Glucocorticoid pharmacology: receptor mechanism, relative potency, indications and contraindications
How glucocorticoids act through the cytosolic receptor, why 11-beta-HSD enzymes decide mineralocorticoid effect and prodrug activation, how to convert between steroids, when HPA suppression and adrenal insufficiency follow, and the rheumatology and palliative indications and contraindications Paper 1 examines.
Tier 1Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Glucocorticoids bind a cytosolic glucocorticoid receptor (GR), which moves to the nucleus and switches genes on (transactivation) or off (transrepression). Effects take hours, except at very high doses.
- Steroids differ in potency, mineralocorticoid effect and duration. Hydrocortisone 20 mg = prednisolone 5 mg = methylprednisolone 4 mg = dexamethasone 0.75 mg.
- 11-beta-HSD1 activates prednisone and cortisone; 11-beta-HSD2 inactivates cortisol in the kidney and placenta.
Loading the rest of the note…
Finished reading?
Sources
- Therapeutic Guidelines: EndocrinologyAU/NZTherapeutic Guidelines Limited, current eTG edition
- Therapeutic Guidelines: RheumatologyAU/NZTherapeutic Guidelines Limited, current eTG edition
- Therapeutic Guidelines: Palliative CareAU/NZTherapeutic Guidelines Limited, current eTG edition
- European Society of Endocrinology and Endocrine Society joint clinical guideline: diagnosis and therapy of glucocorticoid-induced adrenal insufficiencyBeuschlein et al., Eur J Endocrinol 2024;190:G25-51 and J Clin Endocrinol Metab 2024;109:1657-83, 2024
- EULAR evidence-based and consensus-based recommendations on the management of medium to high-dose glucocorticoid therapy in rheumatic diseasesDuru et al., Ann Rheum Dis 2013;72:1905-13, 2013
- Defining conditions where long-term glucocorticoid treatment has an acceptably low level of harm to facilitate implementation of existing recommendations: viewpoints from an EULAR task forceStrehl et al., Ann Rheum Dis 2016;75:952-7, 2016
- EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 updateSmolen et al., Ann Rheum Dis 2023;82:3-18, 2022 update
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback