Hormones – cortisol and corticosteroids

Hormones – cortisol and corticosteroids

Cortisol is a hormone made by the two adrenal glands (one is located on each kidney) and it is essential for life. Cortisol helps to maintain blood pressure, immune function and the body’s anti-inflammatory processes. Located inside the brain, the pituitary gland regulates the amount of cortisol released by the adrenal glands.

Specialists sometimes use synthetic cortisol-like compounds known as corticosteroids to treat common cortisol-related disorders. If taken at high doses or for a prolonged period, this treatment can have a number of side effects, including osteoporosis (thinning of the bones) and developing diabetes.

Role of cortisol in the body

Cortisol can:

help the body to manage stress

convert protein into glucose to boost flagging blood sugar levels

work in tandem with the hormone insulin to maintain constant blood sugar levels

reduce inflammation

contribute to the maintenance of constant blood pressure

contribute to the workings of the immune system.

Conditions treated with corticosteroids

A number of common conditions respond well when treated with corticosteroids (cortisol-like medications) including:

skin disorders – such as psoriasis and dermatitis

inflammatory diseases – such as asthma, ulcerative colitis, lupus and some forms of arthritis

cancer – particularly cancers related to the immune system, such as leukaemia and lymphoma

organ transplant – corticosteroids are used to inhibit the body’s immune response so that a transplanted organ is not rejected

Addison’s disease – an autoimmune disorder that stops the adrenal glands from making sufficient hormones, including cortisol.

Cortisone (manufactured for use as a treatment) is used to manage rather than treat Addison’s disease by replacing the cortisol naturally produced by the body. This may also occur in the management of pituitary disease. The dose required is much lower than the other examples above.

Types of corticosteroids

The type of corticosteroids administered depends on the person’s condition. Where specialists use synthetic forms to treat these disorders, treatment forms include:

creams – applied to the affected areas of the skin

tablets – dosage varies, but is generally kept to the lowest dose possible

injections – injecting straight into the affected joint, which prevents many of the side effects that occur with oral medication (taken by mouth)

inhaler – administered to treat inflammation in the lungs or sinuses.

Side effects of corticosteroids

As cortisol acts on so many organs and tissues of the body, people treated with corticosteroids may experience unwanted side effects. Suddenly stopping the medication can be dangerous, so continue taking your regular dose and see your doctor if you are troubled by side effects.

Some of the more common side effects of cortisol-like drugs include:

thin skin

susceptibility to bruising

high or increased blood pressure

susceptibility to infections

build-up of fat around the face, chest and abdomen

thinning of the limbs

osteoporosis (thinning of the bones) leading to bone fractures, particularly in the spine

fluid retention (oedema)

diabetes.

Corticosteroid-induced osteoporosis

Corticosteroids can cause a loss of bone density in men and women, particularly among postmenopausal women. The bones of the spine are the most vulnerable to fracturing in this setting. Corticosteroids interfere with the proper functioning of bone cells and prevent the intestine from properly absorbing calcium, which also affects the bones.

Symptoms of osteoporosis can include:

bone fractures

severe back pain

kyphosis (hunching of the upper back)

loss of height.

Managing the side effects of corticosteroids

Suggestions to manage the side effects of cortisol treatment include:

Reduce the daily dose under strict medical supervision.

Seek immediate treatment for any infection.

Use vitamin D and calcium supplements.

Use other medications and do weight-bearing exercise to maintain bone strength.

High-dose corticosteroids

Disruption of the workings of the pituitary and adrenal glands may occur where long periods of high-dose corticosteroids have severely decreased the body’s natural cortisol production. When a person stops taking high-dose corticosteroids, they may experience cortisol insufficiency.

Symptoms of cortisol insufficiency can include:

fatigue

nausea and vomiting

low blood pressure, particularly when standing up from a sitting or lying position (orthostatic hypotension)

low blood sugar

shock

coma.

High levels of cortisol and Cushing’s syndrome

Cushing’s syndrome is characterised by high levels of the hormone cortisol. Another name for Cushing’s syndrome is hypercortisolism.

Some people develop Cushing’s syndrome symptoms when they take high levels of oral corticosteroid medication to treat inflammatory conditions such as asthma, lupus or rheumatoid arthritis. Other causes include tumours of the pituitary and adrenal glands, and tumours in other areas of the body. In these cases the body itself is producing too much cortisol.

Symptoms of Cushing’s syndrome may include:

weight gain in the face, abdomen and chest

wasting of the limbs

a fatty hump between the shoulders

flushed face

high blood pressure

skin changes – such as thin skin, easily bruised, slow healing and ulcers

mood swings

weakened bones

irregular (or absence of) periods.

Where to get help

Your doctor