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Corticosteroids are a class of
steroid hormone A steroid hormone is a steroid A steroid is a biologically active organic compound In , organic compounds are generally any s that contain - . Due to carbon's ability to (form chains with other carbon s), millions of organic compounds ...
s that are produced in the
adrenal cortex The adrenal cortex is the outer region and also the largest part of an adrenal gland. It is divided into three separate zones: zona glomerulosa, zona fasciculata and zona reticularis. Each zone is responsible for producing specific hormones. It is a ...
of
vertebrates Vertebrates () comprise all species of animal Animals (also called Metazoa) are multicellular A multicellular organism is an organism In biology, an organism () is any organic, life, living system that functions as an indiv ...

vertebrates
, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids,
glucocorticoid Glucocorticoids (or, less commonly, glucocorticosteroids) are a class of corticosteroid Corticosteroids are a class of steroid hormone A steroid hormone is a steroid that acts as a hormone. Steroid hormones can be grouped into two classes: cor ...
s and
mineralocorticoid Mineralocorticoids are a class of corticosteroids, which in turn are a class of steroid hormone A steroid hormone is a steroid that acts as a hormone. Steroid hormones can be grouped into two classes: corticosteroids (typically made in the adren ...
s, are involved in a wide range of
physiological Physiology (; ) is the scientific Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity or awareness, of someone or something, such as facts A fact is an occurrence in the real world. ...
processes, including
stress response The fight-or-flight response (also called hyperarousal or the acute stress response) is a physiological reaction that occurs in response to a perceived Psychological trauma, harmful event, Trauma (medicine), attack, or threat to survival. It was f ...
,
immune response An immune response is a reaction which occurs within an organism for the purpose of defending against foreign invaders. These invaders include a wide variety of different microorganisms including viruses, bacteria, Parasitism, parasites, and Fungus, ...
, and regulation of
inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogen In biology Biology is the natural science that studies life and living organisms, including their anato ...
,
carbohydrate A carbohydrate () is a biomolecule , showing alpha helices, represented by ribbons. This poten was the first to have its suckture solved by X-ray crystallography by Max Perutz and Sir John Cowdery Kendrew in 1958, for which they received a ...
metabolism Metabolism (, from el, μεταβολή ''metabolē'', "change") is the set of life Life is a characteristic that distinguishes physical entities A bubble of exhaled gas in water In common usage and classical mechanics, a phys ...

metabolism
,
protein Proteins are large biomolecule , showing alpha helices, represented by ribbons. This poten was the first to have its suckture solved by X-ray crystallography by Max Perutz and Sir John Cowdery Kendrew in 1958, for which they received a No ...

protein
catabolism Catabolism () is the set of metabolic Metabolism (, from el, μεταβολή ''metabolē'', "change") is the set of life Life is a characteristic that distinguishes physical entities that have biological processes, such as Cell ...

catabolism
, blood
electrolyte An electrolyte is a medium containing ions that is electrically conducting Electrical resistivity (also called specific electrical resistance or volume resistivity) is a fundamental property of a material that quantifies how strongly it resist ...

electrolyte
levels, and behavior. Some common naturally occurring steroid hormones are
cortisol Cortisol is a steroid hormone, in the glucocorticoid class of hormones. When used as a medication, it is known as hydrocortisone. It is produced in many animals, mainly by the ''zona fasciculata'' of the adrenal cortex in the adrenal gland. ...

cortisol
(),
corticosterone Corticosterone, also known as 17-deoxycortisol and 11β,21-dihydroxyprogesterone, is a 21-carbon steroid hormone A steroid hormone is a steroid that acts as a hormone. Steroid hormones can be grouped into two classes: corticosteroids (typically m ...

corticosterone
(),
cortisone Cortisone is a pregnane (21-carbon) steroid hormone. Cortisone is a naturally-occurring corticosteroid metabolite that is also used as a pharmaceutical prodrug; it is not synthesized in the adrenal glands. Cortisol is converted by the action of ...

cortisone
() and
aldosterone Aldosterone is the main mineralocorticoid steroid hormone produced by the zona glomerulosa of the adrenal cortex in the adrenal gland. It is essential for sodium conservation in the kidney, salivary glands, sweat glands, and colon. It plays a cen ...

aldosterone
(). (Note that cortisone and aldosterone are
isomers In chemistry, isomers are molecules or polyatomic ions with identical molecular formulas — that is, same number of atoms of each element (chemistry), element — but distinct arrangements of atoms in space. Isomerism is existence or possibili ...
.) The main corticosteroids produced by the adrenal cortex are cortisol and aldosterone.


