What are corticosteroids?
Corticosteroids, short corticoids or Cortine, now written more frequently corticosteroids, are a group of about 50 in the adrenal cortex (NNR) formed steroid hormones and chemically similar synthetic materials. All corticoids develop from the starting material cholesterol. Common backbone of hormones is progesterone.
Corticosteroids may be according to their biological effects and their education center divided into three groups:
-Mineralocorticoids (aldosterone main representatives) are formed in the zona glomerulosa of the adrenal cortex and affect mainly the potassium-sodium balance and thus the water content of the body.
-Glucocorticoids (cortisol main representatives) are formed in the zona fasciculata of the adrenal cortex. They provide important effects in glucose, lipid and protein metabolism.
-Androgens (main representative dehydroepiandrosterone (DHEA)) and estrogens are formed in the zona reticularis of the adrenal cortex.
The natural glucocorticoids include cortisone, corticosterone and cortisol; the mineralocorticoids aldosterone and deoxycorticosterone. Synthetic corticosteroids are such. As prednisone and prednisolone, methylprednisolone, triamcinolone, dexamethasone, betamethasone and paramethasone.
Synthesis
The different hormones are formed by hydroxylation of progesterone (incorporation of OH-groups) and oxidation of these groups to keto or aldehyde groups at various positions. The synthesis and secretion of androgens and glucocorticoids is stimulated by ACTH (corticotrophin) from the adenohypophysis (anterior pituitary gland pituitary gland). The synthesis and secretion of mineralocorticoids is stimulated to angiotensin II and potassium.
Overproduction, lack
Pathological overproduction or prolonged administration of glucocorticoids produce a characteristic clinical picture (Cushing's syndrome) with osteoporosis, diabetes mellitus, obesity (especially central obesity) and muscle wasting. Too high mineralocorticoid concentrations interfere with the water-electrolyte balance and damage the kidneys (Conn's syndrome).
A lack of adrenocortical hormones produced the Addison's disease, a life-threatening disease with circulatory insufficiency, dehydration and cachexia. A specific genetic defect, in which produces too much androgen and not enough aldosterone, causing Virilism and water retention; the full picture of the disease is called adrenogenital syndrome.
Reduction
Corticoids are converted in the liver by reduction to inactive derivatives (17-hydroxy, 17-ketosteroids) and excreted in urine and bile.
Corticosteroid therapy
Except for the above mentioned deficiencies, especially glucocorticoids in numerous immune diseases and emergency situations are used medicinally. The natural corticoids are compared with the artificial corticoids less effective. Drugs with a higher affinity to the receptors bind more easily and have the same drug concentration greater effect.
For oral and intravenous therapy equivalent doses are given (the same effective dose cortisone). Prednisone (17α, 21-dihydroxy-1,4-pregnadiene-3,20-dione) is a synthetic corticosteroid which corresponds to a dehydrated variant of cortisone. Its effect is about the four to five times of cortisone.
Corticosteroids are used to treat, inter alia, asthma, eczema, epilepsy, lichen sclerosus, atopic dermatitis, cluster headache, rheumatic diseases, inflammatory bowel disease (Crohn's disease, ulcerative colitis), nephritis, psoriasis (psoriasis) and certain chemotherapies (Hodgkin's disease, NHL ) used.
Corticosteroids side effects
Since corticosteroids induce gastric acid overproduction, a proton pump inhibitor should be taken in addition to prevent the emergence of a gastric ulcer with permanent transfer. In general, particularly for long-term and / or high-dose application, a large number of side effects (eg, Cushing's syndrome, see also 'overproduction'), which require careful consideration in the application required. In a shock therapy in the treatment of epilepsy or multiple sclerosis relapse about an hour after taking a dose of a gastric protective agents should be administered.