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Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are involved in a wide range of physiological processes, including stress response, immune response, and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte levels, and behavior.[1] Some common naturally occurring steroid hormones are cortisol (C 21H 30O 5), corticosterone (C 21H 30O 4), cortisone (C 21H 28O 5) and aldosterone (C 21H 28O 5). (Note that aldosterone and cortisone share the same chemical formula but the structures are different.) The main corticosteroids produced by the adrenal cortex are cortisol and aldosterone.[2]

Contents

1 Classes 2 Medical uses 3 Pharmacogenetics

3.1 Asthma

4 Adverse effects 5 Biosynthesis 6 Classification

6.1 By chemical structure

6.1.1 Group A – Hydrocortisone
Hydrocortisone
type 6.1.2 Group B – Acetonides (and related substances) 6.1.3 Group C – Betamethasone
Betamethasone
type 6.1.4 Group D – Esters

6.1.4.1 Group D1 – Halogenated (less labile) 6.1.4.2 Group D2 – Labile prodrug esters

6.2 By route of administration

6.2.1 Topical steroids 6.2.2 Inhaled steroids 6.2.3 Oral forms 6.2.4 Systemic forms

7 History

7.1 Etymology

8 See also 9 References

Classes[edit]

Cortisol

Corticosterone

Cortisone

Aldosterone

Glucocorticoids such as cortisol affect carbohydrate, fat, and protein metabolism, and have anti-inflammatory, immunosuppressive, anti-proliferative, and vasoconstrictive effects.[3] Anti-inflammatory effects are mediated by blocking the action of inflammatory mediators (transrepression) and inducing anti-inflammatory mediators (transactivation).[3] Immunosuppressive effects are mediated by suppressing delayed hypersensitivity reactions by direct action on T-lymphocytes.[3] Anti-proliferative effects are mediated by inhibition of DNA synthesis and epidermal cell turnover.[3] Vasoconstrictive effects are mediated by inhibiting the action of inflammatory mediators such as histidine.[3] Mineralocorticoids such as aldosterone are primarily involved in the regulation of electrolyte and water balance by modulating ion transport in the epithelial cells of the renal tubules of the kidney.[3]

Medical uses[edit] Synthetic pharmaceutical drugs with corticosteroid-like effects are used in a variety of conditions, ranging from brain tumors to skin diseases. Dexamethasone
Dexamethasone
and its derivatives are almost pure glucocorticoids, while prednisone and its derivatives have some mineralocorticoid action in addition to the glucocorticoid effect. Fludrocortisone
Fludrocortisone
(Florinef) is a synthetic mineralocorticoid. Hydrocortisone
Hydrocortisone
(cortisol) is typically used for replacement therapy, e.g. for adrenal insufficiency and congenital adrenal hyperplasia. Medical conditions treated with systemic corticosteroids:[3][4]

Allergy
Allergy
and respirology medicine

Asthma
Asthma
(severe exacerbations) Chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease
(COPD) Allergic rhinitis Atopic dermatitis Hives Angioedema Anaphylaxis Food allergies Drug allergies Nasal polyps Hypersensitivity pneumonitis Sarcoidosis Eosinophilic pneumonia Some other types of pneumonia (in addition to the traditional antibiotic treatment protocols) Interstitial lung disease

Dermatology

Pemphigus vulgaris Contact dermatitis

Endocrinology
Endocrinology
(usually at physiologic doses)

Addison's Disease Adrenal insufficiency Congenital adrenal hyperplasia

Gastroenterology

Ulcerative colitis Crohn's disease Autoimmune hepatitis

Hematology

Lymphoma Leukemia Hemolytic anemia Idiopathic thrombocytopenic purpura Multiple Myeloma

Rheumatology/Immunology

Rheumatoid arthritiseas Systemic lupus erythematosus Polymyalgia rheumatica Polymyositis Dermatomyositis Polyarteritis Vasculitis

Ophthalmology

Uveitis Keratoconjunctivitis

Other conditions

Multiple sclerosis Organ transplantation Nephrotic syndrome Chronic hepatitis (flare ups) Cerebral edema IgG4-related disease Prostate cancer Tendinosis Lichen planus

Topical formulations are also available for the skin, eyes (uveitis), lungs (asthma), nose (rhinitis), and bowels. Corticosteroids are also used supportively to prevent nausea, often in combination with 5-HT3 antagonists (e.g. ondansetron). Typical undesired effects of glucocorticoids present quite uniformly as drug-induced Cushing's syndrome. Typical mineralocorticoid side-effects are hypertension (abnormally high blood pressure), hypokalemia (low potassium levels in the blood), hypernatremia (high sodium levels in the blood) without causing peripheral edema, metabolic alkalosis and connective tissue weakness.[5] Wound healing or ulcer formation may be ibhibited by the immunosuppressive effects. Clinical and experimental evidence indicates that corticosteroids can cause permanent eye damage by inducing central serous retinopathy (CSR, also known as central serous chorioretinopathy, CSC).[6] 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.[7][8] Corticosteroids have been widely used in treating people with traumatic brain injury.[9] 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.[10] Pharmacogenetics[edit] Asthma[edit] 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.[11][12] Adverse effects[edit]

Lower arm of a 47-year-old female showing skin damage caused by topical corticosteroid use.

