Resistance to the effects of glucocorticoids may show a broad range of clinical findings depending on the nature and severity of the resistance.
Glucocorticoid resistance refers to partial or complete loss of the effect on glucocorticoids on target tissues.
Resistance to glucocorticoids may be primary are secondary.
Resistance to glucocorticoids may range from minimal to severe.
Primary resistance is rare and is associated with mutations in the hormone receptor. There is variability in the production of:
(1) ACTH
(2) cortisol
(3) mineralocorticoids with salt retention and/or hypokalemic alkalosis
(4) adrenal androgens (hirsutism in females, precious puberty or infertility in males)
A patient with primary resistance may show a clinical response to dexamethasone.
Secondary resistance develops during the course of another condition such as:
(1) sepsis
(2) HIV/AIDS
In these conditions there are transient alterations in the expression of the receptors, usually resulting in a partial resistance. In some patients the administration of corticosteroids results in an improved response to vasopressors.
