Corticosteroids And Anabolic

Steroids
• Adrenal gland has cortex and medulla .
• Adrenal cortex secretes steroidal hormones
• Adrenal medula secretes adrenaline and nor-
adrenaline.
• Adrenal cortical hormones are more
important than medullary hormones.
• Among cortical hormones , mineralocorticoids
are more essential than glucocorticoids .
 Adrenal glands
• The adrenal gland consists of the cortex and the medulla.
• The medulla secretes catecholamines, whereas the cortex,
secretes two types of corticosteroids
• The adrenal cortex has three zones, and each zone synthesizes a
different type of steroid hormone from cholesterol.
• The outer zona glomerulosa produces mineralocorticoids-
aldosterone
• The middle zona fasciculata synthesizes glucocorticoids-cortisol
• The inner zona reticularis secretes adrenal androgens.
• Secretion is controlled by pituitary adrenocorticotropic
hormone (ACTH; also called corticotropin), which is released
in response to hypothalamic corticotropin-releasing
hormone (CRH).
• Glucocorticoids serve as feedback inhibitors of ACTH and
CRH secretion.
Corticosteroids
• Betamethasone (Celestone)
• Cortisone (Cortone)
• Dexamethasone (Decadron)
• Hydrocortisone (Cortef)
• Methylprednisolone (Medrol)
• Prednisolone (Prelone)
• Prednisone (Deltasone)
• Triamcinolone (Kenacort, Kenalog)
Mech of action:
Steroid hormone enters the target organ
Binds to specific receptors in cytoplasm
Steroidal receptor complex become activated
Enters the nucleus
Binds to specific site on DNA
Regulate protein synthesis
RESPONSE
 Pharmacological actions
Carbohydrate metabolism:
stimulate glycogen de-
glucocorticoids position and gluconeo-
genesis

Decrease peripheral
utilization of glucose
 Net result
 I) Hyperglycaemia
 II) Decreased sensitivity to insulin
 III) diabetes may bye precipitated .
Lipid metabolism:
 Prolonged use of glucocorticoids cause
redistribution of body fat that is deposited
over the neck , face , shoulder , etc resulting in
moon face , buffalo hump and fish mouth
with thin limbs.
 Protein metabolism:
Glucocorticoids

Protein break down and mobilization of

amino acids from lymphoid tissue ,
muscle , skin , bone ,etc

Muscle wasting , lympholysis, thinning of skin

loss of bone matrix and growth retardation,
wound healing and fibrosis are inhibited.
Electrolyte and Water Metabolism :
 Glucocorticoids have weak mineralocorticoid
action , cause sodium and water retention.
 Promote potassium excretion .
 Prolonged use cause oedema and
Hypertension
Calcium metabolism :
 Prolonged use of these drugs may lead to
osteoporosis and pathological fractures of
vertebral bodies.
Cardiovascular system :
 Glucocorticoids have sodium and water
retaining property.
 On chronic administration , these drugs may
cause hypertension and worsening of CCF
Skeletal muscles :
 Corticosteroids are required for the normal
function of skeletal muscles .weakness occurs
in both hypocorticism and hypercorticism
Central nervous system :
Corticosteroids have a number of indirect
effects on the CNS through maintenance of
 Blood pressure
 Blood glucose concentrations
 Electrolyte imbalance
Blood and Lymphoid Tissue
 Glucocorticoid therapy leads to a decrease in
the number of circulating lymphocytes,
eosinophils , basophils and monocytes.
Anti inflammattory effects
 They have powerful anti inflammatory and
immunosuppressant effects .
 They prevent or suppress the clinical features
of inflammation such as
 redness,
 heat ,
 pain and swelling.
Immunosuppressant effect:
Bone marrow stem cells

