{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T13:50:37Z","timestamp":1776779437644,"version":"3.51.2"},"reference-count":96,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Semin Respir Crit Care Med"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Glucocorticoids (GCs) are essential immunomodulatory agents in the management of critically ill patients with severe systemic inflammation, particularly in conditions such as sepsis, acute respiratory distress syndrome, and severe community-acquired pneumonia. When administered in low-to-intermediate doses for short durations (typically \u22644 weeks, including tapering), GCs have demonstrated substantial benefits in improving patient-centered outcomes, including reduced time on mechanical ventilation, shorter ICU stays, and lower mortality rates. However, the risk-benefit profile of GC therapy in critical illness differs markedly from long-term use in chronic inflammatory diseases and must be carefully evaluated. This study provides an evidence-based synthesis of the most relevant complications associated with the use of GCs in critically ill adults. Hyperglycemia is the most frequent metabolic effect, but it is typically transient and manageable with insulin, and is not associated with worse clinical outcomes. The risk of nosocomial infections has not been shown to increase significantly with appropriate dosing; in fact, immunomodulation by GCs may improve bacterial clearance. Nevertheless, clinicians should remain vigilant for opportunistic infections, particularly invasive fungal infections, in high-risk populations such as those with COVID-19. Musculoskeletal effects, including ICU-acquired weakness, appear to result more from underlying disease and immobilization than from GCs themselves, especially at moderate doses. Neuropsychiatric and gastrointestinal complications are dose-dependent and generally reversible. The transient suppression of the hypothalamic\u2013pituitary\u2013adrenal axis underscores the importance of gradual tapering to prevent inflammatory rebound and adrenal insufficiency. Overall, contemporary data support the safety of GCs when used with precision, directed by patient severity and response to treatment, with careful tapering and monitoring. The incorporation of integrative strategies, such as micronutrient and probiotic supplementation, may enhance GC receptor function and reduce required doses, further improving outcomes. Recognizing and managing potential complications enables clinicians to harness the therapeutic potential of GCs in critical illness fully.<\/jats:p>","DOI":"10.1055\/a-2661-5208","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T23:28:53Z","timestamp":1759966133000},"page":"130-139","source":"Crossref","is-referenced-by-count":3,"title":["Complications Associated with Glucocorticoids Treatment in Critically Ill Patients"],"prefix":"10.1055","volume":"47","author":[{"given":"Paola","family":"Confalonieri","sequence":"additional","affiliation":[{"name":"Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, Hospital of Cattinara, Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicol\u00f2","family":"Reccardini","sequence":"additional","affiliation":[{"name":"Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, Hospital of Cattinara, Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Kette","sequence":"additional","affiliation":[{"name":"Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, Hospital of Cattinara, Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Salton","sequence":"additional","affiliation":[{"name":"Pulmonology Unit, Department of Medical Surgical and Health Sciences, University of Trieste, Hospital of Cattinara, Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,10,8]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"2201514","DOI":"10.1183\/13993003.01514-2022","article-title":"Prolonged higher dose methylprednisolone versus conventional dexamethasone in COVID-19 pneumonia: a randomised controlled trial (MEDEAS)","volume":"61","author":"F Salton","year":"2023","journal-title":"Eur Respir J"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/S2213-2600(24)00405-3","article-title":"Predicting benefit from adjuvant therapy with corticosteroids in community-acquired pneumonia: a data-driven analysis of randomised trials","volume":"13","author":"J M Smit","year":"2025","journal-title":"Lancet Respir Med"},{"issue":"12","key":"ref3","doi-asserted-by":"crossref","first-page":"2078","DOI":"10.1097\/CCM.0000000000002737","article-title":"Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017","volume":"45","author":"D Annane","year":"2017","journal-title":"Crit Care 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Med"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1186\/s40560-018-0321-9","article-title":"Prolonged low-dose methylprednisolone treatment is highly effective in reducing duration of mechanical