Glucocorticoids: Synthesis, Function & Use

• Corticosteroids refer to glucocorticoids, mineralocorticoids, and androgenic sex hormones.
• These are regulated and synthesized by the hypothalamic-pituitary-adrenal axis as needed.
• Stress triggers the hypothalamus to release corticotropin releasing hormone (CRH).
• CRH then activates the anterior pituitary to secrete Adrenal Corticotropic Hormone (ACTH).
• ACTH activates the adrenal glands to secrete glucocorticoid hormone (cortisol).
• High cortisol levels trigger a negative feedback mechanism, shutting down CRH and ACTH production.
• Glucocorticoids are steroid hormones that regulate metabolism and immune response.

Functions of Glucocorticoids

• Suppress inflammation
• Suppress bone formation
• Promote gluconeogenesis, increasing glucose availability
• Increase gastric acid secretion

Use and Indications of Glucocorticoids

• Primarily used for anti-inflammatory properties.
• Common prefixes in drug names are "--sone" or "--lone".
• Examples are dexamethasone, hydrocortisone, budesonide, and fluticasone.
• Chronic use (oral) is for chronic inflammation.
• Used in cases of glucocorticoid deficiency like Addison's Disease.
• Suppress the immune system in organ transplantation to prevent rejection.
• They are also used for autoimmune conditions like Systemic Lupus Erythematosus and Inflammatory Bowel Disease.
• Asthma/COPD (inflamed airways/lungs)
• Cerebral/ spinal cord edema from tumor
• Allergic reactions
• Acute use involves percutaneous administration (e.g., injections) for allergic reactions, sepsis, and status asthmaticus.

Adverse Effects

• Can lead to hyperglycemia and insulin resistance, potentially causing diabetes and hypokalemia.
• Sepsis can occur due to immunity suppression and may mask existing infection.
• All fevers, even low-grade, should be investigated.
• Sodium and fluid retention can cause swelling, leading to weight gain and hypertension.
• Bone and muscle weakness can result in decreased bone formation, potentially causing osteoporosis, muscle weakness, and growth restriction in children.
• Stomach problems like gastritis and ulcers can occur.
• Eyesight changes, such as glaucoma and cataracts are also possible long term effects.
• Weight gain is a common side effect.

Serious Effects

• Mood swings/psychosis (sadness)
• Cushing Syndrome can occur, characterized by a wide round or moon-shaped face, cervical fat deposits, truncal obesity, fragile skin/bruising, acne, and hirsutism due to changes in androgen hormones.

Client Teaching

• Should be taken in the morning with food to mimic the body's natural cortisol secretion and reduce GI effects.
• The dose should be tapered and stopping abruptly can cause acute adrenal crisis, a life-threatening condition.
• Anticipate weight gain and maintain regular exercise.
• Advise dietary changes such as increased calcium and vitamin D, high potassium, and low sodium.
• Report signs of blood glucose elevation, visual changes
• Avoid concurrent use of NSAIDs
• Reduce risk of infection by staying current with vaccinations (except live-attenuated vaccines like nasal spray influenza or MMR) vaccinations.
• Avoid large crowds

Topical Glucocorticoids

• Reduction of inflammation in eczema, psoriasis, contact dermatitis, allergies, and insect bites.

Adverse Effect of Topical Glucocorticoids

• Acne
• Stretch marks
• Skin thinning is possible, avoid using on the face, groin, underarm, or near eyes.
• Avoid occlusive dressing unless prescribed, as it can increase absorption leading to overdose.

Inhaled Glucocorticoids

• Delivered through Metered Dose Inhalers to reach deep into the lungs.
• Spacers hold fine particles of the drugs until inhalation, helpful for those with timing issues.
• After depressing the inhaler, the client should take a big breath and hold it briefly.
• The spacer allows an extra breath if needed to get the full dose.
• Dry powder inhalers are another delivery method.

Adverse Effects of Inhaled Glucocorticoids

• Oral candidiasis is a fungal/yeast infection in the mouth appearing as white patches or sores. Rinsing the mouth after medication can prevent this.
• Hoarseness is another potential side effect.

An overview of corticosteroids, emphasizing glucocorticoids, their synthesis via the hypothalamic-pituitary-adrenal axis, and their functions. It highlights their role in suppressing inflammation, bone formation, and promoting gluconeogenesis. Also covers common uses and indications of Glucocorticoids.