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Một số hormone tự nhiên là [[corticosterone]] ({{chem|C|21|H|30|O|4}}), [[cortisone]] ({{chem|C|21|H|28|O|5}}, 17-hydroxy-11-dehydrocorticosterone) và [[aldosterone]].
==Sinh tổng hợp==
[[Image:Corticosteroid-biosynthetic-pathway-rat.png|thumb|Corticosteroid biosynthetic pathway in rat]]
The corticosteroids are synthesized from [[cholesterol]] within the [[adrenal cortex]]. Most steroidogenic reactions are catalysed by [[enzyme]]s of the [[cytochrome P450]] family. They are located within the [[mitochondria]] and require [[adrenodoxin]] as a cofactor (except [[21-hydroxylase]] and [[17α-hydroxylase]]).
[[Aldosterone]] and [[corticosterone]] share the first part of their biosynthetic pathway. The last part is mediated either by the [[aldosterone synthase]] (for [[aldosterone]]) or by the [[11β-hydroxylase]] (for [[corticosterone]]). These enzymes are nearly identical (they share 11β-hydroxylation and 18-hydroxylation functions), but aldosterone synthase is also able to perform an 18-oxidation. Moreover, aldosterone synthase is found within the [[zona glomerulosa]] at the outer edge of the [[adrenal cortex]]; 11β-hydroxylase is found in the [[zona fasciculata]] and [[zona glomerulosa]].
== Phân loại ==
=== CấuTheo cấu trúc phân tử===
Nói chung, corticosteroids chia thành bốn nhóm, dựa trên cấu trúc hóa học. Phản ứng dị ứng to one member of a class typically indicate an intolerance of all members of the class. This is known as the "Coopman classification",<ref name="isbn1-55009-378-9">{{chú thích sách |author=Rietschel, Robert L. |title=Fisher's Contact Dermatitis, 6/e |publisher=BC Decker Inc |location=Hamilton, Ont |year=2007 |page=256 |isbn=1-55009-378-9 }}</ref> after S. Coopman, who defined this classification in 1989.<ref name="pmid2757954">{{cite journal |author=Coopman S, Degreef H, Dooms-Goossens A |title=Identification of cross-reaction patterns in allergic contact dermatitis from topical corticosteroids |journal=Br. J. Dermatol. |volume=121 |issue=1 |pages=27–34 |year=1989 |month=July |pmid=2757954 |doi= 10.1111/j.1365-2133.1989.tb01396.x}}</ref>
The highlighted steroids are often used in the screening of allergies to topical steroids.<ref>{{chú thích sách |author=Wolverton, SE |title=Comprehensive Dermatologic Drug Therapy |publisher=WB Saunders |year=2001 |page=562 }}</ref>
====Nhóm A — loại Hydrocortisone ====
Dạng bào chế (biệt dược là Advair), chứa fluticasone propionate và
[[salmeterol xinafoate]] (thuốc đối kháng thụ thể β2-adrenergic tác dụng kéo dài ).<ref name=nyc/> thuốc được r children over 12 years old.
====Oral forms====
Such as prednisone and prednisolone.<ref name="dermnetnz.org">{{chú thích web|url=http://dermnetnz.org/treatments/systemic-steroids.html |title=Systemic steroids (corticosteroids). DermNet NZ |publisher=. DermNet NZ |date=2012-05-19 |accessdate=2012-11-30}}</ref>
====Systemic forms====
Available in injectables for intravenous and parenteral routes.<ref name="dermnetnz.org"/>
== Uses of corticosteroids ==
Synthetic [[pharmaceutical drug]]s with corticosteroid-like effects are used in a variety of conditions, ranging from [[brain tumor]]s to [[skin disease]]s. [[Dexamethasone]] and its derivatives are almost pure glucocorticoids, while [[prednisone]] and its derivatives have some mineralocorticoid action in addition to the glucocorticoid effect. [[Fludrocortisone]] (Florinef) is a synthetic mineralocorticoid. [[Hydrocortisone]] (cortisol) is available for replacement therapy, ''e.g.'' in [[adrenal insufficiency]] and [[congenital adrenal hyperplasia]].
