Corticosteroids

• Corticosteroids: Used to treat inflammation, allergies, and adrenal insufficiency.
• Corticosteroids are divided into two main categories based on their primary activity:

1. Glucocorticoids

• Major Hormone:
  • Cortisol (hydrocortisone).
• Effects:
  • Metabolic: ↑ Gluconeogenesis, ↑ blood glucose, protein catabolism, lipolysis.
  • Anti-inflammatory/Immunosuppressive: Inhibit phospholipase A2, ↓ cytokine and antibody production.
• Pharmacologic Agents:
  • Short-acting:
  • Intermediate-acting: Prednisone, Prednisolone, Methylprednisolone.
  • Long-acting: Dexamethasone, Betamethasone.
• Therapeutic Uses:
  • Replacement therapy in adrenal insufficiency (e.g., Addison’s disease).
  • Anti-inflammatory and immunosuppressive therapy (e.g., asthma, rheumatoid arthritis).
  • Diagnosing Cushing’s syndrome (dexamethasone suppression test).
• Adverse Effects:
  • Cushingoid features (weight gain, moon face, buffalo hump), hyperglycemia, osteoporosis, muscle wasting, hypertension, mood changes, adrenal suppression (risk with sudden withdrawal).

2. Mineralocorticoids

• Major Hormone:
  • Aldosterone.
• Effects:
  • Increase sodium and water reabsorption, increase potassium excretion.
• Pharmacologic Agent:
  • Fludrocortisone:
    • Uses: Addison’s disease, congenital adrenal hyperplasia.
    • Adverse Effects: Hypertension, edema, hypokalemia.

3. Synthetic Corticosteroids

• Prednisone:
  • Broad-spectrum anti-inflammatory and immunosuppressive agent.
  • Converted to prednisolone in the liver.
• Dexamethasone:
  • Potent anti-inflammatory with minimal mineralocorticoid activity.
  • Uses include cerebral edema, cancers, and suppression tests.
• Hydrocortisone:
  • Replacement therapy in adrenal insufficiency; retains mineralocorticoid activity.

Clinical Applications of Corticosteroids:

• Inflammatory Diseases: Asthma, arthritis, dermatitis, IBD.
• Autoimmune Disorders: Lupus, MS.
• Cancer Therapy: Hematologic malignancies.
• Endocrine Disorders: Adrenal insufficiency, Cushing’s disease.
• Transplantation: Prevent rejection through immunosuppression.

Side Effects and Management:

• Short-Term Use: Mood swings, increased appetite, fluid retention.
• Long-Term Use: Osteoporosis, adrenal suppression, hyperglycemia, infections, cataracts, muscle weakness.

Management Strategies:

• Tapering: Gradual dose reduction to prevent adrenal insufficiency.
• Bone Protection: Bisphosphonates, calcium, and vitamin D supplementation.
• Monitoring: Regular assessment for side effects and therapy adjustments.

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