Steroid myopathy (SM) was first described in 1932 by Cushing [1]. It can be caused by excessive endogenous or exogenous corticosteroids. Adrenal tumors are associated with excessive endogenous corticosteroid production while excessive exogenous corticosteroid is due to steroid treatment for medical conditions like asthma, chronic obstructive pulmonary disease, and autoimmune diseases such as polymyositis, connective tissue disorders, and rheumatoid arthritis. [2] [3] [4]. On an average, 12% of patients on steroid treatment develop SM [5] with glucocorticoid-induced myopathy being the commonest drug-induced myopathy [6]. Risk factors for the development of SM include the advanced age, patients with cancer, patients with respiratory muscle weakness, debilitation and physical inactivity.

SM can develop either acutely or insidiously. Acute SM is the rapid onset of progressive generalized weakness as well as proximal and distal muscles weakness [7] including respiratory muscle weakness occurring within a week after the onset of treatment with high-dose corticosteroids [8]. It is commonly seen in patients admitted to intensive care who are on mechanical ventilation with neuromuscular blockade. In chronic SM, there is an insidious onset of progressive proximal muscle weakness in the arms and legs. Pelvic girdle muscles are affected more than the arms with sparing of the sphincteric muscles and the muscles innervated by the cranial nerves. Patients may be unable to rise from chairs or climb stairs or raise their arms above their heads to perform activities. With time, myalgias become constant and studies have reported pulmonary symptoms secondary to weakness of the respiratory muscles like the diaphragm [8]. The pattern of SM is identical in iatrogenic SM as well as endogenous SM [5].

• Weakness

  Eight of nine patients with proximal muscle weakness, and two of six without such weakness, experienced a significant decline in respiratory function, leading to symptomatic dyspnea in four patients of the former group. [ncbi.nlm.nih.gov]

  Acute SM is the rapid onset of progressive generalized weakness as well as proximal and distal muscles weakness including respiratory muscle weakness occurring within a week after the onset of treatment with high-dose corticosteroids. [symptoma.com]

• Pain

  Your provider can give you all the risks, benefits, and alternatives, but a needle is placed into the back so that the pain relieving medication can be delivered in the immediate area of the pain. ...Read more See 1 more doctor answer [healthtap.com]

  It is not a painful condition directly, but weak muscles and their tendons are more easily strained, which can lead to pain. [vasculitisfoundation.org]

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: May 12, 2019 [patientslikeme.com]

  Recovery You may have complete recovery or be left with some residual weakness and pain because of muscle damage. Recovery time often takes weeks or months, especially with acute myopathy. [healthfully.com]

• Fatigue

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: May 12, 2019 [patientslikeme.com]

  In addition, patients complain of fatigue, loss of appetite and fever. Polymyalgia rheumatica is often treated with a low-dose of steroids to relieve the muscular pain. Treatment may be needed for two to six years. [livestrong.com]

  Other symptoms of myositis may include Fatigue after walking or standing Tripping or falling Trouble swallowing or breathing Doctors may use a physical exam, lab tests, imaging tests and a muscle biopsy to diagnose myositis. [fpnotebook.com]

  Adrenal insufficiency commonly causes muscle fatigue. The degree of weakness may be difficult to assess but is typically mild. [frontiersin.org]

• Difficulty Climbing Stairs

  Her headaches are gone, but she has difficulty climbing stairs and getting up form a chair.Her blood pressure is 120/70mm Hg, pulse 82/min and respiration are 12/min.Physical examination show 4/5 muscle power in her proximal lower extremities bilaterally [forums.studentdoctor.net]

  Clinical evaluation For the neurological history, a standardized symptom questionnaire was used with special attention given to motor symptoms, weakness, cramps, muscle pain, fatigability, difficulty climbing stairs, and rising from a low seat. [annalsofian.org]

  climbing stairs, arising from a chair, combing hair or lifting objects overhead. [frontiersin.org]

• Pneumonia

  There she developed aspiration pneumonia and had to be intubated. She remained in the ICU for three months, unable to move a muscle and only able to communicate by blinking her eyes. [wrshlaw.com]

  […] patients taking long-term corticosteroid therapy have acquired serious infections such as Tuberculosis and deadly blood infections requiring hospitalization.(10) Some of the infections noted in people taking corticosteroids, such as Pneumocystis Carinii Pneumonia [side-effects-site.com]

  Help please. gratefulltowalkatall over a year ago Hi, I have steroid myopathy after receiving high doses of prednisone for pneumonia. [steadyhealth.com]

  Now that we have the presence of a skeletal muscle angiitis occurring with the serological pANCA and MPO positivity, we’ll review the American Thoracic Society’s consensus criteria for the diagnosis of the idiopathic interstitial pneumonia (IIP) and see [hopkinsarthritis.org]

