Corticosteroids are drugs/medications widely used in several areas of medicine. They are also known as glucocorticoids, cortisone and colloquially steroids (note: do not mix up with anabolic steroids).

They are synthetic analogues of naturally occurring endogenous steroids produced by the adrenal cortex. In practice, corticosteroids are used for their glucocorticoid effects. Pertinent to interventional procedures, some corticosteroid medications are particulate (e.g. Celestone) and frequently avoided in spinal interventions due to the potential risk of embolisation and consequent infarction.

Mechanism of action

In essence, corticosteroids have anti-inflammatory and immunosuppressive effects. They also affect fluid movement, electrolytes, blood sugar and central nervous system.

• genomic mechanism of action

  • acts on intracellular receptors in the cytoplasm that inhibit gene expression and translation for inflammatory white cells

  • reduces proinflammatory chemokines and cytokines

  • reduce cell adhesion molecules

• non-genomic mechanism of action

  • inhibition of phospholipase (A2), which produces inflammatory cytokines

  • impair the release of arachidonic acid

  • regulate apoptosis

  • at high concentrations, inhibit B and T cell production

Administration

• topical: ointments, creams, eye drops

• oral

• inhaled

• intramuscular

• intravenous

• intradermal

• subcutaneous

• intra-articular

• intralesional

Complications

• osteoporosis, osteonecrosis, and fractures

• adrenal suppression

• Cushingoid features

  • redistribution of fat (i.e. moon-like facies, buffalo hump)

• diabetes mellitus and insulin resistance

• proximal myopathy and weakness

• cataracts

• glaucoma

• psychosis

• agitation

• insomnia

• immunosuppression