Glucocorticoids: Functions and Regulation

• Corticosteroids include glucocorticoids, mineralocorticoids, and androgenic sex hormones.
• These hormones are regulated by the hypothalamic-pituitary-adrenal axis.
• Synthesis occurs as needed by the body.
• Stress triggers the hypothalamus to secrete corticotropin releasing hormone (CRH).
• CRH activates the anterior pituitary to release Adrenal Corticotropic Hormone (ACTH).
• ACTH activates the adrenal glands to produce glucocorticoid hormone (cortisol).
• Elevated cortisol levels trigger a negative feedback loop, inhibiting further CRH and ACTH release.
• Glucocorticoids are steroid hormones that regulate metabolism and immune response.
• Glucocorticoids are primarily used for their anti-inflammatory properties.

Functions of Glucocorticoids

• Suppress inflammation
• Suppress bone formation
• Promote gluconeogenesis, increasing glucose availability
• Increase gastric acid secretion
• Common prefixes in glucocorticoid names include "--sone" and "--lone".
• Examples of glucocorticoids: dexamethasone, hydrocortisone, budesonide, and fluticasone.

Indications for Glucocorticoids

• For chronic use, taken orally (PO)
• Chronic inflammation
• Lack of glucocorticoids due to adrenal insufficiency
  • Addison's Disease
• Suppression of the immune system in organ transplantation to prevent rejection
• Autoimmune conditions
  • Systemic Lupus Erythematosus
• Inflammatory Bowel Disease
• Asthma/COPD (inflamed airways/lungs)
• Cerebral/spinal cord edema from tumors
• Allergic reactions

Acute Use

• Percutaneous administration (e.g., injections)
• Allergic reactions
• Sepsis
• Status asthmaticus

Adverse Effects

• Hyperglycemia and insulin resistance, potentially leading to diabetes and hypokalemia
• Sepsis caused by immunity suppression, which can mask existing infections
  • All fevers, even low-grade ones, should be investigated
• Swelling due to sodium and fluid retention, resulting in weight gain and hypertension
• Bone and muscle weakness can lead to osteoporosis, muscle weakness, and growth restriction in children
• Stomach problems such as gastritis and ulcers
• Eyesight changes, including glaucoma and cataracts, with long-term use
• Weight gain
• Sadness and mood swings or psychosis

Cushing Syndrome

• Characterized by a wide, round, or moon-shaped face
• Cervical flat deposits
• Truncal obesity
• Fragile skin and bruising
• Acne and hirsutism due to changes in androgen hormones

Client Teaching

• Medications should be taken in the morning with food to mimic the body's natural cortisol secretion timing and reduce adverse GI effects.
• The dose should be tapered, and clients should be taught to avoid stopping abruptly to prevent acute adrenal crisis, a life-threatening condition caused by a lack of cortisol.
• Weight gain is expected, advocate regular exercise.
• Dietary changes: high calcium and vitamin D, high potassium, and low sodium.
• Report signs of increased blood glucose
• Avoid concurrent use of NSAIDs.
• Report visual changes.
• Reduce the risk of infection.
  • Stay current with vaccinations, except for live-attenuated vaccines like nasal spray flu vaccines and MMR vaccines.
  • Avoid large crowds.

Topical Glucocorticoids

• Used to reduce inflammation in conditions like eczema, psoriasis, contact dermatitis, allergies, and insect bites.

Topical Glucocorticoids Adverse Effects

• Acne and stretch marks
• Skin thinning; avoid use on the face, groin, underarm, and near eyes
• Avoid occlusive dressings unless prescribed, as they can increase absorption and lead to overdose.

Inhaled Glucocorticoids

• Metered Dose Inhalers - help deliver medication deep into the lungs
  • Spacers act as a chamber to hold fine particles of the drugs until the client can inhale the medication, which benefits those who have timing issues.
  • After depressing the inhaler, clients take a big breath and briefly hold it and allows multiple breaths.
• Dry Powder Inhalers

Adverse Effects of Inhaled Glucocorticoids

• Oral Candidiasis
  • A fungal or yeast infection in the mouth that appears as white patches or sores on the tongue, mouth, or throat.
  • The preventive measure is rinsing the mouth after taking the medication.
• Hoarseness