Glucocorticoid biology — a molecular maze and clinical challenge

Abstract

Over fifty years have now elapsed since glucocorticoids were first employed as anti-inflammatory drugs in the clinic. At that time, Dr Philip Hench and his colleagues at the Mayo Clinic made the seminal observation that administering an adrenal cortical steroid extract to a patient with progressive, active rheumatoid arthritis stopped the disease dead in its tracks [1], This soon led to synthetic adrenal cortical steroids gaining a remarkable reputation in the treatment of a wide range of inflammatory and autoimmune disorders. However, it soon became apparent that this efficacy did not come without a cost in terms of potentially serious adverse effects. The fascinating history of glucocorticoid biology from Thomas Addison to the glucocorticoid receptor transgenic mouse is covered in the next chapter (A. Munck, this volume).