Corticosteroids Medicines

Cortisone was isolated from the adrenal cortex by Kendall in 1936, who was later awarded the Nobel Prize for this discovery. This discovery was followed by the successful use not only of cortisone, but of several synthetic derivatives of this naturally-occurring substance in the body which are collectively known as corticosteroids.

Cortisone was isolated from the adrenal cortex by Kendall in 1936, who was later awarded the Nobel Prize for this discovery. This discovery was followed by the successful use not only of cortisone, but of several synthetic derivatives of this naturally-occurring substance in the body which are collectively known as corticosteroids. During the initial years of their use in the 1950s, these were regarded as miracle drugs because they provided dramatic relief in a variety of disorders related to inflammation and allergy. For this reason, they were more indiscriminately used than any other group of drugs known in medical history. In almost all conditions, except in the case of decreased activity of the adrenal gland, their use is empirical. These drugs do not cure the disease, but only provide symptomatic relief, giving a false sense of well being. In spite of this drawback, these drugs are very useful in certain conditions and their relevance cannot be disputed.

The general term, corticosteroids, is used both for the naturally occurring hormones of the adrenal cortex (the outer part of the small gland which rests on the upper end of each kidney), as well as for its synthetic derivatives. There are two main groups of corticosteroids ­ glucocorticoids and mineralocorticoids.

Functions: The functions of these hormones are to maintain the internal environment (homeostasis) of the body and to protect against stress (in a stressful situation there is increased secretion of cortisols). These hormones have powerful anti-inflammatory and anti-allergic actions and modify the metabolic functions involving carbohydrates, proteins: fats, minerals, and fluids. They cause an increase in blood sugar and produce a condition similar to diabetes, or may even precipitate diabetes in some individuals. The breakdown of protein is enhanced, whereas, the synthesis is slowed down, resulting in weakness and wasting of the muscles. The fat metabolism is so altered that there is abnormal deposition of fat on the face (moon-like face), and back (buffalo hump). There is increased excretion of calcium, causing thinning of the bones. They also cause excretion of potassium and retention of sodium in the body. Along with sodium, water is also retained causing edema (tissue swelling under the skin). In children growth retardation is due to early cessation of growing activity in long bones.

Uses .

Due to their wide and varied adverse effects on the body metabolism and organ systems, there are no real therapeutic uses of corticosteroids, except in substitution therapy for adrenal insufficiency. However, in certain acute inflammatory and allergic conditions associated with severe illness, when other drugs fail, these may be life-saving. Their use is empirical (without any sound basis) and palliative (relieving the symptoms without curing the disease). It must be remembered that if at all necessary, these should be used for as short a duration as possible.

Substitution Therapy: Corticosteroids are given in conditions associated with the decreased functioning of the adrenal or pituitary glands (e.g. Addison ''s Disease). In these conditions the level of natural cortisol in the body falls below normal and needs to be substituted till the organ regains normal activity. In this condition small dose is required for very long period, or even lifelong.

In Arthritis: In rheumatoid arthritis and other kind of arthritides (diseases of the bones and joints) corticosteroids should be used only if the disease is progressing in spite of the treatment with other drugs. It must be remembered that once this treatment is begun it has to be continued for several years. If there are periodic attacks of acute inflammation in one or two joints, characterized by reddening, swelling and pain in the joints, corticosteroids can be directly injected into the joint cavity. But this should not be done frequently as there may be chances of painless destruction of the joint.

In Rheumatic Heart Disease: Some physicians prefer corticosteroids to salicylates for the treatment of acute rheumatic carditis. Corticosteroids are more potent anti-inflammatory agents but are more likely to cause rebound inflammation when stopped. Therefore, aspirin cover is provided.

In Allergic Diseases: In severe type of allergic reactions such as anaphylactic shock due to than penicillin, intravenous dexamethasone (8 to 12 mg) may be helpful but it takes more time to act than adrenaline. In minor forms of allergic reactions, an antihistaminic drug should be tried before resorting to these drugs.

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