Effects of cortisone
introduction
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). Enzymes convert cortisone 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 distributed in the body via the bloodstream. More precisely, cortisol belongs to a specific subgroup of steroid hormones, the glucocorticoids.
Cortisol suppresses defense reactions of the body's own immune system and has an anti-inflammatory effect. In addition, the body temperature rises under the influence of cortisone, the energy metabolism is activated and pain reactions are inhibited. Therefore, these drugs are used for the following diseases:
- different types of inflammation, as part of injuries
- inflammatory rheumatic diseases
- Diseases that are caused by an overactive body's own defense system (immune system), such as allergies and so-called autoimmune diseases, in which the body’s defenses are falsely directed against healthy body’s own tissue and thus healthy organs are destroyed by immune cells, which normally only cells or infected with bacteria or viruses Destroy cancer cells
- Swelling, redness, warming, impaired function and pain
Cortisone blocks that 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 an antiallergic, anti-rheumatic and immunosuppressive effect (dampening the body's own immune system). In addition, cortisone can suppress the growth of tumors in cancer.
On the one hand, the term "glucocorticoids" indicates the effect of the substances, because they promote the formation of new glucose Proteins and fats ("gluko" = sugar), on the other hand there is also the origin of the Hormones in the term, because they are produced in the "cortex", i.e. the cortex (more precisely, the adrenal cortex).
How does cortisone work?
The active hormone cortisol is primarily used to control degrading (catabolic) Metabolic pathways responsible.
The Regulation of the sugar metabolism and thus the provision of high-energy 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 Fat loss and increases the total Protein breakdown.
In addition, it has an inhibiting effect on the regular processes of the Immune system and is therefore able to inhibit excessive reactions and inflammatory processes.
That as "Stress hormone“Well-known cortisol has many different regulatory functions within the organism.
In the course of long-term stressful situations, cortisol is increasingly produced and in the blood circulation poured out. It has an effect similar to that in this context Catecholamines adrenaline and norepinephrine. Since, however, in contrast to adrenaline, it only comes in much later.
In the case of cortisol, the binding to a certain 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 of cortisol) has one inhibitory effect on the immune system.
The immune system is also influenced with a time delay to the actual release of the hormone.
After the hormone has taken effect, there is a significant increase in white blood cells (Lymphocytes) with a simultaneous reduction in the number of natural phagocytes (Macrophages).
However, cortisol is not released into the bloodstream randomly, but strictly through part of the bloodstream Brain, the Hypothalamus and the Pituitary gland, controlled.
During stress, physical exertion and / or energy demand, the hypothalamus releases a hormone called CRH (Corticotropin-releasing hormones), which in turn stimulates the pituitary gland to do so ACTH (Adrenocorticotropic hormone) to secrete. ACTH then stimulates cortisol release.
Mechanism of action
Cortisone penetrates the cell wall a body cell and binds to one matching cortisone receptor inside the cell. These glucocorticoid receptors come from almost everywhere in the body but they are increasingly found in the Musculature, in adipose tissue, in the skin, in the liver and in lymphoid tissue. This active ingredient-receptor complex migrates into the cell nucleus, in which the Genetic material (DNA) lies. The cortisone complex is now mediated by the receptor on certain sections of the genetic material, which influences the development of many different proteins. These proteins play an important role in the Development of inflammation or in the immune system. This mechanism of inhibiting the production of proteins results in the desired, but also the, after a certain time unwanted effects of cortisone. Since cortisone only inhibits the formation of inflammatory and immune messenger substances, the effect is only set after at least 20 minutes up to several days a.
However, other mechanisms of action of cortisone are also assumed, as well immediate effects to be watched. Cortisone also seems direct to act on the cell walls and on them one stabilizing effect to have. This prevents water from escaping into the tissue, which is important, for example, if due to allergic reactions or a Insect bite the throat swells from the fluid in the tissue and the airway may be compromised. In these cases Cortisone as an emergency medication The exact mechanisms of action of this rapid cortisone effect have not yet been adequately researched.
Another effect of cortisone is in treating the bronchial asthma used. Cortisone makes the mucous membranes swell, which widens the airways that are narrowed by asthma. Cortisone also lowers toughness and inhibits the formation of bronchial mucus and contributes to the relaxation of the cramped bronchial muscles.
Have among other things Glucocorticoids also Influence on the electrolyte balance (mineral corticoid effect). This effect is more pronounced with the body's own cortisone than with a synthetic cortisone. The fluid excretion is reduced by cortisone and so saves body salt, resulting in a Increase in blood pressure leads. Potassium is an important body salt, its concentration in the blood may not be exceeded or undercut. Usually when treated with cortisone no additional potassium required, but regular blood potassium checks are recommended.
