Don’t be nervous if your doctor suggests using cortisone. Though it does have some side-effects, it has great advantages.
Many people seem to have a fear of cortisone and show reluctance to use it.
Usually this fear is based on inadequate knowledge. More than any other drug, cortisone is thought by patients to have so many side-effects that its use is rarely justified.
The adrenal glands lie just above the kidneys and consist of an outer part, the cortex, and an inner part, the medulla. Both parts produce hormones which are released straight into the blood. Glands which act this way are called endocrine glands.
The medulla produces adrenaline, the main hormone of stress. This acts on the body to increase the action of the heart, to make the lungs breathe more deeply and to strengthen muscle action. All its functions are designed to “key up” the body quickly when danger threatens. It is the hormone of “fight or flight.”
The many functions of cortisone
The cortex produces several different hormones, the main one being cortisone, also related to stress. The stress that calls forth a surge of cortisone may be caused by an operation or injury, or by infection, poisoning or even emotional stress. As well, the cortex produces androgens or male hormones in both men and women.
Cortisone is essential to life and has many functions. It regulates the balance of salts and water and is concerned with the metabolism (build-up and break-down) of sugar and protein. It also reduces inflammation and the effects of the antigen-antibody reaction of allergy.
Either an excess or a fall in an endocrine gland hormone can cause a specific disease.
In Addison’s Disease there is a chronic failure of cortisone production. President Kennedy allegedly suffered from this complaint. Cortisone, usually a combination of two types to mimic the natural production, must be taken regularly by mouth or the person may die.
In Cushing’s Disease there is an over production of cortisone. The usual cause of this is a tumour or overactivity of the pituitary gland.
The pituitary gland is regarded as the “master” gland of the endocrine system. It lies at the base of the brain and produces hormones winch stimulate the other endocrine glands. These include ACTH (adrenocorticotropic hormone), which stimulates the production of cortisone.
In all of this there is a “feedback” mechanism. As the levels of cortisone rise, the production of ACTH is reduced. We always use the term cortisone, but this is a general name to cover both the natural hormones and the synthetic chemicals which have the same action.
When cortisone was first introduced it was hailed as a cure for rheumatoid arthritis. When this proved to be a false hope, cortisone started to gain a bad reputation with the public.
Cortisone cures nothing. Its use may be lifesaving in many conditions or it may greatly reduce the suffering of other disorders. Because of its action of reducing the inflammatory response, it is of greatest use in illnesses in which inflammation causes the symptoms or body changes.
The auto-immune diseases are illnesses in which the body appears to develop an allergy to its own tissues. Antibodies are produced and attack those tissues, causing either destruction or the formation of scar tissue. Rheumatoid arthritis, polyarteritis nodosa, disseminated lupus erythematosus and several other disorders with equally difficult names belong to this group.
Allergic disorders such as asthma and eczema may also require cortisone.
The list of diseases for which cortisone is used is long and varied. The synthetic cortisones include prednisone, prednisolone, triamcinolone, betamethasone, dexamethasone and more recently beclomethasone.
Cortisone may be given by mouth or by injection so as to affect all the tissues of the body, or used to treat local conditions.
Cortisone may be used as a cream or ointment to treat the skin, or as drops for the eye or ear. Various cortisones are injected directly into joints or tendons. Care must be taken, or the hormone may be absorbed into the general circulation and act far from where it was intended.
Cortisone side effects
Unfortunately, cortisone DOES have a number of side-effects.
If used in big doses over some time, as may be necessary to control severe asthma, it may halt growth in children. While this is serious, so may be the asthma.
High doses can lead to swelling of the face. There may be water and salt retention causing oedema or swelling of the tissues. The blood pressure may rise, acne may develop, mental disturbances may occur.
Reduction of the inflammatory response may reduce the body’s ability to resist infection. Of course, all these side-effects are serious, and cortisone is a drug that must be treated with caution.
In children its main use is in controlling severe asthma. The newer derivative, beclomethasone, has the advantage that it is effective locally, yet poorly absorbed. This is now widely used in the form of a spray to treat hay fever and asthma. It is potent, but so little is absorbed that it has no effect on the rest of the body.
Care is necessary using creams and ointments with children. Some people use too much and large amounts of cortisone may be absorbed.
Because of its action in reducing the antibody-antigen effect, cortisone is used in overcoming the rejection response after an organ transplant. It is also used in many forms of cancer to reduce the inflammation and increase thc effect of other agents.
No medical treatment is without some risk. The doctor must weigh up the benefits against the side-effects, and then choose the most effective and least risky therapy.
Next time your doctor suggests using cortisone to treat your complaint, do not be terrified. It is an excellent drug with a wide number of applications. Your doctor is aware of its uses and of its dangers.