Question

1. Glucocorticoids are (pro- / anti-) inflammatory.
2. ACTH suppression is caused by (glucocorticoids / mineralocorticoids.
3. If a patient is taking glucocorticoids, they should take them right before bed.
   1. True
   2. False
4. What is the mineralocorticoid __(a)__ and what is its duration of action __(b)__?
   1. ____________________________________________
   2. ____________________________________________
5. When is cortisol made most?
   1. Early morning upon wakening
   2. During meals
   3. At bedtime

Answer 1

ANSWER :

Glucocorticoids are anti-inflammatory.  

They stabilize the lysosomal membrane so that the proteolytic enzymes are not released. They inhibit synthesis of chemical mediators of inflammation. Cortisol decreases the permeability of capillaries leading to exudation of fluid is prevented. They inhibit the migration of leukocytes into the affected area and inhibit the phagocytic action.

There is induction of annexins in macrophages, endothelium and fibroblasts. They cause negative regulation of COX-2 and of genes for cytokines in macrophages , endothelial cells and lymphocytes. There is decreased production of acute phase reactants from macrophages and endothelial cells , and of ELAM_! and ICAM-1 in endothelial cells. Also there is decreased expression of transcription factors AP-1 , NF-kB ; collagenase and stromolysin. Thus glucocorticoids show antiinflammatory and immunosuppresant actions.

ACTH suppression is caused by glucocorticoids. Corticosteroids especially cortisol exert inhibitory feedback influence on ACTH production by acting directly on the pituitary as well as indirectly through hypothalamus .

FALSE. If a patient is taking glucocorticoid , they should not be taken right before bed. The best time for taking corticosteroids is morning when the body usually produces the most cortisol. When they are given at night the chance of getting suppression of hypothalamo-pituitary-adrenal axis is very high. So as to minimize the h-p-a axis suppression , take the entire daily dose one time at morning.

Mineralocorticoids are the corticosteroids produced from the zona glomerulosa of adrenal cortex. They are mainly Aldosterone and deoxycorticosterone. They maintain sodium chloride concentration and ECF volume. Their plasma half life is under 20 minutes.

Cortisol is made most at early morning upon wakening. Cortisol secreation shows diurnal variation, more in early hours and less in the evening. Nearly half of the entire secreations is in the few morning hours.