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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.

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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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