The Steroid Withdrawal Syndrome: A Review of the Implications, Etiology, and Treatments

Abstract

Steroid therapy is frequently used for chronic pain, particularly inflammatory pain states. Steroid withdrawal syndrome can produce a broad array of signs and symptoms, some of which are not well recognized. High fever is among these. We describe several cases with this clinical scenario and review the syndrome in broader terms.

A prospective study of the hypothalamic-pituitary-adrenal axis in children with acute lymphoblastic leukemia receiving chemotherapy

“…12 One of the most important clinical alarms for laboratory assessment of adrenal decline is detection of the so-called steroid withdrawal syndrome. 13 In our study, 50-75% of ALL children on DXM and PDN developed symptoms and signs of steroid withdrawal syndrome. This agrees with Saracco et al 14 Most of the DXM patients (95%) symptomatized early in their first 3 days of tapering in comparison to 50% of those on PDN whose symptoms occurred by days 4-9.…”

Physician-Reported Corticosteroid Therapy Practices in Certified Palliative Care Units in Japan: A Nationwide Survey

“…3,6 However, long-term corticosteroid use has been reported. 4,7 Corticosteroid withdrawal has different effects such as fever and anorexia, 8 and may exacerbate terminal restlessness. 9 However, a universally accepted protocol for corticosteroid administration, especially for patients in the terminal stage, remains to be established.…”

Retirada da corticoterapia: recomendações para a prática clínica

“…18,19,30 Clinical status is characterized by physical or psychological dependence. 31 Physical dependence is characterized by anorexia, nausea, vomiting, weight loss, asthenia, headache, myalgia, arthralgia, postural hypotension, tachycardia, fever and flaky skin.…”

“…Nevertheless, it is thought that several mediators may be involved, including CRH, vasopressin, proopiomelanocortin, cytokines (interleukin 1 and 6, tumor necrosis factor alpha) prostaglandins (phospholipase A2) and also changes to the noradrenergic and dopaminergic systems. 19,30 Diagnosis is established by demonstrating HPA axis integrity in the presence of symptoms that would suggest adrenal insufficiency. 6 The syndrome is self-limiting, with a duration that varies from 6 to 10 months, and can be easily treated with a temporary increase in corticosteroid dose, followed by slow withdrawal.…”