HOMEOSTASIS &

STEROIDS

Presented by Guided by Guided by

Dr. Shweta Yadav Dr. S.R.Shenoi Dr. Kshitij Bang
(Junior Resident) (Prof. & HOD) (Asso.Prof. & Guide)

Department of Oral & Maxillofacial Surgery

VSPM Dental College, Nagpur
 Content
 Introduction
 History
 Definition
 Classification
 Functional Anatomy
 Biosynthesis
 Components of homeostatic system
 Mechanism of Action
 Pharmacological Action of Gluco- & Mineralocorticosteroids
 HPA Axis & Negative Feedback Mechanism
 Adverse Effects
 Contraindication
 Rule of Two
 Uses in Oral and Maxillofacial Surgery
 Conclusion
 Reference
Introduction
• Steroidal hormones regulate body function to bring about a
programmed pattern of life events and maintain homeostasis in the
face of markedly variable external or internal environment.
• The term ‘corticosteroid’ or ‘corticoid’ includes natural gluco- and
mineralo-corticoids and their synthetic analogues.
• Adrenal Cortex is more important than medulla.

Tripathi KD. Essentials of pharmacology for dentistry. jaypee; 2016.

 History
• Sir Thomas Addison (1855) on ‘The
Clinical Picture of Adrenal Destruction’
• Sir Hans Selye relationship between
Adrenal cortex and Stress
• Sir Hench (1949) jointly with Sir Kendall
and Sir Reichstein – Rheumatoid
Arthritis, got Nobel Prize in 1950

Satoskar RS, Rege N, Bhandarkar SD. Pharmacology and Pharmacotherapeutics-E-Book. Elsevier Health Sciences; 2015 Jul 27.
Definition
• Homeostasis: the co-ordinated physiological process which maintains
most of the steady states of the organism (Sir Walter Cannon).
• The stability of the “milieu interieur” is the primary condition for
freedom and independence of existence (Sir Claude Bernard); i.e.
body systems act to maintain internal constancy.

Truskett P. Bailey and Love's Short Practice of Surgery. ANZ Journal of Surgery. 2014 Mar 1;84(3).
 Classification STEROIDS
• Based on Function
CORTICOSTEROIDS ANABOLIC STEROIDS

GLUCOCORTICOIDS MINERALOCORTICOIDS SEX HORMONE

HYDROCORTISONE, CORTISONE,
ALDOSTERONE, ANDROGEN,
PREDNISOLONE, METHYL
PREDNISOLONE, TRIAMCINOLONE, FLUDROCORTISONE, ESTROGEN,
DEXAMETHASONE, DEOXYCORTICOSTERONE PROGESTERONE
BETAMETHASONE, ACETATE (DOCA)
PARAMETHASONE
Classification of Glucocorticoid
• Based on Duration of Action
Intermediate
Short Acting Long Acting
Acting
• Hydrocortisone • Triamcinolone • Dexamethasone
(Cortisol) • Prednisone • Betamethasone
• Cortisone • Prednisolone • Paramethasone
• Methylprednisolone
• Fludrocortisone

Zandi M. The role of corticosteroids in today's oral and maxillofacial surgery. InGlucocorticoids-new recognition of our familiar friend 2012 Nov 28.
Essentials Of Medical Physiology-6th Edition-K Sembulingam, Prema Sembulingam
 Biosynthesis

Tripathi KD. Essentials of pharmacology for dentistry. jaypee; 2016.

 Basal secretion
Group Hormone Daily
Glucocorticoids Cortisol 5 – 30 mg
Cortisone 2 – 5 mg

Mineralocorticoids Aldosterone 0.12 mg

11- Deoxycorticosterone Trace

Sex Hormones
Androgen DHEA 15 – 30 mg
Progestogen Progesterone 0.4 – 0.8 mg
Oestrogen Oestradiol Trace
Components of homeostatic system

Essentials Of Medical Physiology-6th Edition-K Sembulingam, Prema Sembulingam

 Mechanism of Action
of Glucocorticoid

Mehta AB, Nadkarni NJ, Patil SP, Godse KV et al. Topical corticosteroids in dermatology.Indian J Dermatol Venereol Leprol 2016;82:371-8
 Actions of Glucocorticoids
1. Carbohydrate & protein metabolism
2. Fat metabolism
3. Calcium metabolism
4. Water excretion
5. Cardiovascular system
6. Skeletal muscles
7. Central nervous system
8. Stomach
9. Lymphoid tissue & blood cells
10. Inflammatory responses
11. Immunological & allergic responses

