Use of corticosteroids should always be closely monitored by a physician. The medications should be taken only as prescribed and completed as directed. The body needs to adjust after taking corticosteroids, and any unsupervised cessation may cause problems.

People with certain diseases or conditions should not take corticosteroids. A physician may recommend against use of corticosteroids by patients diagnosed with any of the following conditions, most of which occur when corticosteroids are used for longer periods:

• Diabetes, prediabetes or family history of diabetes. Some types of corticosteroids affect control of glucose (blood sugar). In addition, the American Diabetes Association (ADA) cautions that steroids are toxic to the insulin-producing cells of the pancreas and can cause insulin resistance, a major risk factor for diabetes.

A former president of the ADA has warned that the effect of corticosteroids on blood sugar is commonly underestimated, and that these drugs can cause steroid-induced diabetes and can cause dangerous bouts of high glucose (hyperglycemia) in patients who already have diabetes. Steroid-induced diabetes may resolve after the medication is discontinued, unlike other forms of diabetes, which are considered permanent, with the exception of gestational (pregnancy-induced) diabetes.

• Liver diseases. Corticosteroids may not be eliminated from the body at the usual rate when used with this condition. In addition, inhaled corticosteroids may have a stronger effect on individuals with cirrhosis.
  
  
• Glaucoma. Eye disease involving damage to the optic nerve, usually caused by increased pressure inside the eye. Corticosteroids can cause the pressure in the eye to further increase.
  

  

• Osteoporosis. Condition involving decreased bone density. Osteoporosis is also a possible complication of other conditions, including systemic lupus erythematosus (SLE) and diabetes. High doses of corticosteroids can cause osteoporosis to worsen because they cause the body to lose even more calcium. The American College of Rheumatology advises that patients on long-term corticosteroid therapy receive bisphosphonate drugs to avoid bone loss. However, research indicates that many such patients are not getting this treatment.
  
  
• Hypothyroidism. Decreased production of thyroid hormone. Inhaled corticosteroids may have a stronger effect in individuals with this condition.
  
  
• Infections. Corticosteroids can suppress the body’s immune function and cause infections to worsen if left untreated.
  
  
• Reduced wound healing. Corticosteroids can cause delay in wound healing.
  
  
• Chickenpox, measles, or recent exposure to these conditions. Contagious skin diseases can spread to other parts of the body when using corticosteroids.
  
  
• Tuberculosis. Infectious bacterial disease. Corticosteroid use can cause infections to return in individuals with a history of tuberculosis due to immunosuppression (weakening of the immune system).
  
  
• AIDS (acquired immunodeficiency syndrome). Viral disease that weakens the immune system. Corticosteroids can interfere with the treatment of this condition.
  
  
• Strongyloides. Worm infestation. Corticosteroids can cause the condition to heal more slowly or worsen the infection.
  
  
• Amebiasis. Infection from an ameba (one-celled organism). Some types of nasal corticosteroids worsen this condition.
  
  
• Weight gain. Corticosteroids can increase appetite and cause excessive weight gain.
  
  
• Psychosis. Corticosteroids can worsen this mental disorder.
  
  
• Cardiomyopathy (weakened heart muscle), atrial fibrilation (an abnormal heart rhythm) or other heart disease. Some types of corticosteroids can worsen these conditions.
  
  
• Kidney stones or other kidney disorders. Treatment of kidney disease, particularly with dialysis, can be disrupted by the excess water retention that often accompanies use of corticosteroids.
  
  
• High blood pressure. Corticosteroids can exacerbate this condition by causing the body to retain extra water.
  
  
• High cholesterol. Corticosteroids can increase blood cholesterol levels.
  
  
• Stomach ulcer, ulcerative colitis or other gastrointestinal problem. Corticosteroids can mask the symptoms of a serious stomach or intestinal condition.
  
  
• Myasthenia gravis. Muscle weakness caused by this condition could be exacerbated by corticosteroids.