ventilation and mortality in patients with ARDS","volume":"6","author":"G U Meduri","year":"2018","journal-title":"J Intensive Care"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s40560-020-00464-1","article-title":"Use of glucocorticoids in patients with acute respiratory distress syndrome: a meta-analysis and trial sequential analysis","volume":"8","author":"Y Zayed","year":"2020","journal-title":"J Intensive Care"},{"issue":"04","key":"ref9","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1186\/cc5954","article-title":"Steroids in late ARDS?","volume":"11","author":"N Wajanaponsan","year":"2007","journal-title":"Crit Care"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"69","DOI":"10.3389\/fped.2016.00069","article-title":"Prolonged glucocorticoid treatment in ARDS: impact on intensive care unit-acquired weakness","volume":"4","author":"G U Meduri","year":"2016","journal-title":"Front Pediatr"},{"issue":"08","key":"ref11","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1007\/s00134-022-06684-3","article-title":"Low-dose methylprednisolone treatment in critically ill patients with severe community-acquired pneumonia","volume":"48","author":"G U Meduri","year":"2022","journal-title":"Intensive Care Med"},{"issue":"04","key":"ref12","doi-asserted-by":"crossref","first-page":"358","DOI":"10.4158\/EP.12.4.358","article-title":"Prevalence and predictors of corticosteroid-related hyperglycemia in hospitalized patients","volume":"12","author":"A C Donihi","year":"2006","journal-title":"Endocr Pract"},{"issue":"20","key":"ref13","doi-asserted-by":"crossref","first-page":"11173","DOI":"10.3390\/ijms222011173","article-title":"Glucocorticoid receptor signaling in diabetes","volume":"22","author":"I Kokkinopoulou","year":"2021","journal-title":"Int J Mol Sci"},{"issue":"05","key":"ref14","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1007\/s13300-023-01393-6","article-title":"Practical guide to glucocorticoid induced hyperglycaemia and diabetes","volume":"14","author":"H L Barker","year":"2023","journal-title":"Diabetes Ther"},{"issue":"02","key":"ref15","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1177\/0885066603259551","article-title":"Endocrine changes in critical illness","volume":"19","author":"E S Nylen","year":"2004","journal-title":"J Intensive Care Med"},{"issue":"12","key":"ref16","doi-asserted-by":"crossref","first-page":"2650","DOI":"10.1183\/09031936.96.09122650","article-title":"The role of the host defence response in the progression and 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Kaufmann","year":"2008","journal-title":"Intensive Care Med"},{"issue":"01","key":"ref25","doi-asserted-by":"crossref","first-page":"R3","DOI":"10.1186\/cc10601","article-title":"Early initiation of low-dose corticosteroid therapy in the management of septic shock: a retrospective observational study","volume":"16","author":"H Y Park","year":"2012","journal-title":"Crit Care"},{"issue":"01","key":"ref26","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1164\/rccm.200812-1928OC","article-title":"C5a mediates peripheral blood neutrophil dysfunction in critically ill patients","volume":"180","author":"A Conway Morris","year":"2009","journal-title":"Am J Respir Crit Care Med"},{"issue":"05","key":"ref27","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1378\/chest.111.5.1306","article-title":"Infections and the inflammatory response in acute respiratory distress syndrome","volume":"111","author":"A S Headley","year":"1997","journal-title":"Chest"},{"issue":"01","key":"ref28","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1086\/317645","article-title":"Enhanced extracellular growth of Staphylococcus aureus in the presence of selected linear peptide fragments of human interleukin (IL)-1beta and IL-1 receptor antagonist","volume":"183","author":"S Kanangat","year":"2001","journal-title":"J Infect Dis"},{"issue":"06","key":"ref29","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.1128\/CDLI.8.6.1156-1163.2001","article-title":"Effects of methylprednisolone on intracellular bacterial growth","volume":"8","author":"G U Meduri","year":"2001","journal-title":"Clin Diagn Lab Immunol"},{"issue":"16","key":"ref30","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1056\/NEJMoa051693","article-title":"Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome","volume":"354","author":"K P Steinberg","year":"2006","journal-title":"N Engl 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Med"},{"key":"ref34","first-page":"514","volume-title":"Rationale for Glucocorticoid Treatment in Septic Shock and Unresolving ARDS, in Multiple Organ Failure: Pathophysiology, Prevention, and Therapy, A.E. Baue, E. Faist, and D.E. Fry, Editors","author":"G U Meduri","year":"2000"},{"issue":"18","key":"ref35","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1056\/NEJM198411013111801","article-title":"The effects of high-dose