Glucocorticoids are a class of steroid hormones characterised by an ability to bind with the cortisol receptor and trigger similar effects. Glucocorticoids are distinguished from mineralocorticoids and sex steroids by the specific receptors, target cells, and effects. Technically, the term corticosteroid refers to both glucocorticoids and mineralocorticoids, but is often used as a synonym for glucocorticoid. Steroid hormones are steroids which act as hormones. ... Cortisol is a corticosteroid hormone that is involved in the response to stress; it increases blood pressure and blood sugar levels and suppresses the immune system. ... In biochemistry, a receptor is a protein on the cell membrane or within the cytoplasm or cell nucleus that binds to a specific molecule (a ligand), such as a neurotransmitter, hormone, or other substance, and initiates the cellular response to the ligand. ... Mineralocorticoids is a class of steroids characterised by their similarity to aldosterone and their influence on salt and water metabolism. ... A sex steroid is a steroid hormone which interacts with vertebrate androgen or estrogen receptors. ... In physiology, corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. ...

Cortisol (or hydrocortisone) is the most important human glucocorticoid. It is essential for life and regulates or supports a variety of important cardiovascular, metabolic, immunologic, and homeostatic functions. Glucocorticoid receptors are found in the cells of almost all vertebrate tissues. Cortisol is a corticosteroid hormone that is involved in the response to stress; it increases blood pressure and blood sugar levels and suppresses the immune system. ... The circulatory system or cardiovascular system is the organ system which circulates blood around the body of most animals. ... Santorio Santorio (1561-1636) in his steelyard balance, from Ars de statica medecina, first published 1614 Metabolism (from μεταβολισμος (metabolismos)) is the biochemical modification of chemical compounds in living organisms anggjgjhnd cell (b). ... Immunology is a broad branch of biomedical science that covers the study of all aspects of the immune system in all organisms. ... Homeostasis is the property of an open system, especially living organisms, to regulate its internal environment to maintain a stable, constant condition, by means of multiple dynamic equilibrium adjustments, controlled by interrelated regulation mechanisms. ... The ‘’’glucocorticoid receptor’’’ (GR) is a ligand-activated intracytoplasmatic transcription factor that interacts with high affinity to cortisol and other glucocorticoids. ... Vertebrata is a subphylum of chordates, specifically, those with backbones or spinal columns. ...

Effects

The name glucocorticoid derives from early observations that these hormones were involved in glucose metabolism. In the fasted state, cortisol stimulates several processes that collectively serve to increase and maintain normal concentrations of glucose in blood. These effects include: A hormone (from Greek horman - to set in motion) is a chemical messenger from one cell (or group of cells) to another. ... Cortisol is a corticosteroid hormone that is involved in the response to stress; it increases blood pressure and blood sugar levels and suppresses the immune system. ...

• Stimulation of gluconeogenesis, particularly in the liver: This pathway results in the synthesis of glucose from non-hexose substrates such as amino acids and lipids and is particularly important in carnivores and certain herbivores. Enhancing the expression of enzymes involved in gluconeogenesis is probably the best known metabolic function of glucocorticoids.
• Mobilization of amino acids from extrahepatic tissues: These serve as substrates for gluconeogenesis.
• Inhibition of glucose uptake in muscle and adipose tissue: A mechanism to conserve glucose.
• Stimulation of fat breakdown in adipose tissue: The fatty acids released by lipolysis are used for production of energy in tissues like muscle, and the released glycerol provide another substrate for gluconeogenesis.

