What Is Cortisone? History, Mechanism, and Medical Applications
Cortisol or cortisone is a type of steroid hormone produced by the adrenal cortex. It is a naturally occurring corticosteroid that is even used as a pharmaceutical drug. Cortisone named glucocorticoid is primarily known as an agent responsible for the conversion of proteins to carbohydrates. Cortisone, in the form of a mineral corticoid, helps regulate the salt metabolism in the body. Cortisone is given mainly as a prodrug for its anti-inflammatory effects. It can be converted into an active corticosteroid by the liver after being injected into the body for being effective.
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History of Cortisone
Cortisone was first identified by the American doctors Edward Calvin Kendall and Harold L Mason. During its early stages of discovery, cortisone was known by the name Compound E and cortisol was named Compound F. In the year 1949, a group of doctors discovered that cortisone, when injected in large doses, helped in the treatment of patients with severe rheumatoid arthritis. Later, in the year 1950, Kendall and his colleagues were awarded the Nobel Prize in Physiology for the discovery of the structure and functions of adrenal cortex hormones, including cortisone. Cortisone was first introduced as a commercial drug by Merck & Co. in the 1950s.
Cortisone was influential in the treatment of rheumatoid arthritis, but in the process showed a variety of side effects on the patients, because of which it was later replaced by substitutes that did not show any side effects.
Production of Cortisone
Cortisone is primarily produced by the adrenal cortex. It is one of the end products of a process called steroidogenesis. Steroidogenesis is a process whereby cholesterol is synthesised and passes through a series of modifications in the adrenal cortex to form steroid hormones. In peripheral tissues, such as the kidneys, the cortisol is rendered to inactive cortisone. If the active cortisol is released into the kidney, it might increase the blood pressure in human beings and cause adverse health issues.
As though cortisone is mainly produced by the adrenal cortex, its quantity is very minimal. The amounts of cortisone present in nature are also minimal, which was not enough for clinical trials. Still, in later years scientists found a way to produce cortisone from deoxycholic acid, a bile constituent.
Cortisone Use
Cortisone use is extensive in the field of medicine. People often misunderstand cortisol shot as cortisone. When people say that they are getting a cortisone shot, they actually might be receiving hydrocortisone or one of the many synthetic cortisol steroids. Cortisone shots are injected as a prodrug to be converted into active cortisol by the liver and put into effective use by the body.
Cortisol steroids are used in the field of medicine to treat various ailments. Corticosteroid shots can be induced into the body in many ways. Some of which include intravenously (through the veins), orally, intra-articularly (through the joints), and transcutaneously (into the skin). These steroid shots can prevent the body from numerous ailments such as inflammation, pain, and swelling.
Cortisol shot is used in the treatment of various kinds of cancers, such as leukaemia and lymphoma. Cortisone steroid injection can be used to provide short-term relief from joint pain and inflammation. Dermatologists use cortisone eczema treatment and atopic dermatitis treatment.
Cortisone helps to reduce the side effects such as vomiting and nausea caused by chemotherapy drugs.
Side Effect of Cortisone
Cortisone has been proven to be effective against many pain and ailments, but long-term use can have serious side effects on the human body. The oral use of cortisone has several adverse effects on the body. A person consuming cortisone regularly can experience anxiety, depression, cataracts, glaucoma, Cushing’s syndrome, increased infection risk, or impaired growth.
A person consuming hydrocortisone can experience difficulty in sleeping, mild headache, increased appetite, irritability in the skin, nausea, swelling of ankles and feet, heartburn, and muscle weakness.
FAQs on Cortisone: Key Roles, Uses, and Benefits in Biology
1. What is cortisone and how is it related to cortisol?
Cortisone is a steroid hormone that acts as a prodrug, meaning it is the inactive precursor to the active hormone, cortisol. In the body, cortisone is converted into cortisol, primarily in the liver. Cortisol is the hormone that carries out the physiological functions, such as regulating metabolism, reducing inflammation, and managing stress responses. Both are produced by the adrenal cortex.
2. What is the primary function of cortisone in the human body?
The primary function of cortisone, after its conversion to cortisol, is to help the body manage stress and maintain homeostasis. Its key functions include:
- Metabolism Regulation: It aids in gluconeogenesis, the process of converting proteins and fats into glucose for energy.
- Immune Response Suppression: It has powerful anti-inflammatory effects by inhibiting immune cells and the production of inflammatory substances.
- Blood Pressure Maintenance: It helps regulate blood pressure and cardiovascular function.
3. For which medical conditions is cortisone treatment commonly prescribed?
Due to its strong anti-inflammatory properties, cortisone medication is prescribed for a wide range of conditions. Common examples include:
- Inflammatory Conditions: Arthritis, tendonitis, and bursitis.
- Autoimmune Diseases: Lupus, rheumatoid arthritis, and multiple sclerosis.
- Skin Conditions: Severe eczema, psoriasis, and allergic rashes (often as a topical cream).
- Allergic Reactions: Severe asthma and anaphylaxis.
- Certain Cancers: To manage side effects of chemotherapy or treat leukaemia and lymphoma.
4. What are the potential side effects associated with cortisone use?
While effective, cortisone treatment can have significant side effects, especially with long-term or high-dose use. These can include weight gain, fluid retention, increased blood pressure, mood swings, cataracts, and elevated blood sugar. A more serious long-term risk is osteoporosis (bone thinning) and an increased susceptibility to infections due to its immunosuppressive effects.
5. Why is cortisone classified as a steroid hormone?
Cortisone is classified as a steroid because its chemical structure is derived from cholesterol, featuring a characteristic four-ring carbon framework. Specifically, it is a corticosteroid, a class of steroid hormones produced in the adrenal cortex. This is distinct from anabolic steroids, which are primarily involved in muscle growth and male sexual characteristics.
6. How does cortisone actually work to reduce inflammation?
Cortisone reduces inflammation at a cellular level after being converted to cortisol. Cortisol enters cells and binds to glucocorticoid receptors. This complex then moves into the nucleus and suppresses the genes responsible for producing pro-inflammatory substances like prostaglandins and leukotrienes. By blocking these key inflammatory pathways, it effectively reduces swelling, redness, pain, and immune cell activity in the affected area.
7. What is the difference in how the body uses natural cortisol versus administered cortisone medication?
The primary difference lies in regulation and dosage. The body produces cortisol via a finely tuned feedback system called the HPA (Hypothalamic-Pituitary-Adrenal) axis, releasing it in controlled amounts as needed. In contrast, administered cortisone provides a pharmacological dose, which is often much higher than natural levels. This high concentration overwhelms the body's natural system, leading to powerful therapeutic effects but also suppressing the body's own cortisol production and causing potential side effects.
8. Why must cortisone treatment be tapered off rather than stopped abruptly?
When a person takes cortisone medication for an extended period, the body's natural production of cortisol via the HPA axis is suppressed. If the medication is stopped suddenly, the adrenal glands are not prepared to resume their normal function immediately. This can lead to a state of adrenal insufficiency, causing severe fatigue, weakness, nausea, and low blood pressure. Tapering the dose gradually allows the adrenal glands time to recover and start producing cortisol on their own again.
