Corticosteroids

• Corticosteroids are divided into two main categories based on their primary activity:

Classification of Corticosteroids

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: Hydrocortisone.

• 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:

• 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.