Glucocorticoids have potent anti-inflammatory and immunosuppressive properties. This is particularly evident when they administered at pharmacologic doses, but also is important in normal immune responses. As a consequence, glucocorticoids are widely used as drugs to treat inflammatory conditions such as arthritis or dermatitis, and as adjunction therapy for conditions such as autoimmune diseases. Gluconeogenesis, ultimately, is the generation of glucose from noncarbohydrate sources like lactate, glycerol, and amino acids. ... The liver is one of the largest internal organs of the human body. ... A hexose is a monosaccharide with six carbon atoms having the chemical formula C6H12O6. ... In chemistry, chemistry is really stupid. ... Figure 1: Structure of a Lipid. ... The lion is a well-known, truly carnivorous member of the order Carnivora. ... A deer and two fawns feeding on some foliage In zoology, an herbivore is an animal that is adapted to eat primarily plant matter (rather than meat). ... Ribbon diagram of the enzyme TIM. TIM is catalytically perfect, meaning its conversion rate is limited, or nearly limited to its substrate diffusion rate. ... Adipose tissue is an anatomical term for loose connective tissue composed of energy in the form of fat, although it also cushions and insulates the body. ... ... Anti-inflammatory refers to the property of a substance or treatment that reduces inflammation. ... Immunosuppression is the medical suppression of the immune system. ... Arthritis (from Greek arthro-, joint + -itis, inflammation) is a group of conditions that affect the health of the bone joints in the body. ... Dermatitis is a term literally meaning inflammation of the skin. It is usually used to refer to eczema, which is also known as Dermatitis eczema. ... Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. ...

Glucocorticoids have multiple effects on fetal development. An important example is their role in promoting maturation of the lung and production of the surfactant necessary for extrauterine lung function. Mice with homozygous disruptions in the corticotropin-releasing hormone gene (see below) die at birth due to pulmonary immaturity. Homozygote cells are diploid or polyploid and have the same alleles at a locus (position) on homologous chromosomes. ... Adrenocorticotropic hormone (ACTH or corticotropin) is a polypeptide hormone secreted from corticotropes in the anterior lobe of the pituitary gland in response to corticotropin-releasing hormone (CRH) released by the hypothalamus. ...

Excessive glucocorticoid levels resulting from administration as a drug or hyperadrenocorticism have effects on many systems. Some examples include inhibition of bone formation, suppression of calcium absorption (both of which can lead to osteoporosis), delayed wound healing, muscle weakness and increased risk of infection. These observations suggest a multitude of less dramatic physiologic roles for glucocorticoids.

Mode of action

Glucocorticoids bind to the cytosolic glucocorticoid receptor. This type of receptors gets activated upon ligand binding. After a hormone binds to the corresponding receptor, the newly formed receptor-ligand complex translocates itself into the cell nucleus, where it binds to many glucocorticoid response elements (GRE) in the promoter region of the target genes. The DNA bound receptor then interacts with basic transcription factors, causing the increase in expression of specific target genes. This process is called transactivation and mediates most of the main metabolic and cardiovascular side effects of glucocorticoids. The ‘’’glucocorticoid receptor’’’ (GR) is a ligand-activated intracytoplasmatic transcription factor that interacts with high affinity to cortisol and other glucocorticoids. ... In biochemistry, a receptor is a protein on the cell membrane or within the cytoplasm or cell nucleus that binds to a specific molecule (a ligand), such as a neurotransmitter, hormone, or other substance, and initiates the cellular response to the ligand. ... It has been suggested that this article or section be merged with Ligand (biochemistry). ... A complex in chemistry is a reversible association of molecules, atoms, or ions through weak non-covalent chemical bonds. ... In cell biology, the nucleus (from Latin nucleus or nuculeus, kernel) is found in all eukaryotic cells and contains the nuclear genes which form most of the cells genetic material. ... In genetics, a promoter is a DNA sequence that enables a gene to be transcribed. ... This stylistic schematic diagram shows a gene in relation to the double helix structure of DNA and to a chromosome (right). ... The general structure of a section of DNA Deoxyribonucleic acid (DNA) is a nucleic acid —usually in the form of a double helix— that contains the genetic instructions specifying the biological development of all cellular forms of life, and most viruses. ... In molecular biology, a transcription factor is a protein that binds DNA at a specific promoter or enhancer region or site, where it regulates transcription. ... Gene expression, also called protein expression or often simply expression is the process by which a genes DNA sequence is converted into the structures and functions of a cell. ... Stimulation of transcription mediated by a transcription factor which binds to DNA and elicits the activation of adjacent proteins. ... The circulatory system or cardiovascular system is the organ system which circulates blood around the body of most animals. ...

