Q71: Neurology: PLAB/UK(MLA)/AKT Exam style question
Today we will discuss another Q71 Neurology PLAB 1/ UKMLA exam style question.
A 61-year-old woman presents to the emergency department with morning headaches, nausea, and vomiting. An urgent CT head reveals a mass within the right frontal lobe, and a subsequent MRI head confirms a glioblastoma surrounded by edema. The patient is started on dexamethasone for the cerebral edema. Which of the following is a potential side effect of dexamethasone therapy in this patient?
A. Hypoglycemia
B. Bradycardia
C. Hyperkalemia
D. Immunosuppression
E. Hyponatremia
Answer is given below
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The correct answer is D
Explanation
Dexamethasone is a potent glucocorticoid steroid used to treat vasogenic edema that occurs due to the breakdown of the blood-brain barrier, as is commonly seen in patients with brain tumors. Its use is essential in managing cerebral edema in patients with glioblastoma.
However, dexamethasone therapy is associated with several side effects, one of which is immunosuppression (option D). Glucocorticoids, such as dexamethasone, can suppress the immune response, making patients more susceptible to infections. This effect is especially relevant for patients undergoing surgery or other invasive procedures, as well as those receiving concomitant immunosuppressive treatments, such as chemotherapy.
Hypoglycemia (option A) is not a typical side effect of dexamethasone therapy; in fact, glucocorticoids may cause hyperglycemia by increasing gluconeogenesis and insulin resistance.
Bradycardia (option B) is not typically associated with dexamethasone use. Glucocorticoids can cause fluid retention and hypertension but do not directly affect heart rate.
Hyperkalemia (option C) is not a side effect of dexamethasone therapy. Glucocorticoids can cause hypokalemia due to their mineralocorticoid effects, promoting potassium excretion in the kidneys.
Hyponatremia (option E) is not a typical side effect of dexamethasone. Glucocorticoids can cause fluid retention, which may lead to dilutional hyponatremia in some cases, but this is not a direct effect of the drug on sodium levels.
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Reference:
Dexamethasone intravitreal implant for treating diabetic macular oedema | NICE: This is a final draft guidance from NICE that recommends dexamethasone intravitreal implant for treating visual impairment due to diabetic macular edema only if the diabetic macular edema has not responded well enough to non-corticosteroids, or non-corticosteroids are unsuitable. It also specifies the criteria for starting and stopping treatment, and the need for regular monitoring of intraocular pressure and cataract progression. It was published in March 2021.
Dexamethasone and cerebral edema | Alberta Health Services: This is a document from the Alberta Health Services that provides recommendations on the use of dexamethasone in patients with high-grade gliomas and cerebral edema. It covers the indications, dosage, duration, monitoring, and adverse effects of dexamethasone therapy. It was last updated in February 2021.
Hyperosmolar Therapy for Acute Cerebral Edema | Neurocritical Care Society: This is a guideline from the Neurocritical Care Society that evaluates the role of hyperosmolar agents (mannitol, HTS), corticosteroids, and selected non-pharmacologic therapies in the acute treatment of cerebral edema. It provides recommendations regarding initial management of cerebral edema in neurocritical care patients with subarachnoid hemorrhage, traumatic brain injury, acute ischemic stroke, intracerebral hemorrhage, bacterial meningitis, and hepatic encephalopathy. It was published in January 2016.
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