adrenocorticosteroids.pptVIP

Usage and Course(用法与疗程): High-dose implosion therapy(冲击疗法): Hydrocortisone: 200~300mg/d; 3~5 day Common dose long-term therapy: Controlled dose: Prednisone(泼尼松): p.o. 10~30mg, t.i.d., gradually reduced. Maintainance dose: cortisol secretion follows a circadian rhythm: Every morning: (short-acting) cortisone or hydrocortisone alternate-day morning: (medium-acting) prednisone or prednisolone Small dose replacement therapy: cortisone 12.5~25mg/d or hydrocortisone10~20mg/d * The major secretory products are underlined. Pregnenolone is the major precursor of corticosterone and aldosterone, and 17-hydroxypregnenolone is the major precursor of cortisol. The enzymes and cofactors for the reactions progressing down each column are shown on the left and across columns at the top of the figure. When a particular enzyme is deficient, hormone production is blocked at the points indicated by the shaded bars. * CBG is increased in pregnancy and with estrogen administration, which increases its synthesis by the liver, and in hyperthyroidism; * carbonyl --hydroxy * * A model of the interaction of a steroid, S (eg, cortisol), and its receptor, R, and the subsequent events in a target cell. The steroid is present in the blood in bound form on the corticosteroid-binding globulin (CBG) but enters the cell as the free molecule. The intracellular receptor is bound to stabilizing proteins, including two molecules of heat shock protein 90 (Hsp90) and several others, denoted as X in the figure. This receptor complex is incapable of activating transcription. When the complex binds a molecule of cortisol, an unstable complex is created and the Hsp90 and associated molecules are released. The steroid-receptor complex is able to enter the nucleus, bind to the glucocorticoid response element (GRE) on the gene, and regulate transcription by RNA polymerase II and associated transcription factors. A variety of regulatory factors (not shown) may participate in facilitating (coactivators) or inh