Corticosteroids may cause hypernatremia, hypokalemia, fluid retention, and elevation in blood pressure. These mineralocorticoid effects are most significant with fludrocortisone, followed by hydrocortisone and cortisone, then by prednisone and prednisolone. The remaining corticosteroids, betamethasone, dexamethasone, methylprednisolone, and triamcinolone, have little mineralocorticoid activities. However, large doses of any corticosteroid can demonstrate these effects, particularly if given for longer than brief periods. Therapy with corticosteroids should be administered cautiously in patients with preexisting fluid retention, hypertension, congestive heart failure, and/or renal dysfunction. Dietary sodium restriction and potassium supplementation may be advisable.
Vasculitis is rare but has been described in large, medium and small vessels. Large artery granulomatous inflammation of the vessel wall may resemble Wegener’s granulomatosis, a disease with which sarcoidosis shares many clinical features but not antineutrophil cytoplasmic antibodies. 69 Large artery involvement may also resemble giant cell or Takayasu’s arteritis. Large vessel disease may be a discrete entity or overlap with Blau syndrome (rash, iritis, granulomatous arthritis and a poor prognosis), an autosomal dominant form of the disease. 70 Small- and medium-sized necrotising vasculitis may be implicated in the neurological complications of the disease.