Corticosteroids

Corticosteroids are a class of steroid hormones produced by the adrenal cortex and synthetic analogues used as medications. They are broadly categorized into glucocorticoids, which regulate metabolism and exert potent anti-inflammatory and immunosuppressive effects, and mineralocorticoids, which regulate electrolyte and water balance. Pharmacologic corticosteroids differ in potency, duration of action, and tissue selectivity.

Most corticosteroids can be given systemically (oral, intramuscular, or intravenous) or locally (topical, inhaled, nasal, or intra-articular). The principal systemic glucocorticoids include prednisone/prednisolone, dexamethasone, methylprednisolone, and hydrocortisone. Fludrocortisone is a primary mineralocorticoid. The effects arise from binding to glucocorticoid receptors and modulating gene transcription, with additional rapid non-genomic actions.

Uses include inflammatory and autoimmune diseases (such as rheumatoid arthritis, lupus, inflammatory bowel disease), severe allergic reactions, asthma and COPD exacerbations, dermatologic conditions, and prevention of organ transplant rejection. Some cancers and adrenal insufficiency conditions also use corticosteroids.

Adverse effects depend on dose and duration. Short courses may cause mood changes, hyperglycemia, and fluid retention. Long-term use can cause Cushingoid features, weight gain, hypertension, osteoporosis, diabetes, cataracts, skin thinning, infection risk, and suppressed hypothalamic-pituitary-adrenal axis. Tapering is required to avoid adrenal insufficiency when stopping after prolonged therapy. Localized therapies have fewer systemic effects but carry risks such as skin atrophy or oral thrush with inhaled steroids.

Pregnancy safety varies; most are used only if clearly required. Drug interactions include increased gastric irritation with NSAIDs, and potential interactions with vaccines and other immunosuppressants. Dosing is individualized and aims to use the lowest effective amount for the shortest feasible duration.

History: corticosteroids were discovered in the 1940s-1950s with the development of cortisone and prednisone, revolutionizing treatment of inflammatory disease.