Gynecomastia is an adverse effect of all of the following drugs except:

ESSENTIAL of MEDICAL PHARMOCOLOGY SIXTH EDITION -KD TRIPATHI Page:298 Adverse effect of coisol: 1.Cushing habitus 2.Fragile skin, purple striae-typically on thighs and lower abdomen, easv bruising, telangiectasis, hirsutism. Cutaneous atro- phy occurs with topical use also. 3. Hyperglycaemia, may be glycosuria, preci- pitation of diabetes. -!. Muscular weakness: proximal (shoulder, arm, pelvis, thigh) myopathy occurs occa- sionally-withdraw coicoids. 5. Susceptibility to infection: this is nonspeci- fic; latent tuberculosis may flare; oppou- nistic infections with low grade pathogens (Candida, etc.). 6. Delayed healing: of wounds and surgical incisions. 7. Peptic ulceration: risk is doubled; bleeding and silent perforation of ulcers may occur. Dyspeptic symptoms are frequent with high dose therapy. 8. Osteoporosis: Specially involving veebrae and other flat spongy bones. Compression fractures of veebrae and spontaneous frac- ture of long bones can occur, especially in the elderly. Radiological evidence of osteo- porosis is an indication for withdrawal of coicoid therapy. Coicosteroid induced osteoporosis can be prevented/ arrested by calcium supplements + vit D, bisphospho- nates and by estrogen/ androgen replace- ment therapy in females I males respectively. Avascular necrosis of head of femur, humerous, or knee joint is an occasional abrupt onset complication of high dose coicosteroid therapy. 9. Posterior subcapsular cataract may deve- lop after several years of use, especially in children. 10. Glaucoma: may develop in susceptible individuals after prolonged topical therapy. 11. Growth retardation: in children occurs even with small doses if given for long periods. Large doses do inhibit GH secretion, but this may in addition be a direct cellular effect of coicoids. Sectic- 12. Foetal abnormalities: . Fragile skin, purple striae-typically on thighs and lower abdomen, easv bruising, telangiectasis, hirsutism. Cutaneous atro- phy occurs with topical use also. 3. Hyperglycaemia, may be glycosuria, preci- pitation of diabetes. -!. Muscular weakness: proximal (shoulder, arm, pelvis, thigh) myopathy occurs occa- sionally-withdraw coicoids. 5. Susceptibility to infection: this is nonspeci- fic; latent tuberculosis may flare; oppou- nistic infections with low grade pathogens (Candida, etc.). 6. Delayed healing: of wounds and surgical incisions. 7. Peptic ulceration: risk is doubled; bleeding and silent perforation of ulcers may occur. Dyspeptic symptoms are frequent with high dose therapy. 8. Osteoporosis: Specially involving veebrae and other flat spongy bones. Compression fractures of veebrae and spontaneous frac- ture of long bones can occur, especially in the elderly. Radiological evidence of osteo- porosis is an indication for withdrawal of coicoid therapy. Coicosteroid induced osteoporosis can be prevented/ arrested by calcium supplements + vit D, bisphospho- nates and by estrogen/ androgen replace- ment therapy in females I males respectively. Avascular necrosis of head of femur, humerous, or knee joint is an occasional abrupt onset complication of high dose coicosteroid therapy. 9. Posterior subcapsular cataract may deve- lop after several years of use, especially in children. 10. Glaucoma: may develop in susceptible individuals after prolonged topical therapy. 11. Growth retardation: in children occurs even with small doses if given for long periods. Large doses do inhibit GH secretion, but this may in addition be a direct cellular effect of coicoids. Sectic- 12. Foetal abnormalities 13.psychiastric disturbance etc