  Dermatomyositis Systemic manifestations Common: proximal muscle weakness, dysphonia, dysphagia Less common: respiratory muscle weakness, visual changes, abdominal pain Systemic complications/associations Cardiomyopathy Cardiac conduction defects Aspiration pneumonia [aafp.org]

• Increased Appetite

  Short term effects: weight gain, increased appetite, mood swings, insomnia, irritability, increase in blood sugar, and flushing of the skin. Long term effects: steroid-induced diabetes, osteoporosis, glaucoma and cataracts. [understandingmyositis.org]

  […] blood sugar for individuals with diabetes Difficulty in regulating emotion Difficulty in maintaining linear thinking Weight gain due to increased appetite Immunosuppression Corticosteroid-induced lipodystrophy (moon face, central obesity) Depression, [en.wikipedia.org]

• Myopathy

  We recommend that muscle derived enzyme levels should not be used to differentiate steroid myopathy from inflammatory myopathies. [ncbi.nlm.nih.gov]

• Muscle Weakness

  Proximal muscle weakness developed within 15 days in eight of nine patients and was significantly related to the cumulative dose of steroid. [ncbi.nlm.nih.gov]

  Acute SM is the rapid onset of progressive generalized weakness as well as proximal and distal muscles weakness including respiratory muscle weakness occurring within a week after the onset of treatment with high-dose corticosteroids. [symptoma.com]

• Arthritis

  An 8-year-old boy who had been diagnosed as systemic-onset juvenile rheumatoid arthritis were on treatment for 8 months with methotrexate and additional steroids during activation. [ncbi.nlm.nih.gov]

  : Further experience with triamcinolone in treatment of patients with rheumatoid arthritis. Arthritis Rheum. 1:215, 1958. Google Scholar [6] Kahaleel A.A., Edwards R.H.T., Gohil K. [link.springer.com]

  Showing 1-7 of 7 references Steroid myopathy Further experience with triamcinolone in treatment of patients with rheumatoid arthritis Corticosteroid myopathy : a clinical and pathological study Ste - roid myopathy in connective tissue disease The basophil [semanticscholar.org]

  […] corticosteroid production while excessive exogenous corticosteroid is due to steroid treatment for medical conditions like asthma, chronic obstructive pulmonary disease, and autoimmune diseases such as polymyositis, connective tissue disorders, and rheumatoid arthritis [symptoma.com]

• Myalgia

  Myalgias were seen in five patients and unusual sudden weakness in two. Weakness was always most severe in the pelvic girdle muscles; there was a lesser involvement of shoulder girdle and distal muscles. [ncbi.nlm.nih.gov]

  Myopathy, a term used for any disease of the muscles, may consist of muscle pain and tenderness (known as myalgia), fatigue and possibly even flu-like symptoms. [patientslikeme.com]

  Typical presentations include diffuse myalgia and muscle weakness. Our patient received betamethasone, and she had myalgia and progressive muscle weakness. [journals.lww.com]

  With time, myalgias become constant and studies have reported pulmonary symptoms secondary to weakness of the respiratory muscles like the diaphragm. The pattern of SM is identical in iatrogenic SM as well as endogenous SM. [symptoma.com]

• Muscular Atrophy

  […] dysfunction seen with excess PTH was first described by Vicale in 1949 as proximal weakness associated with easy fatigability, atrophy, and hyperreflexia. [annalsofian.org]

  Palpation revealed symmetric muscular atrophy at the pelvic and shoulder girdles. No signs of effusion or ecchymosis were present. [jaoa.org]

• Paresthesia

  She had been suffering, for about 3 years from progressive muscle weakness of the limbs, accompanied by general paresthesia, cramps of the calves and burning muscle pain both at rest and an effort. [ncbi.nlm.nih.gov]

  She had been suffering, for about 3 years from progressive muscle weakness of the limbs, accompanied by general paresthesia, cramps of the calves and burning muscle pain both at rest and on effort. [semanticscholar.org]

  […] sterility, congestive heart failure and stomatitis In refractory cases only Cyclosporine (Sandimmune) 2.5 to 10 mg per kg per day* Impairs T-cell proliferation; nephrotoxicity, lymphoma, hypertension, hypertrichosis, gingival hyperplasia, hepatotoxicity, paresthesias [aafp.org]

  The common presence of paresthesias and Chvostek’s signs suggests that hyperkalemia causes weakness more through its effects on nerve than muscle ( Adeniyi et al., 2004 ). Hypernatremia is rare but known to cause proximal muscle weakness. [frontiersin.org]

• Insomnia

  Short term effects: weight gain, increased appetite, mood swings, insomnia, irritability, increase in blood sugar, and flushing of the skin. Long term effects: steroid-induced diabetes, osteoporosis, glaucoma and cataracts. [understandingmyositis.org]

