This slide contain all info about corticosteroids

1. 1
1
CORTICOSTEROIDS
CORTICOSTEROIDS
Prof. Dr. Shah Murad
Prof. Dr. Shah Murad
shahmurad74@yahoo.com
shahmurad74@yahoo.com

2. 2
►Corticosteroids
Corticosteroids are a class of
are a class of
steroid hormones
steroid hormones that are produced in the
that are produced in the
adrenal cortex
adrenal cortex.
.
►Corticosteroids are involved in a wide range of
Corticosteroids are involved in a wide range of
physiologic
physiologic systems such as
systems such as
►stress response
stress response,
,
►immune response
immune response and regulation of
and regulation of
inflammation
inflammation,
,
►carbohydrate
carbohydrate metabolism
metabolism,
,
►protein
protein catabolism
catabolism,
,
►blood
blood electrolyte
electrolyte levels, and
levels, and
►behavior.
behavior.

3. 3
►Glucocorticoids
Glucocorticoids such as
such as cortisol
cortisol control
control
carbohydrate, fat and protein metabolism and
carbohydrate, fat and protein metabolism and
are anti-inflammatory by preventing
are anti-inflammatory by preventing
phospholipid
phospholipid release, decreasing
release, decreasing eosinophil
eosinophil
action and a number of other mechanisms.
action and a number of other mechanisms.
►Mineralocorticoids
Mineralocorticoids such as
such as aldosterone
aldosterone
control electrolyte and water levels, mainly by
control electrolyte and water levels, mainly by
promoting sodium retention in the
promoting sodium retention in the kidney
kidney.
.

4. 4
common natural hormones
common natural hormones
►corticosterone
corticosterone (C21H30O4),
(C21H30O4),
►cortisone
cortisone (C21H28O5, 17-hydroxy-11-
(C21H28O5, 17-hydroxy-11-
dehydrocorticosterone)
dehydrocorticosterone)
►aldosterone
aldosterone

5. 5
Biosynthesis
Biosynthesis
► The corticosteroids are synthesized from
The corticosteroids are synthesized from cholesterol
cholesterol
within the
within the adrenal cortex
adrenal cortex.
.
► Most steroidogenic reactions are catalysed by
Most steroidogenic reactions are catalysed by enzymes
enzymes
of the
of the cytochrome
cytochrome P450 family. They are located
P450 family. They are located
within the
within the mitochondria
mitochondria and require
and require adrenodoxin
adrenodoxin as a
as a
cofactor
cofactor
► Aldosterone
Aldosterone and
and corticosterone
corticosterone share the first part of
share the first part of
their biosynthetic pathway.
their biosynthetic pathway.
► The last part is either mediated by the
The last part is either mediated by the aldosterone
aldosterone
synthase
synthase (for
(for aldosterone
aldosterone) or by the
) or by the 11β-hydroxylase
11β-hydroxylase
(for
(for corticosterone
corticosterone). These enzymes are nearly
). These enzymes are nearly
identical (they share 11β-hydroxylation and 18-
identical (they share 11β-hydroxylation and 18-
hydroxylation functions).
hydroxylation functions).

6. 6
►Moreover, aldosterone synthase is found
Moreover, aldosterone synthase is found
within the
within the zona
zona glomerulosa
glomerulosa at the outer
at the outer
edge of the
edge of the adrenal cortex
adrenal cortex; 11β-hydroxylase
; 11β-hydroxylase
is found in the zona fasciculata and
is found in the zona fasciculata and
reticularis.
reticularis.

7. 7
Classes of corticosteroids
Classes of corticosteroids
►Corticosteroids are generally grouped into four
Corticosteroids are generally grouped into four
classes, based on chemical structure.
classes, based on chemical structure.
►Allergic reactions to one member of a class
Allergic reactions to one member of a class
typically indicate an intolerance of all members
typically indicate an intolerance of all members
of the class.
of the class.
"Coopman classification"
"Coopman classification"
The highlighted steroids are often used in the
The highlighted steroids are often used in the
screening of allergies to topical steroids
screening of allergies to topical steroids

