Deamethason

I had a stage 4 GBM last year and had surgery to remove. I had radiation a two rounds of Temadar- Chemo.  My MRI do not show tumor progression but my brain showed swelling and inflamation (inflammation) along with narcrosis(sp?) for seveal months. I have been on steriods Dexamthason for 6 months all the way up to 8mg per day. The last MRI showed 50 % less brain swelling and the Oncology Doctor took me off steriods 2 mgs a week until I am taking none.   What are the effects of the withdrawals off steriods?  I am having headaches and mild seizures.

[Fernando Roque, MD]

Hi.  Your headaches and mild seizures may mean that the inflammation and swelling in your brain is returning.  In this case, you need to be placed back on steroids for a few more months to control the brain swelling.  Prolonged steroid use has a lot of effects on the body.  A major effect is that your adrenals shut down and stop producing cortisol, a hormone needed by the body to regulate metabolic functions.  This is the reason why steroid medications can't be withdrawn all at once, and has to be decreased gradually.  This provides the body with some time for the adrenals to recover their function.  Withdrawing the steroids too fast can result in a condition called "adrenal crisis", a serious condition where the body experiences an acute shortage of cortisol (since the adrenals are not yet ready to produce a large amount).  Symptoms include abdominal pain, nausea and vomiting, weakness, dehydration and shock.  Your headaches and mild seizures are probably not a result of adrenal crisis, but are probably due to continued swelling in your brain because of the tumor.  As I have said earlier, you may need to be placed back on steroid medication for a little more time, since you're still having these symptoms.