Corticosteroids — Non-endocrine Uses & Long-term Effects

Corticosteroids

Sources: Goodman & Gilman's The Pharmacological Basis of Therapeutics 14e, Ch.50 (Adrenocorticotropic Hormone, Adrenal Steroids, and the Adrenal Cortex), pp.1003–1022 · KDT — Tripathi's Essentials of Medical Pharmacology 8e, Ch.20 (Corticosteroids), pp.306–319 · Katzung — Basic & Clinical Pharmacology 16e, Ch.39 (Adrenocorticosteroids & Adrenocortical Antagonists), pp.740–756

PYQ anchor: RGUHS MD Pharmacology Paper III — Corticosteroids: non-endocrine (pharmacotherapeutic) uses and long-term adverse effects

1. Definition, scope & historical anchor

• Corticosteroids (corticoids) = the C₂₁ steroidal hormones of the adrenal cortex with glucocorticoid, mineralocorticoid and weakly androgenic activities, plus their synthetic analogues; the term conventionally covers natural gluco-/mineralo-corticoids and synthetic derivatives (KDT 8e Ch.20, p.306).
• Two functional classes by physiology, both built on a 21-carbon pregnane (cyclopentano-perhydro-phenanthrene) nucleus: glucocorticoids (cortisol/hydrocortisone — carbohydrate/protein/fat metabolism + anti-inflammatory) and mineralocorticoids (aldosterone — Na⁺/K⁺/fluid balance) (KDT 8e Ch.20, p.306; G&G 14e Ch.50, p.1008).
• A C₁₉ androstane class (DHEA, androstenedione) is also secreted — the adrenal-androgen precursors (G&G 14e Ch.50, p.1008; Katzung 16e Ch.39, p.740).
• The adrenal cortex is essential for life — established mid-19th century; cortex shown more important than medulla (Addison 1849; Brown-Séquard adrenalectomy-fatal experiments) (G&G 14e Ch.50, p.1003; KDT 8e Ch.20, p.306).
• Therapeutic era opened by Hench (1949): dramatic relief of rheumatoid arthritis with cortisone → set the stage for corticosteroid use across a wide variety of diseases. Nobel Prize 1950 to Kendall, Reichstein and Hench (KDT 8e Ch.20, p.306; G&G 14e Ch.50, p.1003).
• Because glucocorticoids act on almost every organ system, the decision to start systemic therapy always demands a deliberate risk–benefit weighing in each patient — the recurring theme of the whole topic (G&G 14e Ch.50, p.1003).
• Normal secretion rates (man): hydrocortisone ≈ 10–20 mg/day (≈ half in the early morning hours); aldosterone ≈ 0.125 mg/day (KDT 8e Ch.20, p.307). Because adrenocortical cells store only minute quantities of hormone, release rate is governed by biosynthesis rate — steroids are hydrophobic and cannot be stored (KDT 8e Ch.20, p.306; G&G 14e Ch.50, p.1005).