Corticosteroids Cortisone and Relatives

Besides producing adrenaline, the adrenal glands secrete other hormones that control metabolism and body chemistry. This group of hormones comes from the gland's outer layer, or cortex, and so the principal one is called cortisone. Cortisone and its relatives all have a distinctive molecular structure known as the steroid nucleus (which they share with the male and female sex hormones described below). Pharmacologists have learned to make many semisynthetic drugs with this same structure, starting with raw materials found in certain plants. As a group, these drugs are all called corticosteroids, or simply, steroids, both the endogenous ones and the manmade ones.

One of the dramatic effects of corticosteroids is to reduce inflammation and certain allergic reactions, such as skin rashes. Pharmacologists have maximized this action in some of the new steroids they have created in laboratories. When these drugs are applied topically — that is, when they are put on the skin — they are reasonably safe and sometimes miraculously effective. Doctors also frequently prescribe steroids for systemic use — that is, to be taken internally. There are clear indications for such use, but because steroids seem almost to have magic powers, doctors tend to overprescribe them, sometimes dispensing them for mild cases of poison ivy, diaper rash, back pain, and other conditions not severe enough to warrant their use.

The trouble is that the desirable anti-inflammatory properties of steroids are just one of many actions of these powerful hor mones. Even in moderate doses, systemic steroids can drastically upset the chemical balance of the body and cause serious toxicity, including death. They can also shut off the body's production of its own steroids with such consequences as increased susceptibility to stress and infection.

The adverse physical side effects of steroids are well known to doctors, but less attention is paid to their psychoactivity. These drugs can produce extreme euphoria, resembling the manic phase of manic-depressive psychosis. In such cases, judgment can be severely impaired and behavior become erratic and illogical. With continued use this initial euphoria may turn into intense depression. Steroids can make some people psychotic or suicidal. Not everyone taking steroids systemically experiences these dramatic reactions, but many probably experience more subtle changes in mood; nervousness, insomnia, depression, and other mental changes are common with long-term use. People with a history of psychiatric problems should be cautious about taking steroids. Everyone should be aware that these compounds are among the strongest drugs known and so should be saved for the treatment of really serious illness.

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