Look, they helped you there but they've
made those letters red, C-O-R-T.
Just underline that in corticosteroids to
help reinforce that concept in your brain.
Corticosteroids are a
class of steroid hormones,
and they are produced in the adrenal cortex.
So underline it there too.
Just underscore those in your notes
that helps stand out in your brain
that these are coming from the adrenal cortex.
Now, there's a long, long list of things
that these corticosteroids are involved in.
Let me tell you, they're playing a
big role in nursing school for you
because most of us are stressed
when we're going back to school.
Corticosteroids play a big role in that.
Remember, they'll mess with your immune response,
so the higher the level of corticosteroids,
the more we're going to suppress that immune
response, and that's important to remember.
Because if your patient is on some
high dose of corticosteroids,
they're almost immunocompromised in some
ways, because it regulates inflammation.
So, keep that in mind, kind of write yourself a note
that when they're on high dose corticosteroids
for a long period of time,
it's going to suppress inflammation.
Now, we come down to carb
metabolism and protein metabolism.
That definitely plays a role when you guys
are in nursing school and under stress.
You have higher levels of the hormones
that are going to make you tend to put
on weight right around the middle.
Now, blood electrolyte levels can
also be impacted by corticosteroids.
It starts involving that
sodium with aldosterone
that you've heard us talk about before.
And lastly, you can end up
with some real mood changes
and behavior changes when
someone is on corticosteroids.
Now, for any one of these things,
corticosteroids in my body at normal levels,
they manage my stress response,
my immune response, inflammation,
how I metabolize carbs and proteins,
my blood electrolyte levels,
and it helps me kind of modulate mood.
So when I take a medication
that's a corticosteroid,
all of these have the opportunity to be impacted.
So, let's talk about the specific hormones.
What are those plays that the coach sets in
and what's the football like that the
quarterback throws down the field?
So, when the hypothalamus --
picks up from the rest of your body,
"Hey, I've got this information, and I
think we need more corticosteroids."
It will put out or produce
"Cort" means its target and we're heading for --
we want the corticosteroids, right?
We want the adrenal cortex to make, that's
what tropin says, releasing hormone.
So the play the hypothalamus is sending
in is that we need more corticosteroids.
So, the corticotropin-releasing
hormone is uniquely structured
so it connects and binds in
the anterior pituitary gland.
So when the anterior pituitary --
That's part of that pea-size master
gland, when it receives CRH,
then it puts out adrenocorticotropic hormone.
Now, let's break down that word.
Underline A-D-R-E-N, that means,
the target is the adrenal gland.
Now, C-O-R-T tells me the target is
specifically the cortex of the adrenal gland.
Tropic, that means put it out.
Hormone means messenger.
So, when the hypothalamus senses
that we need more corticosteroids,
it sends the message CRH
to the anterior pituitary.
When the anterior pituitary gets that
message, it sends another message out,
just like a quarterback sending
a football down the field.
It sent a message out in the form
of adrenocorticotropic hormone.
Remember what our target is, adrenal cortex.
So, the adrenal cortex receives that ACTH
and it releases cortisol and aldosterone.
So you got that?
Let's walk through that 1 more time.
The hypothalamus senses
we need more corticosteroids,
like cortisol and aldosterone.
So, the coach sends the play in.
The hypothalamus sends CRH and
it hits the anterior pituitary,
uniquely fitted so it only will get --
send the message to the anterior pituitary.
When the anterior pituitary
receives CRH, it sends out ACTH.
Adrenal cortex receives the
ACTH, catches that ball,
and put out adrenal cortex, adrenal
corticosteroids, cortisol, and aldosterone.
You might think, "What in the world are
we doing going through all these steps?"
Well, these make a huge difference in
you understanding the types of diseases
that we treat with corticosteroids, how
they're helpful, and what the risks are.
So, really, it's not that complicated
if you think of it in this format.
We're involving CRH, ACTH, and then we
end up with cortisol and aldosterone.
Now, there are 2 types of corticosteroids, right?
We just talked about those, but there are
mineralcorticoids and glucocorticoids.
Okay, they've both got that CORT in the middle,
and you'll see we've made that big,
capitalized, and red for you
to remind you that mineralcorticoids and
glucocorticoids come from the adrenal --
So, an example of a mineralcorticoid
is aldosterone, right?
So, aldosterone tells my body, "Hey --"
When that gets secreted, my
body gets the message to know,
"Hey, hang on to sodium.
Reabsorb that sodium."
Now, wherever sodium goes, water follows, okay?
So, anytime I hang on to sodium, I'm
going to also hang on to more water,
I'm going to have more volume in my body,
and my blood pressure is going to go up.
Now, glucocorticoids are things like cortisol.
Now, that's usually what we're looking after.
That's what we want with most patients
when we're giving them corticosteroids.
Now, if someone's adrenal
gland is completely shot,
we're going to have to replace all
the hormones of the adrenal gland.
But usually, we're giving corticosteroids
because we want this glucocorticoid portion.
Okay, so the adrenal cortex
really puts out mostly cortisol,
but sometimes, it also puts out the aldosterone.
We just see more cortisol in your body.
Now, we talked about what aldosterone does, right?
I use that funny word, aldosterone,
just because it's annoying and I know
it will stick in your brain better.
That promotes sodium retention in the kidneys.
Before we move on, can you answer this question?
How does promoting sodium retention
by the kidneys impact my vital signs?
Hopefully, you remembered that when you
absorb more sodium, you'll also --
water will follow, and when I have more
volume on board, my blood pressure --
that's the vital sign that will be impacted --
my blood pressure will be elevated.
Now, cortisol gets a little more personal, right?
It controls my carb, fat, and protein metabolism.
This is the one that helps me put weight on
right around my middle where nobody wants it.
It's also an anti-inflammatory.
So, if I'm having a major inflammatory
response, this will help suppress that.
It stops phospholipid release, and
it also decreases eosinophil action.
So that's all helping me with
that inflammatory response.
So, aldosterone is the sodium, but cortisol,
carb, fat, and protein metabolism,
and really focus on that anti-inflammatory
effect because that's what we want.
When we give corticosteroids, that's
predominantly what our goal is,
so make sure you circle
anti-inflammatory and star that.
So remember, that's usually what we're after.
That's the therapeutic thought.