Adrenocorticosteroids are used for substitution therapy in primary or secondary adrenal insufficiency. They are also used in numerous non-endocrine conditions. Corticosteroids have both anti-inflammatory and immunosuppressive effects and therefore are used in the treatment of chronic inflammatory disorders with immunologic etiology like rheumatoid arthritis, collagen disorders etc.
Due to their anti-allergic effects, they are used in bronchial asthma and skin diseases. Due to their antilymphocytic effect, they are used in malignancies like lymphocytic leukemias and lymphomas. They are also used in breast cancers, which are aggravated by estrogens.
This is because corticosteroids suppress adrenocortical activity by feedback inhibition of ACTH secretion. The adrenal cortex therefore produces less androgen that is precursors to estrogens.
Since corticosteroids reduce edema, they are used in cerebral edema. Patients of cerebral stroke are administered corticosteroids almost immediately on their arrival to the emergency wards. The stress associated with the cerebral stroke tends to cause stress ulcers, and the administration of corticosteroids aggravates them.
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Hence, antacids are administered simultaneously with steroid therapy. Since glucocorticoids enhance the vascular responsiveness to vasoactive substances like nor-epinephrine, they are frequently administered in circulatory shock along with other drugs.
An important precaution that has to be observed during long- term therapy with corticosteroids is that the therapy should not be stopped suddenly. Abrupt cessation of steroid therapy is associated with life-threatening adrenal insufficiency.
Hence, the dose of the steroid must be slowly decreased i.e., tapered. Full recovery from hypothalamic-hypophysial-adrenocortical suppression may require as long as 1 year following cessation of all steroid therapy.