A Textbook of Clinical Pharmacology and Therapeutics

ADRENALCORTEX 303

Table 40.1:Actions of cortisol and consequences of under- and over-secretion

Actions Deficiency Excess

Carbohydrate, protein Enhances gluconeogenesis; antagonizes Hypoglycaemia, loss Cushing’s syndrome: weight

and fat metabolism insulin; hyperglycaemia with or without of weight gain, increase in trunk fat,

diabetes mellitus; centripetal fat deposition; moon face, skin striae,

hypertriglyceridaemia; hypercholesterolaemia; bruising, atrophy, wasting

decreased protein synthesis (e.g. diminished of limb muscles

skin collagen)

Water and salt Inhibits fluid shift from extracellular to Loss of weight, Oedema, thirst, polyuria;

metabolism intracellular compartment; antagonizes hypovolaemia, hypertension; muscular

vasopressin action on kidney; increases hyponatraemia weakness

vasopressin destruction and decreases its

production. Sodium and water retention,

potassium loss

Haematological Lowers lymphocyte and eosinophil counts; Florid complexion and

increases neutrophils, platelets and polycythaemia

clotting tendency

Alimentary Increases production of gastric acid and pepsin Anorexia and nausea Dyspepsia; aggravation of

peptic ulcer

Cardiovascular system Sensitizes arterioles to catecholamines; Hypotension, fainting Hypertension,

enhances production of angiotensinogen. atherosclerosis

Fall in high-density lipoprotein with increased

total cholesterol

Skeletal Decrease production of cartilage and Backache due to

osteoporosis; antivitamin D; increased renal osteoporosis, renal calculi,

loss of calcium; renal calculus formation dwarfing in children (also

anti-GH effect)

Nervous system Altered neuronal excitability; inhibition of Depression and other

uptake of catecholamines psychiatric changes

Anti-inflammatory Reduces formation of fluid and cellular exudate; Increased spread of and
fibrous tissue repair proneness to infections

Immunological Large dose lysis lymphocytes and plasma cells Reduced lymphocyte mass,

(transient release of immunoglobulin) diminished immunoglobulin

production

Feedback Inhibits release of ACTH and MSH Pigmentation of skin and

mucosa

ACTH, adrenocorticotropic hormone; MSH, melanocyte-stimulating hormone; GH, growth hormone.

HYDROCORTISONE (CORTISOL)

Uses

Hydrocortisonehas predominantly glucocorticoid effects, but
also has significant mineralocorticoid activity (Table 40.2).
At physiological concentrations, it plays little if any part in
controlling blood glucose, but it does cause hyperglycaemia
(and can precipitate frank diabetes mellitus) when adminis-
tered in pharmacological doses. This is caused by enhanced

gluconeogenesis combined with reduced sensitivity to insulin.

Hydrocortisone is given (usually with fludrocortisoneto

replace mineralocorticoid) as replacement therapy in patients

with adrenocortical insufficiency.

High-dose intravenous hydrocortisoneis used short term

to treat acute severe asthma (usually followed by oral pred-

nisolone) or autoimmune inflammatory diseases (e.g. acute

inflammatory bowel disease). Hydrocortisone acetateis an

insoluble suspension which can be injected into joints or