therefore be observed and misinterpretation of analytical data may occur. Similar considerations may be appropriate for other fields of forensic applications.
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Qiu, Yu, and Ruihua Shi. "Roles of Steroids in Preventing Esophageal Stricture after Endoscopic Resection." Canadian Journal of Gastroenterology and Hepatology 2019 (April 1, 2019): 1–9. http://dx.doi.org/10.1155/2019/5380815.
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Background and Purposes. Endoscopic resection has been worldwide recognized as a treatment strategy for early esophageal lesions. The occurrence of esophageal stricture after endoscopic resection will reduce the quality of life of patients. This study will evaluate the efficacy and safety of steroids in the prevention of esophageal stricture after endoscopic resection and the influence of different steroid administration methods.Methods. In the relevant literature database, literature from 2008 to 2018 is retrieved by using preset keywords, the search results are carefully screened, and the conclusion of the literature is synthesized to form arguments and draw conclusions.Results. 73 articles met our requirements. Oral steroid administration, not prophylactic endoscopic balloon dilation alone, was effective in preventing esophagostenosis after esophagoscopic treatment and reducing the number of repeated endoscopic balloon dilations even after extensive endoscopic resection. Local steroid injection is useful and economy for preventing esophageal stricture, even though it may raise the risk of perforation during dilations. A wider range of circumferential mucosal defects is an independent predictor for stricture formation for patents given preventive steroid injections after endoscopic submucosal dissection. For complete circular mucosal defect, the further researches are essential to investigate the role of local steroid injection. The effect of other methods such as steroid gel, intravenous infusion of steroid, and novel steroid filling methods require more confirmation.Conclusions. Therefore, steroids play an irreplaceable role in preventing esophageal stricture after endoscopic resection. Oral and local injections of steroids are the two most acceptable methods and more prospective studies are needed to compare the effectiveness and safety of these two methods.
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Rosiou, K., J. Carbonell, V. Dolby, N. Monfared, and C. Selinger. "P498 Sources of excess steroid prescriptions and clinical adverse outcomes associated with steroid excess: The Leeds Steroids study." Journal of Crohn's and Colitis 16, Supplement_1 (January 1, 2022): i462. http://dx.doi.org/10.1093/ecco-jcc/jjab232.625.
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Abstract Background This retrospective study aims to determine steroid prescription practice across primary and secondary care, quantify the proportion of primary care prescriptions communicated to secondary care, and assess outcomes associated with excessive steroid use. Methods The study cohort consists of all patients attending IBD clinics under Leeds Teaching Hospitals from 1/1/2016 to 31/12/2017 with linked primary care records. Data were extracted from the hospital’s electronic health record. Steroid excess was defined based on ECCO guidelines. Cases with excess were reviewed to determine if escalation was implemented, appropriateness of escalation, timeliness of that (within 6 weeks of steroid course) and whether steroid excess was unavoidable. Results 2246 patients were included in the study (Mage: 47.26 y; 47.6% male; 46.4% CD, 46.8% UC; 36.2% of CD patients on thiopurines, 26.3% on biologics; 78.8% of UC patients on 5-ASA, 21.4% thiopurines, 5.6% biologics). During the study period 32.9% of patients were exposed to steroids (77.4% of steroid prescriptions issued for IBD, 27.5% of prescriptions for IBD originating from primary care). Significantly more prescriptions from secondary care were of appropriate dose and duration compared to primary care (84.7% vs 40.7%, p<0.001). Secondary care was made aware within six weeks of steroid initiation in 60.3% of steroid courses prescribed by primary care. 49.5% of patients flared after being prescribed steroids from primary care, compared to 39.1% from secondary care, p=0.003. Steroid excess was observed in 14.5% of patients and was related to IBD in 76% of them. In patients with steroid excess due to their IBD; excess was acted upon in 82.8% of patients (77.5% had treatment escalation). Escalation was considered appropriate in 98.9% of patients however, it was timely in 62.4% of patients and steroid excess was unavoidable in 47.6%. Patients with steroid excess due to IBD had significantly more hospital admissions for IBD (p<0.001), hospital admissions for infections (p=0.036) and more antibiotic courses prescribed by GP (p=0.023) compared to patients without steroid excess. Conclusion Steroid prescribing for IBD flares originating from primary care is common however, steroid dose and duration are frequently inappropriate, and more than one third of courses are not communicated to secondary care in a timely manner. A significantly higher amount of patients flare again after being prescribed steroids by primary care. Finally, over 50% of steroid excess is potentially avoidable and steroid excess is related to negative consequences such as IBD admissions, admissions for infections and antibiotic prescriptions.