The opposite mechanism is called transrepression. The activated hormone receptor interacts with specific transcription factors and prevents the transcription of targeted genes. Glucocorticoids are able to prevent the transcription of any of immune genes, including the IL-2 gene. A hormone receptor is a receptor protein on the surface of a cell that binds to a specific hormone. ... Transcription is the process through which a DNA sequence is enzymatically copied by an RNA polymerase to produce a complementary RNA. Or, in other words, the transfer of genetic information from DNA into RNA. In the case of protein-encoding DNA, transcription is the beginning of the process that ultimately... The abbreviation IL-2 can refer to: Interleukin-2, a cytokine responsible for stimulating the growth of T-lymphocytes. ...

The ordinary glucocorticoids do not distinguish among transactivation and transrepression and influence both the "wanted" immune and "unwanted" genes regulating the metabolic and cardiovascular functions. Currently, intensive research is aimed at discovering selectively acting glucocorticoids that will be able to repress only the immune system.

Pharmacologic properties

A variety of synthetic glucocorticoids, some far more potent than cortisol, have been created for therapeutic use. They differ in the pharmacokinetics (absorption factor, half-life, volume of distribution, clearance) and in pharmacodynamics (for example the capacity of mineralocorticoid activity: retention of sodium (Na+) and water; see also: renal physiology). Because they absorb well through the intestines, they are primarily administered per os (by mouth), but also by other ways like topically on skin. More than 90 per cent of them bind different plasma proteins, however with a different binding specificity. Endogenous glucocorticoids and some synthetic corticoids have high affinity to the protein transcortin (also called CBG, corticosteroid binding protein), while all of them bind albumin. In the liver, they quickly metabolise by conjugation with a sulfate or glucuronic acid and are secreted in the urine. Pharmacokinetics is a branch of pharmacology dedicated to the study of the time course of substances and their relationship with an organism or system. ... Pharmacodynamics is the study of the biochemical and physiological effects of drugs and the mechanisms of drug action and the relationship between drug concentration and effect. ... Mineralocorticoids is a class of steroids characterised by their similarity to aldosterone and their influence on salt and water metabolism. ... General Name, Symbol, Number sodium, Na, 11 Chemical series alkali metals Group, Period, Block 1, 3, s Appearance silvery white Atomic mass 22. ... Water has the chemical formula H2O, meaning that one molecule of water is composed of two hydrogen atoms and one oxygen atom. ... Renal physiology is the study of the physiology of the kidneys. ... The intestine is the portion of the alimentary canal extending from the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine. ... Sagittal section of nose mouth, pharynx, and larynx. ... In medicine, a topical medication is applied to body surfaces such as the skin or mucous membranes such as the vagina, nasopharynx, or the eye. ... Diagram of the layers of human skin In zootomy and dermatology, skin is an organ of the integumentary system made up of a layer of tissues that protect underlying muscles and organs. ... Blood proteins are proteins found in blood plasma. ... Transcortin, also corticosteroid binding protein or CBG, is an alpha-globulin that has high affinity for binding cortisol. ... You may be looking for albumen, or egg white. ... In inorganic chemistry, a sulfate (IUPAC-recommended spelling; also sulphate in British English) is a polyatomic anion or a compound containing this group. ... The α-D form of glucuronic acid. ... Urine is liquid waste excreted by the kidneys and is produced by the process of filtration. ...

Glucocorticoid potency, duration of effect, and overlapping mineralocorticoid potency varies (Table).

