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The patient had a fraternal twin brother, and the two previously performed in parallel academically, but following the steroid treatment the patient exhibited poor memory, attention, concentration, insomnia, and avoidance of eye contact. As a result, he began to fall behind his twin brother in academic, developmental, and social areas.
Methylprednisolone (Depo-Medrol, Medrol, Solu-Medrol) is a synthetic glucocorticoid, primarily prescribed for its anti-inflammatory and immunosuppressive effects. [4] [5] [6] It is either used at low doses for chronic illnesses or used concomitantly at high doses during acute flares.
Corticosteroid-induced lipodystrophy (CIL) is a condition of abnormal fat deposition caused by corticosteroid medications. [1] Fat accumulates in the facial area ("moon face"), dorsocervical region ("buffalo hump"), and abdominal area ("pot belly" or "beer belly"), whereas the thickness of subcutaneous fat in the limbs is decreased. [1]
This weaning process may be over a few days if the course of prednisone is short but may take weeks or months [33] if the patient had been on long-term treatment. Abrupt withdrawal may lead to an Addisonian crisis. For those on chronic therapy, alternate-day dosing may preserve adrenal function and thereby reduce side effects. [34]
Generally a milder topical steroid or non-steroid treatment is used on the in-between days. [ 12 ] For treating atopic dermatitis , newer (second generation) corticosteroids, such as fluticasone propionate and mometasone furoate , are more effective and safer than older ones.
[7] [8] [6] It differs from the similarly named prednisone in having a hydroxyl at the 11th carbon instead of a ketone. Common side effects with short-term use include nausea, difficulty concentrating, insomnia, increased appetite, and fatigue. [5] More severe side effects include psychiatric problems, which may occur in about 5% of people. [9]
Use of corticosteroids has numerous side-effects, some of which may be severe: Severe amoebic colitis: Fulminant amoebic colitis is associated with high case fatality and can occur in patients infected with the parasite Entamoeba histolytica after exposure to corticosteroid medications. [19]
During this recovery time, the patient is vulnerable to adrenal insufficiency during times of stress, such as illness. While suppressive dose and time for adrenal recovery vary widely, clinical guidelines have been devised to estimate potential adrenal suppression and recovery, to reduce risk to the patient. The following is one example: