Therapeutics: glucocorticoids

Introduction

• Prescribed for their anti-inflammatory, immunosuppressive, and anti-fibrotic effects.
• Potency, duration of action, and relative mineralocorticoid activity vary with agent and formulation.
• Common side-effects of all glucocorticoids include polyuria/polydipsia (PU/PD), increased appetite, panting, pyoderma, urinary tract infections, insulin resistance, proteinuria , and (probably) pancreatitis .
• Long-term daily treatment can lead to iatrogenic hyperadrenocorticism (thin skin, muscle wasting, pot belly, calcinosis cutis, adrenal suppression).
• Sudden stopping of treatment can unmask adrenal suppression, which can last for weeks to months.
• Glucocorticoids in topical preparations can be systemically absorbed and lead to clinical side-effects, alkaline phosphatase induction, and adrenal suppression.
• Glucocorticoids induce calciuresis and can be used to treat hypercalcemia once the underlying cause is determined.
• Glucocorticoids at immunosuppressive (but not anti-inflammatory) dosages can suppress total T4 and free T4, without increasing TSH, and may lead to a false diagnosis of hypothyroidism .
• All glucocorticoids can potentially increase the risk of GI ulceration from NSAIDs, especially at high dosages.

Sources

Publications

Refereed papers

• Recent references from PubMed.
• Bizikova P, Linder K E, Paps J, Olivry T (2010) Effect of a novel topical diester glucocorticoid spray on immediate- and late-phase cutaneous allergic reactions in Maltese-beagle atopic dogs: a placebo-controlled study. Vet Dermatol 21 , 70-79 PubMed.
• Corrigan A M, Behrend E N, Martin L G, Kemppainen R J (2010) Effect of glucocorticoid administation on serum aldosterone concentration in clinically normal dogs. Am J Vet Res 71 , 649-654.
• Gottschalk J, Einspanier A, Ungemach F R, Abraham G (2010) Influence of topical dexamethasone applications on insulin, glucose, thyroid hormone and cortisol levels in dogs. Res Vet SciJul 26 [Epub ahead of print].
• Olivry T, Foster A P, Mueller R S, McEwan N A, Chesney C, Williams H C (2010) Interventions for atopic dermatitis in dogs: a systematic review of randomized controlled trials. Vet Dermatol 21 , 4-22 PubMed.
• Bonneau S, Skowronski V, Sanquer A, Maynard L, Eun H M (2009) Therapeutic efficacy of topical hydrocortisone aceponate in experimental flea-allergy dermatitis in dogs. Aust Vet J 87 , 287-291 PubMed.
• Nuttall T, Mueller R, Bensignor E, Verde M, Noli C, Schmidt V, Rème C (2009) Efficacy of a 0.0584% hydrocortisone aceponate spray in the management of canine atopic dermatitis: a randomised, double blind, placebo-controlled trial. Vet Dermatol 20 , 191-198 PubMed.
• Aniya J S, Griffin C E (2008) The effect of otic vehicle and concentration of dexamethasone on liver enzyme activities and adrenal function in small breed healthy dogs. Vet Dermatol 19 , 226-231 PubMed.
• Levine J M, Levine G J, Boozer L, Schatzberg S J, Platt S R, Kent M, Kerwin S C, Fosgate G T (2008) Adverse effects and outcome associated with dexamethasone administration in dogs with acute thoracolumbar intervertebral disk herniation: 161 cases (2000-2006). J Am Vet Med Assoc 232 , 411-417 PubMed.
• Reeder C J, Griffin C E, Polissar N L, Neradilek B, Armstrong R D (2008) Comparative adrenocortical suppression in dogs with otitis externa following topical otic administration of four different glucocorticoid-containing medications. Vet Ther 9 , 111-121.
• Ginel P J, Garrido C, Lucena R (2007) Effects of otic betamethasone on intradermal testing in normal dogs. Vet Dermatol 18 , 205-210.
• Abraham G, Demiraj F, Ungemach F R (2006) Comparison of the hypothalamic-pituitary-adrenal axis susceptibility upon single-dose i.m. depot versus long-acting i.v. triamcinolone acetonide therapy: a direct pharmacokinetic correlation. J Endocrinol 191 , 491-496. Abraham G, Gottschalk J, Ungemach F R (2005) Evidence for ototopical glucocorticoid-induced decrease in hypothalamic-pituitary-adrenal axis response and liver function. Endocrinology 146, 3163-3171.
• Cobb M A, Edwards H J, Jagger T D, Marshall J, Bowker K E (2005) Topical fusidic acid/betamethasone-containing gel compared to systemic therapy in the treatment of canine acute moist dermatitis. Vet J 169 , 276-280.
• Ghubash R, Marsella R, Kunkle G (2004) Evaluation of adrenal function in small-breed dogs receiving otic glucocorticoids. Vet Dermatol 15 , 363-368.
• Deboer D J, Schafer J H, Salsbury C S, Blum J R, Beale K M, Vitale C B, Muse R, Moriello K A, Garfield R A, Keefe T J, McArthur T R (2002) Multiple-center study of reduced-concentration triamcinolone topical solution for the treatment of dogs with known or suspected allergic pruritus. Am J Vet Res 63 , 408-413.
• Goodman S, Sprung C L (2002) The International Sepsis Forums controversies in sepsis: corticosteroids should be used to treat septic shock. Critical Care 6, 381-383.
• Daminet S, Paradis M, Refsal R, Price C (1999) Short term influence of prednisone and phenobarbital on thyroid function in euthyroid dogs. Can Vet J 40 (6), 411-415.
• Olby N (1999) Current concepts in the management of acute spinal cord injury. J Vet Intern Med 13 (5), 399-407.
• Rohrer C R, Hill R C, Fischer A et al(1999) Gastric hemorrhage in dogs given high doses of methylprednisolone sodium succinate. Am J Vet Res 60 (8), 977-981.
• Moore G E, Ferguson D C, Hoenig M (1993) Effects of oral administration of anti-inflammatory doses of prednisone on thyroid hormone response to TRH and TSH in clinically normal dogs. Am J Vet Res 54 (1), 130-135.
• Ridway H B, Moriello K A (1993) Iatrogenic Cushing's syndrome in a dog from owner's topical corticosteroid. Arch Dermatol 129 , 379.
• Nesbitt G H, Fox P R (1981) Clinical evaluation of Panalog Cream used to treat canine and feline dermatoses. Vet Med Small Anim Clin 76 , 535-538.

Other sources of information

• Day M (2008) Glucocorticorticosteroids and Antihistamines. In: Maddison J E, Page S W, Church D B Small Animal Clinical Pharmacology. 2nd edn, Philadelphia, Saunders Elsevier, pp 261-269.
• Plumb D C (1999) Veterinary Drug Handbook. 3rd edition.
• Schimmer B P, Parker K L (1996) ACTH; adrenocortical steroids and their synthetic analogs; inhibitors of the synthesis and actions of adrenocortical hormones. In: Hardman J G, Limbard L E, Goodman & Gilmans The Pharmacologic Basis of Therapeutics.9th edition, New York: McGraw Hill, pp 1459-1485.