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Punekar, Y. S., A. Ahmad, and H. A. Saleh. "Estimating the effect of nasal steroid treatment on repeat polypectomies: survival time analysis using the General Practice Research Database." Rhinology journal 49, no. 2 (June 1, 2011): 190–94. http://dx.doi.org/10.4193/rhino10.004.
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BACKGROUND: Intranasal steroids are effective in preventing or delaying recurrence of nasal polyps. However, their effectiveness in delaying a need for repeat polypectomy in clinical practice is unknown. OBJECTIVES: To compare time to a repeat polypectomy between post-polypectomy intranasal steroid users and non-users. METHODOLOGY/PRINCIPLE: Our cohort consisted of patients in GPRD who had undergone at least one nasal polypectomy procedure in or after the year 2000. These patients were followed for up to 4 years and the time to next polypectomy was estimated. Cox`s proportional hazards regression was used to estimate the effect of post polypectomy intranasal steroid treatment on time to the next polypectomy after controlling for other respiratory conditions and their treatment. RESULTS: The cohort consisted of 1,675 patients with a mean age of 59 years and 68% males. Of these, 576 patients were post-polypectomy steroid users and 1,099 patients were steroid non-users. The median time to repeat polypectomy was 812 days among the steroid users and 736 days among steroid non-users. Significantly less proportion of intranasal steroid users experienced a repeat polypectomy compared to steroid non-users. This difference was consistent among subgroups of females and concomitant rhinitis treatments users. Patients with post polypectomy intranasal steroid use showed lower risk for a repeat polypectomy compared to steroid non-users. Concomitant rhinitis medication users showed a higher risk whereas other confounders were not significant. CONCLUSIONS: Intranasal steroids were effective in delaying a repeat polypectomy. However, further research using a prospective design is necessary to quantify the benefit of ongoing steroid treatment.
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Donovan, Laura, Adela Joanta-Gomez, Julia Furnari, Brandi Mouton, and Andrew Lassman. "QOL-01. RISK FACTORS FOR AND CONSEQUENCES OF PROLONGED DEXAMETHASONE USE IN PATIENTS WITH GLIOBLASTOMA (GBM)." Neuro-Oncology 24, Supplement_7 (November 1, 2022): vii240. http://dx.doi.org/10.1093/neuonc/noac209.929.
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Abstract BACKGROUND Dexamethasone is the primary treatment for tumor-associated edema. Prolonged use can have significant side effects and may negatively impact survival in GBM. Factors associated with steroid dependence and steroid associated side effects (SASEs) are not well established. METHODS We performed a retrospective study of patients with newly diagnosed, IDH-wildtype GBM at our center. Demographics, clinical and tumor characteristics, dexamethasone usage, and SASEs (infections, myopathy, hypertension, fractures, mood symptoms, weight gain, and hyperglycemia) were extracted through chart review. We compared survival outcomes (OS) between patients with and without steroid dependence. Risk factors for steroid dependence were identified through logistic regression analysis. RESULTS 39/92 (35.9%) patients developed steroid dependence. Of these, 26/39 (66.7%) were on steroids at the start of initial treatment. Patients who developed steroid dependence were older, more likely to have STR/biopsy, bilateral disease, KPS < 90, baseline neurological deficits, and to be obese (BMI ≥ 30). 94.9% of patients with steroid dependence experienced ≥ 1 SASE (vs. 34%) and 46.2% experienced ≥ 3 SASEs (vs. 3.8%). Mood symptoms (69.2% vs. 26.4%), hyperglycemia (53.8% vs. 7.5%) and infections (51.3% vs. 7.5%) were the most common SASEs. Median OS was inferior in steroid-dependent patients (18 vs 25 mo). Baseline obesity was identified as a risk factor for developing steroid dependence (OR 5.9). DISCUSSION SASEs are common in patients on prolonged steroids. Obesity may increase the risk of developing steroid dependence. Identifying patients at highest risk for steroid dependence may help guide future interventions to mitigate the negative effects of prolonged dexamethasone use.