8. 8
►Group A
Group A
►(short to medium acting glucocorticoids)
(short to medium acting glucocorticoids)
Hydrocortisone
Hydrocortisone,
, Hydrocortisone acetate
Hydrocortisone acetate,
,
Cortisone acetate
Cortisone acetate,
, Tixocortol
Tixocortol pivalate
pivalate,
,
Prednisolone
Prednisolone,
, Methylprednisolone
Methylprednisolone, and
, and
Prednisone
Prednisone.
.
►Group B
Group B
►Triamcinolone
Triamcinolone acetonide
acetonide, ,
, , Mometasone
Mometasone,
,
Amcinonide
Amcinonide,
, Budesonide
Budesonide,
, Desonide
Desonide,
,
Fluocinonide
Fluocinonide,
, Fluocinolone
Fluocinolone acetonide
acetonide, and
, and
Halcinonide
Halcinonide.
.

9. 9
►Group C
Group C
►Betamethasone
Betamethasone,
, Betamethasone
Betamethasone
sodium phosphate
sodium phosphate,
, Dexamethasone
Dexamethasone,
,
Dexamethasone
Dexamethasone sodium phosphate
sodium phosphate, and
, and
Fluocortolone
Fluocortolone.
.
►Group D
Group D
►Hydrocortisone-17-butyrate
Hydrocortisone-17-butyrate,
,
Betamethasone
Betamethasone valerate
valerate,
, Betamethasone
Betamethasone
dipropionate
dipropionate,
, Prednicarbate
Prednicarbate, , , , , and
, , , , , and
Fluprednidene
Fluprednidene acetate
acetate

10. 10
Routes of adm: of Corticosteroids
Routes of adm: of Corticosteroids
► 1.
1. Topical steroid
Topical steroid for use topically on the skin, eye,
for use topically on the skin, eye,
and mucous membranes.
and mucous membranes.
► 2.
2. Inhaled steroids
Inhaled steroids for use to treat the nasal mucosa,
for use to treat the nasal mucosa,
sinuses, bronchii, and lungs.
sinuses, bronchii, and lungs.
► 3.
3. Oral forms
Oral forms - such as prednisone and prednisolone.
- such as prednisone and prednisolone.
► 4.
4. Systemic
Systemic forms - available in injectibles for use
forms - available in injectibles for use
intravenously and parenteral routes
intravenously and parenteral routes

11. 11
Uses
Uses
►Synthetic
Synthetic drugs
drugs with corticosteroid-like
with corticosteroid-like
effect are used in a variety of conditions,
effect are used in a variety of conditions,
ranging from
ranging from brain tumors
brain tumors to
to skin diseases
skin diseases.
.

12. 12
►Dexamethasone
Dexamethasone and its derivatives are
and its derivatives are
almost pure glucocorticoids, while
almost pure glucocorticoids, while
prednisone
prednisone and its derivatives have some
and its derivatives have some
mineralocorticoid action in addition to the
mineralocorticoid action in addition to the
glucocorticoid effect.
glucocorticoid effect.

13. 13
►Fludrocortisone
Fludrocortisone (Florinef) is a synthetic
(Florinef) is a synthetic
mineralocorticoid.
mineralocorticoid.
►Hydrocortisone
Hydrocortisone (cortisol) is available for
(cortisol) is available for
replacement therapy,
replacement therapy, e.g.
e.g. in
in
adrenal insufficiency
adrenal insufficiency and
and
congenital adrenal hyperplasia
congenital adrenal hyperplasia.
.

14. 14
►Synthetic glucocorticoids are used in the
Synthetic glucocorticoids are used in the
treatment of joint pain or inflammation (
treatment of joint pain or inflammation (
arthritis
arthritis),
), temporal
temporal arteritis
arteritis,
, dermatitis
dermatitis,
, allergic
allergic
reactions,
reactions, asthma
asthma,
, hepatitis
hepatitis,
, systemic lupus
systemic lupus
erythematosus
erythematosus,
, inflammatory bowel disease
inflammatory bowel disease (
(
ulcerative colitis
ulcerative colitis and
and Crohn's
Crohn's disease
disease),
),
sarcoidosis
sarcoidosis and for glucocorticoid replacement
and for glucocorticoid replacement
in
in Addison's disease
Addison's disease or other forms of
or other forms of
adrenal insufficiency
adrenal insufficiency.
.

