In physiology, corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. Corticosteroids are involved in a wide range of physiologic systems such as stress response, immune response and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte levels, and behavior.

• Glucocorticoids such as cortisol control carbohydrate, fat and protein metabolism and are anti-inflammatory by preventing phospholipid release, decreasing eosinophil action and a number of other mechanisms.
• Mineralocorticoids such as aldosterone control electrolyte and water levels, mainly by promoting sodium retention in the kidney.

Corticosterone

Some common natural hormones are corticosterone (C₂₁H₃₀O₄), cortisone (C₂₁H₂₈O₅, 17-hydroxy-11-dehydrocorticosterone) and aldosterone.

Uses

Synthetic drugs with corticosteroid-like effect are used in a variety of conditions, ranging from brain tumors to skin diseases. Dexamethasone and its derivatives are almost pure glucocorticoids, while prednisolone and its derivatives have some mineralocorticoid action in addition to the glucocorticoid effect. Fludrocortisone (Florinef®) is a synthetic mineralocorticoid. Hydrocortisone (cortisol) is available for replacement therapy, e.g. in adrenal insufficiency.

Synthetic glucocorticoids are used in the treatment of joint pain or inflammation (arthritis), dermatitis, allergic reactions, asthma, hepatitis, lupus erythematosus, inflammatory bowel disease (ulcerative colitis and Crohn's disease), sarcoidosis and for glucocorticoid replacement in Addison's disease or other forms of adrenal insufficiency. Topical formulations for treatment of skin or inflammatory bowel disease are available.

Typical undesired effects of glucocorticoids present quite uniformly as drug-induced Cushing's syndrome. Typical mineralocorticoid side effects are hypertension, hypokalemia, hypernatremia, and metabolic alkalosis.

History

Tadeus Reichstein together with 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.

Use of corticosteroids as a drug treatment had been in use for some time, extracted from the adrenal glands of oxen. This preparation cost hundreds of dollars a drop, and was available to few. Percy Julian developed a way to synthesize cortisone from soy beans, thus making it affordable to all at pennies a gram. The exact nature of cortisone's anti-inflammatory nature remained a mystery for years after however, until the leukocyte adhesion cascade was fully understood in the early 1980s.

See also

• Cushing's syndrome
• Steroids (general term)