Pre-receptor Regulation of Cortisol in Hypothalamic-Pituitary-Adrenal Axis Functioning an Metabolism

Glucocorticoids (GCs) are ubiquitous, nuclear hormones, which are essential for life. In man, the main GC is cortisol, produced by the adrenals, endocrine glands that are situated on top of the kidneys. Cortisol exerts its functions in nearly all tissues and is crucial in the mediation of the stress response. Furthermore, cortisol is implicated in glucose and lipid metabolism, modulation of the immune system, maintenance of the vascular tone, bone formation, and skeletal and cardiac muscle function. Cortisol also aff ects brain function including memory modulation and mood regulation. Because of its anti-infl ammatory eff ects, cortisol and its synthetic analogues are now widely used in clinical practice. Indications include rheumatoid arthritis, infl ammatory bowel disease, sarcoidosis, asthma, and dermatological diseases. Additionally, GCs have an important role in prevention of graft versus host disease in organ transplant patients and haematological malignancies. Unfortunately, GC excess due to treatment or endogenous production, e.g. Cushing’s syndrome, has serious adverse eff ects, such as truncal obesity, striae, osteoporosis, hypertension, hypokalaemia, hyperglycaemia, mood disorders and when prescribed to children growth retardation.

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