Indiscriminate use of corticosteroids: Silently emerging systemic complications

Glucocorticoids are essential anti-inflammatory and immunosuppressive agents widely used across medical specialties; however, their indiscriminate and prolonged use has been associated with significant systemic complications . This narrative review aimed to synthesize current evidence on the pathophysiological mechanisms underlying corticosteroid-induced adverse effects and to highlight their clinical implications. A comprehensive literature search was conducted in PubMed/MEDLINE, SciELO, and LILACS, prioritizing publications from the last decade, alongside seminal references. The review examined metabolic, cardiovascular, musculoskeletal, immunological, neuropsychiatric, and ophthalmological complications, with particular emphasis on hypothalamic-pituitary-adrenal axis suppression. Chronic exposure to glucocorticoids was associated with insulin resistance, corticosteroid-induced diabetes, dyslipidemia, central adiposity, hypertension, osteoporosis, myopathy, increased susceptibility to infections, impaired wound healing, mood disturbances, psychosis, cataracts, glaucoma, and risk of adrenal insufficiency after abrupt withdrawal. These effects are often dose- and duration-dependent and may develop insidiously, delaying diagnosis and increasing morbidity. In conclusion, although glucocorticoids remain indispensable in clinical practice, their rational prescription—using the lowest effective dose for the shortest duration—combined with proactive monitoring and patient education, is essential to mitigate preventable iatrogenic harm.