Corticosteroid responsive conditions

Question 1

What are the main uses for corticosteroids?

Answer 1

• Inflammatory long term diseases

- Immunosuppression

Question 2

What does the adrenal cortex normally secrete?

Answer 2

• Hydrocortisone (cortisol) which has glucocorticoid activity and some mineralocorticoid activity
• Also secretes mineralocorticoid aldosterone

Question 3

In deficiency states e.g. Addision’s disease what is the best combination of therapy to achieve physiological replacement and why?

Answer 3

> Oral hydrocortisone and fludrocortisone. > Hydrocortisone alone does not provide sufficient
mineralocorticoid activity for complete replacement.
Replacement therapy is given in 2 doses, the larger in
the morning and the smaller in the evening, mimicking
the normal diurnal rhythm of cortisol secretion.

Question 4

What treatment is given for acute adrenocortical insufficiency?

Answer 4

Hydrocortisone IV every 6 to 8 hours

Question 5

What should be given in hypopituitarism?

Answer 5

Oral hydrocortisone should be
given. As in adrenocortical insufficiency, a
mineralocorticoid is not usually required as adrenal
function is still present.

Question 6

Should additional levothyroxine and sex hormones be given in hypopituitarism?

Answer 6

Should be given as indicated by the pattern of

hormone deficiency.

Question 7

What do high mineralocorticoid steroids often do?

Answer 7

Cause fluid retention

Question 8

What is the most potent mineralcorticoid?

Answer 8

Fludrocortisone

Question 9

What is fludrocortisone used for?

Answer 9

Hypotension (due to fluid retention benefits).

Question 10

Why is the anti-inflammatory activity of fludrocortisone of no clinical relevance?

Answer 10

Due to how high its mineralocorticoid effect is

Question 11

What is important to remember when comparing corticosteroids?

Answer 11

That high glucocorticoid (anti-inflammatory) activity in itself is of no advantage unless it is accompanied by relatively low mineralocorticoid activity. E.g. in fludrocortisone, mineralocorticoid activity is so high that anti-inflam has no clinical relevance

Question 12

What are the similarities between betamethasone and dexamethasone?

Answer 12

They both have a long duration of very high glucocorticoid activity, in conjunction with insignificant mineralocorticoid

activity.
- Makes them particularly suitable for high-dose therapy in conditions where fluid retention would be a disadvantage.

Question 13

What is the most commonly used oral corticosteroid?

Answer 13

• Prednisolone- for long-term disease suppression

- It has predominantly glucocorticoid activity

Question 14

Which steroid is derived from prednisolone?

Answer 14

Deflazacort- has a high glucocorticoid activity