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Nasr, Deena M., Waleed Brinjikji, Alejandro A. Rabinstein, and Giuseppe Lanzino. "Clinical outcomes following corticosteroid administration in patients with delayed diagnosis of spinal arteriovenous fistulas." Journal of NeuroInterventional Surgery 9, no. 6 (June 3, 2016): 607–10. http://dx.doi.org/10.1136/neurintsurg-2016-012430.
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Background and purposeThere have been several previously reported cases of acute progression of myelopathic symptoms in patients with spinal arteriovenous fistula (SAVF) treated with intravenous methylprednisolone. This usually occurs during or immediately following steroid administration. We examined a small case series of patients with SAVF treated with epidural, oral, or intravenous steroids to determine the association between steroid administration and clinical outcomes in these patients.MethodsFollowing Institutional Review Board approval, we conducted a retrospective review of patients with angiographically-confirmed SAVF who received intravenous, oral, or epidural corticosteroids for treatment of their symptoms. We studied patient-reported motor and sensory function following steroid administration using both the modified Rankin Scale and the Aminoff Motor Disability Scale.ResultsTwenty-one patients with SAVF were included in this study. Thirteen patients (61.9%) had intravenous methylprednisolone administered, four patients (19.0%) had epidural steroid injections, and six patients (28.6%) had oral prednisone. Among patients who received intravenous methylprednisolone, seven (53.8%) reported acute worsening of symptoms during or immediately following steroid administration. Among the patients receiving epidural steroids, none reported worsening and one patient reported short-term relief. Among the patients receiving oral steroids, one reported acute worsening of symptoms. Worsened deficits did not consistently resolve after steroid discontinuation.ConclusionsOur study suggests that intravenous methylprednisolone can cause immediate worsening of motor and sensory symptoms when administered to patients with SAVF. Steroid administration should be avoided in patients with a myelopathy secondary to an untreated SAVF because neurological worsening may not be fully reversible.
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Mahmoud, Raed H., and Ibrahim Khalaf Awath. "Assessment of serum levels of malondialdehyde and interleukine-5 in asthmatic patients receiving corticosteroid therapy." Chemical and Environmental Science Archives 02, no. 04 (2022): 35–39. http://dx.doi.org/10.47587/cesa.2022.2401.
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Asthma is a very common chronic disease involving the respiratory system in which the airways occasionally constrict, become inflamed, and are lined with excessive amounts of mucus, often in response to one or more triggers. The current work represents an experimental study that was conducted in Tikrit Teaching Hospital, during the period from April 2008 to the end of November 2008. Around 90 individuals were included in this study from both genders, their ages were from 18 to 80 years. A total of 70 patients with mild and moderate asthma were included in this study from both genders. Their age range from 18 -80 years. It is evident from this study that the highest percentage was 69.2% in patients with mild asthma on steroids was females and 52.6% in asthmatic patients without steroid therapy males, while in mild asthma without steroids and moderate asthma on steroids the percentage is the same in both genders and which was 37.5% and 50% respectively. There was no significant difference between different study groups regarding gender distribution (P > 0.05). The mean level of serum malondialdehyde was 3.39 ± 0.42 in mild asthma without steroid therapy, 4.03 ± 0.18 in moderate asthma without steroid therapy, 2.18 ± 0.12 in mild asthma on steroid therapy, while 2.77 ± 0.56 in moderate asthma on steroid therapy and 3.33 ± 0.16 in the control group. reveals that the mean level of serum interleukin-5 was10.78 ± 3.19 in mild asthma without steroid therapy, 16.65 ± 4.99 pg/ml in moderate asthma without steroid therapy, 3.94 ± 0.82 pg/ml in mild asthma on steroid therapy, while 4.10 ± 1.08 pg/ml in moderate asthma on steroid therapy and 3.32 ± 0.38 pg/ml in the control group.
