What side effects can occur with cortisone?
The occurrence and severity of side effects depend on the type of disease and the duration and dosage of cortisone intake. The side effects are usually closely linked to the actual function of cortisone in the body. It must therefore be clear when prescribing and taking medicines containing cortisone that it is not just a medicine but also a hormone produced naturally in the body.
The intervention in the cortisone household will therefore in any case have an influence on important metabolic processes in the organism. As a rule of thumb, the higher the dose taken and the longer the period of time over which it is taken, the more lastingly the natural hormone balance is affected. When taking low-dose cortisone preparations over a short period of time, no serious side effects are to be expected as a rule.
In a few cases, patients report occasional headaches, but these cannot be attributed with certainty to taking the drug. Long-term overdose, however, can cause serious problems and consequences. Some patients report side effects that are very similar to the symptoms of a disease called Cushing’s syndrome after a long period of high doses of cortisol.
If long-term therapy is needed, reducing the daily dose may reduce the risk of developing side effects. The following symptoms may occur with long-term use: When using cortisone as an ointment the following side effects are possible: delayed wound healing, steroid acne (similar to normal acne), thinning of the skin. When used as a nasal spray or for inhalation, bacterial and fungal infections of the respiratory tract may occur.
This is caused by the inhibition of the immune system in this area. Taking alcohol during treatment with cortisone increases the risk of side effects (see: Cortisone and alcohol – is it tolerated?). – You often suffer from a too high blood sugar level, which can lead to diabetes mellitus.
- In addition, many of these patients have a severe immune deficiency. – High blood pressure can also occur. – In addition, the excessive cortisone content causes muscle atrophy in the arms and legs with simultaneous fat accumulation in the trunk area, also known as trunk obesity.
Water retention is also possible. – The occurrence of osteoporosis and the death (necrosis) of bones, especially bone heads, is also possible in the course of a long-term cortisone overdose. – A further side effect is the inhibition of the natural processes during blood coagulation.
Patients often complain of delayed blood coagulation, poorer wound healing and the appearance of punctiform haematomas all over the body. – In addition, the use of cortisone can lead to a sharp increase in intraocular pressure (glaucoma) and/or lens opacity (cataract). – Since the production of gastric mucus is restricted in the course of cortisone therapy, stomach pain and inflammation of the gastric mucosa often occurs.
- Psychological complaints such as depression, loss of appetite and drive and euphoria are possible. A cortisone therapy can cause side effects that affect the eye. These are two very well known and common clinical pictures, namely glaucoma and cataract.
Cataract, also called cataract, is a clouding of the lens that affects 39% of men and even 46% of women from the age of 75. Cortisone therapy, whether topical or systemic, can lead to such cataracts. Ultimately, only cataract surgery is considered for the treatment of cataracts, as there are no conservative or drug-based treatment options.
The second clinical picture that can be promoted by therapy with cortisone is glaucoma, also known as glaucoma. A frequent anxiety of patients regarding cortisone therapy refers to potential consequences of the therapy for the psyche. Currently, there is an increasing number of questions in various forums on the subject of “cortisone and psychoses”.
It is known that as a rare side effect of a therapy with cortisone, especially a long-term, high-dose therapy, mood changes in the sense of a depressed or euphoric mood or even depressive symptoms can occur. However, it is questionable to what extent individual factors, risks or even previous psychological illnesses also play an increased role in these cases. In the case of psychoses, the study situation is rather vague at the current time.
There are rare cases of patients who have developed psychotic symptoms during a high-dose and long-term therapy with cortisones. In most cases, however, these were temporary dementia symptoms that have completely receded. Older people were also more frequently affected.
Some studies also showed that only patients with a psychiatric pre-existing condition in the sense of a psychotic disorder tended to psychosis when they were treated with high-dose cortisone. It cannot therefore be assumed with certainty that cortisone was actually responsible for the psychoses. Cushing’s syndrome describes the symptomatic manifestation of an excess of cortisone (hypercortisolism) in the body.
