Steroids

Corticosteroids are naturally occurring hormones in the human body. There are a variety of steroids including glucocorticoids, mineralcorticosteroids, androgens, and progestins. Of these, only the glucocorticoids are prescribed regularly to treat relapses in MS.

Glucocorticoids occur naturally in the body as cortisone and hydrocortisone. These hormones are produced by a pair of organs called the adrenal glands, which are situated next to the kidneys. The adrenal glands are organized into two discrete tissue types, somewhat confusingly called the medulla and cortex. These have nothing to do with their namesakes in the brain. Cortisone and hydrocortisone are produced in the adrenal cortex in response to the release of a regulatory hormone called adrenocorticotrophic hormone (ACTH), which is manufactured in both the pituitary gland in the brain and the adrenal cortex. ACTH is naturally secreted in response to a variety of stress factors including fear, anxiety, pain, exercise, infection, and very low levels of blood glucose.

During the mid-20th century, research determined that ACTH given intramuscularly induced recovery from MS exacerbations. More recently, either intravenous or oral steroid administration has become the preferred method prescribed for acute exacerbations of MS. The route of delivery (intravenous or oral) and the length of time that steroids are prescribed varies from physician to physician. You should discuss this issue with your doctor when you first begin your care for MS.

Steroids are not without side effects. Acne, weight gain, seizures, psychosis, depression, headaches, fatigue, facial hair, nausea, vomiting, and adrenal insufficiency can be very serious adverse events. Thus, the long-term use of steroids is not advised, nor is it effective in MS.

Steroids do not appear to have a beneficial effect on progressive forms of the disease. Trials have been done on monthly methylprednisolone use with secondary progressive MS (SPMS) and, although the results were equivocal, the degree of disability was not affected. SPMS is a course that changes over time to a worsening pattern with or without continued relapses. However, this study concluded that more work needed to be done to determine whether steroids might have a place in treating SPMS.

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