Steroid Myopathy Recognition is the clinical identification of progressive muscle weakness and atrophy, typically affecting the proximal muscle groups, as a direct adverse effect of prolonged or high-dose glucocorticoid exposure. This condition is a significant and often debilitating complication of both endogenous hypercortisolism (Cushing’s syndrome) and long-term therapeutic corticosteroid use. Early and accurate recognition is crucial for initiating appropriate therapeutic adjustments to mitigate the catabolic effects and prevent severe functional impairment.
Origin
This term is a clinical descriptor in neurology and endocrinology, combining ‘steroid’ (referring to glucocorticoids) and ‘myopathy’ (meaning muscle disease). The recognition of this side effect has been documented since the widespread clinical use of corticosteroids began in the mid-20th century. It represents a key consideration in the risk-benefit analysis of all glucocorticoid treatment protocols.
Mechanism
Glucocorticoids exert a potent catabolic effect on skeletal muscle by directly increasing the rate of muscle protein degradation while simultaneously inhibiting protein synthesis. Specifically, the high concentration of cortisol activates the Ubiquitin Proteasome System (UPS) and suppresses key anabolic signaling pathways, such as the Insulin/IGF-1 axis. This sustained catabolic state leads to the selective atrophy of Type II (fast-twitch) muscle fibers, resulting in the characteristic proximal muscle weakness observed clinically.
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