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.
Glucocorticoid Mimics
These drugs are used for replacement therapy for adrenal insufficiency.
They also have anti-inflammatory actions to suppress the immune system in hypersensitivity reactions and autoimmune conditions.
They also cause a reduction on intracranial pressure in tumours and infections.
In illness, patients usually double the corticosteroid dose but keep mineralocorticoid dose the same.
Short-acting – Hydrocortisone
Intermediate acting – Prednisolone
Long-acting – Dexamethasone
Steroids are taken in the morning as they have an awakening affect.
Steroids suppress the HPA axis, so patients should be weaned off the drugs slowly to allow for adrenal recovery and prevent them from going into an Addisonian crisis.
Side effects
Adrenal suppression
Steroid-induced diabetes
Hypertension
Weight gain
Peptic ulcer formation
Poor wound healing
Muscle breakdown
Cataracts and glaucoma
Osteoporosis
Steroid-induced psychosis
Hyperglycaemia
Mineralocorticoid mimics – Fludrocortisone
This is used for long-term mineralocorticoid replacement. It mimics aldosterone increasing sodium reabsorption from the kidney to maintain blood pressure.
It is used in replacement therapy in conditions such as Addison’s disease and congenital adrenal hyperplasia.
Side effects
Sodium retention leading to hypertension and hypokalaemia
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