Plainly, there is a distinction between replacement therapy (physiological effects) and the higher doses of pharmacotherapy.
On inorganic metabolism (mineralocorticoid effects): increased retention of sodium by the renal tubule, and increased potassium excretion in the urine.
On organic metabolism (glucocorticoid effects):
• Carbohydrate metabolism: gluconeogenesis is increased and peripheral glucose utilisation (transport across cell membranes) may be decreased (insulin antagonism) so that hyperglycaemia and sometimes glycosuria result. Latent diabetes becomes overt.
• Protein metabolism: anabolism (conversion of amino acids to protein) is decreased but catabolism continues unabated or even faster, so that there is a negative nitrogen balance with muscle wasting. Osteoporosis (reduction of bone protein matrix) occurs, growth slows in children, the skin atrophies and this, with increased capillary fragility, causes bruising and striae. Healing of peptic ulcers or of wounds is delayed, as is fibrosis.
• Fat deposition: this is increased on shoulders, face and abdomen.
• Inflammatory response is depressed, regardless of its cause, so that as well as being of great benefit in 'useless' or excessive inflammation, corticosteroids can be a source of danger in infections by limiting useful protective inflammation. Neutrophil and macrophage function are depressed, including the release of chemical mediators and the effects of these on capillaries.
adrenal steroids and their synthetic analogues
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