Use of Dermatologics during Pregnancy
“Bert” Bertis Britt Little in Drugs and Pregnancy, 2022
Hydrocortisone, another glucocorticoid, is the main steroid produced by the adrenal glands. The frequency of congenital anomalies was not increased among infants whose mothers took hydrocortisone during early pregnancy, including the first trimester (Heinonen et al., 1977). As with prednisone/prednisolone, an increased frequency of cleft palate was found among the offspring of experimental animals whose mothers were given hydrocortisone during embryogenesis (Chaudhry and Shah, 1973; Harris et al., 1980). This is similar to experimental findings with other glucocorticoids. It is possible that a small risk for cleft palate in humans exists with hydrocortisone use during embryogenesis, but it is likely that the risk is small at less than 1 percent (Shepard et al., 2002).
Steroids and Infection
Herman Friedman, Thomas W. Klein, Andrea L. Friedman in Psychoneuroimmunology, Stress, and Infection, 2020
A number of studies concerning steroid effects on resistance to infections have been reported using a variety of animal models. For example, Gerald & Easmon26 studied the effects of anti-inflammatory agents, including hydrocortisone, on chronic Salmonella typhimurium infection using a mouse model. The mice were infected subcutaneously with a relatively low dose of bacteria (5 × 103 organisms per mouse), which did not cause any infectious death within 30 days. Treatment with 25 mg of hydrocortisone per kg orally was begun on day 30 after infection and continued for 4 weeks. Such steroid treatment induced 100% mortality within 25 days, with a corresponding increase in salmonellae to lethal levels in the drug-treated mice. This experimental model clearly demonstrated the reactivation of a latent infection after hydrocortisone treatment. That is, treatment with hydrocortisone appears to cause a serious impairment of host defense system to the bacterial infection. North27 also demonstrated that cortisone treatment dramatically lowered resistance of mice to Listeria monocytogenes and provoked a rapid proliferation of the bacteria in the liver of steroid-treated animals.
Fetal and Neonatal Development of the Exocrine Pancreas
Jean Morisset, Travis E. Solomon in Growth of the Gastrointestinal Tract: Gastrointestinal Hormones and Growth Factors, 2017
Suppression of corticosterone production in rats either chronically by adrenalectomy59 or transiently by treatment with an inhibitor of steroidogenesis, aminoglutethimide,60 delayed the developmental accumulation of pancreatic exocrine enzymes. These effects are reversed by hydrocortisone treatment. Receptors for the glucocorticoids have been demonstrated in the pancreas. Although specific binding for dexamethasone was demonstrable in pancreatic cytosol of newborn rat pups, total binding was very low when compared to other age groups. The glucocorticoid binding capacity gradually increased postnatally, but remained relatively low before weaning.53 There was no significant difference in glucocorticoid binding capacity between 10-d-old and newborn rats. A significant rise was not seen until after the 15th day of life. Binding capacity was greatest at weaning (from the 3rd to 5th weeks after birth) with a peak at day 25. After this period, receptor binding activity declined rapidly for several weeks and then more gradually toward the adult level, which remained higher than that of newborns (Figure 3). It is apparent from this study that the level of glucocorticoid receptors correlates well with the accumulation of pancreatic enzymes.
