Steroid Drugs

The most important drugs used are corticosteroids which aim to mimic or block the effects of the natural glucocorticoid (cortisol) and mineralocorticoid (aldosterone).

– During  illness, patients usually double the corticosteroid dose but keep mineralocorticoid dose the same

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

e.g. Fludrocortisone

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

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
Side effects

• Adrenal suppression

• Hypertension

• Peptic ulcer – increase gastric acid secretion

• Muscle breakdown

• Osteoporosis

• 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.

Sources

Image 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

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