Use Of Corticosteroids

 Dosages of corticosteroids very widely in different disease and different patients. If the use of a corticosteriod can save or prolong life, as in exfoiative dermititis, Pemphigus, Acute Leukamia or Acute Transplant rejection, High doses may need to be given, because the complications of therapy are likely to be less serious than the effects of the disease itself.

When long-term corticosteroid therapy is used in some chronic diseases, the adverse effects or treatment may become greater than the disabilities caused by the disease. To minimise side-effects the maintenance dose should be kept as low as possible.

when potentialy ess harmful measures are ineffective corticosteroids are used topically for the treatment of inflammatory conditions of the skin. Corticosteroids ahould be avoided or used only under specialist supervision in psoriasis.

Notes; Psoriasis is a skin disease marked by red, itchy, scaly patches.

Corticosteroids are used both topically and systemically in the management of ulcerative colitis and chron's disease. They are also included in locally applied creams for haemorrhoids.

Notes; Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease (IBD) that causes long-lasting inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. ... Inflammatory bowel disease.

           Chron's disease is a chronic inflammatory disease of the intestines, especially the colon and ileum, associated with ulcers and fistulae.

           Haemorrhoids is a swollen vein or group of veins in the region of the anus.

Use can be made of the mineraocorticoid activity of fudrocortisone to treat postural hypotension in autonomic neuropathy.

Notes; Postural hypotension is defined as a reduction in systolicblood pressure of 20mmHg or more after standing for at least one minute (Miller, 1999). Also known as orthostatic hypotension, it is a common problem in older people, affecting 10-33% of them (Harris et al, 1991; Patel et al, 1993).

          Autonomic neuropathy is a group of symptoms that occur when there is damage to the nerves that manage every day body functions. These functions include blood pressure, heart rate, sweating, bowel and bladder emptying, and digestion.

High-dose corticosteroids should be avoided for the management of septic shock. However, there is evidence that administration of lower doses of hydrocotisone (50 mg intravenously every 6  hours) and fludrocotisone ( 50 micro-grams daily by mouth) is of benefit in adrenocortical insufficiency resulting from septic shock.

Notes; Septic shock is a serious medical condition that occurs when sepsis, which is organ injury or damage in response to infection, leads to dangerously low blood pressure and abnormalities in cellular metabolism. ... It can cause multiple organ dysfunction syndrome (formerly known as multiple organ failure) and death.

 Dexamethasone and betamethasone have little if any mineralocorticoid action and their long duration of action makes them particularly suitable for suppressing corticotropin secretion in congenital adrenal hyperplasia where the dose shoud be tailored to clinical response and by measurement of  adrenal androgens and 17-hydroxyprogesterone. In common with all thalamic-pituitary-adrenal axis is greatest and most prolonged when they are given at night. In most individuals a single dost of 1 mg of dexamethasone at night, is sufficient to inhibit corticotropin secretion for 24 hours. This is the basis of the 'overnight dexamethasone suppression test' for diagnosing Cushing's syndrome.

Notes; Adrenocorticotropic hormone (ACTH), also known as corticotropin is a polypeptide tropic hormone produced and secreted by the anterior pituitary gland. ... Its principal effects are increased production and release of cortisol by the cortex of the adrenal gland.

           Congenital adrenal hyperplasia (CAH) are any of several autosomal recessive diseases resulting from mutations of genes for enzymes mediating the biochemical steps of production of mineralocorticoids, glucocorticoids or sex steroids from cholesterol by the adrenal glands (steroidogenesis).

            Dehydroepiandrosterone (DHEA) is a steroid hormone produced in the adrenal cortex from cholesterol. It is the primary precursor of natural estrogens. DHEA is also called dehydroisoandrosterone or dehydroandrosterone. Androstenedione (A4) is an androgenic steroid produced by the testes, adrenal cortex, and ovaries.

           The hormone 17-hydroxyprogesterone is a building block for producing the hormone cortisol. ... It causes the adrenal glands to make excess androgens (male steroid hormones) and, in some cases, not enough of the hormones that regulate the body's salt balance.

