• Adrenocorticosteroids and Fetal Lung Maturation
    • Lung maturation is dependent on fetal cortisol
    • If delivery is expected before 34 weeks gestation, maternal glucocorticoid supplementation reduces likelihood of respiratory distress syndrome.
    • Betamethasone (Celestone) preferred due to reduced protein binding -- making more available for placental transfer to the fetal circulation.

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Adrenocorticosteroids in treatment of nonadrenal disorders
Disorder Some Examples

Allergic reactions

 angioneurotic edema, asthma, contact dermatitis, drug reactions, allergic rhinitis, urticaria

Collagen-vascular pathology

 giant cell arteritis, lupus erythematosus, polymyositis, rheumatoid arthritis, temporal arteritis
Eye diseases allergic conjunctivitis, optic neuritis
Gastrointestinal inflammatory bowel disease than
Hematologic acute allergic purpura, leukemia, autoimmune hemolytic anemia, idiopathic thrombocytopenic purpura, multiple myeloma
Infections gram-negative septicemia and
Inflammatory disorders of joints/bones arthritis, bursitis,tenosynovitis
Neurologic cerebral edema, multiple sclerosis
Organ Transplantation prevention/treatment of rejection (immunosuppression)
Pulmonary bronchial asthma, prevention of infant respiratory distress,sarcoidosis, aspiration pneumonia
Renal nephrotic syndrome
Skin atopic dermatitis, dermatoses, mycoses fungoides, seborrheic dermatitis
Thyroid malignant exophthalmos, subacute thyroiditis
adapted from Table 39-2; Goldfien, A.,Adrenocorticosteroids and Adrenocortical Antagonists, in Basic and Clinical Pharmacology, (Katzung, B. G., ed) Appleton-Lange, 1998, p 643.

  •   Glucocorticoid Toxicity
    • Metabolic Effects
      •  iatrogenic Cushing's syndrome
        1.  moon facies
        2.  fat redistribution; e.g. truncal obesity
        3.  acne
        4.  hirsuitism
        5.   insomnia, increased appetite
        6.  weight gain
        7.  muscle wasting
        8.  skin thinning, bruising
        9.  hyperglycemia
        10.  osteoporosis, diabetes, aseptic hip necrosis
        11.  wound healing

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    •  Other Effects:
      • peptic ulcer development
      • myopathy (triamcinolone)
      • nausea, dizziness, weight loss (triamcinolone, methylprednisolone)
      • psychosis (large dose corticosteroids)
      • subcapsular cataracts
      • increased intraocular pressure/glaucoma
      • benign intracranial hypertension
      • growth retardation and children
      • cortisone/hydrocortisone in greater than physiologic amounts: mineralocorticoid effects:
        1. sodium/fluid retention
        2. potassium loss-- hypokalemia
        3. hypochloremic alkalosis
        4. hypertension
    •   Adrenal Suppression
      • significant adrenal suppression observed with extended treatment
      • patient should receive supplemental steroid in cases of accidental trauma/surgery
      • the presence of adrenal suppression requires slow tapering of adrenocorticoid dosage
    •  Precautions
      • patient should be observed to detect development of:
        • hyperglycemia
        • glycosuria
        • Na retention with edema
        • hypertension
        • hypokalemia
        • peptic ulcer
        • osteoporosis
        • hidden infections

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    • Contraindications:
      • peptic ulcer disease
      • heart disease/hypertension with congestive heart failure
      • psychoses
      • diabetes
      • osteoporosis
      • glaucoma
      • herpes simplex infection

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Goldfien, A.,Adrenocorticosteroids and Adrenocortical Antagonists, in Basic and Clinical Pharmacology, (Katzung, B. G., ed) Appleton-Lange, 1998, pp 635-650.