adrenal corticosteroids, antagonists, corticotropin pituitary system, and aldosterone, whose biosynthesis is largely dependent on the renin-angiotensin system.

Numerous analogues have been made in which the major actions have been separated.

When the adrenal cortex fails (Addison's disease) adrenocortical steroids are available for replacement therapy, but their chief use in medicine is for their anti-inflammatory and immunosuppressive effects (pharmacotherapy). These are obtained only when the drugs are given in doses far above those needed for physiological replacement. Various metabolic effects, which are of the greatest importance to the normal functioning of the body, then become adverse effects. Much successful effort has gone into separating glucocorticoid from mineralocorticoid effects1 and some steroids, e.g. dexamethasone, have virtually no mineralocorticoid activity. But it has not yet proved possible to separate the glucocorticoid effects from each other, so that if a steroid is used for its anti-inflammatory action the risks, e.g. of osteoporosis, diabetes, remain.

In the account that follows, the effects of hydrocortisone will be described and then other steroids in so far as they differ. In the context of this chapter 'adrenal steroid' means a substance with hydro-cortisone-like activity. Androgens are described in Chapter 37.

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