Glucocorticoids

Cortisol is the most common naturally occurring glucocorticoid.  Aldosterone is the primary naturally occurring mineralocorticoid. Synthetic glucocorticoids have varying ratios of glucocorticoid to mineralocorticoid activity.  Like other steroids, glucocorticoids activate nuclear receptors (glucocorticoid receptor, mineralocorticoid receptor) to induce transcription and subsequent translation.  

Glucocorticoids have many effects on many organ systems which are detailed below.  Diabetes, hyperglycemia, mood lability, and osteoporosis are all adverse effects. Sudden discontinuation of steroids after long-term use can result in an adrenal crisis, so gradual reductions in dosage is important when discontinuing long-term therapy.  

Class Drugs

• Beclomethasone

• Betamethasone

• Ciclesonide

• Cortisone

• Dexamethasone

• Methylprednisolone

• Hydrocortisone

• Prednisolone

• Prednisone

• Triamcinolone

• Fluticasone

• Budesonide

• Mometasone

• Triamcinolone

Class Mechanism of Action

Wide ranging effects

• Stimulate gluconeogenesis and protein catabolism

• Increase levels of circulating hemoglobin, RBCs, platelets, and PMNs

• Decrease levels of lymphocytes, eosinophils, basophils, and monocytes

• Anti-inflammatory by stabilizing mast cells and basophils, inhibition of phospholipase A2, which reduces prostaglandin and leukotrienes

• Immunosuppressive by decreasing lymphocyte levels and response of macrophages and leukocytes to antigens

• Inhibits TSH and ACTH release by feedback mechanism

Mineralocorticoid effects also present but not as prominent

Class Applications

Diagnosis of Cushing syndrome

Treatment of allergies

Lung maturation of fetus

• Betamethasone or dexamethasone given to the mother in expected premature births 48 hours prior to delivery

Treatment of inflammatory conditions such as:

• Inflammatory bowel disease

• Asthma

• Rheumatoid arthritis

• Psoriasis

Class Adverse Effects

Osteoporosis

• Results from decreased calcium absorption, decreased sex hormone synthesis, and decreased bone formation

• Primarily in long-term use

Cushingoid appearance

• Results from long-term use

• Central adiposity, puffy face (moon face), increased hair, buffalo hump

Weight gain

Diabetes/Hyperglycemia

Acute adrenal insufficiency in abrupt withdrawal of long-term corticosteroids

Increased infection risk

Poor wound healing

Drug Table

Drug Name	Application	Comments	Image
Beclomethasone	Used in asthma, allergic rhinitis, and COPD	Inhaled	"Becky" "Meth" "Ozone"
Betamethasone			"Betamax" "Ozone"
Ciclesonide	Allergic rhinitis	Inhaled	"Circle" "Sun"
Cortisone			"Court" "Ozone"
Dexamethasone			"Dex Phone Book" "Meth" "Ozone"
Methylprednisolone			"Meth" "Predator" "Loan"
Hydrocortisone			"Hydro" "Court" "Ozone"
Prednisolone			"Predator" "Loan"
Prednisone			"Predator" "Endzone"
Triamcinolone	Used in allergic rhinitis, dermatitis	Inhaled, Topical	"Tram" "Cinnamon" "Loan"
Fluticasone	Used in asthma, allergic rhinitis, and COPD	Inhaled	"Flute" "Tick" "Ozone"
Budesonide	Used in asthma, allergic rhinitis, and COPD; Also used in ulcerative colitis and Crohn's disease	Inhaled, Oral	"Budweiser" "Sun"
Mometasone	Used in asthma, allergic rhinitis, and dermatitis	Inhaled, Topical	"Mom" "Ozone"