12. 9 Vitiligo 16 Syncope 19 Constipation 20 Diarrhea 22 Salt craving 34 Abdominal pain 82 Pigmentation of mucous membranes 87 Hypotension (<110/70) 90 Anorexia, nausea, and vomiting 97 Weight loss 98 Pigmentation of skin 99 Weakness Percent of Patients Sign or Symptom Frequency of Symptoms and Signs in Adrenal Insufficiency
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20. b Relative milligram comparisons with hydrocortisone, setting the glucocorticoid and mineralocorticoid properties of hydrocortisone as 1. Sodium retention is insignificant for commonly employed doses of methylprednisolone, triamcinolone, paramethasone, betamethasone, and dexamethasone. a The steroids are divided into three groups according to the duration of biologic activity. Short-acting preparations have a biologic half-life <12 h; long-acting, >48 h; and intermediate, between 12 and 36 h. Triamcinolone has the longest half-life of the intermediate-acting preparations. <0.01 30-40 Dexamethasone <0.01 25 Betamethasone <0.01 10 Paramethasone LONG-ACTING <0.01 5 Triamcinolone <0.01 5 Methylprednisolone 0.25 4 Prednisolone 0.25 4 Prednisone INTERMEDIATE-ACTING 0.8 0.8 Cortisone 1 1 Hydrocortisone SHORT-ACTING Mineralocorticoid Glucocorticoid Commonly Used Name a Estimated Potency b Table 331-9. Glucocorticoid Preparations
21. -Presence of tuberculosis or other chronic infection (chest x-ray, tuberculin test) -Evidence of glucose intolerance or history of gestational diabetes mellitus -Evidence of preexisting osteoporosis (bone density assessment in organ transplant recipients or postmenopausal patients) -History of peptic ulcer, gastritis, or esophagitis (stool guaiac test) Evidence of hypertension or cardiovascular disease -History of psychological disorders A Checklist for Use Prior to the Administration of Glucocorticoids in Pharmacologic Doses
22. -Monitor caloric intake to prevent weight gain. -Restrict sodium intake to prevent edema and minimize hypertension and potassium loss. -Provide supplementary potassium if necessary. -Provide antacid, H2 receptor antagonist, and/or H+,K+-ATPase inhibitor therapy. -Institute alternate-day steroid schedule if possible. Patients receiving steroid therapy over a prolonged period should be protected by an appropriate increase in hormone level during periods of acute stress. A rule of thumb is to double the maintenance dose. -Minimize osteopenia by Administering gonadal hormone replacement therapy: 0.625-1.25 mg conjugated estrogens given cyclically with progesterone, unless the uterus is absent; testosterone replacement for hypogonadal men -Ensuring high calcium intake (should be approximately 1200 mg/d) -Administering supplemental vitamin D if blood levels of calciferol or 1,25(OH)2 vitamin D are reduced -Administering bisphosphonate prophylactically, orally or parenterally, in high-risk patients Supplementary Measures to Minimize Undesirable Metabolic Effects of Glucocorticoids
