Endocrinology · USMLE Step 1 and Step 2

Systemic Corticosteroids song

Systemic Corticosteroids, as a song. Hear the short teaser here. The full song is on YouTube and Spotify.

Systemic Corticosteroids

Full song on YouTube ↗Spotify ↗

Key points in this song10

Corticosteroids bind intracellular glucocorticoid receptors, translocate to the nucleus, and inhibit phospholipase A2 via lipocortin, blocking arachidonic acid release and suppressing both COX and LOX pathways.
Classic adverse effects include hyperglycemia, hypertension, osteoporosis, central obesity, striae, and adrenal suppression — remembered as Cushing syndrome features with exogenous use.
Prolonged corticosteroid use suppresses the HPA axis; abrupt discontinuation can cause adrenal crisis (hypotension, hyponatremia, hyperkalemia) — always taper after >3 weeks of use.
Corticosteroids cause lymphopenia, eosinopenia, and neutrophilia (demargination) — a classic USMLE lab finding on CBC.
Prednisone is a prodrug converted to prednisolone in the liver — avoid in severe hepatic failure; use prednisolone directly instead.
High-dose corticosteroids are first-line for immune thrombocytopenic purpura (ITP), acute asthma exacerbations, giant cell arteritis, and severe community-acquired pneumonia (CAP) with hypoxia.
Dexamethasone is preferred in bacterial meningitis (given before or with first antibiotic dose) to reduce TNF-mediated inflammation and decrease the risk of sensorineural hearing loss.
Inhaled corticosteroids can cause oropharyngeal candidiasis and dysphonia — patients should rinse mouth after use; systemic absorption is minimal but suppression possible at high doses.
Corticosteroids inhibit fibroblast activity and impair wound healing; they also increase susceptibility to opportunistic infections, including reactivation of latent tuberculosis — screen with PPD/IGRA before chronic use.
Mineralocorticoid activity ranking: fludrocortisone > aldosterone >> hydrocortisone > prednisone > dexamethasone (near zero) — key for selecting agents in adrenal insufficiency replacement therapy.