15. 15
►Topical formulations are also available for
Topical formulations are also available for
the
the skin
skin,
, eyes
eyes,
, lungs
lungs,
, nose
nose, and
, and bowels
bowels.
.
►Corticosteroids are also used supportively to
Corticosteroids are also used supportively to
prevent nausea, often in combination with
prevent nausea, often in combination with
5-HT3 antagonists (
5-HT3 antagonists (e.g.
e.g. ondansetron
ondansetron).
).

16. 16
►Typical
Typical undesired effects
undesired effects of glucocorticoids
of glucocorticoids
present quite uniformly as drug-induced
present quite uniformly as drug-induced
Cushing's syndrome
Cushing's syndrome.
.

17. 17
►Typical mineralocorticoid side effects are
Typical mineralocorticoid side effects are
hypertension
hypertension (abnormally high blood
(abnormally high blood
pressure),
pressure), hypokalemia
hypokalemia (low potassium
(low potassium
levels in the blood),
levels in the blood), hypernatremia
hypernatremia (high
(high
sodium levels in the blood) without causing
sodium levels in the blood) without causing
peripheral edema
peripheral edema,
, metabolic alkalosis
metabolic alkalosis and
and
connective tissue weakness
connective tissue weakness

18. 18
►Corticosteroids can cause permanent eye
Corticosteroids can cause permanent eye
damage by inducing
damage by inducing central serous retinopathy
central serous retinopathy
(CSR, also known as central serous
(CSR, also known as central serous
chorioretinopathy, CSC).
chorioretinopathy, CSC).
►A variety of steroid medications, from anti-
A variety of steroid medications, from anti-
allergy nasal sprays (Nasonex, Flonase) to
allergy nasal sprays (Nasonex, Flonase) to
topical skin creams, to eye drops (Tobradex),
topical skin creams, to eye drops (Tobradex),
to Prednisone have been implicated in the
to Prednisone have been implicated in the
development of CSR.
development of CSR.

19. 19
►Cortisone, often mispelled cortizone, brand
Cortisone, often mispelled cortizone, brand
name Cortone, is a corticosteroid used to
name Cortone, is a corticosteroid used to
treat arthritis pain and inflammation.
treat arthritis pain and inflammation.
►Cortisone acetate may also be given in an
Cortisone acetate may also be given in an
intramuscular injection (cortisone shot).
intramuscular injection (cortisone shot).

20. 20
►Prednisone is a potent medication which is
Prednisone is a potent medication which is
used to treat many inflammatory conditions
used to treat many inflammatory conditions
including rheumatoid arthritis.
including rheumatoid arthritis.
►It is important to know the proper use of
It is important to know the proper use of
the drug and be aware of the potential
the drug and be aware of the potential
serious side effects.
serious side effects.

21. 21
►Steroid withdrawal symptoms can occur if
Steroid withdrawal symptoms can occur if
corticosteroid drugs are not discontinued
corticosteroid drugs are not discontinued
gradually.
gradually.
►Tapering the dose
Tapering the dose of steroids minimizes
of steroids minimizes
corticosteroid withdrawal symptoms.
corticosteroid withdrawal symptoms.

22. 22
►Glucocorticoid-induced osteoporosis is both
Glucocorticoid-induced osteoporosis is both
preventable and treatable.
preventable and treatable.
►Glucocorticoids (steroids) are the most
Glucocorticoids (steroids) are the most
common cause of drug-induced
common cause of drug-induced
osteoporosis.
osteoporosis.

23. 23
►The term steroids is often misunderstood.
The term steroids is often misunderstood.
►Corticosteroids (a class of drugs used to treat
Corticosteroids (a class of drugs used to treat
arthritis and many other conditions) are often
arthritis and many other conditions) are often
just called "steroids".
just called "steroids".
►So what's in a name? Confusion results when
So what's in a name? Confusion results when
they are mistaken for
they are mistaken for anabolic steroids
anabolic steroids (drugs
(drugs
used by athletes to boost strength and enhance
used by athletes to boost strength and enhance
physical performance).
physical performance).
►What is the difference between anabolic
What is the difference between anabolic
steroids and corticosteroids?
steroids and corticosteroids?

