Endocrine Abstracts

When in September 1948 the ’Compound E’ was first synthesized and successfully administered as intramuscular injection to a woman with rheumatoid arthritis, hardly that anyone could imagine what profound impact it will have on medical research and practice. In a span of just two years, in 1950, the fascinate drug was renamed to Cortisone and brought from laboratory to broad clinical use. Seventy years later, it is still hard to find a medical field where corticosteroids are not present due to several roles they play in the human body. Corticosteroids are the cornerstone of therapeutical approach in wide spectrum of antinflammatory and autoimmune-based diseases and one among ten most commonly prescribed and over-the-counter drugs. However, from the very beginning to nowadays, the limiting factor regarding their use are side effects. Back to 1948, the reports are saying that after a couple months of continuous therapy with cortisone, the first patient was admitted to psychiatry clinic for comprehensive assessment and treatment of psychotic episodes. Description of side effects along with development of new cortisone derivates in order to minimise toxicity and improve potency shaped the next decades in corticosteroid timeline. The occurrence and magnitude of corticosteroid side effects is time and dose-dependent, following either linear or threshold dose-response pattern. Their extensive use in chronic conditions along with awareness about disadvantages triggered highly innovative research and expansion of new preparations for local administration. Prescribing corticosteroids via inhaled, topical dermal, intra-articular, epidural, intranasal or periocular route, particularly when used at high doses, allows us to target specific problem, diminish system resorption and consequently side effects, ranging from mild suppression of hypothalamic-pituitary axis to life-threatening infections. Corticosteroids inspire and teach. While search for corticosteroid preparations with even better risk-benefit profile continues, their use in chronic inflammatory and autoimmune diseases requires rationality in determining the optimal therapeutical regimen, convenient tapering schedule and often a skilled balancing between desired and side effects.