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Pharmacologic use of glucocorticoids

Author
Lynnette K Nieman, MD
Section Editor
André Lacroix, MD
Deputy Editor
Kathryn A Martin, MD

INTRODUCTION

Natural and synthetic glucocorticoids are used in both endocrine and nonendocrine disorders.

In endocrine practice, glucocorticoids are given only to establish the diagnosis and cause of Cushing's syndrome and for treatment of adrenal insufficiency and congenital adrenal hyperplasia.

Pharmacologic doses of glucocorticoids are used to treat patients with inflammatory, allergic, immunological disorders. If chronic, this supra-physiologic therapy has many adverse effects, ranging from suppression of the hypothalamic-pituitary-adrenal axis and Cushing's syndrome to infections and changes in mental status. (See "Major side effects of systemic glucocorticoids".)

A number of factors that influence both the therapeutic and adverse effects of glucocorticoids will be reviewed here, including the biologic potency, pharmacokinetic properties of the glucocorticoid, daily dose, timing of doses during the day, individual differences in steroid metabolism, and the duration of treatment (table 1).

Other issues, including the determinants of steroid dosing and the approach to glucocorticoid withdrawal to prevent adrenal insufficiency and minimize the likelihood of recurrent activity of the underlying disease are discussed separately. (See "Determinants of glucocorticoid dosing" and "Glucocorticoid withdrawal".)

                        

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Literature review current through: Nov 2016. | This topic last updated: Fri May 15 00:00:00 GMT 2015.
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