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Damayanti, Rizki, and Ria Ervilita. "Skrining Fitokimia Ekstrak Etanol, Etil Asetat Dan N-Heksana Batang myristica Fragrans." Talenta Conference Series: Science and Technology (ST) 2, no. 1 (January 30, 2019): 97–100. http://dx.doi.org/10.32734/st.v2i1.323.
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Telah dilakukan uji skrining fitokimia terhadap batang Myristica fragrans. Uji fitokimia yang dilakukan diantaranya adalah alkaloid, flavonoid, fenolik, saponin, dan terpenoid/ steroid. Hasil uji skrining fitokimia ekstrak etanol batangMyristica fragrans menunjukkan adanya kandungan flavonoid, saponin dan terpenoid/ steroid. Hasil skrining fitokimia pada ekstrak etil asetat menunjukkan adanya falvonoid dan terpenoid/ steroid sedangkan pada ekstrak n-heksana menujukkan adanya senyawa terpenoid/ steroid. Senyawa-senyawa kimia yang tidak terdapat pada ketiga ekstrak dengan variasi pelarut daun Myristica fragrans adalah senyawa alkaloid dan fenolik.
Phytochemical screening tests on the stem of Myristica fragrans have been carried out. Phytochemical tests were included alkaloids, flavonoids, phenolics, saponins, and terpenoids/steroids. The results of the phytochemical screening test of ethanol extract from the stem of Myristica fragrans showed the presence of flavonoids, saponins and terpenoids/steroids. The results of phytochemical screening on ethyl acetate extract showed phalvonoid and terpenoids/steroids whereas n-hexane extract showed terpenoids/steroids. Chemical compounds which were not found in the three extracts with a variety of solvent leaves Myristica fragrans were alkaloid and phenolic compounds.
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Hameed, Ammar F. "Steroid Dermatitis Resembling Rosacea: A Clinical Evaluation of 75 Patients." ISRN Dermatology 2013 (April 21, 2013): 1–4. http://dx.doi.org/10.1155/2013/491376.
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Background. The use of topical steroids on the skin of the face should be carefully evaluated by the dermatologist; however, its misuse still occurs producing dermatological problem resembling rosacea. Objectives. To report the different clinical manifestations of steroid dermatitis resembling rosacea and to discover causes behind abusing topical steroids on the face. Methods. In this prospective observational study, 75 patients with steroid dermatitis resembling rosacea who had history of topical steroid use on their faces for at least 1–3 months were evaluated at the Department of Dermatology, Baghdad Teaching Hospital, between August 2010 and December 2012. Results. The majority of patients were young women who used a combinations of potent and very potent topical steroid for average period of 0.25–10 years. Facial redness and hotness, telangiectasia, and rebound phenomenon with papulopustular eruption were the main clinical presentations. The most common causes of using topical steroid on the face were pigmentary problems and acne through recommendations from nonmedical personnel. Conclusion. Topical steroid should not be used on the face unless it is under strict dermatological supervision.
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Gregory, Sarah, Scott G. Denham, Patricia Lee, Joanna P. Simpson, and Natalie Z. M. Homer. "Using LC-MS/MS to Determine Salivary Steroid Reference Intervals in a European Older Adult Population." Metabolites 13, no. 2 (February 13, 2023): 265. http://dx.doi.org/10.3390/metabo13020265.
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A number of steroids, including glucocorticoids and sex hormones, have been associated with neurodegenerative and cardiovascular conditions common in aging populations. The application of liquid chromatography tandem mass spectrometry (LC-MS/MS) steroid analysis offers an opportunity to conduct simultaneous multiplex steroid analysis within a given sample. In this paper, we describe the application of an LC-MS/MS steroid analysis method for the assessment of reference ranges of steroids in human saliva samples (200 µL) collected from older adults (age 50 years and above) enrolled in a European cohort investigating the risk for Alzheimer’s dementia. Saliva samples were prepared using supported liquid extraction (SLE) along with a calibration curve and analysed using a Waters I-Class UPLC (Ultra Performance Liquid Chromatography) and a Sciex QTrap 6500+ mass spectrometer. Mass spectrometry parameters of steroids were optimised for each steroid and a method for the chromatographic separation of 19 steroids was developed. Lower limits of quantitation (LLOQs), linearity and other method criteria were assessed. In total, data from 125 participants (500 samples) were analysed and assessed for reference ranges (64 male, 61 female). A total of 19 steroids were detected in saliva within the range of the method. There were clear diurnal patterns in most of the steroid hormones detected. Sex differences were observed for androstenedione (A4), testosterone (T), cortisone (E) and aldosterone (Aldo). In the first sample of the day, dehydroepiandrosterone (DHEA) was significantly higher in healthy volunteers compared to those with Alzheimer’s disease biomarkers. This LC-MS/MS method is suitable for the analysis of 19 steroids in saliva in adults.
