Cardiovascular risk factors include the alteration or diminishing of her glucose tolerance and hyperinsulinism (become resistant to insulin), a change in lipoproteins (carry cholesterol in blood) fraction which can cause cardiovascular disease and atherosclerosis (deposition of fatty substances onto inner walls of arteries causing blockage), increased triglyceride levels, hypertension (abnormally high blood pressure), changes in her myocardium (middle muscular layer of heart wall), and increased concentration levels of several different clotting factors. Cardiomyopathy (a typically chronic disorder of heart muscle that may involve hypertrophy and obstructive damage to the heart), myocardial infarction (localized death of the myocardium tissue usually leading to heart failure), heart attack, stroke, and cerebro-vascular accidents have all been causes in deaths where AAS abuse was implicated. Of course the liver, the body’s primary filtration system will come under attack as it has to accommodate the increased toxicity. Among the liver problems promoted are holestatic jaundice (failure of bile flow that causes yellowish pigmentation of skin, tissues, and body fluids), peliosis hepatis (blood-filled cysts develop on liver), hepatocellular hyperplasia (unusual increase of an epithelial parenchymatous cell called hepatocytes in the liver), and cancer. Secondary filters such as the kidneys and gallbladder also become more susceptible to disease.
During conventional pharmacologic dose corticosteroid therapy, ACTH production is inhibited with subsequent suppression of cortisol production by the adrenal cortex. Recovery time for normal HPA activity is variable depending upon the dose and duration of treatment. During this time the patient is vulnerable to any stressful situation. Although it has been shown that there is considerably less adrenal suppression following a single morning dose of prednisolone (10 mg) as opposed to a quarter of that dose administered every six hours, there is evidence that some suppressive effect on adrenal activity may be carried over into the following day when pharmacologic doses are used. Further, it has been shown that a single dose of certain corticosteroids will produce adrenal cortical suppression for two or more days. Other corticoids, including methylprednisolone, hydrocortisone, prednisone, and prednisolone, are considered to be short acting (producing adrenal cortical suppression for 1¼ to 1½ days following a single dose) and thus are recommended for alternate day therapy.
A slightly increased number of basophilic hepatic foci were observed in chronic rat studies with budesonide and in carcinogenicity studies an increased incidence of primary hepatocellular neoplasms, astrocytomas (in male rats) and mammary tumours (female rats) were observed. These tumours are probably due to the specific steroid receptor action, increased metabolic burden on the liver and anabolic effects, effects which are also known from other glucocorticosteroids in rat studies and therefore represent a class effect. No similar effects have ever been observed in man for budesonide, neither in clinical trials nor from spontaneous reports.