Cortisol (hydrocortisone) is the standard of comparison for glucocorticoid potency. Hydrocortisone is the name used for pharmaceutical preparations of cortisol. Data refer to oral dosing, except when mentioned. Note that oral potency may be less than parenteral potency because significant amounts (up to 50% in some cases) may not be absorbed from the intestine. Note that fludrocortisone, DOCA, and aldosterone are not considered glucocorticoids and are included in this table to provide perspective on mineralocorticoid potency. Hydrocortisone is a synthetic corticosteroid drug which may be given by injection or by topical application. ... Prednisone is a synthetic corticosteroid drug which is usually taken orally and can be used for a large number of different conditions. ... Prednisolone is a synthetic corticosteroid drug which is usually taken orally and can be used for a large number of different conditions. ... Methylprednisolone (molecular weight 374. ... Dexamethasone is a synthetic member of the glucocorticoid class of hormones. ... Betamethasone dipropionate is a corticosteroid with anti-inflammatory and immunosuppressive abilities, used especially where water retention is undesirable. ... This article needs cleanup. ... Beclometasone is an inhaled corticosteroid drug for the use of prophylaxis of asthma. ... Fludrocortisone acetate is a synthetic corticosteroid with moderate glucocorticoid potency and much greater mineralocorticoid potency. ... Aldosterone is a steroid hormone synthesized from cholesterol by the enzyme aldosterone synthase. ...

Physiologic replacement of glucocorticoid

Any glucocorticoid can be given in a dose that provides approximately the same glucocorticoid effects as normal cortisol production; this is referred to as physiologic, replacement, or maintenance dosing. This is approximately 6-12 mg/m²/day (m² refers to body surface area (BSA) and is a measure of body size; an average man is 1.7 m²). In physiology and medicine, the body surface area (BSA) is the measured or calculated surface of a human body. ...

Medical uses and effects of high dose glucocorticoids

In much higher doses (termed pharmacologic doses), glucocorticoids are used to suppress various allergic, inflammatory, and autoimmune disorders. They are also administered as posttransplantory immunosuppressants to prevent the acute transplant rejection and the graft-versus-host disease. Nevertheless, they do not prevent an infection and also inhibit later reparative processes. An allergy can refer to several kinds of immune reactions including Type I hypersensitivity in which a persons body is hypersensitised and develops IgE type antibodies to typical proteins. ... Inflammation is the first response of the immune system to infection or irritation and may be referred to as the innate cascade. ... Transplant rejection occurs when the immune system of the recipient of an transplant attacks the transplanted organ or tissue. ... Graft-versus-host disease is a common complication of allogeneic bone marrow transplantation. ...

Some drugs used are cortisol (hydrocortisone), prednisone and dexamethasone.

Immunosuppressive mechanism

Glucocorticoids suppress the cell-mediated immunity. They act by inhibiting genes that code for the cytokines IL-1, IL-2, IL-3, IL-4, IL-5, IL-6, IL-8 and TNF-γ, the most important of which is the IL-2. Smaller cytokine production reduces the T cell proliferation. Cell-mediated immunity is an immune response that does not involve antibodies but rather involves the activation of macrophages and NK-cells, the production of antigen-specific cytotoxic T-lymphocytes, and the release of various cytokines in response to an antigen. ... An inhibitor is a type of effector (biology) that decreases or prevents a chemical reaction. ... Interleukin-1 (IL-1) is secreted by the macrophages, monocytes and dendritic cells. ... Interleukin-2 (IL-2) is an interleukin, a type of biological response modifier, a substance that can improve the bodys natural response to disease. ... Interleukin-3 (IL-3) is an interleukin, a type of biological signal (cytokine) that can improve the bodys natural response to disease as part of the immune system. ... Interleukin-4, abreviated IL-4, is a lymphokine that stimulates the proliferation of activated B-cells, T-cells, and differentiation of CD4+T-cells into Th2 cells, among other effects. ... IL-5 is an interleukin produced by T helper-2 cells and mast cells. ... Interleukin-6 (IL-6) is a pro-inflammatory cytokine secreted by T cells and macrophages to stimulate immune response to trauma, especially burns or other tissue damage leading to inflammation. ... Interleukin-8 (IL-8) is a chemokine produced by macrophages and other cell types such as epithelial cells. ... Cytokines are small protein molecules that regulate communication among immune system cells and between immune cells and those of other tissue types. ... T cells are a subset of lymphocytes that play a large role in the immune response. ...