T- lymphocytes B- lymphocytes

Lymphokines Immunoglobulins

cell mediated immunity Humoral immunity

 Adverse effects
1. Metabolic effects : Hyper glycaemia ,
precipitation of diabetes mellitus or
aggravation of pre existing diabetes.
2. Gastrointestinal tract : peptic ulcateration ,
some times with haemorrhage or perforation
3. Cushings habitus : Abnormal fat distribution
causes peculiar features with moon face ,
buffalo hump and thin limbs .
4. Salt and water retention :Mineralocorticoid
effect may cause oedema , hypertension and
even precipitation of CCF .
5. Muscle : Steroid treatment can cause
hypokalaemia leading to muscle weakness and
fatigability.
6.Bone : Osteoporosis with pathological
fractures of vertebral bodies . Ischaemic necrosis
of femoral head can also occur .
7. Growth retardation : common in children with
dexamethasone and betamethasone
8. Long term therapy with steroids leads to
immunosuppression .
9. Eye : Glaucoma and cataract may occur on
prolonged therapy.
10.CNS: Behavioural disturbances like
nervousness , insomnia , mood changes and
even psychosis may be precipitated.
 Therapeutic uses of Glucocorticoids
Endocrinal uses :
1. Acute adrenal insufficiency : It is a medical
emergency treated with i.v hydrocortisone
and i.v normal saline with 5% glucose to
correct fluid and electrolyte imbalance .
2. Chronic adrenal insufficiency :Treated with
oral hydrocortisone along with adequate salt
and water.
Non endocrinal uses :
1. Rheumatoid arthritis :They produce an
immediate and dramatic symptomatic relief
in rheumatoid arthritis.
2. Osteoarthritis : rarely used .intra-atricular
injection is preferred for acute episodes.
3. Rheumatic fever :Produce more rapid and
symptomatic relief than asprin and are
indicated in cases with carditis and CCF.
4. Hypersensitivity reactions
5.Bronchial asthma : glucocorticoids have anti
inflammatory and anti allergic effects , hence
they reduce mucosal oedema and brochial hyper
irritability.
6. Collagen diseases :collagen diseases such as
polymyositis , polyarteritis nodosa , polymyalgia
rheumatica can be controlled with large doses of
glucocorticoids .
7.Renal diseases . first line drugs in treatment of
nephrotic syndrome .
8.Skin diseases: dramatically relieve itching ,
pain and inflammation in allergic conditions.
9.Organ transplantation : glucocorticoids are
used to prevent and treat graft rejections .
10.Shock .Prompt treatment with i.v
glucocorticoids may be life saving in septic
shock.
 Relative contraindications
1. Hypertension
2. DM
3. Peptic ulcer
4. Tuberculosis
5. osteoporosis
6. Epilepsy
7. Psychosis
8. CCF
9. Renal failure
10. Glaucoma
 Anabolic steroids
 They are synthetic androgens with greater
anabolic and lesser androgenic activity.
 Promote protein synthesis and increase
muscle mass resulting in wt gain .
 Testosterone has potent anabolic effect , but it
cannot be used because of its strong
androgenic effect.
Some of the commonly used anabolic steroids
are :
 Nandrolone phenylpropionate (i.m)
 Nandrolone decanoate (i.m)
 Oxandrolone (oral)
 Stanozolol(oral)
 Ethylestrenol(oral)
 Methandienone(oral, i.m)
 Uses
1. In chronic illness , to improve appetite and
feeling of well being
2. During recovery from prolonged illness,
surgery , burns , trauma etc
3. To counteract the catabolic effects of
exogenously administered adrenal cortical
hormones.
4. In postmenopausal and senile osteoporosis
5. To control itching in chronic biliary
obstruction.
 Adverse effects

1. In females cause virilization leading to

hirusitism , menstrural irregularities, breast
atrophy, acne and deepening of voice .
2. In children , impairment of growth due to
premature closure of epiphyses.
3. Sodium and water retention leading to
oedema
 Precautions and contraindications

1. Pregnancy :should not be used during

pregnancy because of fear of virilization of
female fetus
2. Carcinoma of prostate and breast cancer in
men
3. Renal and cardiac diseases.
 Anabolic steroids are often misused by
athletes to increase muscle strength and
athletic performance , hence are included in
“Dope test “
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