フルドロコルチゾン
Wikipedia preview
出典(authority):フリー百科事典『ウィキペディア(Wikipedia)』「2013/06/23 19:00:18」(JST)
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Fludrocortisone
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Systematic (IUPAC) name |
9-fluoro-11,17-dihydroxy-17- (2-hydroxyacetyl)- 10,13-dimethyl- 1,2,6,7,8,9,10,11,12, 13,14,15,16,17- tetradecahydrocyclopenta[a]phenanthren-3-one |
Clinical data |
AHFS/Drugs.com |
monograph |
Pregnancy cat. |
C |
Legal status |
? |
Routes |
Oral |
Pharmacokinetic data |
Protein binding |
High |
Metabolism |
Hepatic |
Half-life |
3.5 hours |
Identifiers |
CAS number |
127-31-1 Y |
ATC code |
H02AA02 |
PubChem |
CID 31378 |
IUPHAR ligand |
2873 |
DrugBank |
DB00687 |
ChemSpider |
29111 Y |
UNII |
U0476M545B Y |
KEGG |
D07967 Y |
ChEBI |
CHEBI:50885 Y |
ChEMBL |
CHEMBL1201388 N |
Chemical data |
Formula |
C21H29FO5 |
Mol. mass |
380.45 g/mol |
SMILES
- O=C(CO)[C@]3(O)[C@]2(C[C@H](O)[C@]4(F)[C@@]1(/C(=C\C(=O)CC1)CC[C@H]4[C@@H]2CC3)C)C
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InChI
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InChI=1S/C21H29FO5/c1-18-7-5-13(24)9-12(18)3-4-15-14-6-8-20(27,17(26)11-23)19(14,2)10-16(25)21(15,18)22/h9,14-16,23,25,27H,3-8,10-11H2,1-2H3/t14-,15-,16-,18-,19-,20-,21-/m0/s1 Y
Key:AAXVEMMRQDVLJB-BULBTXNYSA-N Y
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N (what is this?) (verify)
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Fludrocortisone (also called 9α-fluorocortisol or 9α-fluorohydrocortisone) is a synthetic corticosteroid with moderate glucocorticoid potency and much greater mineralocorticoid potency. The brand name in the U.S. and Canada is Florinef.
Contents
- 1 Uses
- 2 Dosing
- 3 Chemical properties
- 4 Side effects
- 5 References
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Uses[edit]
Fludrocortisone has been used in the treatment of cerebral salt wasting.[1] It is used primarily to replace the missing hormone aldosterone in various forms of adrenal insufficiency such as Addison's disease and the classic salt wasting (21-hydroxylase deficiency) form of congenital adrenal hyperplasia. Fludrocortisone is the first line of treatment for orthostatic intolerance and Postural Tachycardia Syndrome as well.[citation needed]
Fludrocortisone is also a confirmation test for diagnosing Conns Syndrome (aldosterone producing-adrenal adenoma), the fludrocortisone suppression test. Loading the patient with fludrocortisone would suppress serum aldosterone level in a normal patient, whereas the level will not be altered in a Conns patient. Its effects on increasing Na+ levels, and therefore blood volume, make it useful as an off label treatment for postural orthostatic tachycardia syndrome (POTS)[2]
Dosing[edit]
Fludrocortisone is available in 0.1 mg tablets. Typical daily doses for mineralocorticoid replacement are between 0.05 mg - 0.2 mg. Renin plasma, sodium, and potassium is checked through blood tests in order to verify that the correct dosage is reached.
Chemical properties[edit]
Chemically, fludrocortisone is identical to cortisol except for the substitution of fluorine in place of one hydrogen. Fluorine is a good bioisostere for hydrogen because it is similar in size. The major difference is in its electronegativity.