  "Early experience with the new steroids revealed the occurrence of minor undesirable side-effects, such as facial rounding, hirsutism, diminished carbohydrate tolerance, insomnia, restlessness, weakness, transitory mental clouding, acne, increased skin [side-effects-site.com]

  […] of steroid-induced complications in the setting of aGVHD is similar to that reported for other inflammatory or autoimmune conditions, although the rates of infection complications are higher. 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30 Insomnia [nature.com]

  Mental confusion Memory and attention dysfunction (steroid dementia syndrome) Muscle atrophy[33] Blurred vision Abdominal pain Peptic ulcer Painful hips or shoulders Steroid-induced osteoporosis Stretch marks Osteonecrosis – same as avascular necrosis Insomnia [en.wikipedia.org]

• Asthenia

  […] hypothyroid muscles: type II fiber atrophy, increased numbers of internal nuclei, and "core-like" structures in type I fibers. [11] Various authors have suggested that thyrotoxic myopathy is a result of the overall constellation of weight loss and generalized asthenia [annalsofian.org]

  Prognosis Poor prognostic indicators include recalcitrant disease, delay in diagnosis, older age, malignancy, fever, asthenia-anorexia, pulmonary interstitial fibrosis, dysphagia and leukocytosis. [aafp.org]

• Paresis

  Weakness never exceeded grade 3 paresis. Follow-up During treatment, muscle complaints resolved in 70% of the patients within an average time of 6.4 months (SD 2.3). [annalsofian.org]

• Limb Weakness

  Major criteria include a critical illness (sepsis, multiple organ failure), difficulties with ventilator weaning, and possible limb weakness ( Chawla, 2007 ; Chawla and Gruener, 2010 ; Fernández-Lorente et al., 2010 ). [frontiersin.org]

The workup in SM is focused on differentiating between endogenous hypercortisolism and exogenous glucocorticoid use. Laboratory tests include creatine kinase, lactate dehydrogenase (LDH), and aldose. In acute SM, patients have elevated levels of serum creatine kinase and aldolase [5] [9] with myoglobinuria. On the other hand, in chronic SM the serum levels of creatine kinase are normal but the urine creatinine clearance increases dramatically and can even appear several days prior to the appearance of symptoms of myopathy [2]. Myoglobinuria and rhabdomyolysis are absent in chronic SM.

Electromyography (EMG) and nerve conduction studies (NCS) in acute SM may reveal abnormal spontaneous activity, early recruitment, and small, polyphasic motor units as well as findings suggestive of neuropathy subsequent to high-dose corticosteroid treatment [10] [11].

Muscle biopsy in acute SM shows focal and diffuse necrosis of all types of muscle fibers without the involvement of type II fibers. In chronic SM, the muscle biopsy demonstrates specific atrophy of type IIb muscle fibers, an absence of inflammatory infiltrate, variations in fiber size with centrally placed nuclei, and occasional muscle necrosis [9].

Combined treatment with high-dose GCs, tacrolimus, and intravenous immunoglobulin resulted in beneficial effects against myositis. [ncbi.nlm.nih.gov]

On an average, 12% of patients on steroid treatment develop SM with glucocorticoid-induced myopathy being the commonest drug-induced myopathy. [symptoma.com]

Chronic steroid myopathy is much more variable and can occur weeks, month or years after first treatment or continued treatment. [healthfully.com]

Differential diagnosis between critical illness myopathy and critical illness polyneuropathy is important, as prognosis is more favorable in critical illness myopathy ( Latronico and Bolton 2011 ; Latronico et al 2012 ). [medlink.com]

Idiopathic Inflammatory Myopathy: Managementand Prognosis. Rheum Dis Clin N Am. 2002;28:979–1001. Dalakas M C. Polymyositis, Dermatomyositis and Inclusion BodyMyositis. In: Braunwald E, Fauci A S, Kasper D L, Hauser S L,Longo D L, Jameson J L, eds. [revistas.unimilitar.edu.co]

See section in Myopathies Prognosis[edit | edit source] Corticosteroid-induced myopathy is reversible, with improvement in myopathy within 3 to 4 weeks of tapering corticosteroids, although recovery can take months to a year. [physio-pedia.com]

PROGNOSIS If the underlying cause of the myopathy can be treated successfully, as in the case of endocrine myopathies, the prognosis is usually good. [consultantsinneurology.com]

This subgroup of patients has a better prognosis than adult patients. [aafp.org]

Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10data.com]

Rhabdomyolysis may also be seen with infectious etiologies, alcohol, and toxic exposures. [clevelandclinicmeded.com]

