Pharmacologic Classification of Corticosteroids
Corticosteroids belong to the pharmacologic class of synthetic glucocorticoids (also called adrenal cortex hormones), which are anti-inflammatory and immunosuppressive agents that mimic naturally occurring hormones produced by the adrenal cortex. 1, 2, 3
Primary Pharmacologic Properties
Corticosteroids function through multiple mechanisms that define their therapeutic class:
Anti-inflammatory action: They reduce airway hyperresponsiveness, inhibit inflammatory cell migration and activation, and block late-phase allergic reactions by suppressing proinflammatory gene transcription and increasing anti-inflammatory mediators. 1
Immunosuppressive effects: They decrease leukocyte migration to inflammatory sites, reduce neutrophil-mediated tissue injury, and alter immune cell function through effects on cytokine production. 1, 4
Glucocorticoid activity: They influence carbohydrate and protein metabolism, stimulate gluconeogenesis, facilitate amino acid mobilization from muscle, and play a central role in the body's stress response. 5, 4
Mineralocorticoid activity (variable): Some corticosteroids possess mineralocorticoid properties affecting salt and water balance, though this varies by specific agent—hydrocortisone has mineralocorticoid activity while dexamethasone does not. 1, 5
Subclassification by Route of Administration
The corticosteroid class is further divided based on delivery method:
Systemic corticosteroids include oral agents (prednisone, prednisolone, methylprednisolone) and intravenous formulations (methylprednisolone, hydrocortisone, dexamethasone) that produce whole-body effects. 1, 2
Topical corticosteroids are classified into 7 potency classes (Class 1 ultra-high to Classes 6-7 low potency) based on cutaneous vasoconstriction assays, including agents like clobetasol propionate, betamethasone, and hydrocortisone. 2, 6
Inhaled corticosteroids (budesonide, fluticasone, mometasone) deliver localized airway effects with reduced systemic absorption compared to oral formulations. 1
Intranasal corticosteroids (fluticasone propionate, mometasone furoate, budesonide) provide topical anti-inflammatory effects in the nasal passages and sinuses. 1
Intratympanic corticosteroids (dexamethasone) allow direct delivery to the inner ear for conditions like sudden sensorineural hearing loss. 1
Molecular Classification
At the molecular level, corticosteroids are classified as:
Steroid hormone receptor agonists that bind to intracellular glucocorticoid receptors (GR) and mineralocorticoid receptors (MR), both members of the nuclear receptor transcription factor superfamily. 7, 8
These receptors initiate gene transcription for proteins mediating therapeutic effects, as well as rapid non-genomic effects through classical cell signaling pathways. 8
Common Pitfalls in Classification
Do not confuse corticosteroids with anabolic steroids—they are entirely different drug classes with opposite metabolic effects. 5
Recognize that "steroid" alone is ambiguous; the precise term is "corticosteroid" or "glucocorticoid" to distinguish from other steroid hormones (sex steroids, mineralocorticoids). 1
Understand that all corticosteroids have some degree of both glucocorticoid and mineralocorticoid activity, though the ratio varies dramatically—hydrocortisone has significant mineralocorticoid effects while dexamethasone has essentially none. 1, 5