Use of corticosteroids has numerous side-effects, some of which may be severe:

Neuropsychiatric: steroid psychosis,[13] and anxiety,[14] depression. Therapeutic doses may cause a feeling of artificial well-being ("steroid euphoria").[15] 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.[16] Cardiovascular: Corticosteroids can cause sodium retention through a direct action on the kidney, in a manner analogous to the mineralocorticoid aldosterone. This can result in fluid retention and hypertension. Metabolic: Corticosteroids cause a movement of body fat to the face and torso, resulting respectively in "moon face" and "buffalo hump". and away from the limbs. Due to the diversion of amino-acids to glucose, they are considered anti-anabolic, and long term therapy can cause muscle wasting[17] Endocrine: By increasing the production of glucose from amino-acid breakdown and opposing the action of insulin, corticosteroids can cause hyperglycemia,[18] insulin resistance and diabetes mellitus.[19] 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.[20] 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,[21] the majority of doctors as of 2010[update] still believe this is the case, and would consider protective prophylactic measures.[22] Eyes: chronic use may predispose to cataract and retinopathy. 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.[23] 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.[24] Habituation: Topical steroid addiction (TSA) 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).[25][26] 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.[27] In children the short term use of steroids by mouth increases the risk of vomiting, behavioral changes, and sleeping problems.[28]

Biosynthesis[edit]

Steroidogenesis, including corticosteroid biosynthesis.

The corticosteroids are synthesized from cholesterol within the adrenal cortex.[1] 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
21-hydroxylase
and 17α-hydroxylase). Aldosterone
Aldosterone
and corticosterone share the first part of their biosynthetic pathway. The last part is mediated either by the aldosterone synthase (for aldosterone) or by the 11β-hydroxylase
11β-hydroxylase
(for 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; 11β-hydroxylase
11β-hydroxylase
is found in the zona fasciculata and zona glomerulosa. Classification[edit] By chemical structure[edit] 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".[29][30] The highlighted steroids are often used in the screening of allergies to topical steroids.[31] Group A – Hydrocortisone
Hydrocortisone
type[edit] Hydrocortisone, methylprednisolone, prednisolone, prednisone, and triamcinolone (short- to medium-acting glucocorticoids). Group B – Acetonides (and related substances)[edit] Amcinonide, budesonide, desonide, fluocinolone acetonide, fluocinonide, halcinonide, and triamcinolone acetonide. Group C – Betamethasone
Betamethasone
type[edit] Beclometasone, betamethasone, dexamethasone, fluocortolone, halometasone, and mometasone. Group D – Esters[edit] Group D1 – Halogenated (less labile)[edit] Alclometasone
Alclometasone
dipropionate, betamethasone dipropionate, betamethasone valerate, clobetasol propionate, clobetasone butyrate, fluprednidene acetate, and mometasone furoate. Group D2 – Labile prodrug esters[edit] Ciclesonide, cortisone acetate, hydrocortisone aceponate, hydrocortisone acetate, hydrocortisone buteprate, hydrocortisone butyrate, hydrocortisone valerate, prednicarbate, and tixocortol pivalate. By route of administration[edit] Topical steroids[edit] Main article: Topical steroid 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[edit] For nasal mucosa, sinuses, bronchii, and lungs.[32] This group includes:

Flunisolide[33] Fluticasone
Fluticasone
furoate[33] Fluticasone
Fluticasone
propionate[33] Triamcinolone
Triamcinolone
acetonide[33] Beclomethasone dipropionate[33] Budesonide[33]

There also exist certain combination preparations such as Advair Diskus in the United States, containing fluticasone propionate and salmeterol (a long-acting bronchodilator), and Symbicort, containing budesonide and formoterol fumarate dihydrate (another long-acting bronchodilator)[33]. They are both approved for use in children over 12 years old. Oral forms[edit] Such as prednisone, prednisolone, methylprednisolone, or dexamethasone.[34] Systemic forms[edit] Available in injectables for intravenous and parenteral routes.[34] History[edit]

Introduction of early corticosteroids[35][36][37]

Corticosteroid Introduced

Cortisone 1948

Hydrocortisone 1951

Fludrocortisone
Fludrocortisone
acetate 1954[38]

Prednisolone 1955

Prednisone 1955[39]

