Corticosteroids

Question 1

Describe the relative glucocorticoid and mineralocorticoid activity of commonly used steroids

(Fludrocortisone, Hydrocortisone, Prednisolone, Dexametasone)

Answer 1

• Very high mineralocorticoid activity with minimal glucocorticoid activity with - Fludrocortisone
• High mineralocorticoid activity with some Glucocorticoid activity - hydrocortisone
• Mostly glucocorticoid activity but with low mineralocorticoid activity - Prednisolone
• Very high glucocorticoid activity, minimal mineralocorticoid activity - Dexamethasone

Question 2

What are some side effects of glucocorticoid?

Answer 2

• Endocrine: impaired glucose regulation, increased appetite/weight gain, hirsutism, hyperlipidaemia
• Cushing’s syndrome: moon face, buffalo hump, striae
• Musculoskeletal: osteoporosis, proximal myopathy, AVN 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

Question 3

What are some side effects of mineralocorticoids?

Answer 3

• Fluid retention
• Hypertension

Question 4

If someone is on long-term steroids and they get ill, what should be done?

Answer 4

Their dose of steroids should be doubled during the illness.

Question 5

In what circumstances should a gradual withdrawal of systemic corticosteroids be done?

Answer 5

1. A patient received >40mg of prednisolone daily for more than 1 week.
2. Received more than 3 weeks of treatment
3. Recently received repeated courses.