Section II. GLUCOCORTICOIDS AND SYNTHETIC AGENTS
In this section, you will be provided with information related to agents that can be
classified as either mineralocorticoids or glucocorticoids.
ADRENOCORTICAL SUPPRESSION WITH GLUCOCORTICOID AGENTS
The long-term administration of therapeutic amounts of glucocorticoids may
result in adrenocortical suppression. This adrenocortical suppression occurs because
the therapeutic levels of the synthetic glucocorticoids tend to suppress the release of
adrenocorticotropic hormone (ACTH) from the pituitary gland via a negative feedback
mechanism. This negative feedback mechanism results in the suppression of secretion
and synthesis of the naturally occurring glucocorticoids of the adrenal cortex.
Prolonged suppression may cause the adrenal cortex to atrophy, thus resulting in
adrenocortical insufficiency upon discontinuation of glucocorticoid therapy.
CLINICAL INDICATIONS FOR GLUCOCORTICOIDS
The glucocorticoids have specific indications for use in the treatment of certain
conditions. These indications are discussed below:
a. Replacement Therapy. The glucocorticoids are used in replacement therapy
for several conditions. These include:
(1) Chronic adrenal insufficiency (Addison's Disease). Addison's disease
may develop as a result of adrenal surgery or due to destructive lesions of the adrenal
cortex. The replacement therapy associated with this condition requires approximately
20 to 30 milligrams of hydrocortisone (cortisol) or its equivalent daily, with increased
amounts of medication during periods of stress. (NOTE: Doses as high as 100
milligrams of hydrocortisone per day may be necessary during periods of stress.)
Furthermore, mineralocorticoid therapy will also be necessary with monthly injections of
deoxycorticosterone (Doca, Percorten).
(2) Acute adrenal insufficiency. Acute adrenal insufficiency is usually
associated with disorders of the adrenal cortex. Acute adrenal insufficiency frequently
follows abrupt withdrawal of high doses of corticosteroids (adrenocortical steroids).
Patients who present with acute adrenal insufficiency are usually administered large
doses of hydrocortisone (Solu-Cortef).