Classes

*
Glucocorticoid Glucocorticoids (or, less commonly, glucocorticosteroids) are a class of corticosteroid Corticosteroids are a class of steroid hormone A steroid hormone is a steroid that acts as a hormone. Steroid hormones can be grouped into two classes: cor ...
s such as
cortisol Cortisol is a steroid hormone, in the glucocorticoid class of hormones. When used as a medication, it is known as hydrocortisone. It is produced in many animals, mainly by the ''zona fasciculata'' of the adrenal cortex in the adrenal gland. ...

cortisol
affect carbohydrate, fat, and protein metabolism, and have
anti-inflammatoryAnti-inflammatory (or antiinflammatory) is the property of a substance or treatment that reduces inflammation or swelling. Anti-inflammatory drugs make up about half of analgesics, remedying pain by reducing inflammation as opposed to opioids, whic ...
,
immunosuppressive Immunosuppression is a reduction of the activation or efficacy Efficacy is the ability to perform a task to a satisfactory or expected degree. The word comes from the same roots as '' effectiveness'', and it has often been used synonymously, alt ...
,
anti-proliferative
anti-proliferative
, and
vasoconstrictive
vasoconstrictive
effects. Anti-inflammatory effects are mediated by blocking the action of
inflammatory mediators Inflammatory may refer to: * Inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involvin ...
(
transrepressionIn the field of molecular biology, transrepression is a process whereby one protein Proteins are large biomolecules or macromolecules that are comprised of one or more long chains of amino acid residue (biochemistry), residues. Proteins perform ...
) and inducing anti-inflammatory mediators (
transactivation In the context of gene regulation: transactivation is the increased rate of gene expression Gene expression is the process by which information from a gene In biology, a gene (from ''genos'' "...Wilhelm Johannsen coined the word gene to d ...
). Immunosuppressive effects are mediated by suppressing delayed hypersensitivity reactions by direct action on
T-lymphocytes A T cell is a type of lymphocyte. T cells are one of the important white blood cells of the immune system, and play a central role in the adaptive immune response. T cells can be easily distinguished from other lymphocytes by the presence of a T- ...
. Anti-proliferative effects are mediated by inhibition of
DNA synthesis DNA synthesis is the natural or artificial creation of deoxyribonucleic acid (DNA) molecules. DNA is a macromolecule made up of nucleotide units, which are linked by covalent bonds and hydrogen bonds, in a repeating structure. DNA synthesis occurs w ...
and turnover. Vasoconstrictive effects are mediated by inhibiting the action of inflammatory mediators such as
histamine Histamine is an organic nitrogen Nitrogen is the chemical element with the Symbol (chemistry), symbol N and atomic number 7. It was first discovered and isolated by Scottish physician Daniel Rutherford in 1772. Although Carl Wilhelm Scheele a ...

histamine
. *
Mineralocorticoid Mineralocorticoids are a class of corticosteroids, which in turn are a class of steroid hormone A steroid hormone is a steroid that acts as a hormone. Steroid hormones can be grouped into two classes: corticosteroids (typically made in the adren ...
s such as
aldosterone Aldosterone is the main mineralocorticoid steroid hormone produced by the zona glomerulosa of the adrenal cortex in the adrenal gland. It is essential for sodium conservation in the kidney, salivary glands, sweat glands, and colon. It plays a cen ...

aldosterone
are primarily involved in the regulation of
electrolyte An electrolyte is a medium containing ions that is electrically conducting Electrical resistivity (also called specific electrical resistance or volume resistivity) is a fundamental property of a material that quantifies how strongly it resist ...
and water balance by modulating
ion transportIn biology, a transporter is a transmembrane protein that moves ions (or other small molecules) across a biological membrane to accomplish many different biological functions including, cellular communication, maintaining homeostasis, energy produc ...
in the
epithelial cells Epithelium () is one of the four basic types of animal Animals (also called Metazoa) are multicellular eukaryotic organisms that form the Kingdom (biology), biological kingdom Animalia. With few exceptions, animals Heterotroph, consume ...
of the
renal tubules The nephron is the microscopic structural and functional unit of the kidney The kidneys are two reddish-brown bean-shaped organ (anatomy), organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in ...

renal tubules
of the
kidney The kidneys are two reddish-brown bean-shaped organs An organ is a group of tissues with similar functions. Plant life and animal life rely on many organs that co-exist in organ systems. A given organ's tissues can be broadly categorized ...

kidney
.


Medical uses

Synthetic
pharmaceutical drug A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug Uncoated tablets, consisting of about 90% acetylsalicylic acid, along with a minor amount of inert fillers and binders. Aspir ...
s with corticosteroid-like effects are used in a variety of conditions, ranging from
brain tumor A brain tumor occurs when abnormal cells form within the brain A brain is an organ Organ may refer to: Biology * Organ (anatomy) An organ is a group of Tissue (biology), tissues with similar functions. Plant life and animal life rely on ...
s to
skin disease A skin condition, also known as cutaneous condition, is any medical condition A disease is a particular abnormal condition that negatively affects the structure or function (biology), function of all or part of an organism, and that is ...
s.
Dexamethasone Dexamethasone is a used to treat , a number of s, severe , , , , , eye pain following , (a complication of some forms of cancer), and along with s in . In , it may be used in combination with a medication such as . In , it may be used to imp ...