Methylprednisolone 1956

Triamcinolone 1956

Dexamethasone 1958

Betamethasone 1958

Triamcinolone
Triamcinolone
acetonide 1958

Fluorometholone 1959

Tadeusz Reichstein, Edward Calvin Kendall. and Philip Showalter Hench were awarded the Nobel Prize
Nobel Prize
for Physiology
Physiology
and Medicine
Medicine
in 1950 for their work on hormones of the adrenal cortex, which culminated in the isolation of cortisone.[40] 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.[41] Corticosteroids were voted Allergen of the Year in 2005 by the American Contact Dermatitis Society.[42] 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.[43] 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
Marker degradation
was an important step in mass production of all steroidal hormones, including cortisone and chemicals used in hormonal contraception.[44] In 1952, D.H. Peterson and H.C. Murray of Upjohn
Upjohn
developed a process that used Rhizopus
Rhizopus
mold to oxidize progesterone into a compound that was readily converted to cortisone.[45] 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 Julian's research also aided progress in the field.[46] 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[edit] The cortico- part of the name refers to the adrenal cortex, which makes these steroid hormones. Thus a corticosteroid is a "cortex steroid". See also[edit]

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

References[edit]

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v t e

Pharmacology: major drug groups

Gastrointestinal tract/ metabolism (A)

stomach acid

Antacids H2 antagonists Proton pump inhibitors

Antiemetics Laxatives Antidiarrhoeals/Antipropulsives Anti-obesity drugs Anti-diabetics Vitamins Dietary minerals

Blood
Blood
and blood forming organs (B)

Antithrombotics

Antiplatelets Anticoagulants Thrombolytics/fibrinolytics

Antihemorrhagics

Platelets Coagulants Antifibrinolytics

Cardiovascular system (C)

cardiac therapy/antianginals

Cardiac glycosides Antiarrhythmics Cardiac stimulants

Antihypertensives Diuretics Vasodilators Beta blockers Calcium channel blockers renin–angiotensin system

ACE inhibitors Angiotensin II receptor antagonists Renin inhibitors

Antihyperlipidemics

Statins Fibrates Bile
Bile
acid sequestrants

Skin (D)

Emollients Cicatrizants Antipruritics Antipsoriatics Medicated dressings

Genitourinary system (G)

Hormonal contraception Fertility agents SERMs Sex hormones

Endocrine system (H)

Hypothalamic–pituitary hormones Corticosteroids

Glucocorticoids Mineralocorticoids

Sex hormones Thyroid hormones/Antithyroid agents

Infections and infestations (J, P, QI)

Antimicrobials: Antibacterials (Antimycobacterials) Antifungals Antivirals Antiparasitics

Antiprotozoals Anthelmintics Ectoparasiticides

IVIG Vaccines

Malignant disease (L01–L02)

Anticancer agents

Antimetabolites Alkylating Spindle poisons Antineoplastic Topoisomerase inhibitors

Immune disease (L03–L04)

Immunomodulators

Immunostimulants Immunosuppressants

Muscles, bones, and joints (M)

Anabolic steroids Anti-inflammatories

NSAIDs

Antirheumatics Corticosteroids Muscle
Muscle
relaxants Bisphosphonates

Brain and nervous system (N)

Analgesics Anesthetics

General Local

Anorectics Anti-ADHD agents Antiaddictives Anticonvulsants Antidementia agents Antidepressants Antimigraine
Antimigraine
agents Antiparkinson
Antiparkinson
agents Antipsychotics Anxiolytics Depressants Entactogens Entheogens Euphoriants Hallucinogens

Psychedelics Dissociatives Deliriants

Hypnotics/Sedatives Mood Stabilizers Neuroprotectives Nootropics Neurotoxins Orexigenics Serenics Stimulants Wakefulness-promoting agents

Respiratory system (R)

Decongestants Bronchodilators Cough medicines H1 antagonists

Sensory organs (S)

Ophthalmologicals Otologicals

Other ATC (V)

Antidotes Contrast media Radiopharmaceuticals Dressings Senotherapeutics

v t e

Endogenous steroids

Precursors

Cholesterol 22R-Hydroxycholesterol 20α,22R-Dihydroxycholesterol Pregnenolone 11β-Hydroxypregnenolone 17α-Hydroxypregnenolone 21-Hydroxypregnenolone 17α,21-Dihydroxypregnenolone 11β,17α,21-Trihydroxypregnenolone

Corticosteroids

Glucocorticoids

3α,5α-Tetrahydrocorticosterone 5α-Dihydrocorticosterone 11-Deoxycorticosterone 11-Deoxycortisol 11-Ketoprogesterone 21-Deoxycortisol 21-Deoxycortisone Corticosterone Cortisol Cortisone 17α-Hydroxypregnenolone 17α-Hydroxyprogesterone Pregnenolone Progesterone

