Cortisone itself is basically not an effective drug, because the hormonal drug known as cortisone usually does not contain the inactive cortisone, but its active form cortisol (hydrocortisone). Cortisone is converted by enzymes into the actual active substance cortisol. Both cortisone and its active form belong to the group of steroid hormones.
Steroid hormones are primarily produced in the adrenal cortex and from there are distributed throughout the body via the bloodstream. More precisely, cortisol belongs to a certain subgroup of steroid hormones, the glucocorticoids. Cortisol suppresses defensive reactions of the body’s own immune system and has an anti-inflammatory effect.
In addition, the body temperature increases under the influence of cortisone, the energy metabolism is activated and pain reactions are inhibited. These drugs are therefore used in the following diseases:
- Various types of inflammation, in the context of injuries
- Inflammatory rheumatic diseases
- Diseases caused by an overactive body’s own defence system (immune system), such as allergies and so-called autoimmune diseases, in which the body’s defence is mistakenly directed against healthy body tissue and thus healthy organs are destroyed by immune cells that would normally only destroy cells infected with bacteria or viruses or cancer cells
- Swelling, redness, warming, disturbed function and pain
Cortisone blocks the release of these inflammatory and immune messenger substances from the body cells and inhibits their effect in the inflamed tissue. This explains why cortisone has anti-allergic, anti-rheumatic and immunosuppressive (dampening effect on the body’s own defence system) effects.
In addition, cortisone can suppress the growth of tumours in cancer. The term “glucocorticoids” refers to the effect of the substances, as they promote the formation of new glucose from proteins and fats (“gluco” = sugar), and the origin of the hormones is also included in the term, as they are produced in the cortex (more precisely the adrenal cortex). The active hormone cortisol is mainly responsible for the control of catabolic metabolic pathways.
The regulation of the sugar metabolism and thus the provision of energy-rich compounds is one of the most important tasks of the hormone. In this context, it stimulates the formation of sugar molecules (gluconeogenesis) in the cells of the liver, promotes the breakdown of fat and increases the overall protein breakdown. In addition, it has an inhibitory effect on the regulated processes of the immune system and is therefore able to inhibit excessive reactions and inflammatory processes.
Cortisol, known as the “stress hormone”, has many different regulatory functions within the organism. In the course of long-term stress situations, cortisol is increasingly produced and released into the bloodstream. In this context it has a similar effect to the catecholamines adrenaline and noradrenaline.
In contrast to adrenaline, however, since it is not released until much later. In the case of cortisol, binding to a specific receptor of the cell (G-protein-coupled receptors) is not possible and therefore it must first penetrate completely into the interior of the cell. From there, cortisol can specifically intervene in metabolic pathways.
In addition, cortisone (actually the active form cortisol) has an inhibitory effect on the immune system. The influence on the immune system is also delayed until after the actual release of the hormone. Once the hormone has developed its effect, there is a marked increase in the number of white blood cells (lymphocytes) with a simultaneous reduction in the number of natural macrophages.
However, cortisol is not released randomly into the bloodstream, but is strictly controlled by a part of the brain, the hypothalamus and the pituitary gland. During stress, physical exertion and/or energy requirements, the hypothalamus releases a hormone called CRH (corticotropin-releasing hormone), which in turn stimulates the pituitary gland to secrete ACTH (adrenocorticotropic hormone). ACTH then stimulates the release of cortisol.