Dexamethasone
and its derivatives are almost pure glucocorticoids, while
prednisone Prednisone is a glucocorticoid medication mostly used to immunosuppressive drug, suppress the immune system and decrease inflammation in conditions such as asthma, COPD, and rheumatologic diseases. It is also used to treat high blood calcium du ...

prednisone
and its derivatives have some mineralocorticoid action in addition to the glucocorticoid effect. (Florinef) is a synthetic mineralocorticoid.
Hydrocortisone Hydrocortisone is the name for the hormone cortisol when supplied as a medication. Uses include conditions such as adrenocortical insufficiency, adrenogenital syndrome, hypercalcemia, high blood calcium, thyroiditis, rheumatoid arthritis, derma ...
(cortisol) is typically used for replacement therapy, ''e.g.'' for
adrenal insufficiency Adrenal insufficiency is a condition in which the adrenal glands do not produce adequate amounts of steroid hormones, primarily cortisol; but may also include impaired production of aldosterone (a mineralocorticoid), which regulates sodium conservat ...
and
congenital adrenal hyperplasia Congenital adrenal hyperplasia (CAH) is a group of Genetic disorder#Autosomal recessive, autosomal recessive disorders characterized by impaired cortisol synthesis. It results from the deficiency of one of the five enzymes required for the Biosynthe ...

congenital adrenal hyperplasia
. Medical conditions treated with systemic corticosteroids: *
Allergy Allergies, also known as allergic diseases, are a number of conditions caused by hypersensitivity Hypersensitivity (also called hypersensitivity reaction or intolerance) refers to undesirable reactions produced by the normal immune system, ...

Allergy
and
respirology Pulmonology (, , from Latin ''pulmō, -ōnis'' "lung" and the Ancient Greek, Greek suffix "study of") or pneumology (, built on Greek πνεύμων "lung") is a specialty (medicine), medical specialty that deals with Respiratory disease, di ...
medicine **
Asthma Asthma is a long-term Long-Term Capital Management L.P. (LTCM) was a hedge fund''A financial History of the United States Volume II: 1970–2001'', Jerry W. Markham, Chapter 5: "Bank Consolidation", M. E. Sharpe, Inc., 2002 based in Greenwich, ...

Asthma
(severe exacerbations) **
Chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease The lungs are the primary Organ (anatomy), organs of the respiratory system in humans and many other animals including a few fish and some snails. In mammal ...
(COPD) **
Allergic rhinitis Allergic rhinitis, also known as hay fever, is a type of inflammation in the nose which occurs when the immune system The immune system is a network of biological processes that protects an organism from diseases. It detects and responds ...
**
Atopic dermatitis Atopic dermatitis (AD), also known as atopic eczema, is a long-term type of inflammation of the skin (dermatitis). It results in puritis, itchy, red, swollen, and cracked skin. Clear fluid may come from the affected areas, which often thickens ov ...

Atopic dermatitis
**
Hives Hives, also known as urticaria, is a kind of with red, raised, itchy bumps. They may also burn or sting. Often the patches of rash move around. Typically they last a few days and do not leave any long-lasting skin changes. Fewer than 5% of case ...
**
Angioedema Angioedema is an area of swelling (edema) of the dermis, lower layer of skin and subcutaneous tissue, tissue just under the skin or mucous membranes. The swelling may occur in the face, tongue, larynx, abdomen, or arms and legs. Often it is assoc ...

Angioedema
**
Anaphylaxis Anaphylaxis is a serious allergic reaction Allergies, also known as allergic diseases, are a number of conditions caused by hypersensitivity Hypersensitivity (also called hypersensitivity reaction or intolerance) refers to undesirable rea ...
** Food allergies ** Drug allergies **
Nasal polyp Nasal polyps (NP) are noncancerous growths within the nose A nose is a protuberance in vertebrates that houses the nostrils, or nares, which receive and expel air for Respiration (physiology), respiration alongside the mouth. Behind the nose ...
s **
Hypersensitivity pneumonitis Hypersensitivity pneumonitis (HP) or extrinsic allergic alveolitis (EAA) is a rare immune system disorder that affects the lungs. It is an inflammation of the airspaces (Pulmonary alveolus, alveoli) and small airways (bronchioles) within the lung, ...
**
Sarcoidosis Sarcoidosis is a disease involving abnormal collections of inflammatory cells that form lumps known as granulomata. The disease usually begins in the lungs, skin, or lymph nodes. Less commonly affected are the eyes, liver, heart, and brain. Any ...