Satoskar RS, Rege N, Bhandarkar SD. Pharmacology and Pharmacotherapeutics-E-Book. Elsevier Health Sciences; 2015 Jul 27.
Skeletal system

Ilias I, Zoumakis E, Ghayee H. An Overview of Glucocorticoid Induced Osteoporosis. 2018 Jul 10.
Inflammatory response
The metabolic stress response :the ‘ebb and flow’ model

Truskett P. Bailey and Love's Short Practice of Surgery. ANZ Journal of Surgery. 2014 Mar 1;84(3).
Hypothalamic-Pituitary-Adrenal Axis
 Negative feedback mechanism

Hypothalamo-pituitary-adrenal (HPA) axis Regulation of corticosteroid production and

response to stress which overrides the negative
feedback regulation of ACTH release.
 Excess mineralocorticoid
Hypertension

Promote myocardial
fibrosis & associated Fluid
progression of the retention
disease

Alkalosis Oedema

Hypokalemia

Tripathi KD. Essentials of pharmacology for dentistry. jaypee; 2016.

Mineralocorticoid deficiency
Decreases Na+ resorptive capacity (even in Na+
deficient state)

Absorb water without attended Na+ (to

maintain ECF)

Dilutional hyponatremia

Excessive water enters in the cell

Decrease blood volume & increased hematocrit

Fluid electrolyte imbalance

Circulatory collapse

Tripathi KD. Essentials of pharmacology for dentistry. jaypee; 2016.

Adverse effects of corticosteroids
• Cushing’s habitus • Osteoporosis
• Fragile skin, purple striae • Cataract
• Growth retardation
• Hyperglycaemia
• Foetal abnormalities
• Muscular weakness • Psychiatric disturbances
• Delayed healing • Suppression of hypothalamo-
• Peptic ulceration pituitary-adrenal (HPA) axis

Tripathi KD. Essentials of pharmacology for dentistry. jaypee; 2016.

RULE OF 2
• Adrenal suppression may occur if a patient is taking 20 mg of
cortisone or its equivalent daily, for 2 weeks within 2 years of dental
treatment.
• Withdrawal “Cold turkey”: if glucocorticoid therapy of less than 2
weeks duration.
• Taper off: if Glucocorticoid therapy of greater than 2 weeks duration.
Uses in Oral and Maxillofacial Surgery
• Temporomandibular disorders (TMDs)
• Oral ulcerative and vesiculobullous lesions
• Keloid and hypertrophic scars
• Central giant cell granuloma
• Bell's palsy
• Hypersensitivity Reaction
• Others
Contraindications
1. Peptic ulcer
2. Diabetes mellitus
3. Hypertension
4. Viral and fungal infections
5. Tuberculosis and other infections
6. Osteoporosis
7. Psychosis
8. Epilepsy
9. Renal failure

Tripathi KD. Essentials of pharmacology for dentistry. jaypee; 2016.

Conclusion
• Emphasis is laid on why knowledge of these events is
important to understand the rationale for modern ‘stress-free’
perioperative and critical care.
• Resuscitation, surgical intervention and critical care can
return the severely injured patient to a situation in which
homeostasis becomes possible once again.
References
• Tripathi KD. Essentials of pharmacology for dentistry. jaypee; 2016.
• Satoskar RS, Rege N, Bhandarkar SD. Pharmacology and Pharmacotherapeutics-E-Book.
Elsevier Health Sciences; 2015 Jul 27.
• Truskett P. Bailey and Love's Short Practice of Surgery. ANZ Journal of Surgery. 2014 Mar
1;84(3).
• Essentials Of Medical Physiology-6th Edition-K Sembulingam, Prema Sembulingam
• Kent S, Hennedige A, McDonald C, Henry A, Dawoud B, Kulkarni R, Logan G, Gilbert K,
Exely R, Basyuni S, Kyzas P. Systematic review of the role of corticosteroids in cervicofacial
infections. British Journal of Oral and Maxillofacial Surgery. 2019 Feb 13.
• The Role of Corticosteroids in Today's Oral and Maxillofacial Surgery 2012
http://dx.doi.org/10.5772/48655 Mohammad Zandi
• Ilias I, Zoumakis E, Ghayee H. An Overview of Glucocorticoid Induced Osteoporosis. 2018
Jul 10. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South
Dartmouth (MA): MDText.com, Inc.; 2000-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK278968/
THANK YOU