corticosteroids in patients with septic shock. A prospective, controlled study","volume":"311","author":"C L Sprung","year":"1984","journal-title":"N Engl J Med"},{"issue":"21","key":"ref36","doi-asserted-by":"crossref","first-page":"1931","DOI":"10.1056\/NEJMoa2215145","article-title":"Hydrocortisone in severe community-acquired pneumonia","volume":"388","author":"P F Dequin","year":"2023","journal-title":"N Engl J Med"},{"issue":"03","key":"ref37","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.chest.2022.08.2229","article-title":"Effect of corticosteroids on mortality and clinical cure in community-acquired pneumonia: a systematic review, meta-analysis, and meta-regression of randomized control trials","volume":"163","author":"N Saleem","year":"2023","journal-title":"Chest"},{"issue":"175","key":"ref38","doi-asserted-by":"crossref","first-page":"240131","DOI":"10.1183\/16000617.0131-2024","article-title":"Safety of steroids in severe community-acquired pneumonia","volume":"34","author":"F V Piedepalumbo","year":"2025","journal-title":"Eur Respir Rev"},{"issue":"01","key":"ref39","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s13054-022-03902-8","article-title":"Corticosteroids as risk factor for COVID-19-associated pulmonary aspergillosis in intensive care patients","volume":"26","author":"R Leistner","year":"2022","journal-title":"Crit Care"},{"issue":"02","key":"ref40","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1056\/NEJMoa071366","article-title":"Hydrocortisone therapy for patients with septic shock","volume":"358","author":"C L Sprung","year":"2008","journal-title":"N Engl J Med"},{"issue":"09","key":"ref41","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1056\/NEJMoa1705835","article-title":"Adjunctive glucocorticoid therapy in patients with septic shock","volume":"378","author":"B Venkatesh","year":"2018","journal-title":"N Engl J Med"},{"issue":"02","key":"ref42","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1001\/jamainternmed.2018.5849","article-title":"Association of corticosteroid treatment with outcomes in adult patients with sepsis: a systematic review and meta-analysis","volume":"179","author":"F Fang","year":"2019","journal-title":"JAMA Intern Med"},{"issue":"09","key":"ref43","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1056\/NEJMoa1705716","article-title":"Hydrocortisone plus fludrocortisone for adults with septic shock","volume":"378","author":"D Annane","year":"2018","journal-title":"N Engl J Med"},{"issue":"04","key":"ref44","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1517\/14740338.2016.1140743","article-title":"Long-term side effects of glucocorticoids","volume":"15","author":"M Oray","year":"2016","journal-title":"Expert Opin Drug Saf"},{"issue":"05","key":"ref45","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/j.autrev.2012.12.002","article-title":"Long-term complications of past glucocorticoid use","volume":"12","author":"L P Seguro","year":"2013","journal-title":"Autoimmun Rev"},{"issue":"07","key":"ref46","doi-asserted-by":"crossref","first-page":"3167","DOI":"10.1210\/jc.2002-021827","article-title":"Randomized placebo-controlled trial of androgen effects on muscle and bone in men requiring long-term systemic glucocorticoid treatment","volume":"88","author":"B A Crawford","year":"2003","journal-title":"J Clin Endocrinol Metab"},{"issue":"01","key":"ref47","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1186\/s13054-015-0993-7","article-title":"Clinical review: intensive care unit acquired weakness","volume":"19","author":"G Hermans","year":"2015","journal-title":"Crit Care"},{"issue":"22","key":"ref48","doi-asserted-by":"crossref","first-page":"2859","DOI":"10.1001\/jama.288.22.2859","article-title":"Paresis acquired in the intensive care unit: a prospective multicenter study","volume":"288","author":"B De Jonghe","year":"2002","journal-title":"JAMA"},{"issue":"09","key":"ref49","doi-asserted-by":"crossref","first-page":"2007","DOI":"10.1097\/01.ccm.0000281450.01881.d8","article-title":"Respiratory weakness is associated with limb weakness and delayed weaning in critical illness","volume":"35","author":"B De Jonghe","year":"2007","journal-title":"Crit Care Med"},{"issue":"01","key":"ref50","first-page":"67","article-title":"Ventilator-induced diaphragmatic dysfunction: what have we learned?","volume":"22","author":"B J Petrof","year":"2016","journal-title":"Curr Opin Crit Care"},{"issue":"05","key":"ref51","doi-asserted-by":"crossref","first-page":"R233","DOI":"10.1186\/cc10475","article-title":"Plasma from septic shock patients induces loss of muscle protein","volume":"15","author":"H W van Hees","year":"2011","journal-title":"Crit Care"},{"issue":"04","key":"ref52","doi-asserted-by":"crossref","first-page":"R1165","DOI":"10.1152\/ajpregu.2000.279.4.R1165","article-title":"NF-kappaB mediates the protein loss induced by TNF-alpha in differentiated skeletal