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Reproductive system
Administration of glucocorticosteroids reduces testosterone levels in men. Data from animal studies suggest that one of the possible mechanisms of this effect is impairment of LH signal transduction and steroidogenesis in the Leydig cells. Estrogen is reduced in women after glucocorticosteroid treatment and menstrual irregularities and amenorrhea can occur. Delayed puberty can also be observed. Corticosteroid use during pregnancy may cause intrauterine growth retardation and adrenal suppression in the baby.
Other endocrine effects
Typically, the side effects of long-term glucocorticosteroid administration on the endocrine system include iatrogenic Cushing’s syndrome, diabetes mellitus, adrenal atrophy and growth retardation. The Cushing’s syndrome is characterized by a moon face, buffalo hump, central obesity, glucose intolerance, osteoporosis, etc. Glucocorticosteroid excess causes decreased glucose tolerance and insulin resistance and one fifth of patients may develop overt diabetes. Upon discontinuation of the steroids, the diabetes normally disappears.
Glucocorticosteroid administration suppresses hypothalamic-pituitary-adrenal axis. Glucocorticoids inhibit ACTH secretion by acting directly on the anterior pituitary and by inhibiting the secretion of CRH from the hypothalamus. The suppression of ACTH levels leads to atrophy of the adrenal cortex and secondary adrenal insufficiency with low endogenous cortisol concentrations. This adrenal insufficiency becomes clinically relevant if exogenous therapy is withdrawn too rapidly or in the case of stressful situations when higher glucocorticosteroid levels may be required. For example the frequent use of glucocorticosteroids by athletes necessitates testing for adrenal insufficiency because of the risk of death in cases of associated severe stress (trauma, infection, surgery). In addition, it is not only the synthesis of endogenous glucocorticosteroids that is depressed but also the synthesis of the adrenal androgens. In females, this way may lead to nullification of androgen-dependent anabolism, e.g. of the bones. Glucocorticosteroids can inhibit linear growth in children.
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