## Systemic Adverse Effects of Chronic Corticosteroids ### Correct Adverse Effects (Options 0, 1, 2) **High-Yield:** Chronic corticosteroid use causes multiple serious systemic complications: #### Osteoporosis (Option 0) — TRUE **Key Point:** Corticosteroids inhibit osteoblast differentiation and function while promoting osteoclast activation, leading to rapid bone loss. This is one of the most common and clinically significant complications of long-term therapy [cite:Harrison 21e Ch 335]. - Increased fracture risk (vertebral, hip, rib) - Mechanism: ↓ osteoblast function, ↑ osteoclast activity, ↓ calcium absorption, ↑ PTH - Prevention: calcium supplementation, vitamin D, bisphosphonates #### Hypokalemia and Metabolic Alkalosis (Option 1) — TRUE **Key Point:** Even glucocorticoids (especially in high doses) have mineralocorticoid activity, causing sodium retention and potassium excretion via the collecting duct. This leads to: - Hypokalemia (K^+^ depletion) - Hypernatremia and fluid retention - Metabolic alkalosis (loss of H^+^ in urine) - Hypertension [cite:KD Tripathi 8e Ch 56] #### Immunosuppression and Infection Risk (Option 2) — TRUE **Key Point:** Corticosteroids suppress both cellular and humoral immunity: - ↓ T-cell proliferation and IL-2 production - ↓ Neutrophil chemotaxis and migration - ↓ Antibody production - Increased risk of opportunistic infections (TB, fungal, viral) [cite:Harrison 21e Ch 335] ### Incorrect Statement (Option 3) — THE ANSWER **High-Yield:** Corticosteroids cause **HYPOCALCEMIA**, not hypercalcemia. The mechanisms are: - **↓ Intestinal calcium absorption** (inhibit 1,25-dihydroxyvitamin D synthesis in kidney) - **↑ Urinary calcium excretion** (direct renal effect) - **↓ Osteoblast function** (reduced bone formation) - Net result: **Negative calcium balance** and osteoporosis Hypercalcemia is NOT a complication of corticosteroid therapy. In fact, corticosteroids are used to treat hypercalcemia (e.g., in sarcoidosis, lymphoma) by reducing intestinal calcium absorption and increasing urinary excretion [cite:Harrison 21e Ch 335]. ### Summary Table: Metabolic and Systemic Effects | Complication | Mechanism | Occurs? | |--------------|-----------|----------| | Osteoporosis | ↓ osteoblasts, ↑ osteoclasts, ↓ Ca absorption | ✓ | | Hypokalemia + alkalosis | Mineralocorticoid activity, ↑ K excretion | ✓ | | Immunosuppression | ↓ T-cells, ↓ neutrophil chemotaxis | ✓ | | Hypercalcemia | ↓ intestinal Ca absorption, ↑ urinary Ca loss | ✗ | **Clinical Pearl:** Hypocalcemia and osteoporosis are hallmark complications of chronic corticosteroid use. Patients require calcium and vitamin D supplementation, and bone density monitoring (DEXA scan) is recommended for long-term therapy. Corticosteroids are actually used therapeutically to lower serum calcium in hypercalcemic states.
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.