muscle myotubes","volume":"279","author":"Y P Li","year":"2000","journal-title":"Am J Physiol Regul Integr Comp Physiol"},{"issue":"05","key":"ref53","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1007\/s00134-015-4125-2","article-title":"Diaphragmatic dysfunction in patients with ICU-acquired weakness and its impact on extubation failure","volume":"42","author":"B Jung","year":"2016","journal-title":"Intensive Care Med"},{"issue":"03","key":"ref54","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1097\/CCM.0b013e3182374a84","article-title":"Nuclear factor-\u03baB signaling contributes to mechanical ventilation-induced diaphragm weakness*","volume":"40","author":"A J Smuder","year":"2012","journal-title":"Crit Care Med"},{"key":"ref55","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.jns.2014.07.014","article-title":"Muscle and nerve inflammation in intensive care unit-acquired weakness: a systematic translational review","volume":"345","author":"E Witteveen","year":"2014","journal-title":"J Neurol Sci"},{"issue":"03","key":"ref56","doi-asserted-by":"crossref","first-page":"e92048","DOI":"10.1371\/journal.pone.0092048","article-title":"Inflammation-induced acute phase response in skeletal muscle and critical illness myopathy","volume":"9","author":"C Langhans","year":"2014","journal-title":"PLoS One"},{"key":"ref57","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1164\/ajrccm.163.3.2003001","article-title":"Ventilation-induced chemokine and cytokine release is associated with activation of nuclear factor-kappaB and is blocked by steroids","volume":"163","author":"H D Held","year":"2001","journal-title":"Am J Respir Crit Care Med"},{"issue":"05","key":"ref58","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1097\/00003246-200105000-00027","article-title":"Glucocorticoid suppresses neutrophil activation in ventilator-induced lung injury","volume":"29","author":"N Ohta","year":"2001","journal-title":"Crit Care Med"},{"issue":"04","key":"ref59","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1097\/01.CCM.0000205663.92384.E7","article-title":"Ventilation-induced lung injury in rats is associated with organ injury and systemic inflammation that is attenuated by dexamethasone","volume":"34","author":"N Nin","year":"2006","journal-title":"Crit Care Med"},{"key":"ref60","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.bbi.2013.02.004","article-title":"Stress-induced glucocorticoids as a neuroendocrine alarm signal of danger","volume":"33","author":"M G Frank","year":"2013","journal-title":"Brain Behav Immun"},{"issue":"05","key":"ref61","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1183\/09031936.00134006","article-title":"Steroids and histone deacetylase in ventilation-induced gene transcription","volume":"30","author":"H Dombrowsky","year":"2007","journal-title":"Eur Respir J"},{"issue":"04","key":"ref62","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1097\/SHK.0b013e318188b720","article-title":"High-tidal volume ventilation aggravates sepsis-induced multiorgan dysfunction in a dexamethasone-inhibitable manner","volume":"31","author":"N Nin","year":"2009","journal-title":"Shock"},{"issue":"02","key":"ref63","doi-asserted-by":"crossref","first-page":"e57374","DOI":"10.1371\/journal.pone.0057374","article-title":"Dexamethasone attenuates VEGF expression and inflammation but not barrier dysfunction in a murine model of ventilator-induced lung injury","volume":"8","author":"M A Hegeman","year":"2013","journal-title":"PLoS One"},{"issue":"03","key":"ref64","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1590\/S1806-37562015000000350","article-title":"Pre-treatment with dexamethasone attenuates experimental ventilator-induced lung injury","volume":"42","author":"F F Reis","year":"2016","journal-title":"J Bras Pneumol"},{"key":"ref65","doi-asserted-by":"crossref","first-page":"104057","DOI":"10.1016\/j.ebiom.2022.104057","article-title":"Impact of duration of critical illness and level of systemic glucocorticoid availability on tissue-specific glucocorticoid receptor expression and actions: A prospective, observational, cross-sectional human and two translational mouse studies","volume":"80","author":"A T\u00e9blick","year":"2022","journal-title":"EBioMedicine"},{"issue":"01","key":"ref66","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1023\/A:1009870524359","article-title":"An historical review of glucocorticoid treatment in sepsis. Disease pathophysiology and the design of treatment investigation","volume":"3","author":"G U Meduri","year":"1999","journal-title":"Sepsis"},{"issue":"01","key":"ref67","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1007\/s00134-008-1304-4","article-title":"Intensive care unit-acquired neuromyopathy and corticosteroids in survivors of persistent ARDS","volume":"35","author":"C L Hough","year":"2009","journal-title":"Intensive Care