Glucocorticoid Therapy and Adrenal Suppression

Glucocorticoids are steroid hormones produced by the adrenal cortex. They have pleiotropic effects and contribute substantially to the maintenance of resting and stress-related homeostasis. Although the molecular mechanisms of their actions are not fully understood, most of glucocorticoid effects are mediated by a ubiquitously expressed transcription factor, the glucocorticoid receptor. The latter influences the transcription rate of several glucocorticoid-target genes or interact physically with other transcription factors regulating their transcriptional activity in a positive or negative fashion. We present the molecular mechanisms of glucocorticoid action, and we discuss glucocorticoid treatment in endocrine and non-endocrine disorders, the side effects of glucocorticoids, their concomitant use and interactions with other drugs, and the risk factors for adrenal suppression. We suggest regimens for weaning patients from long-term glucocorticoid therapy, describe the glucocorticoid withdrawal syndrome, and provide some future perspectives on glucocorticoid treatment. For complete coverage of all related areas of Endocrinology, please visit our on-line FREE web-text, WWW.ENDOTEXT.ORG.