Overview
Harmful use of corticosteroids refers to inappropriate or excessive use leading to adverse outcomes, potentially masking clinical deterioration, especially in palliative care settings 14.Diagnosis
Clinical signs of corticosteroid misuse: rapid weight gain, moon face, buffalo hump, easy bruising 4.
Monitoring for masked signs of impending death in palliative care patients receiving dexamethasone 1.
Laboratory tests for corticosteroid levels may be considered for confirmation but are not routinely specified 3.Management
Tapering and discontinuing corticosteroids under medical supervision to avoid withdrawal symptoms 4.
Supportive care addressing specific complications such as infections, metabolic disturbances, and psychiatric issues 4.
Communication with patients and families about the risks and benefits of corticosteroid use 4.Special Populations
Palliative Care: Caution in recognizing the dying phase due to potential masking effects of dexamethasone on clinical deterioration 1.
No specific guidance provided for pregnancy, pediatrics, or elderly populations 234.Key Recommendations
Closely monitor palliative care patients on dexamethasone for signs of masked clinical decline, adjusting care plans accordingly (Evidence: Weak 1).
Implement a structured tapering regimen when discontinuing corticosteroids to prevent withdrawal symptoms (Evidence: Expert opinion 4).
Enhance communication strategies with patients and families regarding the risks of corticosteroid misuse, particularly in palliative settings (Evidence: Expert opinion 4).References
1 van Esch HJ, Lokker ME, Geijteman EC, van der Heide A, van Zuylen L. Can the Dying Phase Be Masked by the Use of Dexamethasone? A Case Report. Journal of pain & palliative care pharmacotherapy 2016. link
2 Borchers AT, Keen CL, Gershwin ME. Use and misuse of corticosteroids. Comprehensive therapy 2003. link
3 Creaser CS, Feely SJ, Houghton E, Seymour M. Immunoaffinity chromatography combined on-line with high-performance liquid chromatography-mass spectrometry for the determination of corticosteroids. Journal of chromatography. A 1998. link00888-1)
4 Goldberg RL, Wise TN. Corticosteroid abuse revisited. International journal of psychiatry in medicine 1986. link