Steroids withdrawal effects
Pro Research Analysisby 
Searched over 200M research papers
Consensus Meter
Steroid Withdrawal Effects: Insights from Recent Research
Introduction to Steroid Withdrawal
Steroid withdrawal, particularly after long-term use, can have significant physiological and psychological effects. This article synthesizes findings from multiple studies to provide a comprehensive overview of the impacts of steroid withdrawal, focusing on blood pressure, adrenal function, immune response, and metabolic effects.
Blood Pressure and Circadian Rhythm
Blood Pressure Reduction in Renal Transplant Recipients
Steroid withdrawal has been shown to significantly reduce blood pressure in renal transplant recipients. A study on pediatric renal transplant patients demonstrated that steroid withdrawal led to a substantial decrease in the percentage of patients with arterial hypertension and a significant reduction in the need for antihypertensive medication. Another study confirmed these findings, showing that steroid withdrawal generally results in a reduction in blood pressure, particularly in patients who were hypertensive prior to withdrawal.
Recovery of Circadian Blood Pressure Rhythm
Steroid withdrawal also positively impacts the circadian rhythm of blood pressure. In pediatric renal transplant recipients, the withdrawal of steroids led to the recovery of nocturnal blood pressure dipping, restoring a normal circadian rhythm in a significant proportion of patients.
Adrenal Function and Symptomatic Complications
Impaired Adrenal Function
Long-term steroid use suppresses endogenous corticoid hormone synthesis, leading to impaired adrenal function. Upon withdrawal, a significant number of patients exhibit symptoms such as fatigue, arthralgias, muscular weakness, and hypotension due to the suppressed adrenal response. This suppression is more pronounced in patients with low basal fasting cortisol concentrations and those who have been on steroids for more than two years.
Clinical Implications
The clinical implications of impaired adrenal function include a slight decrease in renal graft function and mean arterial pressure, particularly in symptomatic patients. Therefore, it is recommended to monitor basal cortisol levels before attempting steroid withdrawal to identify patients at risk of complications.
Immune Response and Rejection Risk
Risk of Acute Rejection
Steroid withdrawal in kidney transplant recipients has been associated with an increased risk of acute rejection. Systematic reviews have shown that both early and late steroid withdrawal significantly increase the risk of acute rejection compared to continuous steroid use. However, preliminary results from a controlled trial suggest that steroid withdrawal at three months post-transplantation does not significantly increase the formation of donor-specific anti-HLA antibodies or the incidence of rejection.
Long-Term Immunosuppressive Therapy
In pediatric liver transplant recipients treated with tacrolimus, steroid withdrawal was feasible in the majority of cases, with many patients successfully transitioning to tacrolimus monotherapy without significant adverse effects.
Metabolic Effects
Diabetes Mellitus and Kidney Function
Early steroid withdrawal in heart transplant recipients has been linked to a higher incidence of diabetes mellitus and more severe stages of kidney failure compared to those who continued steroid therapy for a longer duration. However, a study on renal transplant patients indicated that steroid avoidance or early withdrawal could lead to improvements in steroid-related adverse events such as weight gain, hypertension, and dyslipidemia.
Endocrine and Behavioral Effects
High-dose anabolic steroid administration can acutely suppress the reproductive axis and impact thyroid axis balance, leading to mood and behavioral changes such as increased aggressiveness and cognitive symptoms. These effects highlight the complex interplay between endocrine changes and psychological symptoms during steroid withdrawal.
Conclusion
Steroid withdrawal can lead to significant improvements in blood pressure control and circadian rhythm recovery, particularly in hypertensive patients. However, it also poses risks such as impaired adrenal function, increased risk of acute rejection, and metabolic complications. Careful monitoring and individualized approaches are essential to mitigate these risks and optimize patient outcomes during steroid withdrawal.
Sources and full results
Most relevant research papers on this topic