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Table 5 Assessment and monitoring of patients scheduled for long-term systemic corticosteroid therapy

From: A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy

Baseline: Physical: Investigations:
• Weight • CBC
• Height • Glucose (FPG, A1C, 2-h OGTT or casual PG)
• BMI • Lipids (LDL-C, HDL-C, TC, non-HDL-C, TG, ± apo B)
• Blood pressure • BMD
Subsequent monitoring: Bone health (adults):
• Annual height measurement, and questionnaire for incident fragility fracture
• BMD 1-year post GC initiation
  → If stable: assess every 2–3 years
  → If decreased: assess annually
• Lateral spine x-ray in adults ≥65 years to examine for vertebral fractures
• Use FRAX to estimate fracture risk
  → Available at: http://www.sheffield.ac.uk/FRAX
• Consider referral to endocrinologist/rheumatologist if fracture risk is high and/or BMD is decreasing
Bone health (children):
• Consider a baseline spine BMD and lateral spine x-ray in children receiving ≥3 months of GC therapy
• Repeat at intervals (typically yearly) if there is persistence of risk factors:
  → Ongoing steroid therapy   → Declines in spine BMD Z-scores or BMC
  → Low trauma extremity fractures   → Growth deceleration
  → Back pain   → Cushingoid features
• Referral to a pediatric bone health specialist if there is evidence of bone fragility (low-trauma extremity
or vertebral fractures) or declines in BMD Z-scores
HPA-axis functioning (see Table  8 )
Growth (Children & Adolescents):
• Monitor every 6 months and plot on growth curve
• If growth velocity inadequate, refer to pediatric endocrinologist for further assessment
Dyslipidemia and CV Risk (adults):
• Assess lipids 1 month after GC initiation, then every 6–12 months
• Assess 10-year CV risk using FRS
  → Available at: https://www.cvdriskchecksecure.com/FraminghamRiskScore.aspx
Hyperglycemia/Diabetes:
• Screen for classic symptoms at every visit: polyuria, polydipsia, weight loss
• Monitor glucose parameters:
  → For at least 48 hours after GC initiation [38]
  → Then every 3–6 months for first year; annually thereafter
• In children, monitor FPG annually
  → Annual OGTT if child is obese or has multiple risk factors for diabetes
Ophthalmologic Examination:
• Refer for annual examination by ophthalmologist
  → Earlier examination for those with symptoms of cataracts
• Early referral for intra-ocular pressure assessment if:
  → Personal or family history of open angle glaucoma   → Diabetes mellitus
  → Diabetes mellitus   → High myopia
  → High myopia   → Connective tissue disease (particularly rheumatoid arthritis)
  → Connective tissue disease (particularly rheumatoid arthritis)
  1. BMI body mass index, BMC bone mineral content, BMD bone mineral density, CBC complete blood count, FPG fasting plasma glucose, A1C glycated hemoglobin, PG plasma glucose, LDL-C low-density lipoprotein cholesterol, HDL-C high-density lipoprotein cholesterol, TC total cholesterol, TG triglycerides, apo B apolipoprotein B, FRAX Fracture Risk Assessment Tool, CV cardiovascular, FRS Framingham Risk Score, OGTT oral glucose tolerance test.