Because cortisone works as a drug only in doses that are above the natural hormone level, the body reacts to the excess hormone. The side effects are therefore quasi-normal reactions to the corticosteroid stimuli – as these are increased, so are the effects. Side effects occur primarily with prolonged treatment, while short-term use is rarely problematic.
Desirable effects of cortisone treatment.
Some of the side effects are sometimes desired effects: For example, suppression of the immune system (immunosuppression) may be desired, such as in the therapy of exuberant defenses in the context of an allergic reaction, but it may also be a serious side effect, leading to increased susceptibility to infection.
Typical side effects of cortisone
Adverse side effects as a result of direct hormone action are:
- The so-called Cushing’s syndrome with full moon face, bull neck, facial redness and brittle skin vessels.
- Blood pressure rise
- Blood sugar increase
- Increase in blood lipid levels
- Increased susceptibility to infection
- Weight gain
- Water retention in the tissue
- Osteoporosis: although cortisone does not appear to be the sole trigger, it may increase the risk if susceptible. Therefore, before prolonged cortisone therapy, it is necessary to determine the risk of osteoporosis (bone densitometry) and, if necessary, to initiate preventive measures such as calcium administration or the intake of vitamin D and fluorine.
Cortisone affects the regulatory circuit of hormones.
Another group of side effects affects the regulatory circuit of hormones. By the supply of the glucocorticoid from the outside, the own hormone production falls asleep and can even lead to the shrinkage of the adrenal cortex.
This condition becomes problematic when therapy is discontinued, because it takes some time for the patient’s own production to get going again. In stressful situations, such a patient then finds himself in danger because the adrenal cortex cannot provide the hormone in sufficient quantities quickly enough.
Conversely, a so-called rebound effect can occur – the increased recurrence of disease symptoms if the drug is discontinued too quickly instead of slowly phased out.
Guidelines for proper dosing
The now well-researched consequences of cortisone therapy have also led to the drug being used differently today than it was when it was first discovered. Dosage is based on the severity of the individual clinical picture and the patient’s response.
Acute illnesses are generally treated only for a short time, while chronic illnesses are usually treated for the long term. Efforts are made to help chronic patients with the smallest dose that is still effective.
This process is long and difficult, because after a successful initial treatment with a relatively high dosage, one tries to reduce the active ingredient dosage further and further. However, at very low dosages, this process can only be accomplished very slowly and in very small steps.
It also depends on the patient
The goal is always to keep undesirable side effects as low as possible. To do this, the physician and patient must work together. The patient himself should intensively deal with his cortisone treatment and inform himself as well as possible in order to actively participate in the therapy management.
This includes, among other things, a low-salt, balanced diet in which low-fat dairy products and fruits and vegetables play an important role. Exercise and sport likewise contribute to fewer complaints and side effects.
