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Corticosteroids - Therapeutic uses

Corticosteroids, particularly cortisol and cortisone, are used for the treatment of acute and chronic adrenal insufficiency. When c ortisone is used, it is transformed in the body into cortisol also called hydrocortisone, its active form.

In addition, one can distinguish two types of therapeutic uses according to treatment duration.

1. Urgent and short termtreatments:
   Corticosteroids, are given by parenteral, intramuscular or intravenous route, for the treatment of several diseases: anaphylactic shock, angioedema , as an adjunct to adrenaline, myocarditis, cerebral edema, acute severe asthma, hypercalcemia, acute renal impairment, bacterial meningitis, prevention of vomiting during chemotherapy where dexamethasone is generally used.
   In theory, a treatment of short duration, even at high dosage, has relatively few adverse effects.
2. Long term treatments:
   Corticosteroids are used for the treatment of many diseases, often in combination with other types of drugs. In general, corticosteroids do not cure the diseases but attenuate their manifestations.
   Their indications are very numerous: rheumatoid arthritis and other rheumatic diseases, giant cell arteritis (temporal arteritis, Horton disease), systemic lupus erythematosus, polymyositis, dermatomyositis, idiopathic thrombocytopenia, myasthenia gravis, active chronic hepatitis, organ graft rejection, asthma where corticoids are generally taken by inhalation….
   Corticosteroids for a long course must be prescribed to patients who absolutely need them, at the lowest efficient dose, with once daily intake in the morning to approach the circadian rythm of the physiological secretion. When a reduction in dosage is possible, the reduction should be gradual.
3. Particular uses
   • Antenatal corticosteroid therapy: a particular therapeutic use of the corticosteroid is the antenatal prevention of hyaline membranes disease, of respiratory distress syndrome of premature, by defect of the synthesis of surfactant. Dexamethasone or betamethasone is administrated to the mother 24 to 48 hours before labor.
   • Dexamethasone suppression test: the intake of dexamethasone reduces cortisol secretion in normal people but not in patients with Cushing disease. This test could be also disturbed in depressed patients.

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