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Biological Half Life

Short Acting

<12 hr.

Intermediate acting

12-36 hr.

Long acting

>36 hr.



Most of the known effects of the glucocorticoids are mediated by widely distributed glucocorticoid receptors. These proteins are members of the superfamily of nuclear receptors, which includes steroid, sterol (vitamin D), thyroid, retinoic acid, and many other receptors with unknown or nonexistent ligands (orphan receptors).


All these receptors interact with the promoters of—and regulate the transcription of—target genes.

In the absence of the hormonal ligand, glucocorticoid receptors are primarily cytoplasmic, in oligomeric complexes with heat-shock proteins (hsp). The most important of these are two molecules of hsp90, although other proteins are certainly involved.

Free hormone from the plasma and interstitial fluid enters the cell and binds to the receptor, inducing conformational changes that allow it to dissociate from the heat shock proteins.

The ligand-bound receptor complex then is actively transported into the nucleus, where it interacts with DNA and nuclear proteins. As a homodimer, it binds to glucocorticoid receptor elements (GREs) in the promoters of responsive genes.

In addition to binding to GREs, the ligand-bound receptor also forms complexes with and influences the function of other transcription factors, such as AP1 and NF-κB, which act on non-GRE containing promoters, to contribute to the regulation of transcription of their responsive genes.

These transcription factors have broad actions on the regulation of growth factors, proinflammatory cytokines, etc, and to a great extent mediate the anti-growth, antiinflammatory, and immunosuppressive effects of glucocorticoids.

Two genes for the corticoid receptor have been identified: one encoding the classic glucocorticoid receptor (GR) and the other encoding the mineralocorticoid receptor (MR).


Replacement Therapy

  • Acute adrenal insufficiency
  • Chronic adrenal insufficiency (Addison’s


  • Congenital adrenal Hyperplasia (Adrenogenital syndrome)
  • Dexamethasone suppression test- Diagnosis of

Cushing’s syndrome

Allergic Reactions

  • Anaphylaxis
  • Bee sting
  • Drug reactions
  • Angioneurotic edema
  • Urticaria
  • Serum sickness
  • Allergic rhinitis

Inflammatory condition of bones and joint

  • Rheumatoid arthritis
  • Osteoarthritis
  • Gout
  • Bursitis
  • Tenosynovitis
  • Rheumatic fever

Collagen disease

  • SLE
  • Polyarteritis nodosa
  • Dermatomyositis

Eye disease

  • Acute uveitis- iritis, iridocyclitis
  • Keratitis
  • Allergic conjunctivitis
  • Choroiditis
  • Optic neuritis

Pulmonary diseases

  • Bronchial Asthma- Status asthamaticus, Acute exacerbation
  • Prevention of infant ARDS- Given to mother
  • Sarcoidosis
  • Aspiration pneumonia

Renal disorders

  • Nephrotic syndrome

GI diseases

  • Inflammatory bowel disease- Chron’s

disease, UC

  • Coeliac disease
  • Nontropical sprue
  • Subacute hepatic necrosis

Hematological disorders

  • Acuired hemolytic anaemia
  • Acute allergic purpura
  • ITP
  • Leukemia
  • Lymphoma- HL and other lymphoma
  • Autoimmune hemolytic anemia

Neurological disorders

  • Cerebral edema
  • Neurocysticercosis

Thyroid diseases

  • Malignant exophthalmos
  • Subacute thyroiditis
  • Thyroid Strom


  • Severe form of TB- Miliary, Meningeal, Renal
  • Lepra reaction
  • Bacterial meningitis
  • Pneumocystis carinii pneumonia in AIDS patient
  • ARDS
  • Sepsis

Skin Diseases

  • Atopic dermatitis
  • Dermatoses
  • Pemphigus vulgaris
  • SJ syndrome
  • Lichen simplex chronicus

Autoimmune conditions

  • Myasthenia gravis

Organ transplantation and skin


  • Prevention and treatment of rejection


Nausea and Vomiting

  • A large dose of dexamethasone reduces

emetic effects of chemotherapy and general anaesthesia


  • Hypercalcemia
  • Mountain sickness


  • Peptic ulcer
  • Diabetes mellitus
  • Hypertension
  • Viral and fungal infections
  • TB and other infections
  • Osteoporosis
  • Herpes simplex keratitis
  • Psychosis
  • Epilepsy
  • CHF
  • Renal failure




  • Sodium and water retention
  • Edema
  • Hypokalemic alkalosis
  • Progressive rise in BP


  • Cushing’s habitus– Characterstic appearance with round face, narrow mouth, obesity of trunk
  • Fragile skin, purple striae, early bruising, telangiectasis, hirsuitism, cutaneous atrophy
  • Delayed healing of wound and surgical incision
  • Hyperglycemia, precipitation of diabetes
  • Muscular weakness- Proximal primarily affected, Myopathy
  • Susceptibility to infection- nonspecific for all pathogenic organism; Latent TB may flare up; opportunistic infection (Candida)
  • Peptic ulceration; bleeding and

silent perforation may occur

  • Osteoporosis
  • Posterior sub-capsular cataract
  • Glaucoma
  • Growth retardation- in children due to inhibition of Growth Hormone
  • Fetal abnormalities- Cleft palate and other defect
  • Psychiatric disturbances- mild euphoria, mania, psychosis, nervousness, decreased sleep
  • Suppression of HPA axis

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