steroidresistant

Steroid resistance, also written as steroidresistant, is a term used in medicine to describe a diminished or absent therapeutic response to glucocorticoids (steroids) that are typically effective for inflammatory or immune-mediated conditions. The concept is applied across several specialties, including pulmonology, nephrology, gastroenterology, and dermatology, where a subset of patients fails to achieve expected improvement with standard corticosteroid therapy.

Mechanisms of steroid resistance are diverse and not fully understood. They can include reduced glucocorticoid receptor expression or function, alterations in receptor signaling, increased activity of pro-inflammatory pathways, pharmacokinetic factors that limit steroid bioavailability, and genetic or epigenetic changes that modify cellular responses to steroids. These factors may act alone or in combination to blunt anti-inflammatory effects.

Common contexts in which steroid resistance is observed include steroid-resistant asthma, where inhaled corticosteroids fail to control symptoms or prevent exacerbations; steroid-resistant nephrotic syndrome, which does not respond to a course of corticosteroids and may progress to kidney failure; and inflammatory bowel diseases, such as ulcerative colitis or Crohn’s disease, that do not respond to systemic or local steroids. Other conditions, including dermatologic and rheumatologic diseases, can also exhibit steroid resistance.

Diagnosis generally involves demonstrating an inadequate clinical response after an appropriate trial of glucocorticoids. Management typically requires steroid-sparing strategies or alternative therapies, such as calcineurin inhibitors, alkylating agents, or biologic agents, as well as supportive care and specialist referral. Prognosis varies by disease and mechanism, but steroid resistance is associated with greater morbidity and treatment challenges. Ongoing research seeks to clarify mechanisms and develop targeted treatments to overcome resistance.