Mineralocorticoids

5α-Dihydroaldosterone 11-Dehydrocorticosterone
11-Dehydrocorticosterone
(11-oxocorticosterone, 17-deoxycortisone) 11-Deoxycortisol 11-Deoxycorticosterone 11β-Hydroxyprogesterone
11β-Hydroxyprogesterone
(21-deoxycorticosterone) 18-Hydroxy-11-deoxycorticosterone 18-Hydroxycorticosterone 18-Hydroxyprogesterone Aldosterone Corticosterone Cortisol

Sex steroids

Androgens

11-Ketodihydrotestosterone 11-Ketotestosterone 7β-Hydroxyepiandrosterone 11β-Hydroxyandrostenedione Adrenosterone
Adrenosterone
(11-ketoandrostenedione) Androstenediol Androstenedione Androsterone Dehydroandrosterone DHEA DHEA sulfate Dihydrotestosterone Epiandrosterone Epitestosterone 16α-Hydroxyandrostenedione 16α-Hydroxy-DHEA 16α-Hydroxy-DHEA sulfate Testosterone

Metabolites: 3α-Androstanediol 3α-Androstanediol
3α-Androstanediol
glucuronide 3β-Androstanediol 3α,5β-Androstanediol 3β,5β-Androstanediol 5β-Androstanedione 5β-Dihydrotestosterone Androstanetriols Androstenediol
Androstenediol
sulfate Androsterone
Androsterone
glucuronide Androsterone
Androsterone
sulfate Dihydrotestosterone
Dihydrotestosterone
glucuronide Dihydrotestosterone
Dihydrotestosterone
sulfate Etiocholanolone Etiocholanolone
Etiocholanolone
glucuronide Epietiocholanolone Testosterone
Testosterone
glucuronide Testosterone
Testosterone
sulfate

Estrogens

Estranes: Estetrol Estradiol Estrone Estriol 17α-Estradiol 16β- Epiestriol
Epiestriol
(16β-hydroxyestradiol) 17α- Epiestriol
Epiestriol
(16α-hydroxy-17α-estradiol) 16β,17α- Epiestriol
Epiestriol
(16β-hydroxy-17α-estradiol) 2-Hydroxyestradiol 2-Hydroxyestriol 2-Hydroxyestrone 4-Hydroxyestradiol 4-Hydroxyestriol 4-Hydroxyestrone 4-Methoxyestradiol 16α-Hydroxyestrone

Others: 27-Hydroxycholesterol 3α-Androstanediol 3β-Androstanediol 4-Androstenedione 5-Androstenediol DHEA DHEA sulfate 7-Keto-DHEA 7α-Hydroxy-DHEA 16α-Hydroxy-DHEA

Metabolites: 2-Methoxyestradiol 2-Methoxyestrone 4-Methoxyestrone Estradiol
Estradiol
glucuronide Estradiol
Estradiol
sulfate Estrone
Estrone
glucuronide Estrone
Estrone
sulfate Estriol
Estriol
glucuronide Estriol
Estriol
sulfate Lipoidal estradiol
Lipoidal estradiol
(e.g., estradiol stearate, estradiol palmitate)

Progestogens

Progesterone 16α-Hydroxyprogesterone 17α-Hydroxyprogesterone 20α-Dihydroprogesterone 5α-Dihydroprogesterone 11-Deoxycorticosterone 5α-DHDOC

Metabolites: Allopregnanediol Pregnanediol Pregnanediol
Pregnanediol
glucuronide Pregnanetriol

Neurosteroids

Cholestanes: 24S-Hydroxycholesterol Cholesterol

Pregnanes: 3α-Dihydroprogesterone 3β-Dihydroprogesterone 5α-Dihydrocorticosterone 5α-Dihydroprogesterone 5β-Dihydroprogesterone Allopregnanolone Corticosterone DHC DHDOC 11-Deoxycorticosterone Epipregnanolone Isopregnanolone Pregnanolone Pregnenolone Pregnenolone
Pregnenolone
sulfate Progesterone THB THDOC

Androstanes: 3α-Androstanediol 3α-Androstenol 7-Keto-DHEA 7α-Hydroxy-DHEA 7β-Hydroxy-DHEA 7α-Hydroxyepiandrosterone 7β-Hydroxyepiandrosterone Androsterone DHEA DHEA sulfate Etiocholanolone

Pheromones: 3α-Androstenol 3β-Androstenol Androstadienol Androstadienone Androstenone Androsterone Estratetraenol

Others

Vitamin
Vitamin
D: 7-Dehydrocholesterol Calcidiol/Calcifediol Calcitriol Cholecalciferol

Others: 7α-Hydroxycholesterol 11α-Hydroxyprogesterone 11β-Hydroxyprogesterone Cholesterol
Cholesterol
sulfate