Sarcoidosis
**
Eosinophilic pneumonia Eosinophilic pneumonia is a disease A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not due to any immediate external injury. Diseases are often k ...
** Some other types of
pneumonia Pneumonia is an inflammatory Inflammatory may refer to: * Inflammation, a biological response to harmful stimuli * The word ''inflammatory'' is also used to refer literally to fire and flammability, and figuratively in relation to comments t ...

pneumonia
(in addition to the traditional
antibiotic An antibiotic is a type of antimicrobial An antimicrobial is an agent that kills microorganism A microorganism, or microbe,, ''mikros'', "small") and ''organism In biology, an organism () is any organic, life, living system t ...
treatment protocols) **
Interstitial lung disease Interstitial lung disease (ILD), or diffuse parenchymal lung disease (DPLD), is a group of respiratory diseases affecting the interstitium (the tissue and space around the alveoli (air sacs)) of the lung The lungs are the primary organs ...
*
Dermatology Dermatology is the branch of medicine Medicine is the science Science (from the Latin word ''scientia'', meaning "knowledge") is a systematic enterprise that Scientific method, builds and Taxonomy (general), organizes knowledge in the f ...
**
Pemphigus vulgaris Pemphigus vulgaris is a rare chronic blistering skin disease and the most common form of pemphigus. Pemphigus was derived from the Greek word ''pemphix'', meaning blister. It is classified as a type II hypersensitivity reaction in which antibody, ...
**
Contact dermatitis Contact dermatitis is a type of inflammation of the skin. Some symptoms of contact dermatitis can include itchy or dry skin, a red rash, bumps, blisters, and swelling. The rash isn't contagious or life-threatening, but it can be very uncomfortabl ...

Contact dermatitis
*
Endocrinology Endocrinology (from ''endocrine system, endocrine'' + ''wikt:-logy#Suffix, -ology'') is a branch of biology and medicine dealing with the endocrine system, its diseases, and its specific secretions known as hormones. It is also concerned with the ...
(usually at physiologic doses) ** **
Adrenal insufficiency Adrenal insufficiency is a condition in which the adrenal glands do not produce adequate amounts of steroid hormones, primarily cortisol; but may also include impaired production of aldosterone (a mineralocorticoid), which regulates sodium conservat ...
**
Congenital adrenal hyperplasia Congenital adrenal hyperplasia (CAH) is a group of Genetic disorder#Autosomal recessive, autosomal recessive disorders characterized by impaired cortisol synthesis. It results from the deficiency of one of the five enzymes required for the Biosynthe ...

Congenital adrenal hyperplasia
*
Gastroenterology Gastroenterology is the branch of medicine Medicine is the science Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity, awareness, or understanding of someone or something, such as ...
**
Ulcerative colitis Ulcerative colitis (UC) is a long-term condition that results in inflammation Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, d ...

Ulcerative colitis
**
Crohn's disease Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract The gastrointestinal tract, (GI tract, GIT, digestive tract, digestion tract, alimentary canal) is the tract from the m ...

Crohn's disease
**
Autoimmune hepatitis Autoimmune hepatitis, formerly called lupoid hepatitis, is a chronic, autoimmune disease An autoimmune disease is a condition arising from an abnormal immune response to a functioning body part. There are at least 80 types of autoimmune diseases ...
*
Hematology Hematology ( also spelled haematology in British English British English (BrE) is the standard dialect A standard language (also standard variety, standard dialect, and standard) is a language variety that has undergone substantial co ...
**
Lymphoma Lymphoma is a group of blood cancer, blood malignancies that develop from lymphocytes (a type of white blood cell). The name often refers to just the cancerous versions rather than all such tumours. Signs and symptoms may include Lymphadenopathy, ...

Lymphoma
**
Leukemia Leukemia ( also spelled leukaemia and pronounced ), is a group of blood cancer Tumors of the hematopoietic and lymphoid tissues (American English American English (AmE, AE, AmEng, USEng, en-US), sometimes called United States English ...

Leukemia
**
Hemolytic anemia Hemolytic anemia is a form of anemia Anemia ( also spelled anaemia) is a decrease in the total amount of red blood cell Red blood cells (RBCs), also referred to as red cells, red blood corpuscles (in humans or other animals not having nucle ...
**
Idiopathic thrombocytopenic purpura Immune thrombocytopenic purpura (ITP), also known as idiopathic thrombocytopenic purpura or immune thrombocytopenia, is a type of thrombocytopenic purpura Thrombocytopenic purpura are purpura Purpura () is a condition of red or purple discolo ...
**
Multiple Myeloma Multiple myeloma (MM), also known as plasma cell myeloma and simply myeloma, is a cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast wi ...

Multiple Myeloma
*
Rheumatology Rheumatology (Greek ''ῥεῦμα'', ''rheûma'', flowing current) is a branch of medicine devoted to the diagnosis Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different academic d ...
/
Immunology Immunology is a branch of biology and Medicine that covers the study of immune systems in all organisms. Immunology charts, measures, and contextualizes the Physiology, physiological functioning of the immune system in states of both health and ...
**
Rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects synovial joint, joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and ...
eas **
Systemic lupus erythematosus Lupus, technically known as systemic lupus erythematosus (SLE), is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary between people and may be mild to severe. Co ...
**
Polymyalgia rheumatica Polymyalgia rheumatica (PMR) is a syndrome with pain or stiffness, usually in the neck The neck is the part of the body on many vertebrate Vertebrates () comprise all species of animal Animals (also called Metazoa) are multicellular ...
**
Polymyositis Polymyositis (PM) is a type of chronic inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective respon ...
**
Dermatomyositis Dermatomyositis (DM) is a long-term Long-Term Capital Management L.P. (LTCM) was a hedge fund''A financial History of the United States Volume II: 1970–2001'', Jerry W. Markham, Chapter 5: "Bank Consolidation", M. E. Sharpe, Inc., 2002 based i ...

