6, 7 During this time, several bioactive steroids, including cortisol and aldosterone (the principal active corticosteroids in humans) were isolated from the adrenal cortex and characterized. 3, 4 Hypercortical syndrome was described by Cushing in 1932, 5 and in the 1940s and 1950s, adrenocorticotropic hormone (ACTH) was identified in the anterior pituitary and described as a stimulator of the adrenal cortex. 1, 2 Subsequent research categorized the effects of adrenal insufficiency into two distinct groups: those due to electrolyte imbalance and those due to altered carbohydrate metabolism. This chapter reviews corticosteroid pharmacology and physiology, discusses the use of these hormonal agents in the treatment of neoplasms, and presents the currently understood mechanism of action of corticosteroids in the context of their therapeutic efficacy.Īs early as the mid-nineteenth century, it was observed that a lack of functional adrenal glands is incompatible with life. Since their first clinical application, intensive research has expanded our understanding of the physiology, biochemistry, and pharmacology of steroids and has led to a large body of literature addressing the therapeutic use and harmful side effects of corticosteroids. Cortisol and its synthetic analogs have been in widespread clinical use for the treatment of a variety of disorders for more than 50 years.
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