            The hypothalamic–pituitary–adrenal axis (HPA axis or HTPA axis) is a complex set of direct influences and feedback interactions among three endocrine glands: the hypothalamus, the pituitary gland (a pea-shaped structure located below the thalamus), and the adrenal(also called "suprarenal") glands.

            Cushing's syndrome is a metabolic disorder caused by overproduction of corticosteroid hormones by the adrenal cortex and often involving obesity and high blood pressure.

Betamethasone and dexamethasone are also appropriate for conditions where water retention would be a disadvantage.
A Corticosteroid may be used in the management of raised intracanial pressure or cerebral oedema that occurs as a result of malignancy; high doses of betamethasone or dexamethasone are generally used. However a cortcosteroid should not be used for the management of head injury or stroke because it is unlikely to be of benefit and may even be harmful.

In acute hypersensitivity reactions such as angioedema of the upper respiratory tract and anaphylaxis, cortocosteroids are indicated as an ajunct to emergency treatment with adrenaline (ephinephrine). In such cases hydrocortisone by intravenous (as sodium succinate) in a dose of 100 to 300 mg may be required.

Notes; Intracranial pressure (ICP) is the pressure inside the skull and thus in the brain tissue and cerebrospinal fluid (CSF). ICP is measured in millimeters of mercury (mmHg) and, at rest, is normally 7–15 mmHg for a supine adult.

            Cerebral edema is a life-threatening condition that develops as a result of an inflammatory reaction. Most frequently, this is the consequence of cerebral trauma, massive cerebral infarction, hemorrhages, abscess, tumor, allergy, sepsis, hypoxia, and other toxic or metabolic factors.

            Hypersensitivity (also called hypersensitivity reaction or intolerance) is a set of undesirable reactions produced by the normal immune system, including allergies and autoimmunity.

             Angioedema is the rapid edema, or swelling, of the area beneath the skin or mucosa. It is normally an allergic reaction, but it can also be hereditary. ... Angioedema is similar to urticaria, or hives. However, urticaria affects only the upper dermis, or top layer of skin.

             Anaphylaxis is an acute allergic reaction to an antigen (e.g. a bee sting) to which the body has become hypersensitive.

              The definition of a succinate is a salt or an ester made of succinic acid. A product in the Krebs cycle formed from succinic/butanedioic acid is an example of a succinate.

Corticosteroids are preferably used by inhalation in the management of asthma but systemic therapy in association with bronchodilators is required for emergency treatment of severe acute asthma.

Corticosteroids may also be useful in conditions such as autoimmune hepatitism, rheumatoid of acquried haemolytic anaemia, and some cases of the nephrotic syndrome and thrombocytophenic purpura.

Notes; Autoimmune hepatitis (AIH) is one exception. This type of liverdisease occurs when your immune system attacks your liver cells. AIH is a chronic condition and can result in cirrhosis (scarring) of the liver and (ultimately) liver failure.

            Autoimmune hemolytic anemia (or autoimmune haemolytic anaemia; AIHA) occurs when antibodies directed against the person's own red blood cells (RBCs) cause them to burst (lyse), leading to an insufficient number of oxygen-carrying red blood cells in the circulation.

           Nephrotic Syndrome or Nephrosis is kidney disease, especially when characterized by oedema and the loss of protein from the plasma into the urine due to increased glomerular permeability (also called nephrotic syndrome ). 

            Idiopathic thrombocytopenic purpura (ITP) is a disorder that can lead to easy or excessive bruising and bleeding. The bleeding results from unusually low levels of platelets — the cells that help blood clot.

Corticosteroids can improve the prognosis of serious conditions such as systemic lupus erthematosus, temporal arterities, and poyarteritis nodosa; the effects of the disease process may be suppressed and symptoms relieved, but the underlying condition is not cured, although it may ultimately remit. It is usual to begin therapy in these conditions at fairly high dose, such as 40 to 60 mg prednisolone daily, and then to reduce the dose  to the lowest commensurate with disease control.