24. 24
► According to the National Institute of General
According to the National Institute of General
Medical Sciences, the term "steroid" is a chemical
Medical Sciences, the term "steroid" is a chemical
name for
name for any
any substance that has a characteristic
substance that has a characteristic
chemical structure consisting of multiple chemical
chemical structure consisting of multiple chemical
rings of connected atoms. Some common
rings of connected atoms. Some common
examples of steroids are:
examples of steroids are:
► Vitamin D
Vitamin D
► cholestrol
cholestrol
► estrogen
estrogen
► cortisone
cortisone

25. 25
►Steroids are critical for keeping the body
Steroids are critical for keeping the body
running smoothly.
running smoothly.
►Various steroids have important roles in the
Various steroids have important roles in the
body's reproductive system and both the
body's reproductive system and both the
structure and function of membranes
structure and function of membranes

26. 26
anabolic steroids
anabolic steroids
►According to the National Institute on Drug
According to the National Institute on Drug
Abuse, anabolic steroids are synthetic
Abuse, anabolic steroids are synthetic
substances related to the male sex hormones
substances related to the male sex hormones
(androgens).
(androgens).
►They promote growth of skeletal muscle
They promote growth of skeletal muscle
(anabolic effect) and the development of male
(anabolic effect) and the development of male
sexual characteristics (androgenic effects).
sexual characteristics (androgenic effects).

27. 27
►The proper term for these compounds actually
The proper term for these compounds actually
is
is "anabolic / androgenic"
"anabolic / androgenic" steroids:
steroids:
►“
“anabolic”
anabolic” refers to muscle-building
refers to muscle-building
►“
“androgenic”
androgenic” refers to increased masculine
refers to increased masculine
characteristics
characteristics
►“
“steroids”
steroids” refers to the class of drugs
refers to the class of drugs

28. 28
►Anabolic steroids are available legally only
Anabolic steroids are available legally only
by prescription, to treat conditions that
by prescription, to treat conditions that
occur when the body produces abnormally
occur when the body produces abnormally
low amounts of testosterone, such as
low amounts of testosterone, such as
delayed puberty and
delayed puberty and
some types of impotence.
some types of impotence.

29. 29
Anabolic steroids
Anabolic steroids
►They are also prescribed to treat
They are also prescribed to treat
body wasting in patients with AIDS
body wasting in patients with AIDS and
and
other diseases that result in loss of lean
other diseases that result in loss of lean
muscle mass.
muscle mass.

30. 30
Abuse
Abuse
► Anabolic steroids are being abused
Anabolic steroids are being abused by some athletes
by some athletes
and others to enhance performance or improve
and others to enhance performance or improve
physical appearance. Abuse of anabolic steroids can
physical appearance. Abuse of anabolic steroids can
lead to serious health problems, some of which are
lead to serious health problems, some of which are
irreversible. Major side effects can include:
irreversible. Major side effects can include:
► liver tumors
liver tumors
► cancer
cancer
► jaundice
jaundice
► high blood pressure
high blood pressure
► kidney tumors
kidney tumors
► severe acne
severe acne
► trembling
trembling

31. 31
►In males,
In males, side effects may include shrinking of
side effects may include shrinking of
the testicles and breast development.
the testicles and breast development.
►In females,
In females, side effects may include growth of
side effects may include growth of
facial hair, menstrual changes, and deepened
facial hair, menstrual changes, and deepened
voice.
voice. In teenagers,
In teenagers, growth may be halted
growth may be halted
prematurely and permanently.
prematurely and permanently.

32. 32
►Corticosteroids
Corticosteroids or glucocorticoids, often just
or glucocorticoids, often just
called "steroids", are drugs closely related to
called "steroids", are drugs closely related to
cortisol, a hormone which is naturally
cortisol, a hormone which is naturally
produced in the adrenal cortex (the outer
produced in the adrenal cortex (the outer
layer of the adrenal gland).
layer of the adrenal gland).

33. 33
►Corticosteroids act on the immune system
Corticosteroids act on the immune system
by blocking the production of substances
by blocking the production of substances
that trigger allergic and inflammatory
that trigger allergic and inflammatory
actions, such as prostaglandins.
actions, such as prostaglandins.