Side effects[edit]
- Sodium and water retention
- Swelling due to fluid retention (edema)
- High blood pressure (hypertension)
- Headache
- Low blood potassium level (hypokalemia)
- Muscle weakness
- Fatigue
- Increased susceptibility to infection
- Impaired wound healing
- Increased sweating
- Increased hair growth (hirsutism)
- Thinning of skin and stretch marks
- Disturbances of the gut such as indigestion (dyspepsia), distention of the abdomen and ulceration (peptic ulcer)
- Decreased bone density and increased risk of fractures of the bones
- Difficulty in sleeping (insomnia)
- Depression
- Weight gain
- Raised blood sugar level
- Changes to the menstrual cycle
- Partial loss of vision due to opacity in the lens of the eye (cataracts)
- Raised pressure in the eye (glaucoma)
- Increased pressure in the skull (intracranial pressure)
References[edit]
- ^ Taplin CE, Cowell CT, Silink M, Ambler GR (December 2006). "Fludrocortisone therapy in cerebral salt wasting". Pediatrics 118 (6): e1904–8. doi:10.1542/peds.2006-0702. PMID 17101713.
- ^ Freitas J, Santos R, Azevedo E, Costa O, Carvalho M and Falcão de Freitas A (2000). "Clinical improvement in patients with orthostatic intolerance after treatment with bisoprolol and fludrocortisone". Clinical Autonomic Research 10 (5): 293–299. doi:10.1007/BF02281112.
Corticosteroids – glucocorticoids and mineralocorticoids (H02)
(also A07EA, C05AA, D07, D10AA, R01AD, R03BA, S01BA, S02B, and S03B)
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Mineralocorticoids
(3-one, 4-ene,
no FG at 16) |
- Pregnenedione: ALDOSTERONE
- 11-DEOXYCORTICOSTERONE
- HALOGENATED AT 9: Fludrocortisone
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Glucocorticoids
(3-one, 4-ene,
11-FG,
17-hydroxy) |
Pregnene
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Pregnenedione
(+20-one)
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- HYDROCORTISONE/CORTISOL# (Hydrocortisone aceponate
- Hydrocortisone buteprate
- Hydrocortisone butyrate)
- Budesonide
- Ciclesonide
- Deflazacort
- Medrysone
- Tixocortol
- HALOGENATED AT 6: Cloprednol
- HALOGENATED, WITH FG AT 16: Halcinonide
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Pregnadiene (+1-ene)
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- Rimexolone
- HALOGENATED, WITH FG AT 16: Flunisolide
- Triamcinolone
- Amcinonide
- Fluocinolone acetonide (Fluocinonide)
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Pregnadienediol
(+21-hydroxy)
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- Prednisone (Meprednisone)
- HALOGENATED AT 9: Fluorometholone
- HALOGENATED, WITH FG AT 16: Fluocortolone (Clocortolone
- Diflucortolone
- Fluocortin)
- Desoximetasone
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Pregnadienetriol
(+11-hydroxy)
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- Prednisolone# (Methylprednisolone
- Methylprednisolone aceponate
- Prednicarbate
- Prednylidene)
- Desonide
- HALOGENATED: Fluprednisolone (Difluprednate
- Fluperolone)
- HALOGENATED, WITH FG AT 16: Dexamethasone#
- Betamethasone (Clobetasol
- Clobetasone
- Diflorasone
- Halometasone
- Ulobetasol)
- Beclometasone
- Paramethasone
- Alclometasone
- Fluclorolone acetonide
- Flumetasone
- Fluprednidene
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Pregnatriene
(+2-ene)
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Androstene
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- HALOGENATED, WITH FG AT 16: Fluticasone (Fluticasone propionate
- Fluticasone furoate)
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Other/ungrouped
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- HALOGENATED: Loteprednol
- HALOGENATED, WITH FG AT 16: Fludroxycortide
- Formocortal
- Mometasone furoate
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Aldosterone antagonists |
- Spironolactone
- Eplerenone
- Potassium canrenoate
- Canrenone
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Synthesis modifiers |
- Trilostane
- Carbenoxolone
- Aminoglutethimide
- Metyrapone
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- #WHO-EM
- ‡Withdrawn from market
- Clinical trials:
- †Phase III
- §Never to phase III
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noco (d)/cong/tumr, sysi/epon
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proc, drug (A10/H1/H2/H3/H5)
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Glucocorticoids
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Receptor |
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Enzyme
(inhibitors) |
20,22-Desmolase
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- 22-ABC
- 3,3′-Dimethoxybenzidine
- 3-Methoxybenzidine
- Aminoglutethimide
- Cyanoketone
- Danazol
- Etomidate
- Mitotane
- Trilostane
