Volume 13

Number 01 January 2023
Corticosteroids: a double-edged sword in clinical practice


Prof. Dr. Mahjuba Umme Salam

Cortisone, a steroid hormone secreted from the adrenal cortex, with its synthetic derivatives, has been an important therapeutic agent since its discovery by the combined efforts of three Nobel laureate scientists, Edward Calvin Kendall, Tadeusz Reichstein, and Philip Showalter Hench in 1950.1 It was first used as a therapeutic in Rheumatoid Arthritis and, from then on, its derivatives have been used under the common name ‘steroid’ in numerous areas of medicine for the last 22 years, including the successful use of dexamethasone and methylprednisolone in recent days, in the management of hypoxemic COVID-19 pneumonia patients.2,3 But it has long been realized in medical practice that this is one of the frequently prescribed drugs that warrant most judicious prescribing to avoid its related hazards which, at times produce alarming consequences. Chemically, (CS) are 17-carbon and 4-sterolring hydrocarbons that exert physiological functions in maintaining carbohydrate, protein, and, fat metabolism, surviving in stress, antiinflammatory response, immune-suppression, anti-proliferation, vasoconstriction, and others through genomic and non-genomic mechanisms.4 CS have been one of the most frequently discussed and investigated drugs among clinicians and researchers for ages. Generations of this drug, suitable for different clinical use, with different pharmacological properties and different routes of administrationtopical, oral, intravenous, intramuscular, inhalation, intra-articular, and, intra-lesional, have been invented and widely used in clinical practice so far and, thus have become important therapeutic agents in almost all fields of medicine.