Dermatomyositis
** Polyarteritis **
Vasculitis Vasculitis is a group of disorders that destroy blood vessel The blood vessels are the components of the circulatory system The circulatory system, also called the cardiovascular system or the vascular system, is an organ system that p ...
*
Ophthalmology Ophthalmology () is a branch of medicine and surgery that deals with the diagnosis and treatment of disorders of the eye. An ophthalmologist is a physician who Specialty (medicine), specializes in ophthalmology. The credentials include a degree i ...
**
Uveitis Uveitis () is the inflammation of the uvea, the pigmented layer that lies between the inner retina and the outer fibrous layer composed of the sclera and cornea. The uvea consists of the middle layer of pigmented vascular structures of the eye and ...
**
Optic neuritis Optic neuritis describes any condition that causes inflammation of the optic nerve; it may be associated with demyelinating diseases, or infectious or inflammatory processes. It is also known as optic papillitis (when the head of the optic nerve ...
**
Keratoconjunctivitis Keratoconjunctivitis is inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving imm ...
* Other conditions **
Multiple sclerosis Multiple sclerosis (MS), also known as encephalomyelitis disseminata, is the most common demyelinating disease, in which the Myelin, insulating covers of nerve cells in the Human brain, brain and spinal cord are damaged. This damage disrupts the ...
relapses **
Organ transplantation Organ transplantation is a medical procedure in which an organ Organ may refer to: Biology * Organ (anatomy) An organ is a group of Tissue (biology), tissues with similar functions. Plant life and animal life rely on many organs that co- ...
**
Nephrotic syndrome Nephrotic syndrome is a collection of symptoms due to kidney damage. This includes proteinuria, protein in the urine, hypoalbuminemia, low blood albumin levels, hyperlipidemia, high blood lipids, and significant edema, swelling. Other symptoms m ...
**
Chronic hepatitis Hepatitis is inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cell ...
( flare ups) **
Cerebral edema Cerebral edema is excess accumulation of fluid (edema) in the intracellular or extracellular spaces of the brain. This typically causes impaired nerve function, Intracranial pressure, increased pressure within the skull, and can eventually lead ...
**
IgG4-related disease IgG4-Related Disease(IgG4-RD), formerly known as IgG4-related systemic disease, is a chronic inflammatory condition characterized by tissue infiltration with lymphocytes and IgG4-secreting plasma cells, various degrees of fibrosis (scarring) an ...
**
Prostate cancer Prostate cancer is cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumor A benign tumor is a mass of cells Cell most o ...

Prostate cancer
**
Tendinosis Tendinopathy, a type of tendon A tendon or sinew is a tough, high-tensile-strength band of dense fibrous connective tissue that connects muscle Skeletal muscles (commonly referred to as muscles) are organs An organ is a group of tissue ...
**
Lichen planus Lichen planus (LP) is a chronic inflammatory and immune-mediated disease that affects the skin, nails, hair, and mucous membranes. It is not an actual lichen, and is only named that because it looks like one. It is characterized by polygonal, flat ...

Lichen planus
Topical formulations are also available for the
skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other cuticle, animal coverings, such as the arthropod exoskeleton, have differ ...
, eyes (
uveitis Uveitis () is the inflammation of the uvea, the pigmented layer that lies between the inner retina and the outer fibrous layer composed of the sclera and cornea. The uvea consists of the middle layer of pigmented vascular structures of the eye and ...
), lungs (
asthma Asthma is a long-term Long-Term Capital Management L.P. (LTCM) was a hedge fund''A financial History of the United States Volume II: 1970–2001'', Jerry W. Markham, Chapter 5: "Bank Consolidation", M. E. Sharpe, Inc., 2002 based in Greenwich, ...

asthma
), nose (
rhinitis Rhinitis, also known as coryza, is irritation and inflammation of the mucous membrane inside the nose A nose is a protuberance in vertebrate Vertebrates () comprise all species of animal Animals (also called Metazoa) are multic ...
), and
bowels The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system The human digestive system consists of the gastrointestinal tract The gastrointestinal tract, (GI tract, GIT, di ...
. Corticosteroids are also used supportively to prevent nausea, often in combination with 5-HT3 antagonists (''e.g.''
ondansetron Ondansetron, sold under the brand name Zofran among others, is a medication used to prevent nausea Nausea is a diffuse sensation of unease and discomfort, often perceived as an urge to vomit. While not painful, it can be a debilitating symptom ...

ondansetron
). Typical undesired effects of glucocorticoids present quite uniformly as drug-induced
Cushing's syndrome Cushing's syndrome is a collection of signs and symptoms due to prolonged exposure to glucocorticoids such as cortisol. Signs and symptoms may include hypertension, high blood pressure, abdominal obesity but with thin arms and legs, reddish str ...

