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CORTICOSTEROIDS

 

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Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are involved in a wide range of physiologic processes, including stress response, immune response, and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte levels, and behavior.

Some common naturally occurring steroid hormones are cortisol, corticosterone, cortisone and aldosterone. The main corticosteroids produced by the adrenal cortex are cortisol and aldosterone. Glucocorticoids such as cortisol affect carbohydrate, fat, and protein metabolism, and have anti-inflammatory, immunosuppressive, anti-proliferative, and vasoconstrictive effects. Anti-inflammatory effects are mediated by blocking the action of inflammatory mediators (transrepression) and inducing anti-inflammatory mediators (transactivation). Immunosuppressive effects are mediated by suppressing delayed hypersensitivity reactions by direct action on T-lymphocytes. Anti-proliferative effects are mediated by inhibition of DNA synthesis and epidermal cell turnover. Vasoconstrictive effects are mediated by inhibiting the action of inflammatory mediators such as histidine. Mineralocorticoids such as aldosterone are primarily involved in the regulation of electrolyte and water balance by modulating ion transport in the epithelial cells of the renal tubules of the kidney.

Synthetic pharmaceutical drugs with corticosteroid-like effects are used in a variety of conditions, ranging from brain tumors to skin diseases. Dexamethasone and its derivatives are almost pure glucocorticoids, while prednisone and its derivatives have some mineralocorticoid action in addition to the glucocorticoid effect. Fludrocortisone (Florinef) is a synthetic mineralocorticoid. Hydrocortisone (cortisol) is typically used for replacement therapy, e.g. for adrenal insufficiency and congenital adrenal hyperplasia.

Medical conditions treated with systemic corticosteroids: Allergy and respirology medicine, Asthma (severe exacerbations), Chronic obstructive pulmonary disease (COPD), Allergic rhinitis. Atopic dermatitis. Hives, Angioedema, Anaphylaxis, Food allergies, Drug allergies, Nasal polyps, Hypersensitivity pneumonitis, Sarcoidosis, Eosinophilic pneumonia, Interstitial lung disease, Pemphigus vulgaris, Contact dermatitis, Adrenal insufficiency, Congenital adrenal hyperplasia, Ulcerative colitis, Crohn’s disease, Autoimmune hepatitis, Lymphoma, Leukemia, Hemolytic anemia, Idiopathic thrombocytopenic purpura, Rheumatoid arthritis, Systemic lupus erythematosus, Polymyalgia rheumatica, Polymyositis, Dermatomyositis, Polyarteritis, Vasculitis, Ophthalmology, Uveitis, Keratoconjunctivitis, Multiple sclerosis, Organ transplantation, Nephrotic syndrome, Chronic hepatitis (flare ups), Cerebral edema, IgG4-related disease, Prostate cancer, Tendinosis

Topical formulations are also available for the skin, eyes (uveitis), lungs (asthma), nose (rhinitis), and bowels. Corticosteroids are also used supportively to prevent nausea, often in combination with 5-HT3 antagonists (e.g. ondansetron). Typical undesired effects of glucocorticoids present quite uniformly as drug-induced Cushing's syndrome. Typical mineralocorticoid side-effects are hypertension (abnormally high blood pressure), hypokalemia (low potassium levels in the blood), hypernatremia (high sodium levels in the blood) without causing peripheral edema, metabolic alkalosis and connective tissue weakness. There may also be impaired wound healing or ulcer formation because of the immunosuppressive effects. Clinical and experimental evidence indicates that corticosteroids can cause permanent eye damage by inducing central serous retinopathy (CSR, also known as central serous chorioretinopathy, CSC). A variety of steroid medications, from anti-allergy nasal sprays (Nasonex, Flonase) to topical skin creams, to eye drops (Tobradex), to prednisone have been implicated in the development of CSR. Corticosteroids have been widely used in treating people with traumatic brain injury.