Glucocorticoids

Written by Christine Case-Lo
Medically Reviewed by George Krucik, MD, MBA on May 30, 2013

What are Glucocorticoids?

Many modern health problems involve inflammation. When the immune system goes into action, inflammation can get out of control and cause damage or pain. Glucocorticoids are chemicals that can stop inflammation, but they have many side effects and risks.

Inflammation is the source of many illnesses. Autoimmune diseases and allergies are caused by inappropriate reactions of the immune system. Redness and swelling are hallmarks of inflammation. Inflammation can be beneficial when it alerts the immune system to a site of infection. However, inflammation can become harmful if chronic or inappropriate (i.e. attacking your own cells).

Glucocorticoids (GCs) are steroids that reduce inflammation throughout the body. Cortisol is a naturally occurring GC that is made by your adrenal glands, and works to regulate inflammation and other processes in your body. However, sometimes your levels of cortisol are not enough to counter sudden, chronic, or severe inflammation.

Synthetic GCs are drugs including prednisone, dexamethasone, and hydrocortisone. Synthetic GCs act in a similar way to stop inflammation, and can be even more potent than naturally occurring chemicals.

GCs interrupt inflammation by moving into cells and suppressing the proteins that go on to promote inflammation.  GCs also affect your metabolism by causing cells in the liver to make more sugar. This may lead to too much sugar in the blood, and cause steroid induced diabetes mellitus.

How are Glucocorticoids Used?

Synthetic GCs are used to treat a wide variety of conditions.

Autoimmune diseases like multiple sclerosis, rheumatoid arthritis, inflammatory bowel disease, ulcerative colitis, psoriasis, and eczema can be treated with GCs. These diseases cause extensive inflammation when the body attacks its own cells. Suppressing inflammation can reduce symptoms such as pain, swelling, cramping, and itching. GCs can reduce the activity of immune cells, an important tool for reducing the internal damage of autoimmune diseases.

Allergies and asthma are also caused by inflammation. In these conditions, your immune system can respond to the allergen, including harmless air borne pollen, or peanuts with an aggressive inflammatory reaction. GCs can treat this overreaction by arresting the inflammation and calming immune cell activity. Inhaled GCs like triamcinolone and beclometasone can treat nasal allergies or asthma (as a non-emergency treatment).

GCs can also be used to replace cortisol if you have adrenal insufficiency. This can be caused by a condition such as Addison’s disease, or surgical removal of adrenal glands.

GCs can also treat decompensated heart failure by increasing how the body responds to certain diuretics.

GCs can be used in cancer therapy to reduce some of the side effects of chemotherapy. They may also be used to kill some cancer cells in acute lymphoblastic leukemia, chronic lymphoblastic leukemia, Hodgkin’s lymphoma, Non-Hodgkin’s lymphoma (NHL), and multiple myeloma, among others.

GCs may be used during sensitive neurosurgeries to reduce inflammation in delicate tissues. They are also administered right after an organ transplant to help prevent early rejection of the donor organ.

Skin conditions ranging from eczema to poison ivy are treated with hydrocortisone, an over-the-counter GC used as a topical cream. This is not suitable for long-term treatment without a doctor’s oversight.

Side Effects of Glucocorticoid

GCs may sound like miracle drugs, but there are some very damaging side effects, which make them dangerous for long-term use.

Immunosuppression is a major problem. Your immune system is less functional when taking GCs, and you are more prone to serious infection.

Wound healing requires a certain amount of inflammation. Wound healing can be delayed during GC therapy.

GCs raise your blood sugar. This can trigger temporary and possibly long term diabetes mellitus. Calcium absorption may be suppressed and osteoporosis may result.  Muscle atrophy can also occur with long-term GC therapy. Cholesterol and triglycerides in the blood are increased by GCs.

Psychological effects of GCs can be striking and may prevent some people from using them as therapy. They can cause mood changes, memory problems, and even psychosis.

Ulcers and gastritis may be more likely when GC therapy is being used.

All of these effects are seen in people suffering from Cushing Disease. This is an illness where the adrenal glands make too much cortisol. Long-term GC treatment can result in Cushing Syndrome. In both conditions, you develop:

  • a fatty hump between your shoulders
  • a round face
  • weight gain
  • pink stretch marks
  • weakened bones
  • diabetes
  • high blood pressure
  • thin skin
  • slow healing
  • acne
  • irregular menstrual cycles
  • decreased libido
  • fatigue
  • depression

The need for anti-inflammatory therapy must be balanced against the dangerous side effects. If you need glucocorticoid treatment, you may be weaned off of it slowly to prevent rebound effects.

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