Patients who are on long-term glucocorticoids or are within one year of terminating glucocorticoids should wear a bracelet or carry a card indicating they are on glucocorticoids. Patients must be educated about the need for stress coverage. An ACTH stimulation test will assess adrenal reserves after maintenance glucocorticoids are terminated. If the response is normal, then it is usually reasonable to assume that the patient is not adrenally suppressed and that supplementation for stress is not needed. Slower increases in dosing often leads to a need for even higher doses ultimately and slower control of the disease.
Glucocorticoids cause numerous side effects.
Acute side effects include psychiatric disorders, insomnia, fluid and salt retention, and diabetes. Most side effects increase with higher dose and longer duration of use. A great deal is known about many of the side effects and knowledge about risk factors and pathogenesis can help in prevention and treatment of these problems. Cataracts are common in patients treated with glucocorticoids. Glaucoma occurs in a significant number of patients and thus all glucocortcoid-treated patients should have their intraocular pressure monitored.