Corticosteroids and anticorticosteroids

v t e

Glucocorticoids and antiglucocorticoids (H02)

Glucocorticoids

Natural

Cortisone

Cortisone
Cortisone
acetate

Cortodoxone
Cortodoxone
(cortexolone, 11-deoxycortisol) Desoxycortone
Desoxycortone
(deoxycortone, cortexone, 11-deoxycorticosterone)

Desoxycortone
Desoxycortone
esters

Hydrocortisone
Hydrocortisone
(cortisol)#

Hydrocortisone
Hydrocortisone
esters

Prebediolone
Prebediolone
acetate Pregnenolone

Pregnenolone
Pregnenolone
acetate Pregnenolone
Pregnenolone
succinate

Synthetic

Cortisol-like and related (16-unsubstituted): Chloroprednisone Cloprednol Difluprednate Fludrocortisone Flugestone acetate
Flugestone acetate
(flurogestone acetate) Fluocinolone Fluorometholone

Fluorometholone
Fluorometholone
acetate

Fluperolone

Fluperolone
Fluperolone
acetate

Fluprednisolone

Fluprednisolone
Fluprednisolone
esters

Loteprednol Medrysone Methylprednisolone

Methylprednisolone
Methylprednisolone
esters

Prednicarbate Prednisolone Prednisone Tixocortol

Tixocortol
Tixocortol
pivalate

Methasones and related (16-substituted): Alclometasone Beclometasone

Beclometasone
Beclometasone
esters

Betamethasone

Betamethasone
Betamethasone
esters

Clobetasol

Clobetasol
Clobetasol
propionate

Clobetasone Clocortolone

Clocortolone
Clocortolone
esters

Cortivazol Desoximetasone Dexamethasone

Dexamethasone
Dexamethasone
esters

Diflorasone Diflucortolone

Diflucortolone
Diflucortolone
valerate

Fluclorolone Flumetasone Fluocortin Fluocortolone

Fluocortolone
Fluocortolone
esters

Fluprednidene
Fluprednidene
acetate Fluticasone

Fluticasone
Fluticasone
furoate Fluticasone
Fluticasone
propionate

Halometasone Meprednisone Mometasone

Mometasone
Mometasone
furoate

Paramethasone Prednylidene Rimexolone Triamcinolone Ulobetasol
Ulobetasol
(halobetasol)

Cyclic ketals (16,17-cyclized): Amcinonide Budesonide Ciclesonide Deflazacort Desonide Fluclorolone
Fluclorolone
acetonide (flucloronide) Fludroxycortide
Fludroxycortide
(flurandrenolone, flurandrenolide) Flunisolide Fluocinolone
Fluocinolone
acetonide Fluocinonide Formocortal
Formocortal
(fluoroformylone) Halcinonide Triamcinolone
Triamcinolone
acetonide

Triamcinolone
Triamcinolone
acetonide esters

Antiglucocorticoids

Antagonists: Aglepristone Ketoconazole Mifepristone Ulipristal acetate

Synthesis modifiers

Acetoxolone Aminoglutethimide Carbenoxolone Enoxolone Ketoconazole Metyrapone Mitotane Trilostane

#WHO-EM ‡Withdrawn from market Clinical trials:

†Phase III §Never to phase III

See also Glucocorticoid
Glucocorticoid
receptor modulators Mineralocorticoids and antimineralocorticoids List of corticosteroids

v t e

Mineralocorticoids and antimineralocorticoids (H02)

Mineralocorticoids

Desoxycortone
Desoxycortone
(desoxycorticosterone)

Desoxycortone
Desoxycortone
esters

Hydrocortisone
Hydrocortisone
(cortisol)

Hydrocortisone
Hydrocortisone
esters

Fludrocortisone

Fludrocortisone
Fludrocortisone
acetate

Methylprednisolone

Methylprednisolone
Methylprednisolone
esters

Prednisolone

Prednisolone
Prednisolone
esters

Prednisone

Prednisone
Prednisone
esters

Antimineralocorticoids

Steroidal: Canrenoate potassium (potassium canrenoate) Canrenone Drospirenone Dydrogesterone Eplerenone Gestodene Medrogestone Progesterone Spironolactone Trimegestone

Nonsteroidal: Amlodipine Apararenone§ Benidipine Esaxerenone† Felodipine Finerenone† Nifedipine Nimodipine Nitrendipine

Synthesis modifiers

Acetoxolone Aminoglutethimide Carbenoxolone Enoxolone Ketoconazole Metyrapone Mitotane Trilostane

#WHO-EM ‡Withdrawn from market Clinical trials:

†Phase III §Never to phase III

See also Mineralocorticoid
Mineralocorticoid
receptor modulators Glucocorticoids and antiglucocorticoids List of corticosteroids