Synthetic glucocorticoids are used in the treatment of joint pain or inflammation ([[arthritis]]), [[temporal arteritis]], [[dermatitis]], [[allergic]] reactions, [[asthma]], [[hepatitis]], [[systemic lupus erythematosus]], [[inflammatory bowel disease]] ([[ulcerative colitis]] and [[Crohn's disease]]), [[sarcoidosis]] and for glucocorticoid replacement in [[Addison's disease]] or other forms of [[adrenal insufficiency]].<ref>{{cite journal|author=Higashi AS, Zhu S, Stafford RS, Alexander GC|title=National trends in outpatient asthma treatment, 1997-2009|journal=Journal of General Internal Medicine|volume=26|pages=1465–1470|pmid=21769507|url=http://www.ncbi.nlm.nih.gov/pubmed/21769507}}</ref> Topical formulations are also available for the [[skin disease|skin]], eyes ([[uveitis]]), lungs ([[asthma]]), nose ([[rhinitis]]), and [[inflammatory bowel disease|bowels]]. Corticosteroids are also used supportively to prevent nausea, often in combination with 5-HT3 antagonists (''e.g.'' [[ondansetron]]).
Typical [[adverse drug reaction|undesired effects]] of glucocorticoids present quite uniformly as drug-induced [[Cushing's syndrome]]. Typical mineralocorticoid side-effects are [[arterial hypertension|hypertension]] (abnormally high blood pressure), [[hypokalemia]] (low potassium levels in the blood), [[hypernatremia]] (high sodium levels in the blood) without causing [[peripheral edema]], [[metabolic alkalosis]] and connective tissue weakness.<ref>{{chú thích sách |author=Werner R |title=A massage therapist's guide to Pathology |publisher=Lippincott Williams & Wilkins |location=Pennsylvania |year=2005 |edition=3rd }}</ref> There may also be impaired wound healing or ulcer formation because of the immunosuppressive effects.
Clinical and experimental evidence indicates that corticosteroids can cause permanent eye damage by inducing [[central serous retinopathy]] (CSR, also known as central serous chorioretinopathy, CSC). A variety of steroid medications, from anti-allergy nasal sprays ([[Nasonex]], [[Flonase]]) to topical skin creams, to eye drops ([[Tobradex]]), to prednisone have been implicated in the development of CSR.<ref>{{cite journal|pmid=12359603|year=2002|last1=Carvalho-Recchia|first1=CA|last2=Yannuzzi|first2=LA|last3=Negrão|first3=S|last4=Spaide|first4=RF|last5=Freund|first5=KB|last6=Rodriguez-Coleman|first6=H|last7=Lenharo|first7=M|last8=Iida|first8=T|title=Corticosteroids and central serous chorioretinopathy|volume=109|issue=10|pages=1834–7|journal=Ophthalmology|doi=10.1016/S0161-6420(02)01117-X}}</ref><ref>{{chú thích web|url=http://buteykola.com/2010/07/the-new-york-times-a-breathing-technique-offers-help-for-people-with-asthma |title=The New York Times :: A Breathing Technique Offers Help for People With Asthma |publisher=buteykola.com |date= |accessdate=2012-11-30}}</ref>
Corticosteroids have been widely used in treating people with traumatic brain injury.<ref>{{chú thích sách|title=Corticosteroids for acute traumatic brain injury|author=Alderson P, Roberts I|publisher=The Cochrane Collaboration|chapter=Plain Language Summary|page=2}}</ref> A [[systematic review]] identified 20 randomised controlled trials and included 12,303 participants, then compared patients who received corticosteroids with patients who received no treatment. The authors recommended people with traumatic head injury should not be routinely treated with corticosteroids.<ref>{{cite doi|10.1002/14651858.CD000196.pub2}}</ref>
== Lịch sử ==
Biết đến đầu tiên vào năm 1944.<ref name=MerriamWebster>{{chú thích web|last=Webster|title=First therapeutic use of Corticosteroid|url=http://www.merriam-webster.com/dictionary/corticosteroid|accessdate=30 July 2012}}</ref> [[Tadeusz Reichstein]] cộng tác với [[Edward Calvin Kendall]] và [[Philip Showalter Hench]] đã đạt [[giải Nobel]] cho lĩnh vực [[sinh lý học]] và [[y học]] năm 1950 nhờ tìm ra hormone ở [[tuyến thượng thận]], khi cô lập được [[cortisone]].<ref>http://nobelprize.org/nobel_prizes/medicine/laureates/1950/kendall-lecture.pdf</ref>
