Cortisone – Effects, Uses and Side Effects
Cortisone is a naturally occurring steroid hormone and medication with anti-inflammatory and immunosuppressive properties, used to treat a wide range of medical conditions.
Things worth knowing about "Cortisone"
Cortisone is a naturally occurring steroid hormone and medication with anti-inflammatory and immunosuppressive properties, used to treat a wide range of medical conditions.
What is Cortisone?
Cortisone is a steroid hormone naturally produced by the adrenal cortex. It belongs to the class of glucocorticoids and plays a key role in regulating inflammation, immune responses, metabolism, and the stress response. As a medication, cortisone and its biologically active form cortisol (hydrocortisone) have been widely used in medicine since the 1950s.
Mechanism of Action
Cortisone itself is biologically inactive and must be converted by the liver into its active form, cortisol. Cortisol binds to specific glucocorticoid receptors inside cells and alters gene expression. This leads to suppression of pro-inflammatory molecules such as cytokines and prostaglandins, as well as reduced activity of immune cells.
- Anti-inflammatory effect: Cortisone reduces the production of inflammatory substances in the body.
- Immunosuppression: Activity of immune cells such as T-lymphocytes and macrophages is inhibited.
- Metabolic effects: Cortisone influences carbohydrate, protein, and fat metabolism.
Medical Indications
Cortisone and synthetic glucocorticoids are used to treat a broad range of conditions:
- Inflammatory diseases: Rheumatoid arthritis, Crohn's disease, ulcerative colitis
- Allergic reactions: Severe allergies, anaphylactic shock
- Respiratory conditions: Bronchial asthma, COPD exacerbations
- Skin diseases: Eczema, psoriasis, contact dermatitis
- Autoimmune diseases: Lupus erythematosus, acute relapses of multiple sclerosis
- Transplant medicine: Prevention of organ rejection
- Hormonal disorders: Adrenal insufficiency, Addison's disease
Forms of Administration and Dosage
Cortisone is available in various forms:
- Tablets/Capsules: For systemic treatment of chronic conditions
- Injections: Directly into joints (intra-articular) or into the bloodstream (intravenous)
- Creams and ointments: For local treatment of skin conditions
- Inhalers: For respiratory conditions such as asthma
- Eye drops and nasal sprays: For local treatment of allergies or inflammation
The dosage depends on the condition, its severity, and the route of administration, and must always be determined by a physician. For long-term treatment, the dose is generally reduced gradually (tapering) to avoid adrenal insufficiency.
Side Effects
Cortisone is effective but can cause side effects when used at high doses or over a prolonged period:
- Weight gain and redistribution of body fat (Cushing's syndrome)
- Elevated blood sugar levels, potentially leading to steroid-induced diabetes
- High blood pressure
- Osteoporosis (bone loss) with long-term use
- Suppression of the immune system, increasing susceptibility to infections
- Psychological changes such as mood swings and sleep disturbances
- Skin thinning (skin atrophy) with topical application
- Cataracts and glaucoma with prolonged use
Local forms of administration (e.g., inhalers, creams) generally have significantly fewer systemic side effects compared to oral or intravenous preparations.
Important Notes
Cortisone should not be stopped abruptly after long-term use, as the body's own production of cortisol may be suppressed. Gradual tapering under medical supervision is essential. Patients with diabetes, osteoporosis, peptic ulcers, or active infections should only use cortisone under close medical monitoring.
References
- Buttgereit F, Burmester GR, Lipworth BJ. Optimised glucocorticoid therapy: the sharpening of an old spear. Lancet. 2005;365(9461):801-803.
- World Health Organization (WHO) – Essential Medicines List: Glucocorticoids. www.who.int
- Rhen T, Cidlowski JA. Antiinflammatory action of glucocorticoids – new mechanisms for old drugs. New England Journal of Medicine. 2005;353(16):1711-1723.
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