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Batth, Rituraj, Clément Nicolle, Ilenuta Simina Cuciurean, and Henrik Toft Simonsen. "Biosynthesis and Industrial Production of Androsteroids." Plants 9, no. 9 (September 3, 2020): 1144. http://dx.doi.org/10.3390/plants9091144.
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Steroids are a group of organic compounds that include sex hormones, adrenal cortical hormones, sterols, and phytosterols. In mammals, steroid biosynthesis starts from cholesterol via multiple steps to the final steroid and occurs in the gonads, adrenal glands, and placenta. This highly regulated pathway involves several cytochrome P450, as well as different dehydrogenases and reductases. Steroids in mammals have also been associated with drug production. Steroid pharmaceuticals such as testosterone and progesterone represent the second largest category of marketed medical products. There heterologous production through microbial transformation of phytosterols has gained interest in the last couple of decades. Phytosterols being the plants sterols serve as inexpensive substrates for the production of steroid derivatives. Various genes and biochemical pathways involved in phytosterol degradation have been identified in many Rhodococcus and Mycobacterium species. Apart from an early investigation in mammals, presence of steroids such as androsteroids and progesterone has also been demonstrated in plants. Their main role is linked with growth, development, and reproduction. Even though plants share some chemical features with mammals, the biosynthesis is different, with the first C22 hydroxylation as an example. This is performed by CYP11A1 in mammals and CYP90B1 in plants. Moreover, the entire plant steroid biosynthesis is not fully elucidated. Knowing this pathway could provide new processes for the industrial biotechnological production of steroid hormones in plants.
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Holt, Robert J., Anahita Qashqai, Claudia Vesel, Stephanie D. Taylor, and Naina Barretto. "PSAT261 Use of Steroids Pre- and Post-Teprotumumab in Thyroid Eye Disease Patients." Journal of the Endocrine Society 6, Supplement_1 (November 1, 2022): A808. http://dx.doi.org/10.1210/jendso/bvac150.1672.
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Abstract Background Thyroid eye disease (TED), an autoimmune disease, causes inflammation of the periorbital fat and muscle often leading to eye-bulging (proptosis), double-vision (diplopia), pain, redness and swelling. Steroids are effective in reducing inflammation, but have limited efficacy for proptosis and diplopia, and higher doses can be associated with adverse effects. Teprotumumab, an anti-insulin like growth factor-1 receptor inhibitory antibody, demonstrates significant improvements in proptosis, diplopia and inflammatory symptoms.1 Here we examined steroid use in the period leading up to, and the period after a full course of teprotumumab. Methods Deidentified claims data (IQVIA) from patients completing 8 infusions of teprotumumab (full course) before Dec 31, 2020 were examined for steroid use before and after treatment. To ensure that claims data were adequately captured, patients must have been in the database for at least 1 year before and 6 months after teprotumumab and have had a claim within 4 months of the first dose. The median cumulative dose of steroids (prednisone equivalent) was also determined. Results 565 patients met the inclusion criteria with a mean age of 59.5 (13.3) years. 407 (72%) were female and 158 (28%) were male. 460 (81%) had ≥1 steroid prescription at any time before, during, or after teprotumumab within 69 months before teprotumumab and 16 months afterward with 78% use before, 10% use during and 25% after. 314 (56%) had ≥1 steroid prescription within 1 year before or 6 months after a course of teprotumumab. Of 283 patients who received steroids within 1 year pre-teprotumumab, the median cumulative dose per patient (MCDPP) increased from 295 to 607 mg 3-0 months prior to teprotumumab initiation and 82% (233) stopped steroid use after teprotumumab initiation. The MCDPP decreased by 80% (607mg to 120mg) in the 0-3 months pre-teprotumumab to 3-6 months post-teprotumumab. Finally, the number of patients receiving steroids 3-6 months after teprotumumab decreased by 74% from 3-0 months pre-teprotumumab. Conclusions While reasons for the escalating incidence, and magnitude, of steroid use pre-teprotumumab and reduced use post-teprotumumab could not be definitively determined, remote steroid use increased up until teprotumumab initiation with a majority of patients who had a steroid in the year preceding teprotumumab having no steroid use in the 6 months after teprotumumab. Further, the number of patients receiving steroids and the median cumulative dose of steroids post-teprotumumab was reduced by more than 70% and 80%, respectively from pre-teprotumumab doses, indicating that teprotumumab is a steroid sparing agent. Follow-up analyses will confirm the duration of this effect. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