Microfluidics in drug delivery: review of methods and applications
Published in Pharmaceutical Development and Technology, 2023
Mutasem Rawas-Qalaji, Roberta Cagliani, Noor Al-hashimi, Rahma Al-Dabbagh, Amena Al-Dabbagh, Zahid Hussain
On the other hand, Ali et al. (2011) developed nanosuspension for pulmonary delivery of hydrocortisone via bottom-up (building up NPs from drug molecules via precipitation) approach using the microfluidic reactors (Figure 9). Hydrocortisone is a steroidal drug which is widely used as an anti-inflammatory agent for treatment of many diseases; however, its low aqueous solubility, dissolution rate, and low bioavailable limit its delivery routes and therapeutic efficacy. Moreover, rapid expulsion of conventional eye drops from the corneal surface due to eye blinking and washout due to lachrymal fluid also lead to shorter retention time and low bioavailability. Therefore, frequent administrations are necessary in order to maintain the therapeutic effect. Though, several approaches such as using viscosity-enhancing agents, penetration enhancers, and mucoadhesive materials have been employed to improve ocular permeability and bioavailability; however, results were still unsatisfactory. Encapsulation of hydrocortisone in nanosuspension produced via employing microfluidic devices have significantly improved aqueous solubility, dissolution rate, permeability efficiency, and therapeutic efficacy of hydrocortisone compared to hydrocortisone solution (Davies et al. 1997; Nagarwal et al. 2009; Ali et al. 2011) have also developed hydrocortisone nanosuspension for ophthalmic delivery via anti-solvent precipitation method using the microfluidic reactors.
The pediatric ulcerative colitis activity index (PUCAI) predicts steroid-failure in adults with acute severe colitis
Published in Scandinavian Journal of Gastroenterology, 2021
Ohad Atia, Arun Gupta, Simon Travis, Dan Turner, Benjamin Koslowsky
This was a retrospective multicenter cohort study of adult patients (≥18 years of age) with UC, admitted with ASC from 1993 to 2014 to Shaare Zedek Medical Center, Jerusalem, Israel; and the John Radcliffe Hospital (Oxford University Hospitals Trust), Oxford, United Kingdom. All hospitalized patients with a diagnosis of ASC were consecutively enrolled to avoid selection bias. ASC was defined according to Truelove & Witts’ criteria as ≥6 bloody stools daily with evidence of systemic toxicity (fever, tachycardia, anemia, or an elevated erythrocyte sedimentation rate [ESR] or CRP) [22]. We excluded those not treated with IVCS upon admission, those without sufficient data to calculate the PUCAI, those exposed to infliximab, calcineurin inhibitors, or tacrolimus before the admission, and those positive to Clostridium difficile (CDT) or cytomegalovirus (CMV). When a patient had recurrent ASC events, only the first was included. The day of admission was counted as day one. All patients received the same course of steroid dose by IV hydrocortisone 100 mg*3/d.
Emerging therapeutic targets for sepsis
Published in Expert Opinion on Therapeutic Targets, 2021
Elizabeth W. Tindal, Brandon E. Armstead, Sean F. Monaghan, Daithi S. Heffernan, Alfred Ayala
The use of corticosteroids in the management of sepsis has been a point of debate for decades. Their proposed benefit stemming not only from their function as a systemic immunosuppressant but from their ability to correct a relative adrenal insufficiency, which is thought to be induced by critical illness [12]. Currently, corticosteroids are only used in cases of refractory shock, defined as hypotension that requires multiple vasopressor agents despite adequate fluid resuscitation, and this remains controversial, deemed appropriate on a case-by-case basis using provider judgment and preference. Despite multiple well-powered studies and subsequent meta-analyses, while there is evidence that glucocorticoids may result in a faster resolution of shock, fewer ventilator days and a shorter length of stay in both the hospital and the intensive care unit, this does not seem to result in a reliable improvement in patient outcomes including short- or long-term mortality (Table 1) [13–18]. The notion that there is an improvement in surrogate markers like fewer ventilator days but not mortality suggests a specific patient population that would most benefit from steroids. More recently, the concept of using the combination of broad anti-oxidant/anti-inflammatory agent, high-dose Vitamin C, along with thiamine and hydrocortisone has been proposed as a potential treatment for patients in septic shock [19]. However, while having some modest beneficial effects overall, it appears to be no better than hydrocortisone alone, which as mentioned above has not been universally accepted [20].
Related Knowledge Centers
- Adrenal Insufficiency
- Asthma
- Congenital Adrenal Hyperplasia
- Cortisol
- Dermatitis
- Hypercalcaemia
- Chronic Obstructive Pulmonary Disease
- Infection
- Rheumatoid Arthritis
- Thyroiditis