Systemic corticosteroids should be used with great caution in the presence of heart failure, recent myocardial infarction or hypertension, in patients with diabetes mellitus, epilepsy, glaucoma, hypothyroidism, hepatic failure, osteoporosis, peptic ulceration, psychoses or severe affective disorders and renal impairment. Children may be at increased risk of some adverse effects; in addition, corticosteroids may cause growth retardation and prolonged use is rarely justified. The elderly too may be at greater risk from adverse effects.
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