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17α-Hydroxylase,
17,20-Lyase
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- 22-ABC
- 22-Oxime
- Abiraterone
- Bifonazole
- Clotrimazole
- Cyanoketone
- Cyproterone
- Danazol
- Econazole
- Galeterone
- Gestrinone
- Isoconazole
- Ketoconazole
- L-39
- Liarozole
- LY-207,320
- MDL-27,302
- Miconazole
- Mifepristone
- Orteronel
- Pioglitazone
- Rosiglitazone
- Spironolactone
- Stanozolol
- SU-10,603
- TGF-β
- Tioconazole
- Troglitazone
- VN/87-1
- YM116
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3β-HSD
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- 4-MA
- Azastene
- Cyanoketone
- Danazol
- Epostane
- Genistein
- Gestrinone
- Metyrapone
- Norethisterone
- Oxymetholone
- Pioglitazone
- Rosiglitazone
- Trilostane
- Troglitazone
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21-Hydroxylase
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- Aminoglutethimide
- Amphenone B
- Bifonazole
- Clotrimazole
- Diazepam
- Econazole
- Genistein
- Isoconazole
- Ketoconazole
- Metyrapone
- Miconazole
- Midazolam
- Tioconazole
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11β-Hydroxylase
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- Aminoglutethimide
- Canrenone
- Etomidate
- Fadrozole
- FETO
- Ketoconazole
- Metomidate
- Metyrapone
- Mitotane
- Potassium canrenoate
- Spironolactone
- Trilostane
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18-Hydroxylase
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- Aminoglutethimide
- Canrenone
- FAD286
- Fadrozole
- Ketoconazole
- LCI699
- Metyrapone
- Mespirenone
- Potassium canrenoate
- Spironolactone
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Other |
Endogenous
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- Glucocorticoids: Corticosterone
- Cortisone
- Cortodoxone/Deoxycortisol
- Hydrocortisone/Cortisol
- Antiglucocorticoids: 17-Hydroxyprogesterone
- Deoxycorticosterone
- Pregnenolone
- Progesterone
- Precursors: Cholesterol
- 22R-Hydroxycholesterol
- 20α,22R-Dihydroxycholesterol
- Pregnenolone
- 17-Hydroxypregnenolone
- 17-Hydroxyprogesterone
- Progesterone
- Deoxycorticosterone
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Indirect
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- ACTH/Corticotropin
- CRH
- DHEA
- DHEA sulfate
- Plasma proteins (Transcortin, Albumin)
- Vasopressin
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Procedures
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- Adrenalectomy
- Hypophysectomy
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UpToDate Contents
全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.
English Journal
- Enhanced Emotional Empathy after Mineralocorticoid Receptor Stimulation In Women With Borderline Personality Disorder And Healthy Women.
- Wingenfeld K1, Kuehl LK1, Janke K1, Hinkelmann K1, Dziobek I2, Fleischer J1, Otte C1, Roepke S1.Author information 1Department of Psychiatry, Charité University Medical School Berlin, Campus Benjamin Franklin, Berlin, Germany.2Cluster of Excellence Languages of Emotion, Freie Universität Berlin, Berlin, Germany.AbstractThe mineralocorticoid receptor (MR) is highly expressed in the hippocampus and prefrontal cortex. MR play an important role in appraisal processes and in modulating stress-associated emotional reactions but it is not known whether the MR affects empathy. Borderline personality disorder (BPD) is characterized by disturbed emotion regulation and alterations in empathy. In the current study, we examined whether stimulation of the MR enhances empathy in patients with BPD and healthy individuals. In a placebo-controlled study, we randomized 38 women with BPD without psychotropic medication and 35 healthy women to either placebo or 0.4 mg fludrocortisone, a MR agonist. Subsequently, all participants underwent two tests of social cognition, the Multifaceted Empathy Test (MET) and the Movie for the Assessment of Social Cognition (MASC), measuring cognitive and emotional facets of empathy. Eighteen BPD patients and 18 healthy women received placebo, while 20 BPD patients and 17 healthy women received fludrocortisone. In the MET, fludrocortisone enhanced emotional empathy across groups while cognitive empathy was not affected. In the MASC, no effect of fludrocortisone could be revealed. In both tests, BPD patients and healthy women did not differ significantly in cognitive and emotional empathy and in their response to fludrocortisone. Stimulation of MR enhanced emotional empathy in healthy women and in BPD patients. Whether fludrocortisone might play a therapeutic role in psychotherapeutic processes, remains to be elucidated.Neuropsychopharmacology accepted article preview online, 18 February 2014; doi:10.1038/npp.2014.36.
- Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology.Neuropsychopharmacology.2014 Feb 18. doi: 10.1038/npp.2014.36. [Epub ahead of print]
- The mineralocorticoid receptor (MR) is highly expressed in the hippocampus and prefrontal cortex. MR play an important role in appraisal processes and in modulating stress-associated emotional reactions but it is not known whether the MR affects empathy. Borderline personality disorder (BPD) is char
- PMID 24535100
- STAR splicing mutations cause the severe phenotype of lipoid congenital adrenal hyperplasia: insights from a novel splice mutation and review of reported cases.
- Camats N1, Pandey AV, Fernández-Cancio M, Fernández JM, Ortega AM, Udhane S, Andaluz P, Audí L, Flück CE.Author information 1Pediatric Endocrinology, Department of Pediatrics and Department of Clinical Research, University Children's Hospital Bern, Bern, Switzerland.AbstractOBJECTIVE: The steroidogenic acute regulatory protein (StAR) transports cholesterol to the mitochondria for steroidogenesis. Loss of StAR function causes lipoid congenital adrenal hyperplasia (LCAH) which is characterized by impaired synthesis of adrenal and gonadal steroids causing adrenal insufficiency, 46,XY disorder of sex development (DSD) and failure of pubertal development. Partial loss of StAR activity may cause adrenal insufficiency only.
- Clinical endocrinology.Clin Endocrinol (Oxf).2014 Feb;80(2):191-199. doi: 10.1111/cen.12293. Epub 2013 Aug 17.
- OBJECTIVE: The steroidogenic acute regulatory protein (StAR) transports cholesterol to the mitochondria for steroidogenesis. Loss of StAR function causes lipoid congenital adrenal hyperplasia (LCAH) which is characterized by impaired synthesis of adrenal and gonadal steroids causing adrenal insuffic
- PMID 23859637
- Treatment of endocrine disorders in the neuroscience intensive care unit.
- Hwang JJ1, Hwang DY.Author information 1Division of Endocrinology, Yale School of Medicine, 333 Cedar Street, TAC S147, New Haven, CT, USA, janice.hwang@yale.edu.AbstractOPINION STATEMENT: This review discusses concepts and treatments associated with the most clinically relevant areas of acute endocrine dysfunction amongst patients with common diseases in neuroscience intensive care units (Neuro ICUs). We highlight the following points:• While a thorough work-up for hyponatremia when it is present is always warranted, subarachnoid hemorrhage (SAH) patients who are in a time window concerning for cerebral vasospasm and who are hyponatremic with high urine output are generally thought to have cerebral salt wasting. These patients are typically treated with a combination of continuous hypertonic saline infusion and fludrocortisone.• Diabetes insipidus (DI) is often seen in patients fulfilling death by neurological criteria, as well as in patients with recent pituitary surgery and less often in SAH and traumatic brain injury patients who are not brain dead. Patients with DI in the Neuro ICU often cannot drink to thirst and may require a combination of desmopression/vasopressin administration, aggressive fluid repletion, and serum sodium monitoring.• Diagnosing adrenal insufficiency immediately following pituitary injury is complicated by the fact that the expected atrophy of the adrenal glands, due to lack of a stimulus from pituitary adrenocorticotropic hormone, may take up to 6 weeks to develop. Cosyntropin testing can be falsely normal during this period.• Both hyperglycemia (glucose >200 mg/dL) and hypoglycemia (glucose <50 mg/dL) are strongly associated with neurological morbidity and mortality in ICUs and should be avoided. Glucose concentrations between 120-160 mg/dL can serve as a reasonable target for insulin infusion protocols.• There is no data to suggest that treatment of abnormal thyroid function tests in nonthyroidal illness syndrome/sick euthyroid leads to benefits in either mortality or morbidity. True myxedema coma is a rare clinical diagnosis that is treated with intravenous levothyroxine accompanied by stress-dose steroids.
