Cortisone is an endogenous hormone and one of the most famous drugs ever. It is used successfully in a wide variety of diseases, while many people are afraid of possible risks and side effects. But today there are clear treatment guidelines and precise ideas of when and how cortisone can be used as a medicine.
Cortisone and cortisol
Cortisone is based on cortisol, a vital hormone that is produced in the adrenal cortex, among other things from cholesterol and belongs to the glucocorticoids. In 1936, three independent research groups succeeded in isolating a substance from the adrenal gland, which was later called cortisone.
Ten years later, this substance could also be produced synthetically in the laboratory. The first successful therapy in 1948 was the treatment of a young American woman with severe rheumatoid arthritis - the patient was able to walk painless again after a few days.
The corticosteroids used today are chemically related to the "natural" cortisone. Of importance for the metabolism is actually the cortisol (also called hydrocortisone) or in the therapy of its acetic acid cortisol acetate; Cortisone is basically an oxidation-inactivated form of cortisol. Nevertheless, colloquially, the term "cortisone" for all drugs with cortisol effect has prevailed.
The regulatory mechanism of glucocorticoids
At rest, the body produces 8 to 25 milligrams of cortisol per day, and up to 300 milligrams when stressed. Since the hormone must always be available to the body, its occurrence is controlled by a complicated regulating mechanism.
Within this mechanism, the largest amount of cortisol is formed in several bouts until 6:00 am to 8:00 am, after which hormone production decreases to a minimum at midnight.
The exact knowledge of this control loop, possibly even individually for each patient, is one of the basic prerequisites for successful cortisone treatment.
Glucocorticoids in the metabolism
Glucocorticoids play an important role in many metabolic processes. If necessary, they mobilize the energy reserves stored in the body, for example by increasing the blood sugar level through various processes and boosting the release of fat - and are therefore often referred to as stress hormones.
In addition, glucocorticoids have an important function in inflammation: they can inhibit the inflammatory reactions at different levels (anti-inflammatory effect) - the main property for which cortisol is used medicinally.
As a side effect, muscle and bone mass are broken down. In addition, glucocorticoids also affect the water-electrolyte balance - an effect that is usually undesirable as a drug in cortisol and is therefore suppressed in the synthetic preparations as a side effect.