Corticosteroids

Question 1

What are the main mechanisms of action of glucocorticoids around the body

Answer 1

Metabolism: Increase gluconeogenesis, reduce glucose uptake to
muscle and fat, increase proteolysis, and redistribution of lipids

Bone: Inhibit osteoblast formation, reduce calcium absorption at
the gut

Immune: Inhibit B and T cell responses, reduced transcription of
cytokines, reduced leucocyte adhesion, and reduced phagocytotic
action

Question 2

What is a main ADR of glucocorticoid over-use

Answer 2

Excessive glucocorticoid leads to a Cushing Syndrome
• Significant fat redistribution
• Reduced muscle mass
• Hypocalcaemia
• Reduced bone reabsorption
• Hyperglycaemia
• Affects on the CNS

Question 3

Name some other ADRs in the over-use of steroids

Answer 3

Aside from Cushingoid features, excessive steroids can lead to
increased risk of:
• Cateracts
• Avascular Necrosis
• Peptic ulcers
• Infections
• Mineralocorticoid effects
Adrenal insufficiency can occur with prolonged use; additional
steroids are required prior to surgery if necessary

Question 4

What can be done to reduce the iatrogenic profile of steroids

Answer 4

Steroid sparing agents are used whenever possible to
reduce iatrogenic profile of steroids
Examples include Azathioprine, Methotrexate, and
Cyclophosphamide

Question 5

Why is abrupt cessation of steroids not advised?

Answer 5

adrenal insufficiency

Gradual tapering usually required

Question 6

What are corticosteroids
Where are they produced
What is their main mechanism of action

Answer 6

steroid hormones that are derived from cholesterol
Produced by adrenal cortex (zona glomerulosa)
Act on intracellular receptors, forming hormone receptor (HR) complexes
Act as transcription factors, thus cause effects within few
hours