Adrenal glucocorticoids after twenty years: A review of their clinically relevant consequences
About: This article is published in Journal of Chronic Diseases.The article was published on 1970-03-01. It has received 192 citations till now.
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TL;DR: The administration of glucocorticosteroids results in a wide range of effects on inflammatory and immunologically mediated disease processes, and the corticosteroid regimen should be adjusted to attain maximal therapeutic benefit with minimal adverse side effects.
Abstract: The administration of glucocorticosteroids results in a wide range of effects on inflammatory and immunologically mediated disease processes. Glucocorticosteroids cause neutrophilic leukocytosis together with eosinopenia, monocytopenia, and lymphocytopenia. A principal mechanism whereby corticosteroids suppress inflammation is their impeding the access of neutrophils and monocytes to an inflammatory site. Granulocyte function is relatively refractory, whereas monocyte-macrophage function seems to be particularly sensitive to corticosteroids. Corticosteroid administration causes a transient lymphocytopenia of all detectable lymphocyte subpopulations, particularly the recirculating thymus-derived lymphocyte. The mechanism of this lymphocytopenia is probably a redistribution of circulating cells to other body compartments. There is considerable disagreement about the direct effects of corticosteroid administration on human lymphocyte function. The corticosteroid regimen should be adjusted to attain maximal therapeutic benefit with minimal adverse side effects. Often, alternate-day dosage regimens effectively maintain disease remission with minimization or lack of Cushingoid and infectious complications.
925 citations
TL;DR: Highlights of this update include new epidemiological information on mortality and prevalence of COPD, which charts its emergence as a major health problem for women; a new section on common comorbidities in COPD; and an increased emphasis on the meaningful benefits of combined pharmacological and nonpharmacological therapies.
Abstract: Chronic obstructive pulmonary disease (COPD) is a major respiratory illness in Canada that is both preventable and treatable Our understanding of the pathophysiology of this complex condition continues to grow and our ability to offer effective treatment to those who suffer from it has improved considerably The purpose of the present educational initiative of the Canadian Thoracic Society (CTS) is to provide up to date information on new developments in the field so that patients with this condition will receive optimal care that is firmly based on scientific evidence Since the previous CTS management recommendations were published in 2003, a wealth of new scientific information has become available The implications of this new knowledge with respect to optimal clinical care have been carefully considered by the CTS Panel and the conclusions are presented in the current document Highlights of this update include new epidemiological information on mortality and prevalence of COPD, which charts its emergence as a major health problem for women; a new section on common comorbidities in COPD; an increased emphasis on the meaningful benefits of combined pharmacological and nonpharmacological therapies; and a new discussion on the prevention of acute exacerbations A revised stratification system for severity of airway obstruction is proposed, together with other suggestions on how best to clinically evaluate individual patients with this complex disease The results of the largest randomized clinical trial ever undertaken in COPD have recently been published, enabling the Panel to make evidence-based recommendations on the role of modern pharmacotherapy The Panel hopes that these new practice guidelines, which reflect a rigorous analysis of the recent literature, will assist caregivers in the diagnosis and management of this common condition
711 citations
TL;DR: The molecular mechanisms, sites of action, and effects of glucocorticoids on various cells involved in inflammatory and immunologically mediated reactions are described and treatment principles are provided with examples of specific glucOCorticoid regimens in prototypical conditions.
Abstract: • Glucocorticoids are pleiotropic hormones that at pharmacologic doses prevent or suppress inflamma tion and other immunologically mediated processes. At the molecular level, glucocorticoids form complexes with specific receptors that migrate to the nucleus where they interact with selective regulatory sites within DNA; this results in positive and negative mod ulation of several genes involved in inflammatory and immune responses. At the cellular level, glucocorti coids inhibit the access of leukocytes to inflammatory sites; interfere with the functions of leukocytes, endo thelial cells, and fibroblasts; and suppress the produc tion and the effects of humoral factors involved in the inflammatory response. Clinically, several modes of glucocorticoid administration are used, depending on the disease process, the organ involved, and the extent of involvement. High doses of daily glucocorticoids are usually required in patients with severe diseases involv ing major organs, whereas alternate-day regimens may be used in patients with less aggressive diseases. Intravenous glucocorticoids (pulse therapy) are fre quently used to initiate therapy in patients with rapidly progressive, immunologically mediated diseases. The benefits of glucocorticoid therapy can easily be offset by severe side effects; even with the greatest care, side effects may occur. Moreover, for certain complications (for example, infection diathesis, peptic ulcer, osteoporo sis, avascular necrosis, and atherosclerosis), other drug toxicities and pathogenic factors overlap with glucocor ticoid effects. Minimizing the incidence and severity of glucocorticoid-related side effects requires carefully de creasing the dose; using adjunctive disease-modifying immunosuppressive and anti-inflammatory agents; and taking general preventive measures.