Corticosteroids have been used as drug treatment for some time. [[Lewis Sarett]] of [[Merck & Co.]] was the first to synthesize cortisone, using a complicated 36-step process that started with deoxycholic acid, which was extracted from [[ox]] [[bile]].<ref>Sarett, Lewis H. (1947). “Process of Treating Pregnene Compounds”, U. S. Patent 2,462,133</ref> The low efficiency of converting deoxycholic acid into cortisone led to a cost of US $200 per gram. [[Russell Marker]], at [[Syntex]], discovered a much cheaper and more convenient starting material, [[diosgenin]] from wild Mexican yams. His conversion of diosgenin into [[progesterone]] by a four-step process now known as [[Marker degradation]] was an important step in mass production of all steroidal hormones, including cortisone and chemicals used in [[hormonal contraception]].<ref>{{cite journal |author=Marker, Russell E.; Wagner, R. B.; Ulshafer, Paul R.; Wittbecker, Emerson L.; Goldsmith, Dale P. J.; Ruof, Clarence H. |title=Steroidal Sapogenins |journal=J. Am. Chem. Soc. |volume=69 |issue=9 |year=1947 |doi=10.1021/ja01201a032 |pmid=20262743 |pages=2167–2230}}</ref> In 1952, D.H. Peterson and H.C. Murray of [[Upjohn]] developed a process that used [[Rhizopus]] mold to oxidize progesterone into a compound that was readily converted to cortisone.<ref>{{cite journal |author=Peterson D.H., Murray, H.C. |title=Microbiological Oxygenation of Steroids at Carbon 11 |journal=J. Am. Chem. Soc. |volume=74 |issue=7 |pages=1871–2 |year=1952 |doi=10.1021/ja01127a531 }}</ref> The ability to cheaply synthesize large quantities of cortisone from the diosgenin in yams resulted in a rapid drop in price to US $6 per gram, falling to $0.46 per gram by 1980. [[Percy Lavon Julian|Percy Julian's]] research also aided progress in the field.<ref>Julian, Percy L., Cole, John Wayne, Meyer, Edwin W., and Karpel, William J. (1956) “Preparation of Cortisone”. U. S. Patent 2,752,339</ref> The exact nature of cortisone's anti-inflammatory action remained a mystery for years after, however, until the [[leukocyte adhesion cascade]] and the role of [[phospholipase A2]] in the production of [[prostaglandin]]s and [[leukotriene]]s was fully understood in the early 1980s.
==Side-effects==
Side effects such as cutaneous addiction with the development of uncomfortable and unsightly dermatoses, can occur with just one 15 g tube of moderate steroid over a period of one year.<ref>{{cite journal
| author=Kenneth P Fowler and David J Elpern
| year=2001
| title="Tortured tube" sign
| pmc=1071421
| volume=174
| issue=6
| pages=383–384
| journal=Western Journal of Medicine
| doi=10.1136/ewjm.174.6.383
| pmid=11380999}}</ref>
Use of corticosteroids has numerous side-effects, some of which may be severe:
* Neuropsychiatric: [[steroid psychosis]],<ref name="Psychiatric Adverse Drug Reactions: Steroid Psychosis">{{chú thích web|last=Hall|first=Richard|title=Psychiatric Adverse Drug Reactions: Steroid Psychosis|url=http://www.drrichardhall.com/steroid.htm|publisher=Director of Research Monarch Health Corporation Marblehead, Massachusetts}}</ref> and [[anxiety]],<ref name="">{{Cite journal |author=Korte SM |title=Corticosteroids in relation to fear, anxiety and psychopathology |journal=Neurosci Biobehav Rev |volume=25 |issue=2 |pages=117–42 |year=2001 |pmid=11323078 |doi= 10.1016/S0149-7634(01)00002-1}}</ref> [[depression (mood)|depression]]. Therapeutic doses may cause a feeling of inappropriate well-being ("steroid euphoria").<ref>C R Swinburn, J M Wakefield, S P Newman, and P W Jones Evidence of prednisolone induced mood change ('steroid euphoria') in patients with chronic obstructive airways disease. Br J Clin Pharmacol. 1988 December; 26(6): 709–713. URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1386585/</ref> The neuropsychiatric effects are partly mediated by sensitization of the body to the actions of adrenaline. Therapeutically, the bulk of corticosteroid dose is given in the morning to mimic the body's diurnal rhythm; if given at night, the feeling of being energized will interfere with sleep. An extensive review is provided by Flores and Gumina.<ref>Benjamin H. Flores and Heather Kenna Gumina. The Neuropsychiatric Sequelae of Steroid Treatment. URL: http://www.dianafoundation.com/articles/df_04_article_01_steroids_pg01.html</ref>
*Cardiovascular: Corticosteroids can cause sodium retention through a direct action on the kidney, in a manner analogous to the mineralocorticoid [[aldosterone]]. This can result in fluid retention and [[hypertension]].
