In patients on corticosteroid therapy subjected to unusual
stress, increased dosage of rapidly acting corticosteroids
before, during and after the stressful situation is indicated.
Average and large doses of hydrocortisone or cortisone can cause
elevation of blood pressure, salt and water retention, and
increased excretion of potassium. These effects are less likely
to occur with the synthetic derivatives except when used in
large doses. Dietary salt restriction and potassium
supplementation may be necessary. All corticosteroids increase
calcium excretion. Corticosteroids can produce reversible
hypothalamic-pituitary adrenal (HPA) axis suppression with the
potential for glucocorticosteroid insufficiency after withdrawal
of treatment. Metabolic clearance of corticosteroids is
decreased in hypothyroid patients and increased in hyperthyroid
patients. Changes in thyroid status of the patient may
necessitate adjustment in dosage. Persons who are on drugs which
suppress the immune system are more susceptible to inf