- Current treatment options in neurology.Curr Treat Options Neurol.2014 Feb;16(2):271. doi: 10.1007/s11940-013-0271-4.
- OPINION STATEMENT: This review discusses concepts and treatments associated with the most clinically relevant areas of acute endocrine dysfunction amongst patients with common diseases in neuroscience intensive care units (Neuro ICUs). We highlight the following points:• While a thorough work-up f
- PMID 24390813
Japanese Journal
- Fluctuation in Serum Sodium Levels Related to Ipragliflozin Administration in a Patient with Diabetic Nephropathy and Sequela of Traumatic Brain Injury
- 単孔式腹腔鏡下手術後に老人性鉱質コルチコイド反応性低ナトリウム血症(MRHE)を発症した高齢者卵巣線維腫の一例
- Hypersensitivity to Fludrocortisone Acetate in a Recipient of Bone Marrow Transplantation
Related Links
- Fludrocortisone (also called 9α-fluorocortisol or 9α-fluorohydrocortisone) is a synthetic corticosteroid with moderate glucocorticoid potency and much greater mineralocorticoid potency. The brand name in the U.S. and Canada is Florinef.
Related Pictures
★リンクテーブル★
[★]
- 英
- glucocorticoid (Z), glucocorticoids
- 関
- グルココルチコイド
- 関
- 副腎皮質、副腎皮質ホルモン
- 以下、内的に合成される糖質コルチコイドについて述べる
種類
分類
性状
産生組織
標的組織
生理作用
1. エネルギー代謝
- 糖新生においてグルコースの前駆体となるアミノ酸を肝臓に供給すべく動員する作用 (SP.894)
a. 糖代謝作用
- 糖新生の亢進
- 血糖上昇
- 肝細胞以外のグルコースの取り込みを抑制 (SP.894) ← 末梢でインスリンの作用に拮抗
- グルコース-6-ホスファターゼの活性亢進 (SP.894)
- グリコーゲンの合成亢進
- 血糖値の上昇に伴い、肝臓などでグルコースからグリコーゲンが作られる (SP.894)
b. タンパク質代謝作用
- 肝臓での糖新生の基質を末梢から供給する作用
- 肝細胞以外でのアミノ酸取り込み阻害 (SP.894)
- 特定のアミノ酸合成を阻害 (SP.894)
- 生理的範囲:(肝臓)同化作用が起こる、(肝臓以外)異化作用が起こる
- ステロイド大量投与時:ほとんど異化作用が起こる→副作用につながる
c. 脂質代謝作用
- 脂肪細胞に対して、インスリンの拮抗作用を持つが、一方で糖質コルチコイドにより血糖値が上昇する
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- 脂肪細胞に対してグルコースの取り込みを抑制し、中性脂肪の生合成を抑制し、さらに大量の遊離脂肪酸とグリセロールを放出させる。肝臓でグリセロールからグルコースが合成される。 (SP.894)
- 血糖値の上昇によりインスリンが分泌され、脂肪細胞で脂肪の合成が促進される (SP.894)
- (1)、(2)のいずれの反応が起こるかは体の部位によって異なり、脂肪分布の変化が生じる。
- 中心性肥満、満月様顔貌、バッファローハンプ
2. 電解質代謝作用
- 糖質コルチコイドの電解質コルチコイド様作用。
- Na+再吸収↑、K+排泄↑
- コルチゾールの電解質作用はアルドステロンの約1/400
- コルチゾールの量 はアルドステロンの約 200倍
- ゆえに、電解質コルチコイドの1/2の作用力を持つ