* Metabolic: Corticosteroids cause a movement of body fat to the face and torso, resulting respectively in "[[moon face]]" and "buffalo hump". and away from the limbs. Due to the diversion of amino-acids to glucose, they are considered anti-anabolic, and long term therapy can cause muscle wasting <ref>
Per-Olof Hasselgren, Nima Alamdari, Zaira Aversa, Patricia Gonnella, Ira J Smith, and Steven Tizio. CORTICOSTEROIDS AND MUSCLE WASTING ROLE OF TRANSCRIPTION FACTORS, NUCLEAR COFACTORS, AND HYPERACETYLATION. Curr Opin Clin Nutr Metab Care. 2010 July; 13(4): 423–428. URL: http://ncbi.nlm.nih.gov/pmc/PMC2911625http://ncbi.nlm.nih.gov/pmc/PMC2911625</ref>
* Endocrine: By increasing the production of glucose from amin-acid breakdown and opposing the action of insulin, corticosteroids can cause [[hyperglycemia]],<ref name="">{{Cite journal |author=Donihi AC, Raval D, Saul M, Korytkowski MT, DeVita MA |title=Prevalence and predictors of corticosteroid-related hyperglycemia in hospitalized patients |journal=Endocr Pract |volume=12 |issue=4 |pages=358–62 |year=2006 |pmid=16901792 }}</ref> [[insulin resistance]] and [[diabetes mellitus]],.<ref name="">{{Cite journal |author=Blackburn D, Hux J, Mamdani M |title=Quantification of the risk of corticosteroid-induced diabetes mellitus among the elderly |journal=Journal of General Internal Medicine |volume=17 |issue=9 |pages=1525–1497 |year=2007 |doi=10.1046/j.1525-1497.2002.10649.x }}</ref> By inhibition of the action of [[sex steroids]], they can cause [[erectile dysfunction]], [[hypogonadism]] and [[amenorrhoea]].
* Skeletal: [[Steroid-induced osteoporosis]] imay be a side-effect of long-term corticosteroid use. While cases of [[colitis]] have been reported, corticosteroids are therapeutically employed when the colitis has an auto-immune nature, e.g., [[ulcerative colitis]] and [[Crohn's disease]].
* Gastro-intestinal: While the evidence for corticosteroids causing [[peptic ulcer]]ation is relatively poor except for high doses taken for over a month,<ref name="pmid8826575">{{Cite journal |author=Pecora PG, Kaplan B |title=Corticosteroids and ulcers: is there an association? |journal=Ann Pharmacother |volume=30 |issue=7–8 |pages=870–2 |year=1996 |pmid=8826575 }}</ref> the majority of doctors {{as of|lc=y|2010}} still believe this is the case, and would consider protective prophylactic measures.<ref name="pmid20569095">{{Cite journal |author=Martínek J, Hlavova K, Zavada F, ''et al.'' |title="A surviving myth" — corticosteroids are still considered ulcerogenic by a majority of physicians |journal=Scand J Gastroenterol |volume= 45|issue= 10|pages= 1156–61|year=2010 |month=June |pmid=20569095 |doi=10.3109/00365521.2010.497935 }}</ref>
* Eyes: chronic use may predispose to [[cataract]] and [[retinopathy]].
* Vulnerability to infection: By suppressing immune reactions (which is one of their main reasons for their use in allergies), steroids may cause infections to flare up, notability [[candidiasis]]<ref>Fukushima C, Matsuse H, Tomari S, Obase Y, Miyazaki Y, Shimoda T, Kohno S. Oral candidiasis associated with inhaled corticosteroid use: comparison of fluticasone and beclomethasone.Ann Allergy Asthma Immunol. 2003 Jun;90(6):646-51. http://www.ncbi.nlm.nih.gov/pubmed/12839324
</ref>
* Pregnancy: Corticosteroids have a low but significant [[teratogenic]] effect, causing a few birth defects per 1,000 pregnant women treated. Corticosteroids are therefore contraindicated in pregnancy.<ref name="Shepard-2002">{{Cite journal | last1 = Shepard | first1 = TH. | last2 = Brent | first2 = RL. | last3 = Friedman | first3 = JM. | last4 = Jones | first4 = KL. | last5 = Miller | first5 = RK. | last6 = Moore | first6 = CA. | last7 = Polifka | first7 = JE. | title = Update on new developments in the study of human teratogens | journal = Teratology | volume = 65 | issue = 4 | pages = 153–61 | month = April | year = 2002 | doi = 10.1002/tera.10032 | pmid = 11948561 }}</ref>
== Safety ==
Corticosteroids were voted [[Allergen of the Year]] in 2005 by the American Contact Dermatitis Society.<ref>{{chú thích web|url=http://www.medscape.com/viewarticle/505245 |title=Contact Allergen of the Year: Corticosteroids: Introduction |publisher=Medscape.com |date=2005-06-13 |accessdate=2012-11-30}}</ref>
==See also==
* [[Vitiligo]]
* [[Steroid]]s (general term)
* [[Fluorometholone]]
* [[List of steroid abbreviations]]
== ReferencesTham khảo ==
{{tham khảo|2}}
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