Adrenal insufficiency systemic glucocorticoids

Glucocorticoids have important effects on the nervous system. Adrenal insufficiency causes marked slowing of the alpha rhythm of the electroencephalogram and is associated with depression. Increased amounts of glucocorticoids often produce behavioral disturbances in humans initially insomnia and euphoria and subsequently depression. Large doses of glucocorticoids may increase intracranial pressure (pseudotumor cerebri). 

Therefore, considerations of their systemic effects are of importance. Symptomatic adrenal insufficiency has been reported in children after various regimens of inhaled glucocorticoids. 

Lomenick JP, Reifschneider KL, Lucky AW, Adams D, Azizkhan RG, Woo JG, Backeljauw PF. Prevalence of adrenal insufficiency following systemic glucocorticoid therapy in infants with hemangiomas. Arch Dermatol2009 145(3) 262-6. 

Endocrine Iatrogenic hypercortisolism with or without adrenal insufficiency Locally administered glucocorticoids to patients on ritonavir can cause systemic toxicity. There has been a review of the literature [302 ] on this theme and several reports have documented hypercortisolism after topically applied, inhaled or injected steroids [303-311 ]. A randomised pharmacokinetic and pharmacodynamic study in healthy volunteers [312 receiving combination of beclomethasone with ritonavir (r) and DRV/r showed that DRV /r did not increase steroid exposure, whereas ritonavir alone did (2-fold increase). Adrenal suppression was not observed in any of the study groups. Caution when prescribing steroids to HIV patients on ritonavir is advised. 

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