Talk:Glucocorticoid/Archive 1

annexin-1
"...annexin-1) synthesis, which then binds to cell membranes preventing the phospholipase A2 from coming into contact with its substrate arachidonic acid. This leads to diminished eicosanoid production" -Doesn't it therefore also inhibit prostaglandin and thromboxane production and there fore be reworded from eicosanoid to prostanoid?

that whole section about anti-inflammatory mech is pretty much word to word identical to info on UPTODATE. —Preceding unsigned comment added by 24.141.65.206 (talk) 06:53, 16 November 2007 (UTC)

Side Effects
Why is the list of side-effects presented as a list of issues "research" is seeking to reduce, rather than just a list as it exists today? Does no one else see this?

Glucocorticoid drugs currently being used act nonselectively, so in the long run they may impair many healthy anabolic processes. To prevent this, much research has been focused recently on the elaboration of selectively-acting glucocorticoid drugs. These are the side-effects that could be prevented:

I'm no conspiracy theorist but that is not objective reporting. — Preceding unsigned comment added by Mrsirjojo (talk • contribs) 21:49, 6 June 2011 (UTC)

The side effects are all over the place and scientists still haven't completely figured out what causes what and how, especially because the side effects are different for different people, due to possibly dosage, duration of use, age, sex, genetics, environmental factors, etc. — Preceding unsigned comment added by Greenboite (talk • contribs) 22:02, 15 June 2013 (UTC)

Merger
Much of the article's text has been incorporated from the article Immunosuppressive drug and should be revised. -- Eleassar  my talk 12:19, 27 July 2005 (UTC)

why sentence was deleted
Hi. Just wondered if you could give an example of glucocorticoid replacement therapy where the dose is not given in descending amounts (i.e. half in the morning, third at noon and potent. also sixth in the evening). AFAIK this is the usual way of administration, but I'll be glad if you point me to any sources disproving this.

I also wonder why depression would not belong on the list of side effects.

I'm relatively new to Wikipedia, so I'll be glad to learn why my contributions were deleted, and hey, I may learn something new about my job on the way.

Janek78 09:05, 12 November 2005 (UTC)

Answer: I reverted the following sentence:

Glucocorticoids in replacement therapy are usually given in two doses (1-1/2-0) to reflect the natural levels. The sentence contained an impressive 3 errors and one unclarity in two brief clauses: (a) the number of doses for replacement is variable, from 1 to 4 or more, (b) dosing reflects the kinetics of the specific steroid used rather than the "natural levels", and (c) unlike for example thyroid replacement we do not use "natural levels" as a guide to glucocorticoid replacement. And I had no idea what 1-1/2-0 was intended to mean and didnt think anyone else would either.

Depression is a rare but possible side effect of high dose glucocorticoid therapy, although there are other terms that reflect the transient mental effects of high dose steroids more accurately with fewer misleading implications (e.g., mood changes, steroid psychosis are more commonly used terms for the two main types of effects). However, in the context of potential differences in side effect profiles of non-glucocorticoid vs glucocorticoid substitutes, I don't think we know enough yet to exclude mood or mental effects from the substitutes; those were not recognized as steroid effects until there was far more experience with use than we have with the substitutes.

Janek78, please don't stop contributing; we have all put facts in an article that someone else has corrected. Best regards. alteripse 12:24, 12 November 2005 (UTC)

Replacement therapy
Thanks for the answer, I admit that my formulation was not clear and looking back, I would have deleted what I wrote anyway. :)

But you should notice that I wrote "usually", that does not exclude 1-4 doses, I wanted to give the most common dosing regime. I also have to insist that replacement therapy in adrenal insufficiency reflects the "normal" levels, not the kinetics of the drug. This is what they taught us at school, this is what the Merck Manual says, this is what Lüllmann's pharmacology says, and all other books I have checked. Cortisol production is highest in the morning, then decreases to the lowest level around midnight. Replacement therapy is trying to simulate this by giving the largest dose in the morning, and the rest either in one (or two, or three) lower dose(s). The dose in the evening should be low in order to prevent sleep disorders. This is what all my books say, this is how all my patients (granted, I've only had two or three Addisons so far) took their medication.

