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Adrenal cortex of the adrenal gland.Adrenal cortex of the adrenal gland.
Regulation:Regulation: Stimulation:Stimulation: ACTH. ACTH. Inhibition:Inhibition: Feed back Mechanism. Feed back Mechanism.
Classification of Classification of corticosteroidscorticosteroids
They are all C21 hormones.They are all C21 hormones.
Corticosteroids
GlucocorticoidsRegulate carbohydrates, lipids
and proteins metabolism
e.g. Hydrocortisone
MineralocorticoisControl electrolytes and water
balance
e.g. Aldosterone.
Numbering System of Numbering System of Steroidal ring:Steroidal ring:
HO
1
2
34
56
7
8910
1112
13
1415
16
17
18
19
2021
22 23 2425
26
27
O
Progesterone
O
O
O
17-Hydroxyprogesterone
OH
HO
O
Pregnenolone
HO
Cholestrol
Biosynthesis of Adrenocorticosteroids
O
O
11-Deoxycortisol
OH
HO
O
O
CortisolHydrocortisone
OH
HO
HO
O
O
21-Hydroxyprogesterone
HO
O
O
Corticosterone
HO
HO
O
CHOO
Aldosterone
HO
HO
Physiological Functions and Physiological Functions and Pharmacological Effects:Pharmacological Effects:
Carbohydrates and Proteins Metabolism:Carbohydrates and Proteins Metabolism: Stimulate glucose formation in the brain.Stimulate glucose formation in the brain. Decrease peripheral utilization of glucose.Decrease peripheral utilization of glucose. Promote storage of glucose in the liver.Promote storage of glucose in the liver. Promote gluconeogenesis.Promote gluconeogenesis.
Lipids Metabolism:Lipids Metabolism: Redistribution of body fat (Buffalo hump, Redistribution of body fat (Buffalo hump,
Moon face).Moon face). Enhance lipolyses of Triglycerides.Enhance lipolyses of Triglycerides.
Electrolyte and Water balance:Electrolyte and Water balance: Enhance reabsorption of sodium and water Enhance reabsorption of sodium and water
into plasma.into plasma. Increase urinary excretion of potassium.Increase urinary excretion of potassium.
Blood Picture:Blood Picture: Increase hemoglobin and Red blood cells.Increase hemoglobin and Red blood cells. Decrease white blood cells.Decrease white blood cells.
Anti-inflammatory effects:Anti-inflammatory effects: Suppress inflammations regardless to their Suppress inflammations regardless to their
cause.cause.
Immunosuppressive Effects:Immunosuppressive Effects: Decrease immunity as a result of decrease Decrease immunity as a result of decrease
the WBC’s.the WBC’s.
Cell Growth:Cell Growth: Retardation of cell division and cell Retardation of cell division and cell
growth.growth.
Disease Disease States:States:
Addison’s disease:Addison’s disease: Rare syndrome 1/100,000 due to Hypoadrenalism.Rare syndrome 1/100,000 due to Hypoadrenalism. Causes:Causes:
Atrophy of adrenal gland.Atrophy of adrenal gland. Tuberculoses.Tuberculoses. Low level of ACTH.Low level of ACTH.
Symptoms:Symptoms: Weakness, fatigue, apathy, depression and irritability.Weakness, fatigue, apathy, depression and irritability. Anemia and low blood pressure.Anemia and low blood pressure. Loss of sodium and dehydration.Loss of sodium and dehydration. Hypersensitivity to Insulin.Hypersensitivity to Insulin. Hyper pigmentation.Hyper pigmentation. Nausea and vomiting.Nausea and vomiting.
Cushing’s disease:Cushing’s disease: Rare syndrome 2- 5/Million due to Hyperadrenalism.Rare syndrome 2- 5/Million due to Hyperadrenalism. Causes:Causes:
Tumor of the Adrenal Cortex.Tumor of the Adrenal Cortex. Tumor of the Pituitary gland.Tumor of the Pituitary gland.
Symptoms:Symptoms: Alteration of fat distribution.Alteration of fat distribution. Hypertension.Hypertension. Osteoporosis.Osteoporosis. Growth retardation.Growth retardation. Decrease Immunity.Decrease Immunity.
