Pharmacologic use of glucocorticoids
- Lynnette K Nieman, MD
Lynnette K Nieman, MD
- Section Editor — Adrenal Disease
- Senior Investigator
- Bethesda, MD
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 using physiologic replacement doses and for treatment of congenital adrenal hyperplasia, for which the dose and schedule may not by physiologic.
●Pharmacologic (usually supraphysiologic) doses of glucocorticoids are used to treat patients with inflammatory, allergic, and immunological disorders. If chronic, this supraphysiologic therapy has many adverse effects, ranging from suppression of the hypothalamic-pituitary-adrenal (HPA) 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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- STRUCTURES OF COMMON SYNTHETIC STEROIDS
- Plasma disappearance half-life
- Activation and inactivation in target cells
- Assays of biologic activity
- CRITERIA FOR INITIATING THERAPY
- Medical emergencies
- Chronic therapy
- ROUTE OF ADMINISTRATION
- Parenteral therapy
- Oral administration
- Nonsystemic administration
- Alternate-day administration
- COMPLICATIONS OF CHRONIC USE
- HPA axis suppression
- Cushing's syndrome (iatrogenic)
- MINIMIZING GLUCOCORTICOID SIDE EFFECTS
- INFORMATION FOR PATIENTS