Table 5 Assessment and monitoring of patients scheduled for long-term 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) | ||