Adrenal Insufficiency is a deceptive disorder that may mimic other diseases and could be lethal once diagnosis is delayed. Management is mainly fluids and steroids. Upon referral to an endocrinologist on his second admission and the fear of another critical condition the patient eventually complied with the medications and improved.
Human ; Male ; Adult ; ADVERSE EFFECTS ; STEROIDS ; DEXAMETHASONE ; CUSHING SYNDROME

Child, Preschool ; Dexamethasone ; adverse effects ; Diaphragm ; drug effects ; Humans ; Infusions, Intravenous ; Male ; Spasm ; chemically induced

OBJECTIVETo study the effects of Methylprednisolone and Dexamethasone on the avascular necrosis of femoral head in chickens.

METHODSThirty-six chickens were randomly divided into 6 groups (n = 6): control group (group A), Methylprednisolone low dose group (group B), Methylprednisolone large dose group (group C), small dose Dexamethasone and horse serum group (group D), middle dose Dexamethasone and horse serum group (group E), and Dexamethasone large dose group (group F). On the 6th and 12th weeks, blood samples were obtained to determine the level of total cholesterol triglyeride (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL). On the 12th week, femoral heads were taken off. Paraffin tissue sections were prepared to detect histopathologic change with hematoxylin and eosin staining.

RESULTSOn the 6th week, compared with group A, the level of CHO increased significantly in group C and group F (P < 0.05), and TG increased in group B, C and group E, while HDL decreased in group B, C and group E. On the 12th week, the level of TG and CHO increased in group B, C, E and group F, and HDL decreased in group C, D and group E (P < 0.05). LDL was not detected in most chickens. The ratio of empty lacuna was higher in group C and group E compared with those of the control group (P < 0.05).

CONCLUSIONMethylprednisolone is easier to induce osteonecrosis of femoral head than Dexamethasone. The condition of metabolic disorder in blood may be the basic pathomechanism of steroid-induced necrosis of femoral head.

Animals ; Chickens ; Cholesterol ; blood ; Dexamethasone ; adverse effects ; Disease Models, Animal ; Femur Head Necrosis ; blood ; chemically induced ; Glucocorticoids ; adverse effects ; Humans ; Methylprednisolone ; adverse effects ; Oligopeptides ; blood

The combination use of dexamethasone and calcium gluconate can be applied to hypersensitivity. Severe hypokalemia is a usual complication of dexamethasone and calcium gluconate therapy, which occurs frequently with therapeutic use. Fatal cases, accidental and intentional, occur frequently in forensic practice. The current case report presented a 43-year-old man with diabetes mellitus with infection, to whom dexamethasone and calcium gluconate were administered in the private clinic. With the development of such clinical symptoms of severe hypokalemia as quadriplegia, he was confirmed to have severe hypokalemia through a biochemical test before dying of arrhythmia. And also it presented pathophysiologic mechanism underlying severe hypokalemia as well as suggestions for clinical practice regarding combination use of dexamethasone and calcium gluconate.
Adult ; Anti-Inflammatory Agents/adverse effects* ; Calcium Gluconate/adverse effects* ; Dexamethasone/adverse effects* ; Diabetes Mellitus ; Fatal Outcome ; Humans ; Hypokalemia/chemically induced* ; Male

Following short-term intubation for general anesthesia, respiratory difficulty may result from laryngeal or subglottic edema after extubation. We have hypothesized that this problem could be pretreated by administering a high-dose of dexamethasone intravenously before extubation. After glottic injuries were made under direct laryngoscopic view, intubation was performed and maintained for 1 hour in 33 rabbits. The rabbits were divided into 3 groups; dexamethasone (1 mg/kg) was administered to group 1(n=12) immediately after intubation and group 2(n=10) just before extubation; group 3(n=11) received normal saline, just before extubation. After extubation, subglottic excursion pressure was measured for 4 hours. 15 injured rabbit larynges and 3 normal ones were extracted for histologic section. 2 of 12 rabbits in group 1; 3 of 10 in group 2; and 5 of 11 in group 3, showed mild stridor after extubation(p>0.05). All rabbits developed maximum increase in subglottic pressure within 2 hours after extubation. Group 1 and 2 showed less increase in pressure compared to group 3(p<0.05), but here was no statistical difference between group 1 and 2(p>0.05). Histologic sections of the larynges showed less submucosal edema, including other changes in group 1 and 2, than in group 3(p<0.05). In conclusion, administering a high-dose of dexamethasone before extubation, is effective in prophylaxis and treatment of laryngeal injuries following short-term intubation in rabbits. This is especially true in edema.
Animal ; Dexamethasone/administration & dosage/*therapeutic use ; Intubation, Intratracheal/*adverse effects ; Laryngeal Edema/etiology/*prevention & control ; Rabbits

OBJECTIVETo study the clinical effect of high-dose gamma globulin pulse therapy for abdominal Henoch-Schönlein purpura (HSP).

METHODSThirty-three children with abdominal HSP were randomly assigned to dexamethasone group (15 children) and gamma globulin group (18 children). The children in the dexamethasone group were treated with dexamethasone and conventional treatment, and those in the gamma globulin group were treated with high-dose gamma globulin pulse therapy in addition to the conventional treatment. Clinical outcome and recurrence rate were observed in both groups.

RESULTSCompared with the dexamethasone group, the gamma globulin group had a significantly shorter onset time of rash, a significantly shorter time to complete regression of rash, a significantly shorter time to abdominal pain remission, and a significantly shorter time to disappearance of bloody stool, as well as comparable time to vomiting remission and length of hospital stay. The gamma globulin group had a significantly higher response rate than the dexamethasone group (95% vs 65%; P<0.05) and a significantly lower recurrence rate within 6 months than the dexamethasone group (5.6% vs 33.3%; P<0.05).