Glucocorticoids also suppress the humoral immunity, causing B cells to express smaller amounts of IL-2 and of IL-2 receptors. This diminishes both B cell clone expansion and antibody synthesis. The diminished amounts of IL-2 also causes less T lymphocyte cells to be activated. Humoral immunity is the aspect of immunity that is mediated by secreted antibodies, produced in the cells of the B lymphocyte lineage (B cell). ... B cells are lymphocytes that play a large role in the humoral immune response (as opposed to the cell-mediated immune response). ... Schematic of antibody binding to an antigen An antibody is a protein used by the immune system to identify and neutralize foreign objects like bacteria and viruses. ...

Since glucocorticoid is a steroid, it regulates transcription factors, another factor it down regulates is the expression of Fc receptors on macrophages, so there is a decreased phagocytosis of opsonised cells. A steroid is a lipid characterized by a carbon skeleton with four fused rings. ... In the context of genetics, a transcription factor is a regulatory protein that initiates the transcription of certain genes upon binding with DNA. The binding of a transcription factor to a specific DNA sequence can result in either an increased rate of transcription of the gene, known as activated transcription... // Fc-receptor(s) Introduction Fc-receptor(s) are structures on the surface of cells and can contribute to the protective functions of the immune system. ... A macrophage of a mouse stretching its arms to engulf two particles, possibly pathogens Macrophages (Greek: big eaters, makros = long, phagein = eat) are white blood cells, more specifically phagocytes, acting in the nonspecific defense as well as the specific defense system of vertebrate animals. ... Phagocytosis (literally, cell eating) is a form of endocytosis where large particles are enveloped by the cell membrane of a (usually larger) cell and internalized to form a phagosome, or food vacuole. ... An opsonin is any molecule that acts as a binding enhancer for the process of phagocytosis, for example, by coating the negatively-charged molecules on the membrane. ...

Antiinflammatory effects

Glucocorticoids influence all types of inflammatory events, no matter what their cause. They induce the lipocortin-1 (annexin-1) synthesis, which then binds to cell membranes preventing the phospholipase A2 from coming into contact with its substrate arachidonic acid. This leads to diminished eicosanoid production. The cyclooxygenase (both COX-1 and COX-2) expression is also suppressed, potentiating the effect. In other words, the two main products in inflammation Prostaglandins and Leukotrienes are inhibited by the action of Glucocorticoids. Drawing of a cell membrane A component of every biological cell, the selectively permeable cell membrane (or plasma membrane or plasmalemma) is a thin and structured bilayer of phospholipid and protein molecules that envelopes the cell. ... A phospholipase is an enzyme that converts phospholipids into fatty acids and other lipophilic substances. ... In biochemistry, a substrate is a molecule which is acted upon by an enzyme. ... Arachidonic acid is a polyunsaturated fatty acid with twenty carbons and four cis double bonds, the first at the omega-6 position (20:4n-6). ... In biochemistry, eicosanoids are a class of oxygenated hydrophobic cytokines that largely function as a autocrine and paracrine mediators. ... Cyclooxygenase (COX) is an enzyme (EC 1. ... A prostaglandin is any member of a group of lipid compounds that are derived from fatty acids and have important functions in the animal body. ... Leukotrienes are autocrine and paracrine eicosanoid lipid mediators derived from arachidonic acid by 5-lipoxygenase. ...

