The most important drugs used are corticosteroids which aim to mimic or block the effects of the natural glucocorticoid (cortisol) and mineralocorticoid (aldosterone).
– In illness, patients usually double the corticosteroid dose but keep mineralocorticoid dose the same
a) Mineralocorticoid mimics
These primarily affect the kidney, regulating salt and water balance and increasing Na+ retention
– They are used in replacement therapy to maintain electrolyte and fluid balance in hypoaldosteronism
This is used for long-term mineralocorticoid replacement.
– Used in Addison’s disease and congenital adrenal hyperplasia
Side effects: Sodium retention leading to hypertension + hypokalaemia
b) Glucocorticoid mimics
These drugs have a variety of uses:
– Used for replacement therapy for primary/secondary insufficiency
– Anti-inflammatory actions to settle down the immune system in hypersensitivity disorders
– Immunosuppression for autoimmune diseases
– Reduction on intracranial pressure in tumours and infections
There are several different types of corticosteroids which mimic the effects of cortisol.
- Short-acting – Hydrocortisone (1st drug of choice for replacement therapy)
- Intermediate acting – Prednisolone
- Long-acting – Dexamethasone
– Adrenal suppression
– Peptic ulcer – increase gastric acid secretion
– Muscle breakdown
– Hyperglycaemia including steroid-induced diabetes and weight gain
– Poor wound healing
– Cataracts and glaucoma
– Steroid-induced psychosis
It is advisable to take steroids in the morning as they have an awakening effect which can lead to insomnia.
– Patients stopping long-term glucocorticoid therapy must be weaned of the drug slowly, to allow for adrenal recovery and prevent them from going into an Addisonian crisis.
1. Barbot M, Ceccato F, Scaroni C. Diabetes Mellitus Secondary to Cushing’s Disease. Front Endocrinol (Lausanne). 2018;9. doi:10.3389/fendo.2018.00284