Table 3.

Recommendations for use in specific subgroups

Elderly patients	• For treatment of elderly patients, use slightly lower CS dosages and carefully determine compatibility with other existing therapies [39]
Pediatric patients	• Pediatric patients with onset of disease before puberty should be followed at specialized centers • Pediatric patients should initiate Vitamin D and be monitored for growth, weight, and bone density [40] • Pediatric and, primarily, adolescent patients may need psychological support to manage the stress caused by adverse events associated with steroid use [40]
Comorbidities	• In patients with relevant comorbidities, a specialist should be involved in treatment (e.g., diabetologist, cardiologist, pulmonologist, ophthalmologist) [24, 39, 40] • In cancer patients with active disease and ongoing treatments, collaboration with the oncologist is recommended to agree on treatment protocols
Pregnancy	• While there is limited literature, in clinical practice CS are widely used in pregnancy (not only for the treatment of MG) and there are no formal contraindications to their use [7, 20, 41] • The dose must be the minimum necessary and adapted to the clinical status of the patient; the CS should be reduced to the minimum possible tolerated dose [39] • Management of CS therapy must be agreed with the gynecologist [20, 22, 39, 42], since their negative effects may be different depending on the gestational period (in addition to the anesthetist who will follow the birth for any supplementation needed during parturition)
Breastfeeding women	• The administration of a CS at low doses during breastfeeding is not contraindicated [7, 20], but its use should be discussed with a neurologist, gynecologist, and pediatrician