Corticosteroid receptor
Corticosteroid receptor
modulators

v t e

Glucocorticoid
Glucocorticoid
receptor modulators

GR

Agonists

Cortisol-like and related (16-unsubstituted): 3α,5α-Tetrahydrocorticosterone 5α-Dihydrocorticosterone 9α-Fluorocortisone
9α-Fluorocortisone
(alfluorone) 11-Dehydrocorticosterone
11-Dehydrocorticosterone
(11-oxocorticosterone, 17-deoxycortisone)

11-Dehydrocorticosterone
11-Dehydrocorticosterone
acetate

11-Deoxycorticosterone
11-Deoxycorticosterone
(desoxycortone, deoxycortone, desoxycorticosterone)

Desoxycortone
Desoxycortone
esters

11-Deoxycortisol
11-Deoxycortisol
(cortodoxone, cortexolone)

Cortifen
Cortifen
(cortiphen, kortifen) Cortodoxone
Cortodoxone
acetate

21-Deoxycortisol Δ7-Prednisolone

Δ7- Prednisolone
Prednisolone
21-acetate

Amebucort Chloroprednisone

Chloroprednisone
Chloroprednisone
acetate

Cloprednol

Cloprednol
Cloprednol
acetate

Corticosterone

Corticosterone
Corticosterone
acetate Corticosterone
Corticosterone
benzoate

Cortisol
Cortisol
(hydrocortisone)

Benzodrocortisone
Benzodrocortisone
(hydrocortisone benzoate) Hydrocortamate
Hydrocortamate
(hydrocortisone diethylaminoacetate) Hydrocortisone
Hydrocortisone
esters

Cortisone

Cortisone
Cortisone
acetate

Deprodone

Deprodone
Deprodone
propionate

Dichlorisone

Dichlorisone
Dichlorisone
acetate Dichlorisone
Dichlorisone
diacetate

Difluprednate Endrisone
Endrisone
(endrysone) Etiprednol

Etiprednol
Etiprednol
dicloacetate (etiprednol dichloroacetate)

Fludrocortisone
Fludrocortisone
(fludrocortone)

Fludrocortisone
Fludrocortisone
acetate

Fluorometholone

Fluorometholone
Fluorometholone
acetate

Fluperolone

Fluperolone
Fluperolone
acetate

Fluprednisolone

Fluprednisolone
Fluprednisolone
esters

Halopredone

Halopredone
Halopredone
acetate (halopredone diacetate)

Isoflupredone
Isoflupredone
(9α-fluoroprednisolone)

Isoflupredone
Isoflupredone
acetate

Loteprednol

Loteprednol
Loteprednol
etabonate

Mazipredone
Mazipredone
(depersolone) Medrysone Methylprednisolone

Methylprednisolone
Methylprednisolone
esters

Prebediolone

Prebediolone
Prebediolone
acetate

Prednisolone

Prednazate Prednazoline Prednicarbate
Prednicarbate
(prednisolone ethylcarbonate propionate) Prednimustine Prednisolamate
Prednisolamate
(prednisolone diethylaminoacetate) Prednisolone
Prednisolone
esters

Prednisone

Prednisone
Prednisone
esters

Pregnenolone

Pregnenolone
Pregnenolone
acetate Pregnenolone
Pregnenolone
succinate (pregnenolone hemisuccinate)

Resocortol Tipredane Tixocortol

Butixocort
Butixocort
(tixocortol butyrate)

Butixocort
Butixocort
propionate

Tixocortol
Tixocortol
pivalate

Methasones and related (16-substituted): 16α-Methyl-11-oxoprednisolone Alclometasone

Alclometasone
Alclometasone
dipropionate

Amelometasone Beclometasone
Beclometasone
(beclomethasone)

Beclometasone
Beclometasone
esters

Betamethasone
Betamethasone
(betametasone)

Betamethasone
Betamethasone
esters Cortobenzolone
Cortobenzolone
(betamethasone salicylate)

Ciclometasone
Ciclometasone
(ciclomethasone, cyclomethasone) Clobetasol

Clobetasol
Clobetasol
propionate

Clobetasone

Clobetasone
Clobetasone
butyrate

Clocortolone

Clocortolone
Clocortolone
esters

Cloticasone

Cloticasone
Cloticasone
propionate

Cormetasone
Cormetasone
(cormethasone)

Cormetasone
Cormetasone
acetate

Descinolone Desoximetasone
Desoximetasone
(desoxymethasone) Dexamethasone
Dexamethasone
(dexametasone)

Dexamethasone
Dexamethasone
esters

Diflorasone

Diflorasone
Diflorasone
diacetate

Diflucortolone

Diflucortolone
Diflucortolone
pivalate Diflucortolone
Diflucortolone
valerate

Dimesone

Dimesone
Dimesone
acetate

Doxibetasol
Doxibetasol
(doxybetasol) Fluclorolone Flumetasone
Flumetasone
(flumethasone)

