[Synthetic glucocorticoid]

Various kinds of synthetic glucocorticoids have been developed, based on the structure of the adrenal hormone cortisol (hydrocortisone). They are widely used as anti-inflammatory drugs or immunosuppressants for the treatment of various diseases. Although the synthetic glucocorticoids have little or no mineralocorticoid activity compared with cortisol, they exert adverse effects such as osteoporosis, muscle wasting, hypertension, insulin resistance, truncal obesity, and inhibition of wound repair. Inhaled glucocorticoids have little adverse effects, because they are locally active but are metabolically inactivated. However, when they are used in large amounts, the risk for fracture and inhibition of pituitary-adrenal axis is increased. Selective glucocorticoid receptor modulators (SGRMs), which retain anti-inflammatory activities but have little or no adverse effects, have been developed.