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Musculoskeletal system

Analgesics and anti-inflammatories

Acetaminophen (Paracetamol)

Non-steroidal anti-inflammatory drugs


Opioid agonists, mixed agonist-antagonists and partial agonists

Antigout medications

Antigout medications

Anti-rheumatic medications

Non-biologic disease modifying anti-rheumatic drugs (DMARDs)

Osteoporosis medications

Osteoporosis medications




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External References

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B cells p. 411

glucocorticoid effects p. 118


acute gout attack p. 726

adrenal insufficiency p. 355

adrenal steroids and p. 338

arachidonic acid pathway p. 498

calcium pyrophosphate deposition disease p. 477

Cushing syndrome diagnosis p. 354

diabetes mellitus p. 354

fat redistribution with p. 251

gout p. 477, 500

myopathy p. 251

rheumatoid arthritis p. 476


Content Reviewers

Yifan Xiao, MD

Filip Vasiljević, MD

Justin Ling, MD, MS


Anuj Paul

Samantha McBundy, MFA, CMI

Ursula Florjanczyk, MScBMC

Jake Ryan

Glucocorticoids are a group of steroid hormones, which are secreted by the two adrenal glands that sit like hats, one on top of each kidney. Each one has an inner layer called the medulla and an outer layer called the cortex. The adrenal cortex secretes different corticosteroid hormones: like glucocorticoids under the control of adrenocorticotropic hormone, or ACTH.

Normally the hypothalamus, located at the base of the brain, secretes corticotropin releasing hormone, known as CRH, which stimulates the anterior pituitary gland to secrete adrenocorticotropic hormone, known as ACTH. ACTH then travels to the pair of adrenal glands and binds to the ACTH receptors on adrenocortical cells. This causes the adrenocortical cells to release the glucocorticoids from the zona fasciculata, which have powerful anti-inflammatory and metabolic effects. These glucocorticoids have a negative feedback effect on the hypothalamic-pituitary-adrenal axis, meaning excess corticosteroids suppress the release of both CRH and ACTH into the circulation.

Now, once made, glucocorticoids enter the circulation and travel via the blood to reach the target cells. Steroids are lipophilic molecules, so they cross the cell membrane, enter inside the cell, and bind with a cytoplasmic receptor protein, called a ‘glucocorticoid receptor’. Now, this ‘glucocorticoid-receptor complex’ undergoes some structural changes, which allow them to enter inside the nucleus and bind with the ‘glucocorticoid response elements’ or GRE on the chromatin. Now, this induces transcription of specific mRNA that’s used to synthesize different proteins, which in turn modifies various cell functions and metabolic effects in the body.


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  2. "Rang and Dale's Pharmacology" Elsevier (2019)
  3. "Goodman and Gilman's The Pharmacological Basis of Therapeutics, 13th Edition" McGraw-Hill Education / Medical (2017)
  4. "Adrenal insufficiency - recognition and management" Clin Med (Lond) (2017)
  5. "Clinical Pharmacology of Corticosteroids" Respiratory Care (2018)
  6. "Treatment with Synthetic Glucocorticoids and the Hypothalamus-Pituitary-Adrenal Axis" International Journal of Molecular Sciences (2017)

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