Table 1.
The Glucocorticoid Toxicity Index (6).
| Composite Glucocorticoid Toxicity Index | Item Weight | Specific List |
| BMI | ||
| Improvement in BMI | −8 | Major increase in BMI |
| No change in BMI | 0 | |
| Moderate increase in BMI | 21 | |
| Major increase in BMI | 36 | |
| Glucose tolerance | ||
| Improvement in glucose tolerance | −8 | Diabetic retinopathy |
| No change in glucose tolerance | 0 | Diabetic nephropathy |
| Worsening of glucose tolerance | 32 | Diabetic neuropathy |
| Worsening of glucose tolerance despite treatment | 44 | |
| Blood pressure | ||
| Improvement in blood pressure | −10 | Hypertensive emergency |
| No change in blood pressure | 0 | Posterior reversible encephalopathy syndrome |
| Worsening hypertension | 19 | |
| Worsening hypertension despite treatment | 44 | |
| Lipids | ||
| Improvement in lipids | −9 | |
| No change in lipids | 0 | |
| Worsening hyperlipidemia | 10 | |
| Worsening hyperlipidemia despite treatment | 30 | |
| Bone density | ||
| Improvement in bone density | −1 | Major decrease in bone density |
| No change in bone density | 0 | Insufficiency fracture |
| Decrease in bone density | 29 | |
| Steroid myopathy | ||
| No steroid myopathy | 0 | Severe steroid myopathy |
| Mild steroid myopathy | 9 | |
| Moderate steroid myopathy or greater | 63 | |
| Skin Toxicity | ||
| No skin toxicity | 0 | Severe skin toxicity |
| Mild skin toxicity | 8 | |
| Moderate skin toxicity or greater | 26 | |
| Neuropsychiatric toxicity | ||
| No neuropsychiatric symptoms | 0 | Psychosis |
| Mild neuropsychiatric symptoms | 11 | GC-induced violence |
| Moderate neuropsychiatric symptoms or greater | 74 | Other severe neuropsychiatric symptoms |
| Infection | ||
| No significant infection | 0 | Grade IV infection |
| Oral/vaginal candidiasis or uncomplicated zoster | 19 | Grade V infection |
| Grade 3 infection or greater | 93 | |
| Endocrine | Adrenal insufficiency | |
| Gastrointestinal | Perforation, peptic ulcer disease | |
| Musculoskeletal | Avascular necrosis, tendon rupture | |
| Ocular | Central serous retinopathy, intraocular pressure elevation, posterior subcapsular cataract. | |
The composite list includes features of glucocorticoid toxicity that are weighted and given numerical scores. The specific list includes adverse features of glucocorticoid treatment but considered significant but are not given a numerical score. Scores can range from −36 to 439, with increasing scores relating to an increase in glucocorticoid toxicity burden and negative scores reflecting an improvement in toxicity (16).
BMI, body mass index; GC, glucocorticoid.