Use of Corticosteroids in the Severely Ill Patient

摘要: Besides primary and secondary adrenal insufficiency, many medical conditions benefit from the use of corticosteroids because their anti-inflammatory immunosuppressive activity. Several mechanisms are involved in suppression inflammation by glucocorticoids, remain to be elucidated. Glucocorticoids inhibit recruitment leukocytes monocyte-macrophages into affected areas synthesis a great variety chemotactic substances other factors that mediate increased capillary permeability, vasodilatation, contraction various nonvascular smooth muscles. All natural synthetic glucocorticoids act binding specific cytoplasmic glucocorticoid receptor. The complex receptor has ability enter nucleus cell bind sites DNA control transcription glucocorticoid-regulated genes. At present list whose or release is inhibited includes arachidonic acid its metabolites (prostaglandins leukotrienes), platelet activating factor (PAF), nitric-oxide pathway, tumor necrosis (TNF) interleukins. can thus onset evolution [1–7].