I admit that rather than just "depression", it would have been better to say "mania/depression" or "mood changes", as you suggest.

I do not intend to stop contributing, I'm glad we can discus this and hopefully reach a conclusion/consensus. With regards. Janek78 13:04, 12 November 2005 (UTC)

Sorry, it is erroneous "to insist that replacement therapy in adrenal insufficiency reflects the "normal" levels, not the kinetics of the drug." I hope they did not teach you that in school and it is not what the Merck manual says. Steroid replacement is actually based on trying to match natural production rates, not "levels". Levels are what we measure in the blood, like T4, described in units of concentration like mcg/dL, whereas production rates are amounts per unit of time, like mg per 24 hours. We do not measure blood steroid levels as a guide to replacement. Because they fluctuate so much, the phrase "natural level" doesn't even mean anything useful as a description of physiology. We use the production rates as a crude first approximation to replaceent dosing, not levels. The dosing interval has nothing to do with natural levels or natural production; it is primarily determined by the kinetics of the glucocorticoid used. Hydrocortisone is usually given as 2 or 3 doses a day by mouth, but often q4-6 hours by IV. If prednisone is used for replacement, it is given in 1 or 2 doses a day by mouth. If dexamethasone is used for replacement, it given as a single dose a day. Do you see that all these dosing intervals depend on the kinetics of the steroid used and not on "natural levels".? If you intended to explain that the distribution of the doses throughout the day are sometimes intended to imitate the morning cortisol peak you should have said so and I would not have disagreed; I had no idea that is what you meant (and it is by no means a universally accepted necessity anyway). You may be doing the right thing by your patients, but your description of it needs to be more accurate. alteripse 19:14, 12 November 2005 (UTC)

If we are to split hair here, we should talk about secretion, not production; and secretion, in my opinion, leads to change in levels (see cortisol curve). So arguing about production/levels is IMHO irrelevant. But I don't want to push this point; I guess the whole argument was caused by my bad use of English (which you might have noticed is not my first language). Indeed, what I wanted to say was that the dose is distributed unevenly throughout the day, with most of the dose given in the morning (which is true for hydrocortison, prednison, and dexamethasone). I may not be "a universally accepted necessity anyway", but it is accepted enough to be included in the prescribing information of these drugs. My point was aimed at the chronic use of substitution, i.e. not including any IV administration. But again, I see your point now, I think that we actually agree with each other, it was just my unclear formulation that did not say what I wanted to say. I'll have to pay more attention to what I write. :) So what would be a suiting formulation? "In substitution therapy, a larger proportion of the dose is usually given in the morning to reflect the circadian changes in cortisol secretion" ?? Janek78 09:07, 13 November 2005 (UTC)

In terms of linguistic precision, you are correct that secretion is more precise than production, though you will often hear American endocrinologists refer to the "cortisol production rate" in this context. You are also correct that all my criticisms were aimed what you said, not what you know. But honing your language use hones your thinking, and I doubt your professors would let you get away with saying it that way (I wouldn't have). Your final sentence is fine and I would not have changed it.

Final nitpicks: (1) you referred to replacement and did not distinguish between acute and chronic; we do give IV replacement for short periods of time for a number of circumstances, (2) I do not understand how you could give oral dexamethasone with most of the dose in the morning, since its effects last about 24 hours and even the smallest single mg pill is a replacement for most adults. alteripse 11:51, 13 November 2005 (UTC)

Ad (2) - OK, in most people you would use only a single dose of dexamethasone, but in cases requiring higher doses, you would again give a higher dose in the morning, would you not? That was my point. But never mind that, I think we have clarified our views now. :) Thanks for your effort. Janek78 13:54, 13 November 2005 (UTC)

natural sources?
What "natural" sources are there of Glucocorticoids? -69.87.204.151 22:37, 2 March 2007 (UTC)

Request- Yes, I m also intrested in the information that how can we maintain the natural secretion of glucocoticoids by making some changes in our food habbits in our day to day life.

storage temperature
What are optimum long-term storage temperatures? -69.87.204.151 22:37, 2 March 2007 (UTC)

Comparative steroid potencies
The "Comparative steroid potencies" table is very helpful -- it would be even better if more complete. Please add other data such as Lidex Fluocinonide if you have access to this data. -69.87.204.151 02:24, 3 March 2007 (UTC)

