Cortisol: What It Is, Treatment Methods, and Side Effects

Cortisol is a hormone-like substance naturally synthesized in the human body. There may be diseases associated with its deficiency. Some patients may not synthesize sufficient amounts of cortisol in their bodies. Complete lack of cortisol synthesis is not possible in a healthy body. For these patients, cortisol replacement therapy, which has offered very effective solutions in recent years, is applied. This is because the effects of cortisol are undeniably important for the immune system and the body's ability to heal itself. In cases where it is not produced, exogenous synthetic hormones, meaning cortisol obtained from external sources, should be administered. The synthetic form of cortisol that cannot be synthesized in the body is called cortisone. There may be misconceptions in the public about the use of cortisol and cortisone, leading to the belief that cortisol has more negative effects. Of course, while cortisol treatment has negative effects, it also provides significant treatment opportunities for the patient. Every medication can have side effects, even if they are minor. The effects of cortisol treatment can be managed as long as doctor visits are not neglected and post-treatment recommendations are followed. Cortisol is a hormone produced in the outer part of the adrenal gland called the cortex. One of the naturally occurring hormones formed as a result of a series of biochemical reactions using cholesterol as a raw material is cortisol. Two different groups of hormones are produced by the adrenal gland: glucocorticoids and mineralocorticoids. In the glucocorticoid group, there are hormone-like products known as cortisol and cortisone. Both glucocorticoids, cortisol and cortisone, affect the body’s protein and carbohydrate mechanisms. Cortisone is actually the inactive form of cortisol. After its production, cortisone is processed in the liver to obtain the active form, cortisol. Therefore, the active form of cortisol is administered for the treatment of many diseases.

What Does Cortisol Do?

The pathway directly affected by cortisol involves the conversion of protein and fat molecules in the body into glucose. Before treatment, cortisol naturally raises blood sugar levels in the body. During fasting, when low-calorie foods are consumed, or when the brain receives a hunger signal in any way, cortisol comes into play, producing glucose from stored fats and then from stored protein molecules. In this way, cortisol normalizes low blood sugar levels.

In recent years, another mechanism of cortisol as an important breakthrough in treatment is based on the functioning of the immune system. In immunology, drug preparations containing cortisol and cortisone are life-saving for patients. Especially for chronic diseases affecting various organs of the body that are left untreated, cortisol treatment is an indispensable breakthrough. The reason for using cortisol in the immune system is typically in situations requiring immunosuppression. In some diseases or when an organ transplant is performed, where the body perceives the transplanted organ as foreign tissue, cortisol may be used for a lifetime.

Cortisol production facilitates an increase in the number of platelets, red blood cells, hemoglobin, and PMNL (polymorphonuclear leukocytes) in the blood. The effects of cortisol significantly contribute to the patient's life across a wide range of areas, from blood production to repairing the immune system.

Cortisol, taken orally, through parenteral (intravenous) methods, or as a cream, regulates the vital functions of many patients today. In this sense, there are great benefits to the production of synthetic forms of cortisol. The ease of administering cortisol into the body shortens hospitalization periods, prevents the development of diseases that shorten life expectancy and leave lasting effects on the patient, and minimizes unintentional errors in other treatment options.

In Which Diseases Is Cortisone Used for Treatment?

Cortisone is a primary medication used for many chronic and life-threatening diseases, as well as acute conditions. Therefore, considering the role of cortisone in most diseases, it has effects that reduce mortality rates compared to its side effects. Cortisone may sometimes be recommended for a short period, while other times it may require lifelong use. In the following diseases, cortisone is often prescribed for long-term use, increasing patient comfort and minimizing the likelihood of morbidity:

• Cushing's syndrome
• Addison's disease
• Congenital adrenal hyperplasia (CAH)
• Anemia
• Rheumatoid arthritis
• Rheumatic carditis
• Physical stress situations such as transplants
• Skin diseases like lichen planus, erythema, keloid, chronic dermatitis, eczema, and psoriasis
• Allergic and anaphylactic reactions
• Shock
• Bronchial asthma
• Liver diseases such as chronic active hepatitis, cirrhosis, and subacute hepatic necrosis
• Kidney diseases like systemic lupus erythematosus (SLE) and glomerulonephritis
• Acute respiratory distress syndrome (ARDS)
• Hyperkalemia, inflammatory bowel diseases
• Eye inflammation

The development process of diseases, the patient's history, other treatment options, and the care during the treatment process are among many factors that influence which treatment models are most suitable. Therefore, while the mentioned diseases are those that require cortisone treatment, medical supervision is essential regarding at which stage of treatment cortisone should be taken, for how long, and in what manner. Otherwise, if the potential side effects of cortisone use are not taken into account, unwanted effects may occur.

What Are the Side Effects of Cortisone?

When cortisone is prescribed or when patients are told that they need to use cortisone for a lifetime, the first side effects that come to mind are significant. However, when considering the permanent effects that the diseases treated with cortisone may have on the patient, the side effects of cortisone can be considered tolerable. It is necessary to benefit from the treatment period as much as possible while minimizing the side effects. This begins with the patient choosing an appropriate nutrition and exercise routine for their treatment. As is known, the greatest effect of cortisone is to create an opposite effect to insulin, which means that the most common and undesirable effect seen in patients is weight gain due to increased blood sugar levels. With a proper diet, a low-salt and low-sugar diet, more frequent consumption of greens at meals, and sufficient daily physical activity, the side effects caused by cortisone can be corrected. Additionally, the long-term side effects of cortisone include:

• Catabolic effects (destructive effects) leading to growth cessation and protein loss
• Increased fat tissue in the torso and upper body, while thinning occurs in the legs
• Eye pressure
• Abnormal mood swings characterized by excessive reactions, leading to insomnia
• Edema, hypokalemic alkalosis
• Osteoporosis
• Hypertension
• Decreased secretion of vitamin D
• Weakness and quick fatigue
• Increased susceptibility to infections

These side effects may arise in patients in the long or short term. The way cortisone is used is also very important to minimize or even eliminate most of them. To make the most of cortisone, it should be taken on an empty stomach in the morning. If possible, it is recommended to use it every other day instead of daily. If cortisone needs to be discontinued, it should be done gradually over a few days by reducing the dosage rather than stopping abruptly. A low-salt and low-sugar diet should be preferred, and plenty of water should be consumed. Calcium and vitamin D supplements may be taken with a doctor's recommendation. A protein-rich diet should be prioritized. Due to the increased susceptibility to infections in these patients, live vaccines may be risky. Additionally, since there is a risk of interaction with other medications, patients must inform their physician about any new medications, vitamin supplements, or vaccinations.

With the discovery of cortisone's use in diseases, there are no longer old hopelessness regarding diseases that have emerged recently and are becoming more common. The positive effects of cortisone treatment are manageable compared to the side effects. For both short-term and long-term cortisone treatment, consulting a specialist is advisable. You can schedule an appointment immediately for information about what to do after treatment.