Glucocorticoid effects on the immune system

[qw098]

Confused M2 here...

So.. glucocorticoids such as cortisol are knowm to be used for immunosuppressant activities to inhibit inflammation. Right?

Then how come uptodate says:

Glucocorticoids — Cortisol is the main glucocorticoid produced by the adrenal gland. Adrenocorticotropin hormone (ACTH) is made in the pituitary and stimulates the adrenal gland to produce cortisol. Cortisol has many important functions including:

• Helping to regulate glucose (blood sugar) levels
• Increase fat in the body
• Help to defend the body against infection
• Help the body respond to stress

I'm thinking of this question in the context of adrenal insufficiency vs. something like Cushing's disease. (Low cortisol levels vs high cortisol levels) Which of these two conditions will increase the chance of infection?

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[cbrons]

Its really not that simple. It has to do with allostasis - how much cortisol over what period time? Endogenous glucocorticoids regulate pro and anti inflammatory (and pro and anti immunogenic) cytokines and processes. They either do this directly or indirectly as a result of their direct action on something else. The overall point is that these TV hacks who constantly say "stress is bad" because steroids do xyz ... well its just really not that simple. Obviously super high or super low levels of any component of thr endocrine system is probably going to be bad overall but there is a lot of redudancy built into the system thanks to the innumerable negative feedback loops and multiple levels of control.

 

[cbrons]

Its really not that simple. It has to do with allostasis - how much cortisol over what period time? Endogenous glucocorticoids regulate pro and anti inflammatory (and pro and anti immunogenic) cytokines and processes. They either do this directly or indirectly as a result of their direct action on something else. The overall point is that these TV hacks who constantly say "stress is bad" because steroids do xyz ... well its just really not that simple. Obviously super high or super low levels of any component of thr endocrine system is probably going to be bad overall but there is a lot of redudancy built into the system thanks to the innumerable negative feedback loops and multiple levels of control.

Obviously symthetic versions of endogenous hormones given to treat variois conditions does not fit this last description.