Leukocytosis
hi,

i was wondering how glucocorticoid administration causes an initial leukocytosis in patients?

thank you

Glucocorticoid in inflammation o	Stimulate gluconeogenesis in the liver o	Depress protein synthesis in muscle and make amino acid available to be exported to the liver o	Immunosuppression o	Lymphocytes and cell death via apoptosis o	Glucocorticoids act on nuclear receptor and stimulate endonuclease activity o	Inhibits glucose uptake o	Glucocorticoids also has anti-inflammatory properties o	Glucocorticoids stabilize lysosomes, which may be released at the site of injury o	Inhibits: •	Extra supply of body fluid •	Infiltration of leukocytes and marcophages •	Synthesis of connective tissue to heal the wound •	May block the production of prostagladins o	Inflammation is not a synonym for infection and IL-6 is a marker for inflammation o	Glucocorticoid binds to glucocorticoid receptor complex and inhibits NFkB o	Glucocorticoid is also involve in stress o	Under prolonged stress, adrenal hypertrophy occurs o	Atrophy of lymphoid organs o	Adrenal level of cholesterol is depleted due to the overproduction of glucocorticoid —Preceding unsigned comment added by Dcdo01 (talk • contribs) 22:09, 9 February 2010 (UTC)

Beclometasone
I see one critical problem on the table in relation to Beclometasone inhalers. It states that 8 puffs, 4 times a day is = to 14mg prednisolone. In micrograms this equates to (14,000mcg). So one puff is equal to 437.5mcg of prednisolone. The probelem herein lies, is the fact that there are different dosage presentations marketed. (50mcg, 100mcg, 200mcg, 250mcg) The example listed are those marketed in Ireland by IVAX. Different dosages may be marketed elsewhere or by different manufacturers. Giving a certain number of puffs of beclometasone compared with prednisolone is meaningless without a quantified dosage. Finally the suggested dosage 8 puff x4 times a day well exceed the manufacturers recommended dosages. —Preceding unsigned comment added by 193.120.116.178 (talk) 02:27, 1 November 2007 (UTC)

For inhaled corticosteroids (eg for asthma) it would be useful to add information about the systemic bioavailability. The article currently doesn't indicate anywhere that the inhaled steroids produce pretty low systemic doses, which is why they are a lot safer than long-term oral therapy. —Preceding unsigned comment added by 216.254.24.205 (talk) 16:40, 24 February 2008 (UTC)

For Treatment of Alopecia
I read several research papers and review papers and come to an conclusion that alopecia is a autoimmune dieases. And some researchers suggest Finasteride is the only temporary treatment of this while others claim that a combination of GLUCOCORTICOID (Such as Predinisolone)and a immunosupressive drug CICLOSPORINE is the permanant solution for the disease. I m also suffring from the disease (not too severe)so i consulted several doctors but they are not up-to date with these latest medical adavancements and they beleve that this disease could not be cure at all. And other highly qualified doctors are out of my range. Threfor i started taking FINASTERIDE 1mg/day in the morning, in first three month i feel a dramatic growth of hair on my head, but after 3 month again all hairs fall down withen a month!! even i did not stop taking finasteride but hair continue on falling. Now i started PREDINOSOLONE 7-8 mg/day in 4 divided doases. and my hairs stop falling. Please suggest me- should i also take CICLOSPORINE? if yes what doases? How long i should take predinisolone? Should i adjust the doases of predinisolone? if yes How? Can i continue Finasteride? Please give me these usefull suggestions. —The preceding unsigned comment was added by 202.141.36.72 (talk) 07:26, 8 May 2007 (UTC).


