The natural adrenocortical hormones are steroid molecules produced and released by the adrenal cortex. Secretion of adrenocortical steroids is controlled by the pituitary release of ACTH.
Doses
Dosage requirements are variable and must be individualized.:
Short-term therapy:
The patient needs duration less than 2 weeks.
Alternate day therapy:Z
The recommended dose is multiplied by 2 given every other day (to give chance for the pituitary to release ACTH and prevent sudden withdrawal symptoms).
Long term therapy:
The patient needs duration more than 3 weeks. Small and large dose therapy:
Small and large dose therapy:
Uses:
Replacement therapy:
 A) Treatment of adrenocortical insufficiency: In chronic adrenocortical insufficiency (Addison’s disease) e.g. TB of suprarenal cortex.
B) In acute adrencortical insufficiency (Addisonian crisis), i.e. Prolonged corticosteroid therapy:
produce feed back inhibition of anterior pituitary which decrease ACTH secretion results in decrease corticosteroid release from adrenal cortex. When the exogenous corticosreoid therapy is stopped, its blood level markedly decrease leading to severe hypoadrenal function, severe hypotension and shock (adrenal crisis)
Treatment:
- Therapy consists of correction of fluid and electrolyte abnormalities
- Treatment of precipitating factors
- Large amounts of parenteral hydrocortisone. Hydrocortisone sodium succinate or phosphate in doses of 100 mg intravenously is given every 8 hours until the patient is stable. The dose is then gradually reduced, achieving maintenance dosage within 5 days.
Hypothalamo-pituitary-adrenal axis suppression (addissonian crisis):
This can be avoided by:
- Gradual withdrawal of the corticosteroids to give chance for the pituitary to release ACTH and stimulate adrenal cortex to secrete endogenous corticosteroids.
- Alternate day therapy.
- Avoid prolonged use.
- Give long acting ACTH before stoping corticosteroids.
Side effects of glucocorticoids are related to large doses and/or prolonged administrations. When the glucocorticoids are used for short periods (less than 2 weeks), it is unusual to see serious adverse effects even with moderately large doses.