Cortisone is a hormone produced by the body and one of the best-known medications of all. It is successfully used for a wide variety of diseases, and at the same time many people are afraid of possible risks and side effects. But today there are clear therapy guidelines and precise ideas about when and how cortisone can be used as a medicine.
Cortisone and cortisol
Cortisone (cortisone) is based on cortisol, a vital hormone that is formed in the adrenal cortex from cholesterol, among other substances, and belongs to the glucocorticoids. In 1936, three independent groups of researchers succeeded in isolating a substance from the adrenal gland that was later named cortisone.
Ten years later, this substance could also be produced synthetically in the laboratory. The first successful therapy was the treatment of a young American woman with severe rheumatoid arthritis in 1948 – the patient was able to walk again without pain after a few days.
The corticoids used today are chemically related to the “natural” cortisone. What is actually important for the metabolism is cortisol (also known as hydrocortisone) or, in therapy, its acetic acid ester cortisone acetate; in principle, cortisone is a form of cortisol inactivated by oxidation. Nevertheless, the term “cortisone” has become colloquially accepted for all drugs with cortisol effect.
The regulatory mechanism of glucocorticoids.
At rest, the body produces 8 to 25 milligrams of cortisol per day, and up to 300 milligrams during stressful conditions. Because the hormone must always be available to the body, its occurrence is controlled by a complicated regulatory mechanism.
Within this mechanism, the largest amount of cortisol is produced in several spurts until the morning between 6 and 8 a.m., after which hormone production decreases again until a minimum is reached at midnight.
Precise knowledge of this regulatory circuit, possibly even individually for each patient, is one of the basic requirements for successful cortisone treatment.
Glucocorticoids in metabolism
Glucocorticoids play an important role in many metabolic processes. When needed, they mobilize the energy reserves stored in the body, for example, by increasing blood glucose levels and boosting fat release through various processes – and are therefore often referred to as stress hormones.
In addition, glucocorticoids have an important function in inflammation: They can inhibit inflammatory reactions at various levels (antiphlogistic effect) – the main property for which cortisol is used medicinally.
As a side effect, muscle and bone mass are reduced. In addition, glucocorticoids also affect water-electrolyte balance – an effect that is usually undesirable with cortisol as a drug and is therefore suppressed as a side effect in the synthetic preparations.
