## **Core Concept**
Systemic steroids, also known as corticosteroids, are widely used for their potent anti-inflammatory and immunosuppressive properties. They can affect various bodily systems and have numerous side effects. The question tests the understanding of the side effects associated with systemic steroid use.

## **Why the Correct Answer is Right**
Hypokalemia, or low potassium levels, is not a direct side effect of systemic steroids. In fact, systemic steroids can cause hyperkalemia (high potassium levels) due to the mineralocorticoid effects of some steroids, particularly those with significant aldosterone-like activity. However, the most commonly associated electrolyte imbalance is hypokalemia indirectly through other effects like increased renal potassium excretion in the context of mineralocorticoid activity, but directly steroids can cause hyperkalemia.

## **Why Each Wrong Option is Incorrect**
- **Option A:** Systemic steroids can cause **Cushing's syndrome**, which includes a range of symptoms and signs such as weight gain, hypertension, and glucose intolerance, due to the excess of cortisol.
- **Option B:** Steroids are known to cause **osteoporosis** as a side effect, particularly with long-term use. This is due to the interference with calcium metabolism and bone formation.
- **Option C:** **Immune suppression** is a well-known effect of systemic steroids. They suppress the immune system by affecting various immune cells, making patients more susceptible to infections.
- **Option D:** Systemic steroids can lead to **hypertension** through several mechanisms, including sodium retention and increased sensitivity to catecholamines.

## **Clinical Pearl / High-Yield Fact**
A key point to remember is that not all steroids have the same side effect profile. The side effects can vary depending on the specific steroid used, its dose, and the duration of therapy. For example, **fludrocortisone**, a synthetic corticosteroid with significant mineralocorticoid activity, can cause more pronounced electrolyte and fluid balance changes compared to **prednisone**, which has less mineralocorticoid activity.

## **Correct Answer:** . Hypokalemia