Management of glucocorticoid therapy, including pharmacology and physiology
Normal physiology being replaced or overridden
- Cortisol secretion ~5-10 mg/m2/day (~15-25 mg hydrocortisone equivalent)
- Diurnal: peak 6-8 am, nadir around midnight
- >90% protein bound (CBG, albumin) - inflammation and oestrogen raise CBG and hence total cortisol
- 11beta-HSD2 in kidney inactivates cortisol -> protects the mineralocorticoid receptor
- Overwhelmed in high-dose therapy and in liquorice ingestion -> apparent mineralocorticoid excess
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