Exploring the Visual Profile in Pediatric Scoliosis: Insights from a Controlled Comparative Study.

The potent anti-inflammatory and immunosuppressive effects of corticosteroids make them useful for short courses of therapy across a wide range of inflammatory, allergic, autoimmune, and neurologic conditions. However, prolonged use is associated with numerous adverse effects. In a landmark meta-analysis of 93 studies, including 6,602 patients, Conn and Poynard found that chronic corticosteroid use was associated with a higher prevalence of diabetes, osteoporosis, and sepsis []. Corticosteroids disrupt multiple mechanisms involved in glucose homeostasis [,]. Angelopoulos et al. described this process as multifactorial, involving acute hyperglycemia, insulin resistance, and, in some patients, the development of new-onset steroid-induced diabetes []. Acutely, steroid-induced hyperglycemia is driven by a reduction of insulin-mediated glucose uptake into skeletal muscle, increased hepatic glucose production through glycogenolysis, and gluconeogenesis driven by protein catabolism. Over time, corticosteroids lead to peripheral insulin resistance and impaired pancreatic beta cell function, thus resulting in new-onset diabetes. Steroid-induced diabetes is estimated to occur in 10%-20% of patients receiving chronic glucocorticoid therapy and may develop insidiously in patients without a prior history of hyperglycemia []. In severe cases, this metabolic derangement may progress to hyperosmolar hyperglycemic state, a life-threatening endocrinologic emergency characterized by profound hyperglycemia, hyperosmolality, and dehydration [,]. In patients with underlying inflammatory, degenerative, or neuromuscular disorders, corticosteroids may also suppress pain and inflammatory symptoms, potentially delaying recognition of progressive disease. For example, patients with degenerative disc disease and lumbar spinal stenosis may develop radicular symptoms that, if unrecognized or untreated, can progress to cauda equina syndrome. Cauda equina syndrome is a rare but serious neurologic emergency caused by compression of the lumbosacral nerve roots that form the cauda equina []. It commonly presents with severe back pain and red flag symptoms, including saddle anesthesia, bowel or bladder dysfunction, sensory deficits, and radicular pain [,]. Prompt recognition and surgical intervention are critical to prevent permanent neurologic damage [-].