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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