Cortisone as a stress hormone
The cortisone concentration in the blood follows a natural daily rhythm (circadian rhythm) and therefore varies at different times during the day and at night. The cortion concentration in the blood rises on average around three o'clock in the morning. The growth hormone HGH (Human Growth Hormon), which is involved in the nightly recovery processes, is displaced by the cortisone. The formation of cortisone is controlled by the so-called internal clock. Cortisone prepares the body for waking up early in the morning. The cortisone level reaches its highest values between five and eight o'clock in the morning, after which it falls again continuously.
Elevated cortisone levels can be measured during stress, hypoglycaemia or during pregnancy.
Please also read: Stress in pregnancy, cortisone in children
Cortisone protects the body from the negative consequences of severe stress and adapts it to current environmental conditions.
For example, it raises the blood sugar level, which provides energy, and is involved in the contraction of vessels in the body, so it has a blood pressure-increasing effect. The increased cortisone concentration in the blood stimulates the body to sweat, and digestion is slowed down (as more blood is drawn into the muscles).
Cortisone as a so-called "stress hormone" can also have effects on the central nervous system, where it can be euphoric (triggering feelings of happiness) or dysphoric (ill-tempered, irritable, mood-worsening) through stimulation.
Regulation of the blood sugar level by cortisone
Cortisone belongs to the group of glucocorticoids. These substances help the body so that it has sufficient nutrients and building blocks available in stressful situations (but also in phases of hunger between meals). Cortisone affects the so-called catabolic metabolism, which means that it mobilizes the resources stored in the body. Cortisone, for example, promotes the production of blood sugar in the liver (Gluconeogenesis) and stimulates fat mobilization from fat cells (Lipolysis). In addition, the release of glucagon is promoted by cortisone. Glucagon is the so-called antagonist of the hormone insulin. Glucagon is released into the blood by the pancreas after a protein-rich meal or when the blood sugar level drops, and causes the blood sugar level to rise. By stimulating the effects of glucagon, cortisone also causes blood sugar to rise. Cortisone also has a direct inhibitory effect on cellular sugar absorption, which increases the sugar level in the blood and inhibits the release of insulin. Insulin can then no longer lower blood sugar levels.
Since cortisone is able to increase the blood sugar level, treatment with cortisone can promote a diabetic metabolic situation with high blood sugar concentrations.
Effect of cortisone in andrenogenital syndrome
The andrenogenital syndrome is an inherited metabolic disorder in which a disruption of hormone production in the Adrenal cortex present and through a masculinization with girls or one premature sex development in boys and Disturbances in the salt balance with fluid loss expresses. The formation of cortisone and aldosterone (thirst hormone) is disturbed in andrenogenital syndrome. Due to the lack of cortisone, the central control in the brain tries (Hypothalamus and Pituitary gland) To stimulate the adrenal gland in a compensatory way by increasing the release of corticotropin from the pituitary gland. Corticotropin stimulates the adrenal cortex to produce its hormones. This ultimately leads to complete exhaustion of the formation of cortisone in the adrenal cortex. A medicamentous gift of cortisone removes the lack of cortisone in the blood, the pituitary gland stops the overproduction of corticotropin, and the adrenal cortex recovers and the symptoms caused by the lack of cortisone disappear.
unwanted effects
The undesirable effects of cortisone are directly related to the desired effects. Due to the interference of cortisone in the sugar, protein and bone metabolism as well as in the body's water balance, taking high doses of cortisone over a longer period of time, for example, can lead to a permanently high blood sugar level or bone loss (osteoporosis). Signs of Cushing's disease can also be an undesirable effect of cortisone, such as a full moon face, obesity on the trunk or muscle weakness. To prevent these side effects, a dose of cortisone was determined (so-called Cushing's threshold), up to which the occurrence of Cushing's syndrome is highly unlikely.
In addition, cortisone weakens the immune system, which prevents the defense reactions against germs and infections can occur more easily.
A drug administration of cortisone also disrupts the hormonal control loop for the formation of endogenous cortisone. For this reason, therapy with cortisone should never be stopped suddenly, instead the body should be given time to adjust by slowly reducing the dose in order to produce sufficient cortisone itself again.
The simultaneous consumption of alcohol, especially in larger quantities, can intensify the effect of cortisone and thus lead to more side effects (see: Cortisone and alcohol - are they compatible?).
Read more on the topic: Taper off cortisone