Glucocorticoids also stimulate the lipocortin-1 escaping to the extracellular space, where it binds to the leukocyte membrane receptors and inhibits various inflammatory events: epithelial adhesion, emigration, chemotaxis, phagocytosis, respiratory burst and the release of various inflammatory mediators (lysosomal enzymes, cytokines, tissue plasminogen activator, chemokines etc.) from neutrophils, macrophages and mastocytes. White Blood Cells is also the name of a White Stripes album. ... In zootomy, epithelium is a tissue composed of a layer of cells. ... Schematic of cell adhesion The study of cell adhesion is part of cell biology. ... A memorial statue in Hanko, Finland, commemorating the thousands of emigrants who left the country to start a new life in the United States Emigration is the act and the phenomenon of leaving ones native country to settle abroad. ... Chemotaxis is the phenomenon in which bodily cells, bacteria, and other single-cell or multicellular organisms direct their movements according to certain chemicals in their environment. ... Phagocytosis (literally, cell eating) is a form of endocytosis where large particles are enveloped by the cell membrane of a (usually larger) cell and internalized to form a phagosome, or food vacuole. ... Respiratory burst is the rapid release of reactive oxygen species (superoxide radical and hydrogen peroxide) from different types of cells. ... In blood coagulation, tissue plasminogen activator (tPA) is an enzyme (EC 3. ... Chemokines are a class of chemotactic cytokines, or small secreted protein signals. ... Neutrophil granulocytes (commonly referred to as neutrophils) are a class of white blood cells and are part of the immune system. ... A macrophage of a mouse stretching its arms to engulf two particles, possibly pathogens Macrophages (Greek: big eaters, makros = long, phagein = eat) are white blood cells, more specifically phagocytes, acting in the nonspecific defense as well as the specific defense system of vertebrate animals. ... A mast cell (or mastocyte) is a resident cell of connective tissue that contains many granules rich in histamine and heparin. ...

Side effects

Glucocorticoid drugs currently being used act nonselectively, so in the long run they may impair many healthy anabolic processes. To prevent this, much research has been focused recently on the elaboration of selectively acting glucocorticoid drugs. These are the side effects that could be prevented:

• muscle breakdown (proteolysis), weakness; reduced muscle mass and repair
• reduced bone density (osteoporosis, higher fracture risk, slower fracture repair)
• increased skin fragility, easy bruising
• increased visceral and truncal fat deposition (central obesity), appetite stimulation
• increased gluconeogenesis, insulin resistance, impaired glucose tolerance, "steroid diabetes" (see diabetes mellitus)
• expansion of malar fat pads and dilation of small blood vessels in skin
• anovulation, irregularity of menstrual periods
• growth failure, pubertal delay
• increased plasma amino acids, increased urea formation; negative nitrogen balance
• increased hepatic glycogen synthesis
• excitatory effect on central nervous system

In high doses, hydrocortisone (cortisol) and those glucocorticoids with appreciable mineralocorticoid potency can exert a mineralocorticoid effect as well, although in physiologic doses this is prevented by rapid degradation of cortisol by 11β-hydroxysteroid dehydrogenase isoenzyme 2 (11β-HSD2) in mineralocorticoid target tissues. Mineralocorticoid effects can include salt and water retention, extracellular fluid volume expansion, hypertension, potassium depletion, and metabolic alkalosis. A top-down view of skeletal muscle Muscle is the contractile tissue of the body and is derived from the mesodermal layer of embryonic germ cells. ... Grays illustration of a human femur, a typically recognized bone. ... Osteoporosis is a disease of bone in which bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, the amount and variety of non-collagenous proteins in bone is changed, and a concomitantly fracture risk is increased. ... Diagram of the layers of human skin In zootomy and dermatology, skin is an organ of the integumentary system made up of a layer of tissues that protect underlying muscles and organs. ... A bruise or contusion or ecchymosis is a kind of injury, usually caused by blunt impact, in which the capillaries are damaged, allowing blood to seep into the surrounding tissue. ... Adipose tissue is an anatomical term for loose connective tissue composed of adipocytes. ... Central obesity (or apple-shaped or masculine obesity) occurs when the main deposits of body fat are localised around the abdomen and the upper body. ... The appetite is the desire to eat food, felt as hunger. ... Gluconeogenesis, ultimately, is the generation of glucose from noncarbohydrate sources like lactate, glycerol, and amino acids. ... In medicine, insulin resistance denotes a decompensation of glucose homeostasis where the tissues appear to be less responsive to insulin. ... For the disease characterized by excretion of large amounts of severely diluted urine, see diabetes insipidus. ... The arterial system The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... In medicine, anovulation is absence of ovulation when it would be normally expected (in a post-menarchal, premenopausal woman). ... Menstrual cycle. ... Puberty is described as delayed when a boy or girl has passed the usual age of onset of puberty with no physical or hormonal signs that it is beginning. ... In chemistry, chemistry is really stupid. ... Urea is an organic compound of carbon, nitrogen, oxygen and hydrogen, with the formula CON2H4 or (NH2)2CO. Urea is also known as carbamide, especially in the recommended International Non-proprietary Names (rINN) in use in Europe. ... A diagram showing the CNS: 1. ... In some animals, including mammals, the two types of extracellular fluids are interstitial fluid and blood plasma. ... For other forms of hypertension see hypertension (disambiguation) Hypertension or high blood pressure is a medical condition wherein the blood pressure is chronically elevated. ... General Name, Symbol, Number potassium, K, 19 Chemical series alkali metals Group, Period, Block 1, 4, s Appearance silvery white Atomic mass 39. ... Alkalosis refers to a condition reducing hydrogen ion concentration of arterial blood plasma. ...