34. 34
Corticosteroids
Corticosteroids
► Betamethasone
Betamethasone (Celestone)
(Celestone)
► Budesonide
Budesonide (Entocort EC)
(Entocort EC)
► Cortisone
Cortisone (Cortone)
(Cortone)
► Dexamethasone
Dexamethasone (Decadron)
(Decadron)
► Hydrocortisone
Hydrocortisone (Cortef)
(Cortef)
► Methylprednisolone
Methylprednisolone (Medrol)
(Medrol)
► Prednisolone
Prednisolone (Prelone)
(Prelone)
► Prednisone
Prednisone (Deltasone)
(Deltasone)
► Triamcinolone
Triamcinolone (Kenacort, Kenalog)
(Kenacort, Kenalog)

35. 35
Corticosteroids (Steroids): Benefits
Corticosteroids (Steroids): Benefits
vs. Risks
vs. Risks
►Corticosteroids are powerful drugs which can
Corticosteroids are powerful drugs which can
quickly reduce swelling and inflammation,
quickly reduce swelling and inflammation,
greatly improve symptoms and provoke
greatly improve symptoms and provoke
incredible results.
incredible results.
►However, there are potential consequences and
However, there are potential consequences and
side effects.
side effects.
►The power of corticosteroids should not be
The power of corticosteroids should not be
feared, but
feared, but must
must be respected.
be respected.

36. 36
►To maximize benefits, but minimize potential
To maximize benefits, but minimize potential
side effects, steroids are usually prescribed in
side effects, steroids are usually prescribed in
low doses or for short durations.
low doses or for short durations.
►The potent effect of corticosteroids can result
The potent effect of corticosteroids can result
in serious side effects which mimic
in serious side effects which mimic
Cushing's disease
Cushing's disease, a malfunction of the adrenal
, a malfunction of the adrenal
glands resulting in an overproduction of
glands resulting in an overproduction of
cortisol
cortisol

37. 37
The list of potential side effects is
The list of potential side effects is
long and can include:
long and can include:
► increased appetite and weight gain
increased appetite and weight gain
► deposits of fat in chest, face,
deposits of fat in chest, face, upper back
upper back, and stomach
, and stomach
► water and salt retention leading to swelling and edema
water and salt retention leading to swelling and edema
► high blood pressure
high blood pressure
► diabetes
diabetes
► osteoporosis
osteoporosis
► cataracts
cataracts
► acne
acne
► muscle weakness
muscle weakness
► thinning of the skin
thinning of the skin
► increased susceptibility to infection
increased susceptibility to infection
► stomach ulcers
stomach ulcers
► psychological problems such as depression
psychological problems such as depression
► adrenal suppression and crisis
adrenal suppression and crisis

38. 38
Tappering off the dose of steroids
Tappering off the dose of steroids
►Side effects are minimized by taking the
Side effects are minimized by taking the
lowest doses possible (that still yields positive
lowest doses possible (that still yields positive
results) and following doctor's orders.
results) and following doctor's orders.
►It is important to avoid self regulation of the
It is important to avoid self regulation of the
dosage, either by adding more or stopping the
dosage, either by adding more or stopping the
drug without a schedule.
drug without a schedule.

39. 39
►Steroids
Steroids must
must be gradually reduced to permit
be gradually reduced to permit
the adrenal glands to resume natural cortisol
the adrenal glands to resume natural cortisol
production.
production.
►Eliminating doses too quickly can result in
Eliminating doses too quickly can result in
adrenal crisis
adrenal crisis (a life-threatening state caused
(a life-threatening state caused
by insufficient levels of cortisol).
by insufficient levels of cortisol).
►Another possible complication to coming off
Another possible complication to coming off
steroids is withdrawal syndrome, or rebound
steroids is withdrawal syndrome, or rebound
effect, which is the body's exaggerated
effect, which is the body's exaggerated
response to removal of the drug.
response to removal of the drug.

40. 40
Prednisone
Prednisone
►Prednisone
Prednisone is a synthetic drug closely related to
is a synthetic drug closely related to
cortisol, a hormone which is naturally produced
cortisol, a hormone which is naturally produced
in the adrenal cortex.
in the adrenal cortex.
►Prednisone is used to treat
Prednisone is used to treat rheumatoid arthritis
rheumatoid arthritis,
,
systemic lupus
systemic lupus erythematosus
erythematosus,
, polymyositis
polymyositis,
,
polymyalgia
polymyalgia rheumatica
rheumatica,
, giant cell
giant cell arteritis
arteritis,
,
vasculitis
vasculitis, and other inflammatory conditions
, and other inflammatory conditions

