Therapeutic uses of corticosteroids

(By Dr. Ahmad Najmi, Index Medical College, Indore)

1. Endocrine Disorders
Acute adrenal insufficiency
Primary adrenocortical insufficiency
Ad. Insufficiency second. to Ant. Pituitary
Congenital adrenal hyperplasia
2. Rheumatic carditis
Not responding to salicylates
Severely ill pts.
Prednisolone 40mg in divided doses
Salicylates given concurrently to prevent reactivation
3. Arthritis
Not the drug of first choice
Prednisolone 5 or 7.5 mg
Intra-articular injection
4. Renal diseases (Nephrotic syndrome)
Prednisolone 60 mg in divided doses for 3 – 4 weeks
If remission occurs continue for 1 year
Do not modify the course of disease; Some may benefit
5. Collagen diseases
DLE, pemphigus vulgaris, polyarteritis nodosa
Defect in connective tissue proteins in joints, various organs and deeper layer of skin
6. Allergic diseases
Anaphylactic shock, blood transfusion reaction, hay fever
Prednisolone (short course)
7. Bronchial asthma
Not routinely used except in Status asthmaticus
Methyl prednisolone sodium i.v. given followed by oral prednisolone
Inhaled steroids (Minimal HPA axis suppression
8. Ocular diseases
Outer eye & anterior segment: local application
Posterior segment: systemic use
Caution: bacterial, viral & fungal conjunctivitis
9. Dermatological conditions
Pempigus: Life saving therapy is steroids
Eczema, dermatitis & psoriasis: respond well
10. . Diseases of intestinal Tract
Ulcerative colitis: cortisol retention enema
11. Cerebral oedema
Questionable value in cerebral oedema following trauma, cerebrovascular oedema
Valuable in oedema associated with neoplasm and parasites
13. Malignancy
Part of multi drug regimens for acute lymphatic leukaemia (children), chronic lymphatic leukaemia (adult)

Prednisolone 1mg/Kg start; gradually reduce the dose