Corticosteroids

Corticosteroids are amongst the most commonly prescribed therapies in clinical practice. They are used both systemically (oral or intravenous) or locally (skin creams, inhalers, eye drops, intra-articular). They augment and in some cases replace the natural glucocorticoid and mineralocorticoid activity of endogenous steroids.

The relative glucocorticoid and mineralocorticoid activity of commonly used steroids is shown below:

Minimal glucocorticoid activity, very high mineralocorticoid activity,	Glucocorticoid activity, high mineralocorticoid activity,	Predominant glucocorticoid activity, low mineralocorticoid activity	Very high glucocorticoid activity, minimal mineralocorticoid activity
Fludrocortisone	Hydrocortisone	Prednisolone	DexamethasoneBetmethasone

Side-effects

The side effects of corticosteroids are numerous and represent the single greatest limitation on their usage. Side-effects are more common with systemic and prolonged therapy.

Glucocorticoid side-effects

endocrine
- impaired glucose regulation
- increased appetite/weight gain
- hirsutism
- hyperlipidaemia
Cushing's syndrome
- moon face
- buffalo hump
- striae
musculoskeletal
- osteoporosis
- proximal myopathy
- avascular necrosis of the femoral head
immunosuppression
- increased susceptibility to severe infection
- reactivation of tuberculosis
psychiatric
- insomnia
- mania
- depression
- psychosis
gastrointestinal
- peptic ulceration
- acute pancreatitis
ophthalmic
- glaucoma
- cataracts
suppression of growth in children
intracranial hypertension
neutrophilia

Mineralocorticoid side-effects

fluid retention
hypertension