Cortisone

Cortisone is one of a family of steroid hormones secreted by the cortex (outer layer) of the adrenal gland, which is located on the kidneys. The adrenal cortex is the chief organ of homeostasis (the body's ability to remain internally stable even in the presence of stressful changes in the environment, such as extreme cold, hunger, thirst, and danger). The adrenocortical steroids, called corticosteroids or corticoids, are classified according to what they do. Glucocorticoids control sugar metabolism (the continuous process in living organisms in which matter is broken down into simpler units or waste matter), and mineralocorticoids control the metabolism of minerals and water.

The principal glucocorticoids are corticosterone and hydrocortisone (cortisol) and the principal mineralocorticoid is aldosterone. Cortisone, originally called compound E, is a glucocorticoid, but also has some mineralocorticoid properties. It quickly converts protein to the carbohydrate glucose (sugar), and it helps regulate salt metabolism. The adrenal cortex's production of cortisone and hydrocortisone is controlled by the hormone ACTH (adrenocorticotropic hormone), which is secreted by the pituitary gland (a small, oval gland attached to the base of the brain).

Three scientists won the 1950 Nobel prize in medicine for their work with cortisone and other adrenal hormones. In fact, most of today's information about cortisone is due primarily to the work of Swiss chemist Tadeus Reichstein (1897-) and Americans Edward Calvin Kendall (1886-1972), a biochemist, and Philip Showalter Hench (1896-1965), a medical researcher. Kendall first began work on adrenal cortex hormones because an extract had been used successfully against Addison's disease, which is caused by adrenal gland problems. The original hormone theory, developed

by the British physiologists William Bayliss and Ernest Starling, held that each type of gland secreted (released) only one hormone. By the mid-1930s, however, Kendall and others believed that the adrenal gland produced many hormones. In 1936 Reichstein was the first scientist to isolate the hormone that was later named cortisone, making it the first corticosteroid evere described. Kendall isolated a series of adrenal substances and converted one he called "compound E" into an active substance that he believed to be a steroid.

Hench and Kendall studied compound E, thinking it may be useful in treating arthritis because of its anti-inflammatory effect (the ability to prevent or suppress the heat, redness, swelling, and tenderness of inflammation). In 1948 and 1949, Hench and Kendall gave the name cortisone to compound E. The next year Hench and another colleague were the first to use it to successfully treat arthritis.

Corticosteroids Within the Body

Corticosteroids have widespread effects within the body. They influence the metabolism of protein, carbohydrates, and fat, and the functions of the cardiovascular system, the kidneys, skeletal muscle, nervous system, and other organs and tissues. Because of this, they must be used carefully. Longterm corticosteroid treatments have some serious side effects. These include edema (fluid retention), high stomach acidity, slow growth in children, osteoporosis (a bone disease, especially affecting older women, that decreases bone mass and makes bones porous, or full of tiny holes, and weak), and a redistribution of body fat that can result in a disorder called Cushing's syndrome.

Cortisone and other corticosteroids are used mainly in the treatment of deficiencies in the pituitary-adrenal complex. For example, they are used as replacement hormones in Addison's disease, and for people whose adrenal glands have been removed. They are also prescribed to reduce inflammation (swelling) in bronchial asthma, allergies, arthritis, and other connective tissue diseases. Other uses include therapy for some types of kidney disease, diseases resulting in inflammation of the eye, skin irritations, and some diseases of the intestinal tract. Glucocorticoids can be used in some types of cancer therapy, and the glucocorticoid prednisone is used with the drug cyclosporine to help reduce the body's immune response and prevent rejection of transplanted organs.

Scientists have experimented to produce synthetic steroids that can be more specifically prescribed. These synthetics act more specifically to treat the patient without affecting his or her entire hormonal balance. They have replaced natural corticosteroids in many instances.