Glukokortikoidbehandlung

Glukokortikoide (glucocorticoids) are a class of steroid hormones produced by the adrenal cortex and a group of synthetic drugs with similar properties. The endogenous hormone cortisol is the most important natural glucocorticoid, and synthetic analogs are used therapeutically for their potent anti-inflammatory and immunosuppressive effects. Glukokortikoide act by binding to glucocorticoid receptors in the cytoplasm, leading to translocation into the nucleus where they regulate gene transcription. They upregulate anti-inflammatory proteins and repress several proinflammatory genes, including cytokines and enzymes such as COX-2, thereby reducing inflammation and immune activity.

Clinical uses include management of asthma, chronic obstructive pulmonary disease, allergic reactions, autoimmune diseases (such as rheumatoid arthritis, systemic lupus erythematosus), dermatologic conditions, inflammatory bowel disease, and as part of organ transplantation regimens. They can be given orally, by injection, topically, or inhaled, with dose and duration tailored to disease severity. Potency is often described as low, medium, high, or very high; examples include hydrocortisone (low), prednisone/prednisolone (medium), methylprednisolone (high), and dexamethasone or betamethasone (very high).

Adverse effects depend on dose and duration and may include hyperglycemia, hypertension, weight gain, osteoporosis, muscle weakness, mood changes, and increased infection risk. Long-term use can cause Cushingoid features and suppression of the hypothalamic-pituitary-adrenal axis, necessitating gradual withdrawal to avoid adrenal insufficiency. Caution is advised in pregnancy, infections, diabetes, and glaucoma; vaccines may have reduced efficacy during systemic therapy. Drug interactions include nonsteroidal anti-inflammatory drugs increasing GI risk and cytochrome P450 interactions.