Conn’s syndrom:Conn’s syndrom: Causes:Causes:
Inability of adrenal cortex to carry out 17Inability of adrenal cortex to carry out 17-hydroxylation of -hydroxylation of pregnenolone. That leads to low level of Cortisol and high level pregnenolone. That leads to low level of Cortisol and high level of Aldosterone.of Aldosterone.
They can be administered by IV, IM injections, oral, topical or by They can be administered by IV, IM injections, oral, topical or by inhalation.inhalation.
They can be short, intermediate or long-acting. Unlike natural They can be short, intermediate or long-acting. Unlike natural corticoids they do not undergo first pass metabolism.corticoids they do not undergo first pass metabolism. Cortisone and Cortisone acetate:Cortisone and Cortisone acetate:
Can be given orally or by IM injection.Can be given orally or by IM injection. Acetate has longer duration of action.Acetate has longer duration of action. Drug of choice in replacement therapy.Drug of choice in replacement therapy.
O
O
OH
HO
O
O
O
OH
HO
HO
Cortisone CortisolHydrocortisone
Fludrocortison:Fludrocortison: 99-fluorocortisone. -fluorocortisone. 10 times more active than cortisone as antiinflammatory.10 times more active than cortisone as antiinflammatory. 300- 800 times more active as mineralocorticoids.300- 800 times more active as mineralocorticoids.
Prednisone and Prednisolone:Prednisone and Prednisolone: They are They are ΔΔ1 1 corticoids. corticoids. 3, 4 times more active than cortisone and hydrocortisone.3, 4 times more active than cortisone and hydrocortisone. Prepared by microbial dehydrogenation (Prepared by microbial dehydrogenation (Corynebacterium Corynebacterium
simplexsimplex) or chemically using SeO) or chemically using SeO22..
O
O
OH
HO
O
O
O
OH
HO
HO
Prednisone Prednisolone
Triamcinolone:Triamcinolone: 99-fluoro, 16-fluoro, 16-hydroxyprednisolone.-hydroxyprednisolone. Activity equal to prednidolone but with less Activity equal to prednidolone but with less
Dexamethasone:Dexamethasone: 99-fluoro, 16-fluoro, 16-methylprednisolone.-methylprednisolone. 5- 7 times more active than prednidolone.5- 7 times more active than prednidolone.
Betamethasone:Betamethasone: 99-fluoro, 16-fluoro, 16-methylprednisolone.-methylprednisolone. Slightly more active than Dexamethasone.Slightly more active than Dexamethasone.
99-fluoro, 16-fluoro, 16-methylprednisolone.-methylprednisolone. 99-chloro analog of Betamethasone.-chloro analog of Betamethasone. Topical activity 500 times more than Topical activity 500 times more than
(BDP):(BDP): Prodrug metabolized to more active 17-Prodrug metabolized to more active 17-
BMP.BMP. 17-BMP is 30 times more active than BDP.17-BMP is 30 times more active than BDP. Topical activity 500 times more than Topical activity 500 times more than
Diagnostic uses:Diagnostic uses: Cause of Hyperadrenalism:Cause of Hyperadrenalism:
Non specific due to obesity or stress.Non specific due to obesity or stress. Cushing’s syndrome.Cushing’s syndrome.
2 mg Dexamethasone every 6 hr for 8 doses 2 mg Dexamethasone every 6 hr for 8 doses to diagnose the cause.to diagnose the cause.
Side effects:Side effects: Due to Prolonged use:Due to Prolonged use:
Fluid and electrolyte disturbances, edema and Fluid and electrolyte disturbances, edema and hypertension.hypertension.
Hyperglycemia and glucosuria.Hyperglycemia and glucosuria. Peptic ulcer.Peptic ulcer. OsteoporosesOsteoporoses MyopathyMyopathy Growth arrestGrowth arrest Increase susceptibility to infections.Increase susceptibility to infections.
Withdrawal Symptoms:Withdrawal Symptoms: Rapid withdrawal after prolonged use leads to Rapid withdrawal after prolonged use leads to