Steroid induced osteoporosis pathophysiology

An intracellular signaling molecule with protein kinase activity known as Akt1 (a major isoform of Akt) [ 6 ] may play a central role in the atrophic and hypertrophic responses of muscle to glucocorticoids and IGF-I, respectively [ 7,8 ]. Glucocorticoid-induced suppression of Akt1 ultimately results in increased amounts of the ubiquitin-ligase atrogin-1 (MAFbx) that targets muscle proteins for degradation [ 7,9 ]. Conversely, IGF-I signaling leads to enhanced activity of Akt1 that suppresses muscle atrophy and that induces muscle hypertrophy [ 8 ].

The obvious priority is immediate discontinuation of any further topical corticosteroid use. Protection and support of the impaired skin barrier is another priority. Eliminating harsh skin regimens or products will be necessary to minimize potential for further purpura or trauma, skin sensitivity, and potential infection. Steroid Atrophy [10] [11] is often permanent, though if caught soon enough and the topical corticosteroid discontinued in time, the degree of damage may be arrested or slightly improve. However, while the accompanying Telangectasias may improve marginally, the Striae is permanent and irreversible. [1]

The most commonly used AAS in medicine are testosterone and its various esters (but most commonly testosterone undecanoate , testosterone enanthate , testosterone cypionate , and testosterone propionate ), [53] nandrolone esters (most commonly nandrolone decanoate and nandrolone phenylpropionate ), stanozolol , and metandienone (methandrostenolone). [1] Others also available and used commonly but to a lesser extent include methyltestosterone , oxandrolone , mesterolone , and oxymetholone , as well as drostanolone propionate , metenolone (methylandrostenolone), and fluoxymesterone . [1] Dihydrotestosterone (DHT; androstanolone, stanolone) and its esters are also notable, although they are not widely used in medicine. [54] Boldenone undecylenate and trenbolone acetate are used in veterinary medicine . [1]

Steroid induced glaucoma may develop after application of steroid preparations applied to the skin of the eyelids. This elevation occurs most frequently with chronic use, such as in patients with atopic dermatitis. Close IOP monitoring of these patients is essential and consideration of a non-steroidal topical medication, such as tacrolimus and pimecrolimus, should be considered as an alternative. Elevation in intraocular pressure has also been noted with application of steroids on skin that was not periocular, either from ocular contamination or systemic absorption. 22 Patients should be advised to wash their hands after applying dermatologic steroids or to use gloves.

Steroid induced osteoporosis pathophysiology

steroid induced osteoporosis pathophysiology

Steroid induced glaucoma may develop after application of steroid preparations applied to the skin of the eyelids. This elevation occurs most frequently with chronic use, such as in patients with atopic dermatitis. Close IOP monitoring of these patients is essential and consideration of a non-steroidal topical medication, such as tacrolimus and pimecrolimus, should be considered as an alternative. Elevation in intraocular pressure has also been noted with application of steroids on skin that was not periocular, either from ocular contamination or systemic absorption. 22 Patients should be advised to wash their hands after applying dermatologic steroids or to use gloves.

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