Corticosteroids are steroid hormones, produced either artificially or in the adrenal cortex. The hormone affects carbohydrate metabolism, electrolyte levels and protein catabolism as well as immune responses, gluconeogenesis (glyconeogenesis) and gonad function.
Glucocorticoids such as cortisol control carbohydrate, fat and protein metabolism and are anti-inflammatory by preventing phospholipid release, decreasing eosinophils action and a number of other mechanisms. Mineralocorticoids control electrolyte and water levels, mainly by promoting sodium retention in the kidney. The most common natural hormones are corticosterone (C21H30O4), cortisone (C21H28O5, 17-hydroxy-11-dehydrocorticosterone) and aldosterone.
Tadeus Reichstein together with Edward Calvin Kendall and Philip Showalter Hench were awarded the Nobel Prize for Physiology and Medicine in 1950 for their work on hormones of the adrenal cortex which culminated in the isolation of cortisone.
Use of corticosteroids as a drug treatment had been in use for some time, extracted from the adrenal glands of oxen. This preparation cost hundreds of dollars a drop, and was available to few. Percy Julian developed a way to synthesize cortisone from soy beans, thus making it affordable to all at pennies a gram. The exact nature of cortisone's anti-inflammatory nature remained a mystery for years after however, until the Leukocyte Adhesion Cascade was fully understood in the early 1980s.
Synthetic drugs with corticosteroid-like effect are used in a variety of conditions, ranging from brain tumors to skin diseases. Dexamethasone and its derivatives are almost pure glucocorticoids, while prednisolon and its derivatives have some mineralocorticoid action in addition to the glucocorticoid effect. Fludrocortisone is a synthetic mineralocorticoid. Hydrocortisone (cortisol) is available for replacement therapy.
Typical undesired effects of glucocorticoids present quite uniformly as drug-induced Cushing's syndrome. Typical mineralocorticoid side effects are hypertension, hypokalemia, hypernatremia, and metabolic alkalosis.
Synthetic glucocorticoids are used in the treatment of joint pain or inflammation (arthritis), dermatitis, allergic reactions, asthma, hepatitis, lupus erythematosus, ulcerative colitis, Crohn's disease, sarcoidosis and for glucocorticoid replacement in Addison's disease. Topical formulations for treatment of skin or bowel diseases are available.
See also: Cushing's syndrome