The combination of clinical problems produced by prolonged, excess glucocorticoids, whether synthetic or endogenous, is termed Cushing's syndrome.

Adrenal suppression and withdrawal

In addition to the effects listed above, use of high dose steroids for more than a week begins to produce suppression of the patient's adrenal glands because the exogenous glucocorticoids suppress hypothalamic corticotropin releasing hormone (CRH) and pituitary adrenocorticotropic hormone (ACTH). With prolonged suppression the adrenal glands atrophy (physically shrink) and can take months to recover full function after discontinuation of the exogenous glucocorticoid. Corticotropin-releasing hormone (CRH), also called corticotropin-releasing factor (CRF) or corticoliberin, is a polypeptide hormone involved in the stress response. ... Adrenocorticotropic hormone (ACTH or corticotropin) is a polypeptide hormone synthesised (from POMC, pre-opiomelanocortin) and secreted from corticotropes in the anterior lobe of the pituitary gland in response to the hormone corticotropin-releasing hormone (CRH) released by the hypothalamus. ...

During this recovery time, the patient is vulnerable to adrenal insufficiency during times of stress, such as illness. While there is wide individual variation in suppressive dose and time for adrenal recovery, clinical guidelines have been devised to estimate potential adrenal suppression and recovery, to reduce risk to the patient. The following is one example, but many variations exist or may be appropriate in individual circumstances. In medicine, adrenal insufficiency (or hypocortisolism) is the inability of the adrenal gland to produce adequate amounts of cortisol in response to stress. ...

• If a patient has been receiving daily high doses for 5 days or less, they can be abruptly stopped (or reduced to physiologic replacement if patient is adrenal deficient). Full adrenal recovery can be assumed to occur by a week afterward.
• If high doses were used for 6-10 days, reduce to replacement dose immediately and taper over 4 more days. Adrenal recovery can be assumed to occur within 2-4 weeks of completion of steroids.
• If high doses were used for 11-30 days, cut immediately to twice replacement, and then by 25% every 4 days. Stop entirely when dose is less than half of replacement. Full adrenal recovery should occur within 1-3 months of completion of withdrawal.
• If high doses were used more than 30 days, cut dose immediately to twice replacement, and reduce by 25% each week until replacement is reached.
• Then change to oral hydrocortisone or cortisone as a single morning dose, and gradually decrease by 2.5 mg each week. When a.m. dose is less than replacement, the return of normal basal adrenal function may be documented by checking 0800 cortisol levels prior to the morning dose; stop drugs when 0800 cortisol is 10 μg/dl. It is difficult to predict the time to full adrenal recovery after prolonged suppressive exogenous steroids; some people may take nearly a year.
• Flare-up of the underlying condition for which steroids are given may require a more gradual taper than outlined above.

See also

• Immunosuppressive drug