====== Corticosteroids (Glucocorticoids & Mineralocorticoids) ======

Corticosteroids are synthetic analogs of adrenal cortex hormones.

They are divided into:
  * Glucocorticoids (anti-inflammatory / immunosuppressive)
  * Mineralocorticoids (volume regulation)

Core physiology:
  * [[endocrine:physiology:hpa_axis|HPA Axis Physiology]]
  * [[endocrine:physiology:glucocorticoid_signaling|Glucocorticoid Signaling Pathway]]

★ = High-yield / core drug for mastery

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===== Systemic Glucocorticoids =====

^ Drug ^ Relative GC Potency ^ Mineralocorticoid Activity ^ Duration ^ ★ ^
| [[endocrine:drugs:hydrocortisone|Hydrocortisone]] | Low | Moderate | Short | ★ |
| [[endocrine:drugs:cortisone|Cortisone]] | Low | Moderate | Short |  |
| [[endocrine:drugs:prednisone|Prednisone]] | Moderate | Low | Intermediate | ★ |
| [[endocrine:drugs:prednisolone|Prednisolone]] | Moderate | Low | Intermediate | ★ |
| [[endocrine:drugs:methylprednisolone|Methylprednisolone]] | Moderate–High | Minimal | Intermediate | ★ |
| [[endocrine:drugs:triamcinolone|Triamcinolone]] | Moderate–High | None | Intermediate |  |
| [[endocrine:drugs:dexamethasone|Dexamethasone]] | High | None | Long | ★ |
| [[endocrine:drugs:betamethasone|Betamethasone]] | High | None | Long | ★ |

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===== Inhaled Glucocorticoids =====

^ Drug ^ Notes ^ ★ ^
| [[endocrine:drugs:beclomethasone|Beclomethasone]] | Early ICS |  |
| [[endocrine:drugs:budesonide|Budesonide]] | Also GI-targeted form | ★ |
| [[endocrine:drugs:ciclesonide|Ciclesonide]] | Prodrug activated in lung |  |
| [[endocrine:drugs:flunisolide|Flunisolide]] | Less common |  |
| [[endocrine:drugs:fluticasone|Fluticasone]] | Most commonly used | ★ |
| [[endocrine:drugs:mometasone|Mometasone]] | Long pulmonary retention |  |

Used in:
  * [[respiratory:clinical:asthma|Asthma]]

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===== Intranasal Glucocorticoids =====

^ Drug ^ Notes ^ ★ ^
| [[endocrine:drugs:beclomethasone|Beclomethasone]] | Also inhaled |  |
| [[endocrine:drugs:budesonide|Budesonide]] | Also inhaled | ★ |
| [[endocrine:drugs:flunisolide|Flunisolide]] | Less common |  |
| [[endocrine:drugs:fluticasone|Fluticasone]] | First-line congestion therapy | ★ |
| [[endocrine:drugs:mometasone|Mometasone]] | High potency |  |
| [[endocrine:drugs:triamcinolone|Triamcinolone]] | OTC option |  |

Used in:
  * [[allergy:clinical:allergic_rhinitis|Allergic Rhinitis]]

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===== Topical Dermatologic Glucocorticoids =====

^ Drug ^ Typical Potency ^ ★ ^
| [[endocrine:drugs:hydrocortisone|Hydrocortisone]] | Low | ★ |
| [[endocrine:drugs:desonide|Desonide]] | Low–Moderate |  |
| [[endocrine:drugs:triamcinolone|Triamcinolone]] | Moderate | ★ |
| [[endocrine:drugs:betamethasone|Betamethasone]] | High | ★ |
| [[endocrine:drugs:fluocinonide|Fluocinonide]] | High |  |
| [[endocrine:drugs:clobetasol|Clobetasol]] | Very High | ★ |

Used in:
  * [[dermatology:clinical:atopic_dermatitis|Atopic Dermatitis]]
  * [[dermatology:clinical:contact_dermatitis|Contact Dermatitis]]

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===== GI-Targeted Glucocorticoids =====

^ Drug ^ Notes ^ ★ ^
| [[endocrine:drugs:budesonide|Budesonide]] | High first-pass metabolism | ★ |
| [[endocrine:drugs:hydrocortisone|Hydrocortisone]] | Rectal formulations |  |

Used in:
  * [[gastroenterology:clinical:ibd|Inflammatory Bowel Disease]]

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===== Mineralocorticoids =====

^ Drug ^ Primary Use ^ ★ ^
| [[endocrine:drugs:fludrocortisone|Fludrocortisone]] | Adrenal insufficiency | ★ |

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===== Class-Wide Adverse Effects =====

Short-term:
  * Hyperglycemia
  * Mood changes
  * Insomnia
  * Fluid retention (more with mineralocorticoid activity)

Long-term:
  * HPA axis suppression
  * Osteoporosis
  * Myopathy
  * Increased infection risk
  * Skin thinning
  * Cataracts / glaucoma

See:
  * [[endocrine:physiology:hpa_axis|HPA Axis Physiology]]

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===== High-Yield Pearls =====

  * Dexamethasone and betamethasone have no mineralocorticoid activity.
  * Inhaled steroids are foundational therapy in asthma.
  * Intranasal steroids are first-line for allergic rhinitis congestion.
  * Chronic systemic use suppresses ACTH.
  * One molecule = one page; routes described within drug monographs.