However, there are no sensory deficits and no neurological deficits that would point to a central nervous/spinal cord etiology and no cranial nerve involvement.[7] Patients may have additional sequelae of chronic glucocorticoid administration, including [ncbi.nlm.nih.gov]

Objective: To study the etiology, varied presentations, and outcome after therapy of patients with endocrine myopathies. [annalsofian.org]

The etiology of dermatomyositis remains unknown; some studies have reported an association with histocompatability antigens, environmental agents (e.g., virus, drugs) and autoimmunity. 1 The average age at diagnosis is 40, and almost twice as many women [aafp.org]

Objectives: Outline the epidemiology of corticosteroid-induced myopathy. Explain the pathophysiology of corticosteroid-induced myopathy. Describe the evaluation of corticosteroid-induced myopathy. [ncbi.nlm.nih.gov]

Nonetheless, the patients with myositis experienced an increase in muscle strength, apparently due to factors other than muscle volume change. [15] Epidemiology Frequency United States The exact incidence of steroid myopathy is unknown; sensitivity to [emedicine.medscape.com]

Table 1 Clinical Features of Common Myopathies Myopathy Epidemiology Distribution of Weakness Other Systemic Manifestations Acquired Myopathies Dermatomyositis Female > male Peak incidence: children and ages 40–60 yr Symmetrical proximal muscle weakness [clevelandclinicmeded.com]

Pathogenesis and Epidemiology The mechanism of steroid myopathy is unclear but is possibly related to the steroid's influence on cellular receptors and intracellular signaling molecules. 9, 10 This influence may reduce protein synthesis, increase protein [jaoa.org]

The first classifies the wide variety of disorders that can cause neurologic symptoms the patient with cancer, discusses the pathophysiology of nervous system metastases, the pathophysiology and treatment of brain edema and the approach to supportive [books.google.com]

The pathophysiology of steroid myopathy has not been clarified and may be pronounced. [ard.bmj.com]

Inflammation also has a role in the pathophysiology of most muscular dystrophies, including the dystrophinopathies, facioscapulohumeral dystrophy and the dysferlinopathies. [ncbi.nlm.nih.gov]

Conclusion: Myositis is a rare complication of anabolic steroid injections and the pathophysiological mechanism of this substance is unknown. [revistas.unal.edu.co]

Physical therapy attempts to prevent these sequela. [physio-pedia.com]

Patients should be informed that physical activity can help prevent and mitigate the effects of corticosteroid-induced myopathy, and should be prescribed physical therapy as part of a preventive and treatment regimen. [ncbi.nlm.nih.gov]

Knowledge of the pathogenesis, genetics, and molecular biology of neuromuscular disorders is essential both in developing and applying new therapies and preventive measures, and in formulating genetic and prognostic advice. [books.google.com]

1. Cushing H. The basophil adenoma of the pituitary body and their clinical manifestation. Johns Hopkins Med J. 1932;50:137
2. Askari A, Vignos PJ Jr, Moskowitz RW. Steroid myopathy in connective tissue disease. Am J Med. 1976 Oct;61(4):485-92.
3. Yamaguchi M, Niimi A, Minakuchi M, et al. Corticosteroid-induced myopathy mimicking therapy-resistant asthma. Ann Allergy Asthma Immunol. 2007 Oct;99(4):371-4.
4. Lacomis D, Smith TW, Chad DA. Acute myopathy and neuropathy in status asthmaticus: case report and literature review. Muscle Nerve. 1993 Jan;16(1):84-90.
5. Alshekhlee A, Kaminski HJ, Ruff RL. Neuromuscular manifestations of endocrine disorders. Neurol Clin. 2002;20:35–58.
6. Gupta A, Gupta Y. Glucocorticoid-induced myopathy: pathophysiology, diagnosis, and treatment. Indian J Endocrinol Metab. 2013 Sep-Oct; 17(5): 913-916
7. Van Balkom RH, van Der Heijden HF, van Herwaarden CL, Dekhuijzen PN. Corticosteroid-induced myopathy of the respiratory muscles. Neth J Med. 1994;45:114–22.
8. Dekhuijzen PN, Decramer M. Steroid-induced myopathy and its significance to respiratory disease: a known disease rediscovered. Eur Respir J. 1992 Sep;5(8):997-1003.
9. Pereira RM, Freire de Carvalho J. Glucocorticoid-induced myopathy. Joint Bone Spine. 2011;78:41–4.
10. Ahlbeck K, Fredriksson K, Rooyackers O, et al. Signs of critical illness polyneuropathy and myopathy can be seen early in the ICU course. Acta Anaesthesiol Scand. 2009 Jul; 53(6):717-23.
11. Hanson P, Dive A, Brucher JM, et al. Acute corticosteroid myopathy in intensive care patients. Muscle Nerve. 1997 Nov; 20(11):1371-80