Socrates and Sophistry: Croup
Socrates’ manner of philosophy was one of hypotheses. He is thought to be one of the forefathers of this type of thinking. He employed a method of negative hypothesis elimination, whereby a series of questions could be asked, and in this way eliminate incorrect suppositions, and those that are contradictory.
In the Socrates and Sophistry series we will continue to look at either widely disseminated misinformation that is carried on through generations of texts and teachers, or ask questions where there is no accepted and agreed upon answer, or simply ask questions where the answer may be quite clear, just out of reach of us mortals with Google. Again we encourage anybody, of any persuasion, qualification, or inclination to contribute. There can be no wrong answers, only crowdsourced ideas.
Question:
Why does dexamethasone work so quickly (as early as 30 minutes) in croup?
Conventional teaching:
Glucocorticoids are required to bind to ligands within the cell and be transported into the nucleus, where they have their effect on DNA transcription.
But…to me, this doesn’t make sense.
What are your thoughts?
We open this to our faithful readers…
Emergency physician. Lives for teaching and loves clinical work, but with social media, she is like the syndromic cousin in the corner who gets brought out and patted on the head once in a while | Literary Medicine | @eleytherius | Website |
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Some possibilities: It is becoming increasingly understood that steroids do not only act through the classical nuclear receptor pathway, but also through non-genomic pathways… One option is that dexamethasone acts as a vasoconstrictor via an adrenergic alpha-1 pathway, helping to clear edema (in a similar sense to nebulised adrenaline in acute stridor). The papers below also outline some other inflammatory mechanisms.
Alangari A. Genomic and non-genomic actions of glucocorticoids in asthma. Annals of Thoracic Medicine 2010 07;5(3):133-139.
Croxtall, J. D., Peter Th W van, H., Choudhury, Q., Gilroy, D. W., & Flower, R. J. (2002). Different glucocorticoids vary in their genomic and non-genomic mechanism of action in A549 cells. British Journal of Pharmacology, 135(2), 511-9