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Acharya, Anup, Bandana Pokharel, Shiva Bhushan Pandit, and Suman Bartaula. "Efficacy and cost-effectiveness analysis of steroid in treatment of Otitis Media with Effusion (OME) in children: A Randomized Trial." Journal of Gandaki Medical College-Nepal 13, no. 2 (December 25, 2020): 111–15. http://dx.doi.org/10.3126/jgmcn.v13i2.30198.
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Background: Otitis media with effusion (OME) is a common disorder in children and lacks international consensus for its treatment. Out of various treatment options, few studies have show promising benefits of steroids for this condition. The objective of this study was to find the efficacy of steroid in treatment of OME and compare effectiveness of various modalities of treatment for OME. Also, we conducted their cost-effectiveness analysis.
Methods: In this experimental study, 160 children between one and 12 years of age having OME between September 2018 and January 2020 were randomized into four parallel groups and were managed with antibiotics-antihistamines-decongestant combination, nasal steroid spray, oral steroid, and watchful observation respectively. They were re-evaluated in one-month period for improvement in OME and appearance of any adverse effects. Improvement was compared with Chi-square test.
Results: A total of 160 participants were randomly divided into four groups by block randomization. The group treated with nasal steroid spray showed statistically significant improvement. The group treated with oral steroid showed improvement but was not statistically significant. Improvement was significantly lower in observation group. Cost of treatment was in the decreasing order in antibiotics-combination, nasal steroid spray, oral steroid and observation groups respectively.
Conclusions: Topical nasal steroid was the only efficacious treatment among the four modalities for OME. Furthermore, steroids were safe and cheaper than antibiotics combination.
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S., Skandashree B., Hema N. G., and Surendran K. A. K. "Clinico-epidemiological study of topical steroid dependent face in a tertiary care hospital at Mysore." International Journal of Basic & Clinical Pharmacology 9, no. 7 (June 26, 2020): 1073. http://dx.doi.org/10.18203/2319-2003.ijbcp20202944.
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Background: Topical steroids are the most commonly prescribed drugs in dermatology. The adverse effects of steroid misuse are noticeable 3 to 4 weeks after application. Steroid rosacea, hypertrichosis and acneiform eruptions are few of them. A new entity known as topical steroid dependent face, topical steroid dependent face (TSDF) has been recently coined to encompass symptoms such as erythema, burning sensation on attempted cessation of topical steroid application.Methods: A questionnaire-based analysis was done among patients attending dermatology outpatient department of government medical college hospital, Mysore between November 2018 to May 2019. Prior approval of the institutional ethics committee, and consent of patients were obtained. A total of 200 outpatients with facial dermatosis using topical steroids on face for a period greater than one month were taken up for study.Results: The results included population across different age groups, between 16 to 60 years. 56% belonged to the age group of 16 to 30 years. Most common steroid abused was mometasone cream 0.1% (50%), betamethasone valerate cream 0.1% (24.5%) followed by clobetasol ointment 0.05% (21.5%). The major adverse effect with steroid abuse, were acne 72% facial redness 67%. Hyperpigmentation 51%, hypertrichosis 32.5% and skin atrophy 21%.Conclusions: The present study highlights and creates awareness on the burden of facial topical steroid abuse and the poor attitude towards them.