Most people have been prescribed prednisone (or a glucocorticoid) at one point in their lives or at least have heard of it. Even though corticosteroids are used so commonly, the general public does not know much about them.
What is a corticosteroid? Does your body naturally make it?
Corticosteroids are a class of chemicals that are produced in the cortex of the adrenal gland, a 2-3 inch gland located over each kidney. Corticosteroids can be further divided into mineralocorticoids and glucocorticoids. Mineralocorticoids, like aldosterone, are mainly responsible for blood pressure and salt retention. Glucocorticoids, like cortisol and prednisone are responsible for suppressing inflammation and raising blood sugar. Glucocorticoids can have some mineralocorticoid activity too.
When does a doctor prescribe glucocorticoids? How are glucocorticoids administered?
Glucocorticoids are typically used to treat inflammatory conditions. They can be administered through inhalers, as is the case with asthma. They can be taken by mouth or intravenously if a systemic (whole body) effect is desired. They can be used topically for some dermatological issues such as eczema. They can also be directly injected into a joint or inflamed muscle.
What are some examples of glucocorticoids? Mineralocorticoids?
Commonly prescribed glucocorticoids include hydrocortisone, cortisone, prednisone, prednisolone, triamcinolone, and methylprednisolone. Like previously stated, these can have some mineralocorticoid activity. Fludrocortisone is a mainly used for its mineralocorticoid activity.
How much prednisone does the body make a day? Cortisol?
The adrenal cortex makes roughly 9-11 mg of cortisol per day and 10-20 mg of prednisone per day.
What can happen if I take glucocorticoids for too long?
Using glucocorticoids for longer than 7 days can cause the body to stop producing its own. This phenomenon is referred to as adrenal suppression. Patients that are at highest risk of developing adrenal suppression are those that take 20 mg of prednisone (or comparable dose of other glucocorticoids) daily for at least 3 weeks and anyone who has received an evening dose of ≥5 mg of prednisone (or comparable dose) for more than a few weeks. Long-term glucocorticoid use can also cause Cushing syndrome. This can have symptoms such as fat redistribution, muscle wasting, skin thinning, psychological changes, weak bones, and other systemic findings.
What precautions do doctors take to prevent adrenal suppression?
Doctors aim to prevent adrenal suppression by prescribing a “taper” at the end of a glucocorticoid regimen. The taper consists of a few days of decreasing doses towards the end of therapy to allow the patient’s adrenal gland to start producing endogenous glucocorticoids.
If you have any questions about glucocorticoid use, adrenal suppression, or Cushing syndrome call Scottsdale Sports Medicine Institute to schedule an appointment with Dr David Carfagno.
Dr. David Carfagno is a Board Certified Internist and Sports Physician, who trained at the Cleveland Clinic Foundation
Bianchi, V., & Esposito, A. (2012). Cortisol : Physiology, Regulation and Health Implications. New York: Nova Science Publishers, Inc.
Furst, D. Glucocorticoid Withdrawal. In: UptoDate, Post TW (Ed), Uptodate, Waltham, MA. (Accessed on July 26, 2015.)
Kraan, G. (1998). The Daily Cortisol Production Reinvestigated in Healthy Men. The Serum and Urinary Cortisol Production Rates Are Not Significantly Different. Journal of Clinical Endocrinology & Metabolism, 1247-1252.