Cushing's syndrome
. Typical mineralocorticoid side-effects are
hypertension Hypertension (HTN or HT), also known as high blood pressure (HBP), is a Chronic condition, long-term Disease, medical condition in which the blood pressure in the artery, arteries is persistently elevated. High blood pressure usually does not ...
(abnormally high blood pressure), steroid induced diabetes mellitus, psychosis, poor sleep,
hypokalemia Hypokalemia is a low level of potassium Potassium is a chemical element upright=1.0, 500px, The chemical elements ordered by link=Periodic table In chemistry Chemistry is the science, scientific study of the properties and b ...
(low potassium levels in the blood),
hypernatremia Hypernatremia, also spelled hypernatraemia, is a high concentration of sodium in the Serum (blood), blood. Early symptoms may include a strong feeling of thirst, weakness, nausea, and anorexia (symptom), loss of appetite. Severe symptoms include de ...
(high sodium levels in the blood) without causing
peripheral edema Peripheral edema is edema (accumulation of fluid causing swelling) in tissues perfused by the peripheral vascular system, usually in the lower Limb (anatomy), limbs. In the most dependent parts of the body (those hanging distally), it may be called ...
,
metabolic alkalosis Metabolic alkalosis is a metabolic Metabolism (, from el, μεταβολή ''metabolē'', "change") is the set of life Life is a characteristic that distinguishes physical entities that have biological processes, such as signal ...
and connective tissue weakness. Wound healing or ulcer formation may be inhibited by the immunosuppressive effects. Clinical and experimental evidence indicates that corticosteroids can cause permanent eye damage by inducing
central serous retinopathy Central serous chorioretinopathy (CSC or CSCR), also known as central serous retinopathy (CSR), is an eye disease that causes visual impairment, often temporary, usually in one eye. When the disorder is active it is characterized by leakage of f ...

central serous retinopathy
(CSR, also known as central serous chorioretinopathy, CSC). This should be borne in mind when treating patients with
optic neuritis Optic neuritis describes any condition that causes inflammation of the optic nerve; it may be associated with demyelinating diseases, or infectious or inflammatory processes. It is also known as optic papillitis (when the head of the optic nerve ...
. There is experimental and clinical evidence that, at least in
optic neuritis Optic neuritis describes any condition that causes inflammation of the optic nerve; it may be associated with demyelinating diseases, or infectious or inflammatory processes. It is also known as optic papillitis (when the head of the optic nerve ...
speed of treatment initiation is important. A variety of steroid medications, from anti-allergy nasal sprays ( Nasonex, Flonase) to topical skin creams, to eye drops (Tobradex), to prednisone have been implicated in the development of CSR. Corticosteroids have been widely used in treating people with traumatic brain injury. A systematic review identified 20 randomised controlled trials and included 12,303 participants, then compared patients who received corticosteroids with patients who received no treatment. The authors recommended people with traumatic head injury should not be routinely treated with corticosteroids.


Pharmacology

Corticosteroids act as agonists of the glucocorticoid receptor and/or the mineralocorticoid receptor. In addition to their corticosteroid activity, some corticosteroids may have some progestogen (medication), progestogenic activity and may produce sex-related side effects.


Pharmacogenetics


Asthma

Patients' response to inhaled corticosteroids has some basis in genetic variations. Two genes of interest are CHRH1 (corticotropin-releasing hormone receptor 1) and TBX21 (transcription factor T-bet). Both genes display some degree of polymorphic variation in humans, which may explain how some patients respond better to inhaled corticosteroid therapy than others. However, not all asthma patients respond to corticosteroids and large sub groups of asthma patients are corticosteroid resistant.


Adverse effects

Use of corticosteroids has numerous side-effects, some of which may be severe: * Severe amebic colitis: Fulminant amebic colitis is associated with high case fatality and can occur in patients infected with the parasite ''Entamoeba histolytica'' after exposure to corticosteroid medications. * Neuropsychiatric: steroid psychosis, and anxiety (mood), anxiety, depression (mood), depression. Therapeutic doses may cause a feeling of artificial well-being ("steroid euphoria"). The neuropsychiatric effects are partly mediated by sensitization of the body to the actions of adrenaline. Therapeutically, the bulk of corticosteroid dose is given in the morning to mimic the body's diurnal rhythm; if given at night, the feeling of being energized will interfere with sleep. An extensive review is provided by Flores and Gumina. * Cardiovascular: Corticosteroids can cause sodium retention through a direct action on the kidney, in a manner analogous to the mineralocorticoid
aldosterone Aldosterone is the main mineralocorticoid steroid hormone produced by the zona glomerulosa of the adrenal cortex in the adrenal gland. It is essential for sodium conservation in the kidney, salivary glands, sweat glands, and colon. It plays a cen ...