Med"},{"issue":"06","key":"ref68","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1007\/s00134-004-2174-z","article-title":"Does ICU-acquired paresis lengthen weaning from mechanical ventilation?","volume":"30","author":"B De Jonghe","year":"2004","journal-title":"Intensive Care Med"},{"issue":"S 03","key":"ref69","first-page":"S612","article-title":"Management issues with exogenous steroid therapy","volume":"17","author":"H Patt","year":"2013","journal-title":"Indian J Endocrinol Metab"},{"issue":"03","key":"ref70","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1152\/physrev.00028.2014","article-title":"The sick and the weak: neuropathies\/myopathies in the critically ill","volume":"95","author":"O Friedrich","year":"2015","journal-title":"Physiol Rev"},{"issue":"05","key":"ref71","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1164\/rccm.200605-665OC","article-title":"Impact of intensive insulin therapy on neuromuscular complications and ventilator dependency in the medical intensive care unit","volume":"175","author":"G Hermans","year":"2007","journal-title":"Am J Respir Crit Care Med"},{"issue":"06","key":"ref72","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1378\/chest.116.6.1733","article-title":"Chronic glucocorticoid therapy-induced osteoporosis in patients with obstructive lung disease","volume":"116","author":"M F Goldstein","year":"1999","journal-title":"Chest"},{"issue":"01","key":"ref73","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.jbspin.2010.02.025","article-title":"Glucocorticoid-induced myopathy","volume":"78","author":"R M Pereira","year":"2011","journal-title":"Joint Bone Spine"},{"key":"ref74","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.jns.2013.12.023","article-title":"Steroid myopathy in patients with chronic respiratory diseases","volume":"338","author":"O S Levin","year":"2014","journal-title":"J Neurol Sci"},{"issue":"05","key":"ref75","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1176\/appi.ajp.2011.11071009","article-title":"Suicidal behavior and severe neuropsychiatric disorders following glucocorticoid therapy in primary care","volume":"169","author":"L Fardet","year":"2012","journal-title":"Am J Psychiatry"},{"issue":"10","key":"ref76","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1176\/appi.ajp.2014.13091264","article-title":"Adverse consequences of glucocorticoid medication: psychological, cognitive, and behavioral effects","volume":"171","author":"L L Judd","year":"2014","journal-title":"Am J Psychiatry"},{"issue":"04","key":"ref77","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1210\/endrev\/bnae008","article-title":"The glucocorticoid receptor: isoforms, functions, and contribution to glucocorticoid sensitivity","volume":"45","author":"J Lockett","year":"2024","journal-title":"Endocr Rev"},{"issue":"04","key":"ref78","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1016\/S0893-133X(99)00054-8","article-title":"Hippocampal remodeling and damage by corticosteroids: implications for mood disorders","volume":"21","author":"E S Brown","year":"1999","journal-title":"Neuropsychopharmacology"},{"issue":"04","key":"ref79","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1038\/nri.2017.1","article-title":"Immune regulation by glucocorticoids","volume":"17","author":"D W Cain","year":"2017","journal-title":"Nat Rev Immunol"},{"issue":"04","key":"ref80","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1080\/08998280.2019.1629223","article-title":"Steroid-induced psychosis","volume":"32","author":"M Janes","year":"2019","journal-title":"Proc Bayl Univ Med Cent"},{"issue":"02","key":"ref81","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.jaad.2016.02.1241","article-title":"Prevention and management of glucocorticoid-induced side effects: a comprehensive review: OCULAR, cardiovascular, muscular, and psychiatric side effects and issues unique to pediatric patients","volume":"76","author":"A Caplan","year":"2017","journal-title":"J Am Acad Dermatol"},{"key":"ref82","doi-asserted-by":"crossref","first-page":"161","DOI":"10.3389\/fendo.2020.00161","article-title":"General adaptation in critical illness: glucocorticoid receptor-alpha master regulator of homeostatic corrections","volume":"11","author":"G U Meduri","year":"2020","journal-title":"Front Endocrinol (Lausanne)"},{"key":"ref83","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.pnpbp.2013.01.005","article-title":"Lymphocyte glucocorticoid receptor expression level and hormone-binding properties differ between war trauma-exposed men with and without PTSD","volume":"43","author":"G Mati\u0107","year":"2013","journal-title":"Prog Neuropsychopharmacol Biol Psychiatry"},{"issue":"06","key":"ref84","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1513\/AnnalsATS.201606-468OC","article-title":"Psychiatric symptoms in survivors of acute respiratory distress syndrome. 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