Metabolic Effects:

↑gluconeogenesis = ↑glucose;

(but ↑glycogen synthesis in liver)

↓uptake of glucose by muscle cells

↑lipolysis

↑muscle and bone catabolism

Anti-inflammatory & immunosuppressive:

↓lymphocytes, ↓macrophages and APCs

↓phospholipase A2 activation products

↓ COX-2 expression

Iatrogenic Cushing’s syndrome:

Cataracts,

fat redistribution,

glaucoma,

muscle wasting,

peptic ulcers

·         Addison’s disease (chronic adrenocortical insufficiency)

·         Congenital adrenal hyperplasia

·         Cushing’s syndrome (adrenal hyperplasia due to ACTH secreting pituitary tumor)

·         Aldosteronism

·         Lung maturation in fetus

·         Immunosuppressive drug (e.g. organ transplants)

Metabolic Effects:

↑gluconeogenesis = ↑glucose;

(but ↑glycogen synthesis in liver)

↓uptake of glucose by muscle cells

↑lipolysis

↑muscle and bone catabolism

Anti-inflammatory & immunosuppressive:

↓lymphocytes, ↓macrophages and APCs

↓phospholipase A2 activation products

↓ COX-2 expression

Iatrogenic Cushing’s syndrome

Cataracts,

fat redistribution,

glaucoma,

muscle wasting,

peptic ulcers

·         Addison’s disease (chronic adrenocortical insufficiency)

·         Congenital adrenal hyperplasia

·         Cushing’s syndrome (adrenal hyperplasia due to ACTH secreting pituitary tumor)

·         Aldosteronism

·         Lung maturation in fetus

·         Immunosuppressive drug (e.g. organ transplants)

Metabolic Effects:

↑gluconeogenesis = ↑glucose;

(but ↑glycogen synthesis in liver)

↓uptake of glucose by muscle cells

↑lipolysis

↑muscle and bone catabolism

Anti-inflammatory & immunosuppressive:

↓lymphocytes, ↓macrophages and APCs

↓phospholipase A2 activation products

↓ COX-2 expression

Iatrogenic Cushing’s syndrome

Cataracts,

fat redistribution,

glaucoma,

muscle wasting,

peptic ulcers

·         Addison’s disease (chronic adrenocortical insufficiency)

·         Congenital adrenal hyperplasia

·         Cushing’s syndrome (adrenal hyperplasia due to ACTH secreting pituitary tumor)

·         Aldosteronism

·         Lung maturation in fetus

·         Immunosuppressive drug (e.g. organ transplants)

Selective inhibitor of steroid 11-hydroxylation, interfering with cortisol and corticosterone synthesis

Transient dizziness, GI disturbances, salt and water retention, hirsutism

RX: Cushing’s syndrome

DX: If 11-deoxycortisol levels do not rise and ACTH rise = impaired adrenal insufficiency.

If neither 11-deoxycortisol nor ACTH rise = impaired HPA axis at pituitary or hypothalamus.

Glucocorticoid and mineralcorticoid;

Promotes reabsorption of sodium from distal convoluted and collecting tubules

Edema, hypertension, hypokalemia

Replace aldosterone in various forms of adrenal insufficiency such as Addison's disease and congenital adrenal hyperplasia.

Aldosterone and androgen receptor antagonist; also a diuretic (CH 13)

Hyperkalemia, cardiac arrhythmia, menstrual abnormalities, gynecomastia

Primary aldosteronism

Hirsutism in women

Aldosterone receptor antagonist; more selective than spironolactone => no effect on androgen receptor

hyperkalemia

Hypertension