aldosterone
. This can result in fluid retention and hypertension. * Metabolic: Corticosteroids cause a movement of body fat to the face and torso, resulting in "moon face", "buffalo hump", and "pot belly" or "beer belly", and cause movement of body fat away from the limbs. This has been termed corticosteroid-induced lipodystrophy. Due to the diversion of amino-acids to glucose, they are considered anti-anabolic, and long term therapy can cause muscle wasting. * Endocrine: By increasing the production of glucose from amino-acid breakdown and opposing the action of insulin, corticosteroids can cause hyperglycemia, insulin resistance and diabetes mellitus. * Skeletal: Steroid-induced osteoporosis may be a side-effect of long-term corticosteroid use. Use of inhaled corticosteroids among children with asthma may result in decreased height. * Gastro-intestinal: While cases of colitis have been reported, corticosteroids are often prescribed when the colitis, although due to suppression of the immune response to pathogens, should be considered only after ruling out infection or microbe/fungal overgrowth in the gastrointestinal tract. While the evidence for corticosteroids causing peptic ulceration is relatively poor except for high doses taken for over a month, the majority of doctors still believe this is the case, and would consider protective prophylactic measures. * Eyes: chronic use may predispose to cataract and glaucoma. * Vulnerability to infection: By suppressing immune reactions (which is one of the main reasons for their use in allergies), steroids may cause infections to flare up, notably candidiasis. * Pregnancy: Corticosteroids have a low but significant teratogenic effect, causing a few birth defects per 1,000 pregnant women treated. Corticosteroids are therefore contraindicated in pregnancy. * Habituation: Topical steroid addiction (TSA) or red burning skin has been reported in long-term users of topical steroids (users who applied topical steroids to their skin over a period of weeks, months, or years). TSA is characterised by uncontrollable, spreading dermatitis and worsening skin inflammation which requires a stronger topical steroid to get the same result as the first prescription. When topical steroid medication is lost, the skin experiences redness, burning, itching, hot skin, swelling, and/or oozing for a length of time. This is also called 'red skin syndrome' or 'topical steroid withdrawal' (TSW). After the withdrawal period is over the atopic dermatitis can cease or is less severe than it was before. * In children the short term use of steroids by mouth increases the risk of vomiting, behavioral changes, and sleeping problems.


Biosynthesis

The corticosteroids are synthesized from cholesterol within the
adrenal cortex The adrenal cortex is the outer region and also the largest part of an adrenal gland. It is divided into three separate zones: zona glomerulosa, zona fasciculata and zona reticularis. Each zone is responsible for producing specific hormones. It is a ...
. Most steroidogenic reactions are catalysed by enzymes of the cytochrome P450 family. They are located within the mitochondria and require adrenodoxin as a cofactor (except 21-hydroxylase and 17α-hydroxylase). Aldosterone and
corticosterone Corticosterone, also known as 17-deoxycortisol and 11β,21-dihydroxyprogesterone, is a 21-carbon steroid hormone A steroid hormone is a steroid that acts as a hormone. Steroid hormones can be grouped into two classes: corticosteroids (typically m ...

corticosterone
share the first part of their biosynthetic pathway. The last part is mediated either by the aldosterone synthase (for
aldosterone Aldosterone is the main mineralocorticoid steroid hormone produced by the zona glomerulosa of the adrenal cortex in the adrenal gland. It is essential for sodium conservation in the kidney, salivary glands, sweat glands, and colon. It plays a cen ...

aldosterone
) or by the 11β-hydroxylase (for
corticosterone Corticosterone, also known as 17-deoxycortisol and 11β,21-dihydroxyprogesterone, is a 21-carbon steroid hormone A steroid hormone is a steroid that acts as a hormone. Steroid hormones can be grouped into two classes: corticosteroids (typically m ...

corticosterone
). These enzymes are nearly identical (they share 11β-hydroxylation and 18-hydroxylation functions), but aldosterone synthase is also able to perform an 18-oxidation. Moreover, aldosterone synthase is found within the zona glomerulosa at the outer edge of the
adrenal cortex The adrenal cortex is the outer region and also the largest part of an adrenal gland. It is divided into three separate zones: zona glomerulosa, zona fasciculata and zona reticularis. Each zone is responsible for producing specific hormones. It is a ...
; 11β-hydroxylase is found in the zona fasciculata and zona glomerulosa.


Classification of corticosteroids


By chemical structure

In general, corticosteroids are grouped into four classes, based on chemical structure. Allergic reactions to one member of a class typically indicate an intolerance of all members of the class. This is known as the "Coopman classification". The highlighted steroids are often used in the screening of allergies to topical steroids.


Group A – Hydrocortisone type

Hydrocortisone Hydrocortisone is the name for the hormone cortisol when supplied as a medication. Uses include conditions such as adrenocortical insufficiency, adrenogenital syndrome, hypercalcemia, high blood calcium, thyroiditis, rheumatoid arthritis, derma ...
, hydrocortisone acetate, cortisone acetate, tixocortol pivalate, prednisolone, methylprednisolone, and
prednisone Prednisone is a glucocorticoid medication mostly used to immunosuppressive drug, suppress the immune system and decrease inflammation in conditions such as asthma, COPD, and rheumatologic diseases. It is also used to treat high blood calcium du ...

prednisone
.


