Adrenocorticoid

Corticosteroids

Corticosteroid released from adrenal cortex

Anatomic Position of Adrenal Gland Anatomically, the adrenal glands are located in the thoracic abdomen situated 'on' top of the kidney one on each side, specifically on their anterosuperior aspect. In humans, the adrenal glands are found at the level of the 12th thoracic vertebra.

Adrenal Gland

Medulla Epinephrine Norepinephrine

Cortex Gluco-corticoid Minerocorticoid Sex Hormone

Gluco-corticoid and minerocorticoid together terms as Corticosteroid

Adrenal Medulla Response :Fear and Flight Condition

-Corticosteroid made in adrenal cortex by cholestrol , under the influence of ACTH -Two main hormones are made Gluco-corticoids group : Hydrocortisone Mineralocortcoid group : Aldosteron -Secretion Hydrocortisone :10-20mg daily Aldosteron : 0.125 mg daily

Effects of: Gluco-corticoid: Carbohydrate, Fat and Protien Metabolism

Minerlocorticoid : Na+,k+ and fluid balance

1.Minerlaocorticoid Action - Increase Na+ reabsorption in the kidney - Increased K+ and H+ excretion

Mechanism of action Corticosteroid PENETRATE

Cell Wall

2. Gluco-corticoids Action Carbohydrate

Deposition of glycogen in Liver (including bringing glycogen from tissues)

Fat

Lypolysis

Calcium

Decreased absorption by intestine and increased by renal excretion

Water excretion

Maitain normal GFR with aldosteron(by excreting excess water)

CVS

Restrict capillary permeablity (leads to vaso constriction and myocardial contractility)

CNS

Maintain the level of sensory perception, maintain normal level of excitability of neuron

Stomach

Increase gastric secretion

Blood cells

Increase number of RBC, Platelate,neutrophil. Decrease number of Lymphocyte, Eosinophil, Basophil

Inflammation

Suppressed by it

Immunological

Suppress all types of hyper sensitization and allergic pheromone

Pharmacokinetics - All natural and synthetic corticoids are absorbed and effective by oral route. - Hydrocortisone undergoes high first pass effect - Corticosteroid generally metabolised by liver

Corticosteroid used in: 2. Repalcement therapy 4. Nonendocrine diseases

A.Replacement Therapy in 1]. Acute adrenal insufficiency 2]. Chronic adrenal insufficiency (Addision’s disease) 3]. Congenital adrenal hyperplasia (adrenogenital syndrome)

B].For Nonendocrine disease 1. 2. 4. 5. 5. 6. 7. 8. 9. 10. 11.

Arthritis Collegen disease Glomerulo nephritis, nephrotic syndrom, polyartritis nodosa Severe allergic reactions Autoimmune disease Autohaemolytic anaemia, idiopathic thrombocytopaenic ,active chronic hepatitis Bronchail asthma Lungs Aspirational pneumonia, Infective disaese Tuberculosis , bacterial meningitis, Eye disease allergic conjunctivitis ,iritis, keratitis, Skin diseases(Eczema) Intestinal disease Ulcerative disease, Crohn’s disease,chronic inflammatory disease Cerebral oedema

-Malignancy Lymphatic leukaemia, Hodgkin’s disease -In organ and skin transplant -Septic shock -Hyperthyroidism

Corticosteroid drugs Compound Available in Type name market with name of

Indicated in

Hydrocortisone(co Lycortin-S,Efcorlin Gluco-corticoid rtisol) (inj)

Replacement therapy, status asthmaiticus, ulcerative colitis

Prednisolone

Allergies, inflammation, autoimmune disease

Deltacortiril,Hosta same cortin, Nucort(tab)

Methyleprednisolo Solu-medrol, same ne Methylprednisolon e(inj)

Rheumatoid arthritis, renal transplant, ulcerative colitis

Triamcinolone

-

Kenacort,Tricort

Pure glucocorticoid

Dexamethosone

Decadron, dexona(tab)

Pure Glucocorticoid

Shock, Cerebral edema,

Betamethasone

Betnesol, Betacortril,

same

Cerebral oedema

Desoxycorticoster on acetate(DOCA)

Docabolin

PURE Addision’s MINERALOCORT disease ICOID

Fludrocortisone

Fluricot

mineralocorticoid

Addision’s disease, adrenal hyperplasia

Aldosteron

-

same

Low availbility of drug

Adverse effects of Corticosteroids 1. Minerlocorticoids Sodium and water retention,edema, hypokalemia , Rise in Bp

2. Glucocorticoids adverse effects 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Cushing’s habitus Fragile skin , purple stria Easy bruising, hirsutism Hyperglycaemia(precipitation of diabetes) Muscular weakness Delayed healing, Osteoporosis Glaucoma Growth retardation Foetal abnormilities :Neonatal death, mental retardation, gestational daibetes (if given pregnant women)

11. Psychiatric Mild euphoria, lead to maniac psychosis, mood changes.

12. Suppresion of hypothalmo-pitutary-adrenal axis: Causes atrophy of adrenal gland leads to withdrawal symptom like anorexia, ,mailaise, fever, hypotension, weakness

Contraindication 1. Peptic ulcer 2. Diabetes mellitus 3. Hypertension 4. Viral and fungal infections 5. Osteoporosis 6. Herpes simplex keratitis 7. Psychosis 8. Epilepsy 9. CHF 10. Renal failure