Flumetasone
Flumetasone
acetate Flumetasone
Flumetasone
pivalate

Fluocinolone Fluocortin

Fluocortin
Fluocortin
butyl (fluocortin butylate)

Fluocortolone

Fluocortolone
Fluocortolone
esters

Fluprednidene
Fluprednidene
(fluprednylidene)

Fluprednidene
Fluprednidene
acetate

Fluticasone

Fluticasone
Fluticasone
furoate Fluticasone
Fluticasone
propionate

Halocortolone Halometasone Icometasone

Icometasone
Icometasone
enbutate (icometasone butyrate acetate)

Isoprednidene Locicortolone
Locicortolone
(locicortone)

Locicortolone
Locicortolone
dicibate (locicortone dicibate)

Meclorisone

Meclorisone
Meclorisone
dibutyrate

Meprednisone
Meprednisone
(methylprednisone)

Meprednisone
Meprednisone
acetate Meprednisone
Meprednisone
hydrogen succinate (methylprednisone hemisuccinate)

Mometasone

Mometasone
Mometasone
furoate

Paramethasone

Paramethasone
Paramethasone
acetate Paramethasone
Paramethasone
disodium phosphate Paramethasone
Paramethasone
phosphate

Prednylidene

Prednylidene
Prednylidene
diethylaminoacetate

Rimexolone Ticabesone

Ticabesone
Ticabesone
propionate

Timobesone

Timobesone
Timobesone
acetate

Triamcinolone

Triamcinolone
Triamcinolone
diacetate

Ulobetasol
Ulobetasol
(halobetasol)

Ulobetasol
Ulobetasol
propionate

Vamorolone

Cyclic ketals (16,17-cyclized): Acrocinonide
Acrocinonide
(triamcinolone acroleinide) Amcinafal
Amcinafal
(triamcinolone pentanonide) Amcinafide
Amcinafide
(triamcinolone acetophenide) Amcinonide
Amcinonide
(triamcinolone acetate cyclopentanonide) Budesonide Ciclesonide Cicortonide Deflazacort
Deflazacort
(azacort) Descinolone
Descinolone
acetonide Desonide
Desonide
(hydroxyprednisolone acetonide)

Desonide
Desonide
disodium phosphate Desonide
Desonide
pivalate

Dexbudesonide Drocinonide

Drocinonide
Drocinonide
phosphate

Fluazacort Fluclorolone
Fluclorolone
acetonide (flucloronide) Fludroxycortide
Fludroxycortide
(flurandrenolone, flurandrenolide) Flumoxonide Flunisolide

Flunisolide
Flunisolide
acetate

Fluocinolone
Fluocinolone
acetonide

Ciprocinonide
Ciprocinonide
(fluocinolone acetonide cyclopropylcarboxylate) Fluocinonide
Fluocinonide
(fluocinolide, fluocinolone acetonide acetate) Procinonide
Procinonide
(fluocinolone acetonide propionate)

Formocortal Halcinonide Itrocinonide Rofleponide

Rofleponide
Rofleponide
palmitate

Tralonide Triamcinolone
Triamcinolone
acetonide

Flupamesone (triamcinolone acetonide metembonate) Triamcinolone
Triamcinolone
acetonide esters

Triamcinolone
Triamcinolone
aminobenzal benzamidoisobutyrate (TBI-PAB) Triclonide

Others/atypical (other expanded steroid ring systems, homosteroids, and non-pregnane steroids): Cortisuzol Cortivazol Domoprednate Naflocort Nicocortonide

Nicocortonide
Nicocortonide
acetate

Nivacortol
Nivacortol
(nivazol) Oxisopred RU-28362

Non-corticosteroids with some glucocorticoid activity: 15β-Hydroxycyproterone acetate 17α-Hydroxyprogesterone Chlormadinone acetate Cyproterone Cyproterone
Cyproterone
acetate Danazol Delmadinone acetate Desogestrel Etonogestrel Flugestone Flugestone acetate
Flugestone acetate
(flurogestone acetate) Fluoxymesterone Gestodene Medrogestone Medroxyprogesterone acetate Megestrol acetate Metribolone Norgestomet Osaterone acetate Progesterone Promegestone RU-2309 Quingestrone Segesterone acetate
Segesterone acetate
(nestorone) Tetrahydrogestrinone

Nonsteroidal glucocorticoids: AZD-5423 GSK-9027

Mixed (SEGRMs)