 * Wikipedia is not the place to ask for medical advice. You are as likely to get a 12 year old to respond, as you are to get a knowledgable answer (I make no judgement on which mine is!!!).  In my purely personal opinion the significant side effects of immunosuppresives like cyclosporine (an anti rejection drug used for solid organ transplantation) and steroids are significant, especially over the long term. I realize that your post is old, so my response is mainly to anyone else who read your question or had similar thoughts...Fuzbaby (talk) 04:23, 28 May 2009 (UTC)

Genomics vs. non-genomic effects
It is not clear if the non-genomic effects of glucocorticoids are mediated by the glucocorticoid receptor and if they are, it may involve a membrane associated rather than a cytosolic version of the receptor. Furthermore most if not all of the actions of the glucocorticoid receptor are genomic (direct transactivation or indirect transrepression). So the phrase:


 * the GC-receptor complex turns inflammatory proteins up and down, either directly by binding to them in the cytoplasm of the cell, ...

is at best misleading and at worst may be false. If there are direct interactions between GR and pro- or anti-inflammatory proteins, then specific examples need to be included (i.e., which proteins are directly regulated through protein-protein interactions) backed up with reliable sources documenting the evidence for direct interaction. Please note that NF-κB or AP-1 don't count since these in turn regulate the expression (through a transrepression mechanism) of pro-inflammatory proteins. Cheers. Boghog2 (talk) 05:21, 9 March 2009 (UTC)


 * Did you read the NEJM article? Nbauman (talk) 15:40, 9 March 2009 (UTC)

It took me a while, but now I have access the article. After reading it, I have the following observations:

The only references that the NEJM article provides to support the non-genomic activity of glucocorticoids are #17, #18, and #90.
 * #17: Vasodialation
 * #18: Membrane associated GR mediates lymphocytolysis which in turn cites
 * #90: Evidence for non-genomic activity but not proven that it is mediated by GR

That is it.

Reference #17 provides strong evidence for a non-genomic effect but it is vasodilatation not anti-inflammatory. Reference #18 appears non-genomic but it is a membrane associated GR. Finally reference #90 provides evidence for a non-genomic effect of glucocorticoids, but it is not clear if this is GR mediated.

This contrasts sharply with the very large number of genes (on the order of 1% of the genome ) that are directly through transactivation or indirectly through transrepression regulated by GR/glucocorticoid complexes.

So compared to the large number of genes that are regulated by glucorticoids which is extremely well documented, the non-genomic pathway at most plays a minor role in mediating the effects of glucocorticoids. While I think the non-genomic pathway should be mentioned somewhere in the article, I think it is inappropriate to mention this in the lead since it give undue weight to a relatively minor pathway which to date has not been very well characterized. Returning to the sentence:


 * the GC-receptor complex turns inflammatory proteins up and down, either directly by binding to them in the cytoplasm of the cell, ...

The NEMJ article does not provide a single unambiguous example which would support the above statement. Boghog2 (talk) 23:11, 9 March 2009 (UTC)


 * Look at Figure 2. Nbauman (talk) 16:53, 10 March 2009 (UTC)

Figure 2 is a cartoon depiction of the mechanism of GR action. What is missing from this cartoon is perspective on the relative importance of (1) transactivation vs (2) transrepression vs (3) non-genomic pathways. As I have already indicated above, the first two pathways are far more important than the third. Approximately 2000 genes are regulated either directly or indirectly by the glucocorticoid receptor. These genes include cytokines, second messengers, enzymes, and other transcription factors which collectively have powerful immunological and metabolic effects on the organism. In contrast, the non-genomic mechanisms of GR action that have been documented to date appear to have very narrow and transient activity. A high percentage of the antiiflammatory effects of glucocorticoids are from genomic effects. Figure 2 is extremely misleading in that it implies that the non-genomic effects are comparable importance to the genomic effects.

Can you cite a single unambiguous documented example of the glucocorticoid receptor directly modulating the activity of an anti- or pro-inflammatory protein through a non-genomic mechanism? Boghog2 (talk) 19:04, 10 March 2009 (UTC)

ethymology
Is anybody capable of explaining the name of these compounds? To me as a chemist the word Glucocorticoid sounds like a compound consisting of a glucose molecule joimed to a steroid. But the structure only shows a steroid. T.vanschaik (talk) 21:17, 6 July 2009 (UTC)
 * Interesting question. According to Citizendium:
 * glucocorticoids are defined as a group of corticosteroids that affect carbohydrate (e.g., glucose) metabolism
 * corticosteroids in turn are steroid hormones synthesized by the adrenal cortex
 * so paraphrasing, gluco+cort+icoid = glucose + cortex + steroid. Boghog2 (talk) 21:48, 6 July 2009 (UTC)