41. 41
►The use of oral corticosteroids is associated
The use of oral corticosteroids is associated
with an increased risk of fracture, but there
with an increased risk of fracture, but there
is limited information on the relationship
is limited information on the relationship
between corticosteroid dose, bone mineral
between corticosteroid dose, bone mineral
density (BMD), and fracture
density (BMD), and fracture

42. 42
►Oral corticosteroid treatment is associated
Oral corticosteroid treatment is associated
with osteoporosis and an increased risk of
with osteoporosis and an increased risk of
fracture
fracture

43. 43
►fracture risk doubles with each standard
fracture risk doubles with each standard
deviation reduction in bone mineral density
deviation reduction in bone mineral density
(BMD)
(BMD)

44. 44
►It is not known whether the same is true for
It is not known whether the same is true for
corticosteroid-induced osteoporosis.
corticosteroid-induced osteoporosis.
►There is some evidence that fractures
There is some evidence that fractures
associated with the use of corticosteroid occur
associated with the use of corticosteroid occur
at a higher BMD (bone mineral density ) than
at a higher BMD (bone mineral density ) than
those caused by involutional osteoporosis,
those caused by involutional osteoporosis,
although this has been disputed
although this has been disputed

45. 45
PERMISSIVE EFFECTS
PERMISSIVE EFFECTS
►Besides therapeutic effects, glucocorticoids also
Besides therapeutic effects, glucocorticoids also
possess some effects which are called
possess some effects which are called
“permissive” effects.
“permissive” effects.
►It means that in the absence of glucocorticoids,
It means that in the absence of glucocorticoids,
many normal functions become deficient.
many normal functions become deficient.
►For example, in the absence of glucocorticoids,
For example, in the absence of glucocorticoids,
the lipolytic responses of fat cells to
the lipolytic responses of fat cells to
catecholamines, ACTH and growth hormone are
catecholamines, ACTH and growth hormone are
diminished.
diminished.

46. 46
EFFECTS ON METABOLISM
EFFECTS ON METABOLISM
►Glucocorticoids promote glycogen deposition
Glucocorticoids promote glycogen deposition
in liver by inducing glycogen synthetase and
in liver by inducing glycogen synthetase and
promoting Gluconeogenesis.
promoting Gluconeogenesis.

47. 47
►They inhibit glucose utilization by peripheral
They inhibit glucose utilization by peripheral
tissues.
tissues.
►They cause increased release of glucose
They cause increased release of glucose
from liver.
from liver.
►They cause hyperglycemia and thus
They cause hyperglycemia and thus
stimulate insulin release.
stimulate insulin release.

48. 48
►They stimulate lipase and cause lipolysis.
They stimulate lipase and cause lipolysis.
►They also promote lipolysis due to glucagon,
They also promote lipolysis due to glucagon,
growth hormone, adrenaline and thyroxine.
growth hormone, adrenaline and thyroxine.
►The cAMP induced breakdown of triglycerides is
The cAMP induced breakdown of triglycerides is
enhanced and fatty acids and glycerol are
enhanced and fatty acids and glycerol are
released into the circulation.
released into the circulation.

49. 49
►The increased insulin release stimulates
The increased insulin release stimulates
lipogenesis and to a lesser degree inhibit
lipogenesis and to a lesser degree inhibit
lipolysis, leading to a net increase in fat
lipolysis, leading to a net increase in fat
deposition
deposition

50. 50
►Glucocorticoids cause breakdown of proteins
Glucocorticoids cause breakdown of proteins
and mobilization of aminoacids from
and mobilization of aminoacids from
peripheral tissues.
peripheral tissues.
►This protein breakdown is manifested as ---
This protein breakdown is manifested as ---
muscle wasting, lipolysis, loss of osteiod
muscle wasting, lipolysis, loss of osteiod
from bone and thinning of skin
from bone and thinning of skin

51. 51
►Thus glucocorticoids are catabolic
Thus glucocorticoids are catabolic.
.
►They try to maintain glucose supply to brain,
They try to maintain glucose supply to brain,
during starvation, by exerting following effects.
during starvation, by exerting following effects.
►Gluconeogenesis.
Gluconeogenesis.
►Inhibition of peripheral glucose uptake.
Inhibition of peripheral glucose uptake.
►Release of aminoacids from muscle catabolism.
Release of aminoacids from muscle catabolism.
►Stimulation of lipolysis.
Stimulation of lipolysis.