SYNTHETIC corticosteroid drugs have both mineralo- and glucocorticoid activity to varying degrees although, in most situations, they are primarily prescribed for their glucocorticoid effects. While corticosteroids undoubtedly have a central role in the treatment of a number of diseases, their misuse is also responsible for causing problems, either directly by, for example, immunosuppression in the presence of sepsis, or indirectly by masking a diagnosis and thereby preventing appropriate treatment. In addition, corticosteroids suppress the hypothalamic-pituitary-adrenal axis (HPA) which can lead to the development of iatrogenic hyperadrenocorticism. In all cases, monitoring of therapy is vital as side effects are common and can be potentially life-threatening. This article describes the basic pharmacology and physiological effects of corticosteroids and discusses the rationale behind the decision to use this group of drugs. It outlines how to choose the appropriate dose rate and duration of treatment and highlights some strategies for reducing systemic side effects.
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