The degree and extent of bone loss is most closely related to cumulative corticosteroid dose. The most rapid rate of bone loss is during the first 3 to 6 months of therapy. All patients starting gluocorticoids at any dose with an anticipated duration of at least 3 months or longer should start calcium 1200-1500mg/day and vitamin D 800-1000 international units/day supplementation. These patients should also be counseled on smoking cessation and weight-bearing activities. Additionally, they should be assessed for fall risk, baseline height, and history of fragility fractures.
Psychiatric Disorders : psychic disturbances, psychological dependence, insomnia. A wide range of psychiatric reactions including affective disorders ( such as irritable, euphoric, depressed and labile mood, and suicidal thoughts), psychotic reactions (including mania, delusions, hallucinations and aggravation of schizophrenia), behavioural disturbances, irritability, anxiety, sleep disturbances, and cognitive dysfunction including confusion and amnesia have been reported. Reactions are common and may occur in both adults and children. In adults, the frequency of severe reactions have been estimated to be 5-6%. Psychological effects have been reported on withdrawal of corticosteroids; the frequency is unknown.
Variability in cortisol assays creates an additional problem with setting criteria for a normal response to ACTH that apply to all centers. Two studies comparing cortisol results obtained with different assays showed a positive bias of radioimmunoassays and immunofluorometric enzyme assays of 10 to 50 percent compared with a reference value obtained using isotope dilution gas chromatography-mass spectrometry. As a result, in one study, depending on the combination of assay and criterion used, between 0 and 100 percent of healthy volunteers would be considered to have a normal response to ACTH. This illustrates the difficulty of interpreting cortisol responses that are close to the cutoff point. (3)