Dear Dr. Messmer, Thank you so much for your thoughtful reply. I feel much more informed, and comforted by your explanation of steroids. I'm no longer hesitant to try this medication! Best regards, Kate Reid "John Messmer, M.D." <jjm23@p...> wrote: Short answer: not to worry; there should be no problem.
Long answer: The term "steroid" refers to any compound containing a sterol ring structure (I am not going to make this longer with an organic chem lecture so don't worry about what a sterol is). CholeSTEROL is the basic sterol. From cholesterol the body makes other steroids including sex hormones, cortisol, and aldosterone.
For this discussion we are concerned about corticosteroids, that is, steroids produced by the adrenal gland cortex. For administration for medical purposes, there are synthetic versions of these to replicate two basic functions: to reduce inflammation and to retain sodium. When we discuss the dangers of steroids, we are referring to the cortisol type of steroid that reduces inflammation but also suppresses tissue growth and can make a singer not notice that the vocal apparatus is being irritated. These should be used with caution.
The other type is called a mineralocorticoid and is used in high doses to treat people who do not make enough aldosterone, such as, Addisons's disease. In smaller doses it can be used to increase the blood pressure in those who have postural hypotension as you do. It has minimal to no effect on tissue growth or inflammation. Therefore it should have minimal to no effect on the voice.
One other option for hypotension is midodrine. This is not a steroid, It stimulates the alpha adrenergic receptors which cause blood pressure elevation. It can cause a big increase in blood pressure so it requires regular blood pressure monitoring.
John
John Messmer, M.D. Assistant Professor, Family and Community Medicine Penn State Hershey Medical Center
> -----Original Message----- > From: Kate Reid [mailto:radishes@r...] > Sent: Friday, June 21, 2002 1:18 PM > To: vocalist-temporary@yahoogroups.com > Subject: [vocalist] Affects of steroids on the voice > > > > Hello, > I was wondering if anyone has any comments concerning the > long-term use of corticosteroids on the voice (I would > particularly appreciate comments from doctors on the list!). > After nearly a year of passing out and having heart > palpitations on nearly a daily basis, I have been recently > diagnosed with orthostatic tachycardia syndrome, a disorder > that causes the heart rate to increase and blood pressure to > drop dramatically when the patient changes position.... > My specialist has recommended that I take Florinef, which is > a corticosteroid used to regulate blood pressure and retain > fluids and electrolytes.
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