1. 1 ADRENOCORTICOSTEROIDS Major categories of action: Glucocorticoids: affecting intermediary metabolism & resistance to stress Mineralocorticoids: regulation of salt & water retention Corticosteroids with: androgenic activity estrogenic activity

2. 2 Major glucocorticoid: Cortisol Major mineralocorticoid: Aldosterone Major androgen: Dehydroepiandrosterone (DHEA)

3. 3 Adrenocorticosteriods Short acting Cortisone, Hydrocortisone Intermediate acting Prednisone ( ORAL ),Prednisolone, Methylprednisolone Triamcinolone Long acting Dexamethasone, Betamethasone, Paramethasone

4. 4 Actions Metabolism – increases plasma glucose stress hormone Blood cells : decreases Lymphocytes Monocytes Eosinophils, basophils Immune suppression Anti inflammatory action

5. 5 Others Stimulates gastrin secretion Osteoporosis Myopathy

6. 6 Clinical Uses Diagnosis of adrenal function, i.e Dexamethasone suppression test – Cushings syndrome Treatment of Adrenal function disorders – Addison's disease Inflammatory/immunological disorders (at higher doses) Rheumatoid arthritis, osteoarthritis Allergic reactions Bronchial asthma Acceleration of lung maturation

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11. 11 Special considerations During illness - specially if fever is present Supplemental fludrocortisone (mineralocorticoid) Strenuous exercise with sweating During very hot weather Gastrointestinal upsets

12. 12 Glucocorticoid Toxicity Metabolic Effects iatrogenic Cushing's syndrome moon facies fat redistribution; e.g. truncal obesity acne hirsuitism insomnia, increased appetite weight gain muscle wasting skin thinning, bruising hyperglycemia osteoporosis, Impaired wound healing

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14. 14 Other Effects Peptic ulcer development Myopathy Nausea, dizziness, weight loss Subcapsular cataracts Increased intraocular pressure/glaucoma Psychosis (large dose corticosteroids) Benign intracranial hypertension

15. 15 MINERALOCORTICOIDS Sodium/fluid retention Potassium loss-- hypokalemia Hypochloremic alkalosis Hypertension

16. 16 CI - Adrenocorticosteriods Peptic ulcer disease Heart disease/hypertension with congestive heart failure Psychoses Diabetes Osteoporosis Glaucoma

17. 17 Antagonists of Adrenocortical Agents Metyrapone : selective inhibitor of steroid synthesis Use - Cushing's syndrome Major adverse effects: Salt and water retention Hirsuitism

18. 18 Aminoglutethimide: Blocks cholesterol to pregnenolone conversion Uses ; malignancies of Adrenal cortex + Dexamethasone : Breast Ca Ketoconazole: antifungal imidazole Use - Cushing's disease Mifepristone : anti glucocorticoid + anti progestin

19. 19 Anti Mineralocorticoids Antagonist – Spironolactone Competes for the receptors Inhibits Na reabsorption & prevents K excretion Uses Hyperaldosteronism Hirsutism in women Diuretic