Adrenocorticosteroids

1. Dr. Maria Idrees; PT
MS (RIU)
DPT (TUF)
Adrenocorticosteroids

2.  The glucocorticoids (cortisol, corticosterone)
are primarily involved in the control of glucose
metabolism and the body’s ability to deal with
stress.
 Mineralocorticoids, such as aldosterone, are
involved in maintaining fluid and electrolyte
balance in the body.

3. Role of Glucocorticoids
in Normal Function
 The primary glucocorticoid released in humans is
cortisol (also known as hydrocortisone).

4. Mechanism of Action
of Glucocorticoids
 Specifically, glucocorticoids exert their classic
cellular effects first by entering the target cell
and binding to a receptor located in the cytosol.
 Binding the glucocorticoid to the receptor
creates an activated hormone-receptor complex.
 This activated complex then travels
(translocates) to the nucleus of the cell, where it
binds directly to specific DNA gene segments
that control inflammation.

5. Physiologic Effects of
Glucocorticoids
 Effects on
Glucose,
Protein, and
Lipid
Metabolism

6.  Anti-Inflammatory Effects
 glucocorticoids often inhibit transcription
factors that normally stimulate genes within
specific cells to express inflammatory
components.
 Glucocorticoids—for example—act on
macrophages, lymphocytes, and endothelial
cells to inhibit the expression of inflammatory
proteins (cytokines) such as interleukin-1,
interleukin-6, tissue necrosis factor alpha,
interferon gamma, and similar inflammatory
cytokines.

7.  Immunosuppression
 Glucocorticoids have long been recognized
for their ability to inhibit hypersensitivity
reactions, especially delayed or cell-mediated
allergic reactions.
 Many immunosuppressive effects are
mediated by the same actions that explain the
anti inflammatory effects of these drugs.

8. Therapeutic Glucocorticoid
Agents

9. Glucocorticoid Use in Endocrine
Conditions
 Replacement Therapy
 Glucocorticoid replacement is instituted in
both primary and secondary adrenal
insufficiency.
 In primary insufficiency (Addison disease),
glucocorticoid production is deficient because
of the destruction of the adrenal cortex.
 In secondary insufficiency, adrenal cortex
function is diminished because of other
factors, such as a lack of adequate ACTH
release from the anterior pituitary.
Replacement therapy can also be initiated

10. Use in Non endocrine
Conditions

12. Adverse Effects of
Glucocorticoids
 Adrenocortical Suppression
 Drug-Induced Cushing Syndrome
(adrenocortical hypersecretion)
 Breakdown of Supporting Tissues
 Other Adverse Effects
o Peptic ulcer
o Glaucoma
o psychoses

13. Drugs That Inhibit Adrenocortical
Hormone Biosynthesis
 Aminoglutethimide (Cytadren)
 Metyrapone (Metopirone)
 Ketoconazole (Nizoral)
 Mitotane (Lysodren)

14. Mineralocorticoids
 Mineralocorticoids are also steroid
hormones that are produced by the
adrenal cortex.
 The principal mineralocorticoid in
humans is aldosterone.
 Aldosterone is primarily involved in
maintaining fluid and electrolyte balance
in the body.
 This hormone works on the kidneys to
increase sodium and water reabsorption

15. Regulation of Mineralocorticoid
Secretion
 A primary stimulus for aldosterone release is increased
levels of angiotensin II
 Basically, a sudden fall in blood pressure initiates a chain
of events that generates increased circulating levels of
angiotensin II
 Angiotensin II helps maintain blood pressure by
vasoconstricting peripheral vessels
 Angiotensin II helps exert a more prolonged
antihypotensive effect by stimulating aldosterone
secretion from the adrenal cortex.
 In addition, aldosterone secretion is regulated by
increased plasma potassium levels
 Elevated plasma potassium serves as a stimulus to

16. Mechanism of Action of
Mineralocorticoids

17. Adverse Effects of
Mineralocorticoid Agonists
 Hypertension
 Other adverse effects
peripheral edema
weight gain
hypokalemia

18. Mineralocorticoid Antagonists
 Spironolactone (Aldactone)
 Eplerenone (Inspra)