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Liver toxicity: We are of the firm opinion that liver toxicity is often hyped when it comes to oral steroids. Not all cases of liver toxicity are due to oral steroids, and not all cases of liver toxicity are due to the use of oral steroids. However, we do believe that an increased incidence of liver toxicity is very likely when patients receiving steroid injections come onto our treatment program and the initial diagnosis is liver damage as a result of oral steroids. We have had some patients die of liver failure on the early stages of steroid treatment.
There is a lot to say that we do not believe as the medical community does regarding the safety of steroids and we are not sure that it would be wise to recommend steroid therapy for every case. But, since we have had a few cases such as these, we are not too concerned about the toxicity of the initial oral steroids that are used. We do feel that some cases of liver toxicity in combination with excessive oral steroid use should be investigated by a pathologist. If the case is suspected of liver toxicity, the first step is to remove the patient to an institution. After a pathologist’s investigation and confirmation that the patient has suffered liver failure via steroid therapy, we do believe that the physician should begin considering a liver transplant for this patient.
What type of testing do you recommend if a physician suspects liver failure due to steroid therapy?
Based on our initial investigation, we believe that the best indicator of liver toxicity in an oral steroid use patient is the first sign of hepatocyte necrosis. We always recommend an initial liver biopsy for any oral steroid overdose that involves liver damage. We recommend the follow-up of an autopsy for any liver damage in subjects treated with oral steroids and a liver transplant for patients coming on any type of treatment and any type of liver disease that is suspected of being caused by steroid therapy. Because of the amount of hepatocytes in each case, we would recommend the most extensive liver screening before transplant as well.
Can steroid therapy reduce the risk of liver damage when a hepatocyte membrane membrane is punctured?
Generally, no. An examination of the hepatocytes following puncture is generally not necessary. However, we do recommend that the patient have a liver biopsy performed immediately following the puncture for hepatocyte necrosis if a hepatocyte membrane membrane is punctured. We feel that a single, thorough examination of each hepatocyte for the puncture of the hepatocytes is best. We do not feel that a single examination for hepatocyte necrosis is necessary in any individual case, but the patient may need a more extensive examination depending on the severity of the injury
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