Dagrocorat Fosdagrocorat Mapracorat

Antagonists

7α-Hydroxy-DHEA 17α-Methylprogesterone Aglepristone Asoprisnil Asoprisnil
Asoprisnil
ecamate C108297 C113176 CORT-108297 Cyproterone
Cyproterone
acetate Guggulsterone Ketoconazole Lilopristone LLY-2707 Metapristone (RU-42633) Miconazole Mifepristone
Mifepristone
(RU-486) Onapristone ORG-34116 ORG-34517 (SCH-900636) ORG-34850 Pregnenolone
Pregnenolone
16α-carbonitrile Relacorilant
Relacorilant
(CORT-125134) RTI 3021–012 RTI 3021–022 Telapristone Tibolone Toripristone Ulipristal acetate

Others

Antisense oligonucleotides: IONIS-GCCRRx (ISIS-426115)

See also Receptor/signaling modulators Glucocorticoids and antiglucocorticoids Mineralocorticoid
Mineralocorticoid
receptor modulators List of corticosteroids

v t e

Mineralocorticoid
Mineralocorticoid
receptor modulators

MR

Agonists

11-Dehydrocorticosterone
11-Dehydrocorticosterone
(11-oxocorticosterone, 17-deoxycortisone)

11-Dehydrocorticosterone
11-Dehydrocorticosterone
acetate

11-Deoxycorticosterone
11-Deoxycorticosterone
(desoxycortone, deoxycortone, desoxycorticosterone)

Desoxycortone
Desoxycortone
esters

11-Deoxycortisol
11-Deoxycortisol
(cortodoxone, cortexolone)

Cortifen
Cortifen
(cortiphen, kortifen) Cortodoxone
Cortodoxone
acetate

11β-Hydroxyprogesterone 16α,18-Dihydroxy-11-deoxycorticosterone 17α-Hydroxyaldosterone 18-Hydroxy-11-deoxycorticosterone 19-Norprogesterone Aldosterone Corticosterone

Corticosterone
Corticosterone
acetate Corticosterone
Corticosterone
benzoate

Cortisol
Cortisol
(hydrocortisone)

Benzodrocortisone
Benzodrocortisone
(hydrocortisone benzoate) Hydrocortamate
Hydrocortamate
(hydrocortisone diethylaminoacetate) Hydrocortisone
Hydrocortisone
esters

Cortisone

Cortisone
Cortisone
acetate

Fludrocortisone
Fludrocortisone
(fludrocortone)

Fludrocortisone
Fludrocortisone
acetate

Mometasone

Mometasone
Mometasone
furoate

Prednisolone

Prednazate Prednazoline Prednicarbate
Prednicarbate
(prednisolone ethylcarbonate propionate) Prednimustine Prednisolamate
Prednisolamate
(prednisolone diethylaminoacetate) Prednisolone
Prednisolone
esters

Prednisone

Prednisone
Prednisone
esters

Antagonists

Steroidal: 6β-Hydroxy-7α-thiomethylspironolactone 7α-Acetylthio-17α-hydroxyprogesterone 7α-Thiomethylspironolactone
7α-Thiomethylspironolactone
(SC-26519) 7α-Thioprogesterone
7α-Thioprogesterone
(SC-8365) 7α-Thiospironolactone
7α-Thiospironolactone
(SC-24813) 16α-Hydroxyprogesterone 17α-Hydroxyprogesterone
17α-Hydroxyprogesterone
(hydroxyprogesterone) 18-Deoxyaldosterone 18,19-Dinorprogesterone Canrenoate potassium (potassium canrenoate) Canrenoic acid
Canrenoic acid
(canrenoate) Canrenone
Canrenone
(canrenoate y-lactone) Dicirenone Dimethisterone Drospirenone Dydrogesterone Eplerenone Gestodene Guggulsterone Hydroxyprogesterone caproate Medrogestone Mespirenone Metribolone Mexrenoate potassium Mexrenoic acid
Mexrenoic acid
(mexrenoate) Mexrenone Oxprenoic acid
Oxprenoic acid
(oxprenoate) Oxprenoate potassium
Oxprenoate potassium
(RU-28318) Pregnenolone Progesterone Prorenoate potassium Prorenoic acid
Prorenoic acid
(prorenoate) Prorenone RO-14-9012 RU-26752 SC-5233
SC-5233
(spirolactone) SC-8109 SC-11927 (CS-1) SC-19886 SC-27169 Spirorenone Spironolactone Spiroxasone Tibolone Trimegestone ZK-91587 ZK-97894

Nonsteroidal: Amlodipine Apararenone Benidipine BR-4628 Esaxerenone Felodipine Finerenone Nifedipine Nimodipine Nitrendipine PF-03882845 SM-368229

See also Receptor/signaling modulators Mineralocorticoids and antimineralocorticoids Glucocorticoid
Glucocorticoid
receptor modulators List of corticosteroids

Authority control

LCCN: sh8500

.