Glucocorticoids: Angels and DemonsGlucocorticoids are the most widely used of all hormones, and nine times out of ten, when we talk about them, we are talking about them. It has magical and powerful effects that can save lives and treat many “difficult diseases”, but it is also widely criticized for its numerous and varied side effects. Many people are afraid of this name and feel that as soon as they get involved with it, they will become fat, endocrine disruption, and drug dependence beckons. But what is the actual situation? First of all, let’s get to know glucocorticoids. Glucocorticoids are endogenous substances found in everyone’s body, named because they are secreted by the adrenal cortex and regulate the metabolism of sugar. It regulates the metabolism of sugar, protein, and fat in the body, and has an effect on water and inorganic salts, but it is not these regulating effects that are often the reason for using it as a drug. Glucocorticoids have a very powerful anti-inflammatory effect in larger doses, protecting the body from inflammatory reactions, as well as suppressing immune responses and combating shock. Therefore, it is used to treat a wide range of inflammatory and autoimmune diseases. The glucocorticoid drugs on the market are all modified versions of endogenous hormones, with different characteristics but all possessing the same powerful anti-inflammatory ability. Drugs with names like “XX Pine” or “XX Pine Dragon” are often members of this family. It must be acknowledged that these drugs are often very effective and have a wide range of effects, including anti-inflammatory, antipyretic, and immune suppressant responses. They may be effective even when all other drugs are helpless. This is why they are used to treat many critical and “difficult” conditions. For example, glucocorticoids are often the first choice for autoimmune diseases, where the immune system mistakenly destroys its own organs, and glucocorticoids can suppress this abnormal immune response very well and are relatively inexpensive. Another example is asthma, which is caused by inflammation of the bronchial tubes, but this inflammation is not caused by infection and is difficult to eliminate, in which case glucocorticoids can also play a very good anti-inflammatory role and significantly reduce asthma attacks. However, as you have heard, these well-used hormones can also have many side effects. As mentioned above, glucocorticoids regulate the metabolism of many substances in the body, and the doses of hormones used to exert their anti-inflammatory effects are often high, and these foreign hormones can interfere with the metabolic processes in the body. Disruption of metabolism can manifest itself in a variety of side effects, such as fat accumulation on the face and abdomen, thinning of the skin, osteoporosis, hyperglycemia, hyperlipidemia, and impairment of growth and development. It can also damage the digestive tract, causing ulcers and bleeding. In addition, glucocorticosteroids have an effect on the nervous system, and their use may lead to over-excitement at night and may even show symptoms of mental disorders at high doses. The worst part is that it suppresses the immune response, not only making it easier for infections to occur, but also masking the symptoms of infections after they occur, creating the illusion of “peace”. This kind of medication is really uncomfortable. In addition to the side effects during use, there is another problem with glucocorticosteroids – stopping them. This is what we sometimes hear when we say that “hormones can cause dependence”. However, it is important to clarify that the term “dependence” does not mean that taking hormones is like becoming addicted to drugs. The secretion of hormones in the body is regulated by the hypothalamus and the pituitary gland, and this regulation allows the hormone levels to remain relatively stable. If you take extra hormones, the hormone level in your body will rise, and when the regulation center finds this situation, it will automatically reduce the secretion of its own hormones to maintain the balance. In the long run, the body becomes accustomed to this state of “secretion of few hormones is enough”. At this time, if the hormones are suddenly withdrawn, the regulation center will not be able to respond to the situation, and the hormone level in the body will be too low, and the symptoms of drug withdrawal will occur, as if the body has become dependent on the drugs. So, how do we choose glucocorticoids that are both effective and troublesome? First of all, it must be admitted that for many diseases, we have no better drugs to choose from, and the disease itself must be treated, glucocorticosteroids still cannot be left out. If hormones are refused because of fear of side effects, the uncontrolled development of the disease often leads to more serious consequences, even life-threatening. However, glucocorticosteroids should not be allowed to cause so much trouble. Proper use can help reduce some side effects. For example, keeping the dose at the lowest effective dose, and not using them systemically when they can be used topically (e.g., by inhalation). There are also some preventive measures that can be taken. During the medication period, you can take calcium supplements, use some drugs to protect the gastric mucosa, and have regular reviews. As for the problem of stopping the medication, it is better to solve, just need to slowly reduce the dosage under the guidance of the doctor, to give the body a process of adaptation. People often hope that medications will be both very effective and very safe, but the reality is not so rosy. We are often faced with drugs like glucocorticoids that are both angels and can be demons. Staying away from them for fear of side effects is not the real solution. Until better drugs come along, we have to accept their imperfections and use them properly.