CONCLUSIONSHigh-dose gamma globulin pulse therapy has a marked clinical effect in the treatment of abdominal HSP. It is safe and reliable and has a low recurrence rate, and therefore, it holds promise for clinical application.

Child ; Child, Preschool ; Dexamethasone ; adverse effects ; therapeutic use ; Female ; Humans ; Male ; Purpura, Schoenlein-Henoch ; drug therapy ; Recurrence ; gamma-Globulins ; administration & dosage ; adverse effects

OBJECTIVETo examine the hyperglycemic effects of periocular dexamethasone injection in type 2 diabetic patients after vitreoretinal surgery (VRS).

METHODSThis was a retrospective non-randomized controlled trial. Twenty consecutive hospitalized patients with type 2 diabetes and ocular inflammatory reaction after VRS were enrolled in this study. Ten patients received 2.5 mg dexamethasone and 10 patients received 5 mg dexamethasone. Fourteen consecutive type 2 diabetic patients without ocular inflammatory reaction after VRS were used as control group. We measured fasting blood glucose (FBG) and at 2 h after each meal (post prandial glucose, PBG; 09:00, 13:00, and 19:00 h) after periocular dexamethasone injection. Differences among three groups were determined by q tests.

RESULTSThe PBG levels in both dexamethasone-treated groups started to increase within 5 h after injection (i.e., PBG at 13:00 h), and were significantly increased at 19:00 h after injection (P<0.05). BG levels were almost 2-fold higher than at baseline and compared with the control group. The BG values declined gradually by 24 h to 48 h after injection. There were no differences in BG levels between the two dexamethasone-treated groups (P>0.05), except for PBG at 19:00 h on day 2 after injection (P<0.05).

CONCLUSIONPeriocular dexamethasone injection can cause transient hyperglycemia in diabetic patients after VRS. BG monitoring should be performed following such injection.

Anti-Inflammatory Agents ; administration & dosage ; adverse effects ; Dexamethasone ; administration & dosage ; adverse effects ; Diabetes Mellitus, Type 2 ; blood ; Humans ; Hyperglycemia ; chemically induced ; Injections, Intraocular ; Retrospective Studies ; Vitreoretinal Surgery

Humans ; Multiple Myeloma/drug therapy* ; Feasibility Studies ; Antibodies, Monoclonal/adverse effects* ; Dexamethasone/therapeutic use* ; Antineoplastic Combined Chemotherapy Protocols

This study was aimed to investigate the effect of dexamethasone (Dex) on immunosuppressive ability of mesenchymal stem cells (MSC) during expansion and differentiation of MSC. MSC were cultured in 96-well flat-bottom plates. Proliferation assays were performed by using the BrdU colorimetric ELISA Kit. To explore the effect of Dex on MSC immunosuppressive ability, MSC were firstly cultured in complete culture medium for 14 d with Dex (10 nmol/L), and then, peripheral blood mononuclear cells (PBMNC) were co-cultured with MSC in 96-well flat-bottom plates for 3 d. Phytohemagglutinin A (PHA, 10 µg/ml) was used to stimulate activation of PBMNC. The concentrations of IFN-γ in culture supernatants was detected by ELISA. The results indicated that there was no obvious difference in representative phenotypes of MSC between experimental and control groups after MSC were treated with low concentration of Dex (10 nmol/L) for 14 d, but the suppression of Dex-treated MSC on lymphocyte activation in same concentration of cells was significantly reduced as compared with control group. After the Dex-treated MSC were co-cultured with IFN-γ for 12 h, the immunoregulatory ability of MSC was recovered in a certain degree. It is concluded that the Dex impairs the immunosuppressive ability of MSC, the IFN-γ can protect and reverse the immunosuppressive ability of MSC impaired by Dex, so that, when the immunoregulatory activity of MSC is investigated, it is necessary to avoid adding Dex in the culture medium.
Cells, Cultured ; Dexamethasone ; adverse effects ; Humans ; Immune Tolerance ; drug effects ; Interferon-gamma ; immunology ; Leukocytes, Mononuclear ; Lymphocyte Activation ; immunology ; Mesenchymal Stromal Cells ; cytology ; drug effects ; immunology

This study was purposed to investigate the effects of high-dose dexamethasone on structure and function of thymic epithelial cells (TEC). Male C57BL/6 mice aged 6 to 8 weeks were used as experimental animals. The mice were injected intraperitoneally with dexamethasone (20 mg/kg), and the other mice treated with saline were used as controls. Thymus was harvested at day 5 after treatment. The histological changes of the treated thymus were monitored by HE staining and in situ immunofluorescence staining. The ratio of each subset in the thymus were analyzed by using flow cytometry, and quantitative PCR was applied to detect the expression levels of IL-22 and Foxn1, which represent the regenerative function of thymus. The results showed that compared with control mice, the structure of TEC in mice treated with high-dose dexamethasone was damaged and the thymic cell number was declined dramatically (P < 0.05); the ratios of thymus cell subsets were changed, the number of double positive (DP) thymus cells among these subsets declined sharply (P < 0.05); the expression levels of Foxn1 and IL-22 increased by 34 and 8 folds respectively. It is concluded that the use of high-dose dexamethasone can lead to damage of the structure and function of TEC, and induce up-regulation of the expression of genes related to thymus repair.
Animals ; Dexamethasone ; administration & dosage ; adverse effects ; Epithelial Cells ; cytology ; drug effects ; Forkhead Transcription Factors ; metabolism ; Interleukins ; metabolism ; Male ; Mice ; Mice, Inbred C57BL ; Thymus Gland ; cytology ; drug effects