3. 水代謝作用
- GFR↑、ADHに拮抗、細胞内への水移動の抑制→水利尿作用を有する。 尿崩症 + 副腎不全 → 多尿がいくらか改善されると考えて良いと思われる。仮面尿崩症
4. 骨・軟骨に対する作用
- a. ビタミンDと拮抗して腸管からのCa吸収阻害 (SP.894)
- b. 腎尿細管におけるCa再吸収阻害 (SP.894)
- c. 骨芽細胞の分化・増殖を抑制 (SP.894)
- 糖質コルチコイドの大量投与→軟骨↓骨成長↓(活性型ビタミンD3に拮抗・尿細管Ca再吸収↓→PTH↑、骨芽細胞の分化抑制、タンパク質の異化作用↑)→骨粗鬆症、骨壊死 or 骨端線閉鎖を促進(←?要調査)
- b.の機序で尿に排泄されるカルシウムが増加 → 高カルシウム尿症 → 尿路結石
5. 抗炎症作用
- 胸腺やリンパ組織を萎縮させる → 炎症反応や免疫反応を抑制
- リンパ球数の減少、白血球の遊走抑制、抗体産生低下、ヒスタミン放出抑制(局所の毛細血管拡張抑制) (SP.894)
- 末梢好中球数は増加する(YN.F-78) → 白血球増多症
SPC.330
- a) 核内受容体を介してlipocortinを発現させ、これがphospholipase A2を阻害する。これにより、アラキドン酸の産生が抑制され、炎症を促進するロイコトリエンの産生も抑制される。
- b) 末梢血Tリンパ球、単球、好酸球、好塩基球:骨髄からの放出減少と再分配(?)のため末梢血中では減少する。
- c) 末梢血好中球:炎症部位への集合が抑制され(血管外への遊走が抑制される(GOO.1600))、末梢血中では増加する。
- d) Bリンパ球はヘルパーT細胞が抑制されるために抗体産生能が減少する。
- e) リンパ球などの細胞表面の立体構造を換えて抗体や補体の結合を抑制する。
- f) 毛細血管(毛細管)の収縮により、血管の透過性は低下する。
6. 循環器
- カテコールアミン・アンジオテンシンIIによる血管収縮作用の許容作用 → 糖質コルチコイドなしではその作用を十分に及ぼし得ない
- 欠乏症では血管のカテコールアミン・アンジオテンシンIIに対する感受性低下
7. 中枢神経系
8. 成長発達
- 胎児期の消化酵素・リン脂質(肺胞表面の張力に関与)の合成に関与 (SP.895)
- 小児期で骨や熱強訴域に直接作用して身長の伸びを抑制する (SP.895)
作用機序
免疫抑制(GOO. 657,674,1600)
- 糖質コルチコイドはリポコルチンを産生→リポコルチンはホスホリパーゼA2の活性を修飾→アラキドン酸産生↓
分泌調節
- 1. 概日リズム
- 2. フィードバック制御
- 3. ストレス反応
臨床関連
用量
- Low-to-moderate doses — Doses of 1 mg/kg per day of prednisone in children or 40 mg per day in adults may be considered an approximate threshold at which significant toxicities begin to appear with extended use in most individuals.
副作用
- 副腎皮質ホルモン剤
- Patients receiving a glucocorticoid dose equivalent to ≥20 mg of prednisone daily for one month or longer who also have another cause of immunocompromise (eg, certain hematologic malignancies or a second immunosuppressive drug)
- https://www.uptodate.com/contents/treatment-and-prevention-of-pneumocystis-pneumonia-in-hiv-uninfected-patients?
- 0.5mg/kg以上のプレドニゾロン(PSL)を3週間以上投与され、かつST予防投与されていない間質性肺炎74例中7例(9.5%)でPCPを発症(榎本達治,他.ステロイド療法中の間質性肺炎患者に発症したニューモシスチス肺炎の臨床的検討.日呼吸会誌 2005: 43: 725-30)
[★]
- 英
- fludrocortisone
- 化
- 酢酸フルドロコルチゾン fludrocortisone acetate
- 商
- フロリネフ
[★]
- 日
- 関
- 同
- Florinef