There’s a moment in every medical ward round where someone says, “Start steroids,” and another quietly mumbles, “Here we go again…” 🙃
Whether it’s a miracle for autoimmune flares or a backup plan for unexplained inflammation (looking at you, Dr. Basit Khan), steroids are the pharmacological chameleons of medicine. But like any miracle, they come with baggage. And trust me — the baggage is heavy. 💼
At Sheikh Khalifa Bin Zayed Hospital, Quetta, I once saw a young gentleman from Mashkay, Balochistan, with a textbook case of Cushingoid features after self-medicating steroids for joint pain. By the time he reached us, he had moon facies, buffalo hump, and a BP reading that could give Dr. Imran Baloch a panic attack. 😬
So, for all the house officers trying to remember what steroids can ruin (besides your sleep schedule), here’s a mnemonic you won’t forget:
🧠 Mnemonic: “STEROIDS HARM”
| Letter | Side Effect | Clinical Pearl |
|---|---|---|
| S | Sugar ↑ (Hyperglycemia) | Even the leanest patient turns prediabetic faster than chai disappears in OPD. 🍵 |
| T | Thin Skin / Tearing | One scratch and their forearm looks like it went through a thorn bush in Awaran. |
| E | Eye problems (Cataracts, Glaucoma) | Dr. Bilal Chaudhary sees more cataracts from steroids than from sunlight. ☀️👁️ |
| R | Rounded Face (Cushingoid) | “Doctor sahab, chehra motay hogaya hai!” – every third steroid follow-up patient. 😑 |
| O | Osteoporosis | Ask Dr. Faisal Afridi – post-steroid fractures are practically an orthopedic rite. 🦴 |
| I | Infections (Immunosuppression) | TB reactivation? Opportunistic fungi? Been there, seen that. Thanks, steroids. 🦠 |
| D | Depression / Delirium / Psychosis | Dr. Behroz Rahim has a name for it: Prednisolone Psychosis. It’s a real vibe. 😵💫 |
| S | Stomach ulcers / GI bleeding | Steroids + NSAIDs = GI carnage. Protect the gut or face the wrath of hematemesis. |
| H | Hypertension | Seen systolics touch 200? Steroids can pump those numbers way up. 💥 |
| A | Adrenal Suppression | Taper, don’t ghost. The adrenals are like junior doctors – they panic easily. 😅 |
| R | Retardation of growth (in kids) | In Paeds, Dr. Bilal keeps a hawk’s eye on growth charts for good reason. 📏 |
| M | Myopathy (Proximal muscle weakness) | Classic: “Can’t get up from a chair” – the thighs bear the brunt. 🪑🦵 |
💬 Wisdom from the Wards in Quetta, Balochistan
There was this one time during our post-call breakfast (aka “survival chai”), Dr. Danish Ramzan joked, “Steroids can fix anything… including your patient’s sense of reality.”
He wasn’t wrong.
I’ve seen patients walk in euphoric, swear they’re doing great, and then crash with an opportunistic infection because someone forgot to warn them about the immunosuppressive firepower packed in those little white tabs.
In one tragic but educational case, a middle-aged man from Tump, Balochistan, was admitted to CCU with hypertensive urgency. He’d been on steroids for “general body weakness” prescribed by a local Hakeem. His BP? 220/130. His potassium? Let’s just say even Dr. Basit raised his eyebrows — and that doesn’t happen often. 😶
Steroids are potent allies but reckless enemies. Use them with respect, monitor aggressively, and educate your patients like their lives depend on it — because they do.
📌 Pro Tip: Always document the indication, dose, and plan for tapering. That one line can save you an awkward Medico-Legal Committee meeting. You’re welcome. 😉
👨⚕️ Written by:
Dr. Aurangzaib Qambrani
MBBS, PLAB, MRCP-UK
Sheikh Khalifa Bin Zayed Hospital, Quetta
