The role of glucocorticoids in the development of hyperglycemia
Systemic glucocorticoids (GCs) are widely used to manage exacerbations of bronchial asthma. With short courses of therapy, the risk of adverse reactions is minimal. However, long-term systemic use leads to classic steroid effects.
The main systemic complications of long-term steroid therapy include:
- Hyperglycemia (elevated glucose concentration).
- Osteoporosis (decreased bone mineral density).
- Suppression of the hypothalamic-pituitary-adrenal axis.
Prevention of systemic effects in asthma
To avoid systemic absorption of drugs into the bloodstream and the development of hyperglycemia, the inhalation route of administration is fundamentally preferred in the treatment of bronchial asthma. Medications should act strictly locally — within the airways.
Tapering baseline therapy (inhaled GCs) to minimize risks is performed only after a comprehensive assessment of:
- The level of asthma control.
- Pulmonary function.
- The presence of risk factors for exacerbations.
If risk factors are present, the dose is reduced exclusively under strict medical supervision. Optimal conditions for this include the absence of acute respiratory infections, no pregnancy, and the constant availability of the attending physician. The patient must have a written action plan and a supply of medications in case of deterioration.
Hyperglycemia as a cause of hyperhidrosis
Hyperglycemia itself belongs to endocrinological disorders (along with thyrotoxicosis, hypothyroidism, pheochromocytoma, and acromegaly) that can act as an etiological factor for hyperhidrosis — a disorder of sweating.
Features of hyperhidrosis in endocrine disorders:
- Course pattern: most often intermittent. It manifests episodically or paroxysmally as a reaction to thermal stimuli or emotional outbursts.
- Classification: can be diffuse (generalized), segmental, or focal.
- Complications: in severe cases, hyperhidrosis can lead to dehydration, hypothermia, and electrolyte imbalances in the blood.
Class and exam questions
The inhalation route allows the drug to act locally in the airways. Systemic absorption into the bloodstream (when taking oral forms) is undesirable because it causes side effects, including hyperglycemia.
The inhalation route allows the drug to act locally in the airways. Systemic absorption into the bloodstream is undesirable as it causes pronounced side effects, including hyperglycemia and osteoporosis.
How are glucose levels and sweating related?
Hyperglycemia is an endocrinological disorder that can provoke episodic or paroxysmal sweating disorders (hyperhidrosis) in response to emotional or thermal stimuli.
Are systemic GCs safe in short courses?
Yes, when used in short courses to manage exacerbations, the side effects of systemic glucocorticoids are minimal. Classic complications occur specifically with long-term use.
What else to study on this topic
- Pathogenesis of aspirin-induced asthma and the role of NSAIDs
- Classification and complications of severe hyperhidrosis
- Contraindications to prescribing β2-agonists and antimuscarinics
- Horner's syndrome: clinical presentation and lesion localization
- Secretory disorders: hypolacrimia and hyposalivation
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