Group B – Acetonides (and related substances)

Amcinonide, budesonide, desonide, fluocinolone acetonide, fluocinonide, halcinonide, and triamcinolone acetonide.


Group C – Betamethasone type

Beclometasone, betamethasone, dexamethasone, fluocortolone, halometasone, and mometasone.


Group D – Esters


=Group D1 – Halogenated (less labile)

= Alclometasone dipropionate, betamethasone dipropionate, betamethasone valerate, clobetasol propionate, clobetasone butyrate, fluprednidene acetate, and mometasone furoate.


=Group D2 – Labile prodrug esters

= Ciclesonide, cortisone acetate, hydrocortisone aceponate, hydrocortisone acetate, hydrocortisone buteprate, hydrocortisone butyrate, hydrocortisone valerate, prednicarbate, and tixocortol pivalate.


By route of administration


Topical steroids

For use topically on the skin, eye, and mucous membranes. Topical corticosteroids are divided in potency classes I to IV in most countries (A to D in Japan). Seven categories are used in the United States to determine the level of potency of any given topical corticosteroid.


Inhaled steroids

For nasal mucosa, sinuses, bronchi, and lungs. This group includes: * Flunisolide * Fluticasone furoate * Fluticasone propionate * Triamcinolone acetonide * Beclomethasone dipropionate * Budesonide * Mometasone furoate * Ciclesonide There also exist certain combination preparations such as Advair Diskus in the United States, containing Fluticasone/salmeterol, fluticasone propionate and salmeterol (a long-acting bronchodilator), and Symbicort, containing budesonide/formoterol, budesonide and formoterol fumarate dihydrate (another long-acting bronchodilator). They are both approved for use in children over 12 years old.


Oral forms

Such as prednisone, prednisolone, methylprednisolone, or dexamethasone.


Systemic forms

Available in injectables for intravenous and parenteral routes.


History

Tadeusz Reichstein, Edward Calvin Kendall. and Philip Showalter Hench were awarded the Nobel Prize for Physiology and Medicine in 1950 for their work on hormones of the adrenal cortex, which culminated in the isolation of
cortisone Cortisone is a pregnane (21-carbon) steroid hormone. Cortisone is a naturally-occurring corticosteroid metabolite that is also used as a pharmaceutical prodrug; it is not synthesized in the adrenal glands. Cortisol is converted by the action of ...

cortisone
. Initially hailed as a miracle cure and liberally prescribed during the 1950s, steroid treatment brought about adverse events of such a magnitude that the next major category of anti-inflammatory drugs, the nonsteroidal anti-inflammatory drugs (NSAIDs), was so named in order to demarcate from the opprobrium. Corticosteroids were voted Allergen of the Year in 2005 by the American Contact Dermatitis Society. Lewis Sarett of Merck & Co. was the first to synthesize cortisone, using a 36-step process that started with deoxycholic acid, which was extracted from ox bile. The low efficiency of converting deoxycholic acid into cortisone led to a cost of US$200 per gram. Russell Marker, at Syntex, discovered a much cheaper and more convenient starting material, diosgenin from wild Mexican yams. His conversion of diosgenin into progesterone by a four-step process now known as Marker degradation was an important step in mass production of all steroidal hormones, including cortisone and chemicals used in hormonal contraception. In 1952, D.H. Peterson and H.C. Murray of Upjohn developed a process that used ''Rhizopus'' mold to oxidize progesterone into a compound that was readily converted to cortisone. The ability to cheaply synthesize large quantities of cortisone from the diosgenin in yams resulted in a rapid drop in price to US$6 per gram, falling to $0.46 per gram by 1980. Percy Lavon Julian, Percy Julian's research also aided progress in the field.Julian, Percy L., Cole, John Wayne, Meyer, Edwin W., and Karpel, William J. (1956) "Preparation of Cortisone". U. S. Patent 2,752,339 The exact nature of cortisone's anti-inflammatory action remained a mystery for years after, however, until the leukocyte adhesion cascade and the role of phospholipase A2 in the production of prostaglandins and leukotrienes was fully understood in the early 1980s.


Etymology

The ''wikt:cortico-#Prefix, cortico-'' part of the name refers to the
adrenal cortex The adrenal cortex is the outer region and also the largest part of an adrenal gland. It is divided into three separate zones: zona glomerulosa, zona fasciculata and zona reticularis. Each zone is responsible for producing specific hormones. It is a ...
, which makes these steroid hormones. Thus a corticosteroid is a "cortex steroid".


See also

* List of corticosteroids * List of corticosteroid cyclic ketals * List of corticosteroid esters * List of steroid abbreviations


References

{{Authority control Endocrinology Steroids Hormones Steroid hormones Corticosteroids World Anti-Doping Agency prohibited substances