710 citations
TL;DR: Although vital to the management of SLE, corticosteroids have an over-all deleterious effect on the heart and systemic hypertension and left ventricular hypertrophy appear or, when present, worsen; congestive cardiac failure increases; epicardial apartment of Me.
646 citations
TL;DR: As with cyclic AMP and other types of steroids, glucocorticoids may play a more important role in fetal cellular and tissue differentiation than previously appreciated.
474 citations
References
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TL;DR: No statistically significant difference in sarcoid manifestations was found primarily due to sex or race except for a higher incidence of hypoalbuminemia and hyperglobulinemia in Negro subjects.
735 citations
685 citations
TL;DR: The granulocyte turnover rate (GTR) is presented, the number of granulocytes turned over through the blood in a unit of time, and the size of the TBGP, CGP and MGP in normal subjects.
Abstract: When granulocytes are labeled with diisopropyl-fluorophosphate (DFP32) and then returned to the circulation of the donor, the labeled granulocytes are distributed in a pool of cells which is approximately two times larger than that calculated from the blood volume and the concentration of granu-locytes in the circulating venous blood (1, 2). This pool has been referred to as the total blood granulocyte pool (TBGP) and it consists of two subcompartments or pools. These pools have been designated the circulating granulocyte pool (CGP) and the marginal granulocyte pool (MGP). The size of the CGP can be calculated from the blood volume and the absolute granulocyte count. Equilibration between the granulocytes in the CGP and in the \"noncirculating\" or MGP is sufficiently rapid and complete to allow these two pools to be considered as one kinetically, and the size of the TBGP can be determined by the isotope dilution principle. Since the cells are removed from the TBGP in an exponential fashion with a mean half-time disappearance (Ti) of 6.6 hours, the granulocyte turnover rate (GTR), that is, the number of granulocytes turned over through the blood in a unit of time, can be calculated. The purpose of this paper is to present data on the GTR in normal subjects, as well as additional data on the size of the TBGP, CGP and MGP in normal subjects. The influence of steroids, physical exercise, epinephrine and bacterial endotoxin on these parameters in normal subjects has also been studied. Twenty-five volunteers from the Utah State Prison, in addition to the 45 subjects previously reported (1, 2), were used in these studies. All of the subjects were normal healthy males, 20 to 50 years of age, with normal leukocyte values. The subjects ate breakfast at 6:00 a.m. and the infusion of labeled blood was begun between 8:00 and 10:00 a.m. The methods for labeling blood in vitro, for the isolation of leukocytes from the blood samples, for the determination of leukocyte radioactivity, and for the calculation of the TBGP, CGP and T± have been described in previous publications (1, 2, 5). The GTR, defined as the number of granulocytes turned over through the blood each day per kilogram body weight, was calculated from the following equation (6): GTR = 24 X 0.693/Ti (hrs) X TBGP (no. cells X 107/kg). The DFP32 was purchased from the New England Nuclear Corp., Boston, Mass., as a dilute solution …
613 citations
TL;DR: The unusually high species specificity of human growth hormone has been further demonstrated by immunologic studies, in which antigenic similarity and biologic effectiveness have closely paralleled one another among various mammalian species.
Abstract: THE recent isolation of human growth hormone from pituitary glands collected at autopsy has been of major importance in the investigation of human pituitary physiology.1 , 2 Metabolic studies have confirmed the remarkable anabolic and growth-promoting actions of this hormone in man,3 , 4 in contrast to the negative or equivocal clinical results previously observed with bovine growth hormone. The unusually high species specificity of human growth hormone has been further demonstrated by immunologic studies, in which antigenic similarity and biologic effectiveness have closely paralleled one another among various mammalian species.5 An assay taking advantage of immunologic specificity was first reported by Read and . . .
519 citations