[Principles of glucocorticoid therapy from the viewpoint of the internist]

40 years after the first clinical application of cortisone, glucocorticoids have become an indispensable part of the treatment of various internal disorders. The many side effects of glucocorticoids, however, clearly diminish their utility and stand in the way of their full acceptance by the patient. All principles of glucocorticoid therapy, therefore, aim at the improvement of the ratio between benefits and unwanted effects. There are 3 ways to achieve this goal: 1. Topical application (e.g. beclomethasone-17, 21-dipropionate for the local therapy of bronchial asthma); 2. special timing of glucocorticoid administration (e.g. alternating therapy); 3. active fight against unwanted effects by means of additional therapeutic measures (e.g. prophylactic therapy of osteoporosis induced by steroids). New perspectives may offer themselves as soon as macrocortin--a mediator of glucocorticoid action--will become available.