Introduction to Adrenocorticoid Pharmacology

NOTE: Adrenocorticoids and adrenocorticosteroids are used interchangeably. So are glucocorticoids and glucocorticoisteroids.

Adrenocorticosteroids are produced in the adrenal cortex and regulated by ACTH. They are synthesized from a cholesterol backbone and broken into two subcategories: Mineralcorticoid and Glucocorticoid.

The mineralcorticoid hormone produced in the adrenal gland is useful for electrolyte homeostasis. An example of a mineralcorticoid is aldosterone. The release of aldosterone causes the retention of sodium and water and excretion of potassium.  It’s easy to remember this because the prefix ‘mineral-‘ is related to electrolytes.

The glucocorticoid hormones affect carb, fat and protein metabolism. An example of a glucocorticoid is cortisol. It’s easy to remember this because the prefix ‘gluco-‘ is related to energy [metabolism].

Recap

• Adrenocorticoids are produced in the Adrenal Cortex
• Regulated by ACTH
• Synthesized from Cholesterol
• Mineralcorticoids deal with electrolyte homeostasis (e.g. aldosterone)
• Glucocorticoids deal with energy metabolism (e.g. cortisol)

Disease States

Regardless of whether the adrenocorticosteroid in question is a mineralcorticoid or glucocorticoid, there’s problems associated with either if the levels are not normal.

Cushing’s Disease: In Cushing’s disease we have an overproduction/excess of adrenocorticoids. These people have hypertension because of the sodium and water retention (due to aldosterone).  Also since their energy metabolism (due to cortisol) is affected, fat redistributes onto their face (moon face) and (in severe cases) on their back (hunch back).  People who have been on long-term glucocorticoids, such as prednisone have these issues as well.

Addison’s Disease: In Addison’s disease we have a low production of adrenocorticoids (cortisol and aldosterone). This requires therapy with the intake of both mineralcorticosteroids and glucocorticosteroids. For this reason, a person’s with this disease will have to be on two drugs.

Note: The trend over the past few years has been to encourage people to stop using traditional labels based on names of people (such as Islets of Langerhans or Addison’s Disease), but instead to call them by their technical names.  So Addison’s disease is technically also called hypoglucocorticosteroidism.

Recap

• Cushing’s Disease
  • High output of adrenocorticosteroids
  • Hypertension
  • Fat Redistribution
• Addison’s Disease
  • Low production of adrenocorticosteroids
  • Requires therapy with mineralocorticoids and glucocorticoids

Now let’s go in much greater detail about this topic: Corticosteroid Pharmacology