Question

Which effect might be taking a glucocorticoid have on a patient's metabolic panel?

Answer 1

Glucocorticoid is a steroid hormone, which is produced by the adrenal gland in human body. It is used as anti-inflammatory and immunosuppressant agent for the patients in the treatment of bronchial asthma, auto-immune diseases and administered to the patients beforehand who would be undergoing organ transplant.

There are different effects of glucocorticoids on patient's metabolic panel which are as follows -

1. Metabolic effect on carbohydrate metabolism:

Excess intake of glucocorticoid can decrease glucose utilization which increases the production of hepatic glucose and stimulate glucagon secretion. The following can be observed.

• It stimulates Gluconeogenesis (production of glucose).
• Decrease of glucose utilization by cells.
• Concentration of blood glucose increases.

2. Metabolic effect on protein metabolism:

This steroid decreases the rate of protein synthesis and protein breakdown within 3-4 hours. With prolonged therapeutic use of glucocorticoid; muscle wasting and concomitant weakness can be observed.

3. Metabolic effect on glucose metabolism:

This steroid promotes glucose production in the liver and reduces the sensitivity of cells to insulin. As a result glucose accumulates in the body and can cause a rise in blood sugar levels. The side effects vary from person to person based on the dose of glucocorticoids. At the time of glucocorticoid intake the blood sugar levels in patient should be monitored more often than regular intervals to keep a track of the drug's impact on diabetes control.

4. Metabolic effect on mineral and bone metabolism:

The long term exposure to glucocorticoids result in decrease of cell proliferation and reduced protein synthesis. Reduction in osteoblast proliferation is associated with reduced cyclin-dependent kinases and cyclin-D3. The reduction in protein synthesis by osteoblast is directed by glucocorticoid regulators - osteoblasts gene, osteocalcin, osteopontin, fibronectin, alkaline phosphatase and collagenase. This results in reduction of osteoblasts numbers which in turn effects bone formation.

5. Metabolic effect on fat metabolism:

The fatty acids mobilize from adipose tissue thereby increase in the concentration of free fatty acids in the plasma and increases utilization of energy. Glucocorticoids also enhance the oxidation of fatty acids in cell. This results in excess stimulation of food intake with fat being generated in some tissues of the body more rapidly than it is mobilized and oxidized. As a result a type of obesity where excess fat is deposited in the chest and head regions of the body giving a buffalo-like torso and a rounded 'moon-face'.