(3) Congenital adrenal hyperplasia syndrome (CAH). In CAH, the
production of hydrocortisone (cortisol) and, at times, aldosterone is interfered with or
prevented due to an inherited enzyme deficiency. The treatment of CAH requires the
administration of hydrocortisone. The dosage of this agent must be adjusted over a
long course of therapy to permit linear growth in children.
b. Therapeutic Uses of Glucocorticoids in Nonendocrine Diseases. The
glucocorticoids are commonly used in the treatment of a variety of nonendocrine
disorders. These products are useful because they produce anti-inflammatory and anti-
immunologic actions in the body. The effects produced by these agents are seen with
pharmacologic doses. Thus, patients who receive systemic glucocorticoid therapy for
nonendocrine disorders risk developing adverse effects (such as moon face and buffalo
hump, increased susceptibility to infection, etc.) associated with excessive levels of
these substances. Glucocorticoids are used to treat the following disorders:
(1) Treatment of inflammatory diseases such as rheumatoid arthritis,
osteoarthritis (degenerative joint disease), and rheumatic carditis.
Pharmacologic doses of glucocorticoids are not curative, but rather they help
improve the symptoms associated with these various diseases.
(a) Rheumatoid arthritis. Optimal therapy for patients who have only
one or two joints afflicted with rheumatoid arthritis is 20 to 25 milligrams of
hydrocortisone administered by intra-articular injection. More advanced cases of this
disease require 5 to 20 milligrams of triamcinolone or 10 milligrams of prednisone orally
in divided doses.
(b) Osteoarthritis (degenerative joint disease). Patients with
osteoarthritis are sometimes administered 20 to 25 milligrams of hydro-cortisone by
intra-articular injection. This administration should be done infrequently because of
dissolvement of joints.
(c) Rheumatic joints. The administration of glucocorticoids in patients
who have rheumatic carditis is reserved for patients who fail to respond to salicylates in
life-threatening situations. Prednisone, 40 milligrams, is given orally in divided daily
doses as treatment in these instances.
(2) Treatment of inflamed joints, tendons, bursae, and soft tissues. These
conditions are treated locally with hydrocortisone injections.
(3) Treatment of renal disease. Prednisone, 80 to 120 milligrams, is given
daily in oral doses to people who have nephrotic syndrome due to primary renal
disease. Prednisone has little or no effect in acute or chronic glomerulonephritis.