This results in typical symptoms that can be summarized as a syndrome. The majority of Cushing’s syndromes are caused by long-term therapy with cortisone. There are also so-called endogenous Cushing’s syndromes, which are caused by hormone-producing tumours.
Typical symptoms of Cushing’s syndrome are truncal obesity with a bull’s neck and a full moon face, osteoporosis, loss of strength due to a reduction in muscle mass, high blood pressure and thinning of the skin. Psychological changes, such as depressive episodes or euphoria, are also possible. A short-term side effect of a cortisone injection can be a kind of flush.
A flush is a reddening of the upper body and face that occurs in attacks. However, this side effect disappears after a short time and has no worrying effects or consequences. Apart from a flush, redness in the sense of telangiectasia can occur.
These are dilations of very small blood vessels, so-called capillaries. These occur when cortisone is applied locally to the skin and are often irreversible. Both systemic and local therapy with cortisone can lead to a so-called steroid acne.
However, in local therapy it is far less frequent than in systemic cortisone therapy. It is most frequently found in patients who receive cortisone in the long term for the treatment of autoimmune diseases, after organ transplants or in asthma. Typically, dark red papules, which look like pimples, appear on the back and shoulders, but also on the face.
Later, the classic comedones develop, which resemble a pimple with a black tip. If it is therapeutically justifiable, cortisone therapy can be reduced somewhat for treatment. Often, however, cortisone is not dispensable for the treatment of another disease, so that steroid acne is treated analogously to dermatological acne therapy.
According to current studies, long-term high-dose therapy with cortisone can have negative effects on the liver. The underlying mechanisms are not yet fully understood, but there is evidence that cortisone interferes with the lipid metabolism of the liver. This leads to increased fat deposits in the liver and the risk of steatosis hepatis, a fatty liver, increases.
However, it is possible to take action oneself to reduce the risk of fatty liver under cortisone therapy. A low-fat diet during cortisone therapy reduces the risk of fatty liver. Increased sweating, high blood pressure and restlessness are among the symptoms that usually only occur with high-dose and long-term cortisone therapy.
Women may react more sensitively to cortisone and occasionally suffer from increased sweating and hot flushes. Overall, however, sweating is one of the rather rare and unpleasant, but not threatening, side effects of cortisone. A possible side effect of cortisone is the retention of water in the tissue, which is also known as oedema.
Cortisone affects important channels in the kidney, which are responsible for the reabsorption of water and electrolytes. Cortisone promotes the reabsorption of sodium and water into the body, which would otherwise have been excreted with the urine. The water accumulates in the body tissue and causes oedema.
In short-term cortisone therapy, however, this effect is not as great and the edema is flushed out again by itself after the cortisone is discontinued. Cortisone has a so-called diabetogenic effect. It affects the fat and carbohydrate metabolism in the body in various ways and can thus increase blood sugar levels.
Important diabetogenic effects include the formation of glucose in the liver and the inhibition of insulin secretion. Long-term cortisone therapy can thus also cause diabetes mellitus in a healthy person. However, this side effect is particularly relevant for people who already have diabetes, especially for patients with diabetes mellitus type I.
Blood sugar is elevated as a result of therapy with cortisone, which means that larger quantities of insulin may have to be administered. As a diabetic, one should consult the doctor treating him/her before cortisone therapy, so that the drug therapy can be adjusted. Long-term cortisone therapy should never be terminated abruptly, but should always be discontinued.
Abrupt discontinuation of a high-dose, long-term cortisone therapy can lead to symptoms of adrenal cortex insufficiency. The externally supplied cortisone inhibits the production of the body’s own adrenal cortex, so that too little adrenal cortex hormone is available when the therapy is abruptly discontinued. Possible symptoms are a drop in blood pressure, fatigue, exhaustion, salt cravings and lack of strength.
As a complication, a so-called “Addison’s crisis” can even occur. The consequences are fever and drowsiness, vomiting, diarrhoea and hypoglycaemia. In addition, severe dehydration and an extreme drop in blood pressure, even shock, can occur.
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