Hormones - cortisol

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

Some disorders can be treated with synthetic cortisol-like compounds sometimes known as corticosteroids. 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).

The 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
• Inhibit inflammation
• Contribute to the maintenance of constant blood pressure
• Contribute to the workings of the immune system.

Conditions treated with cortisol-like drugs

Some of the conditions treated with cortisol-like drugs include:

• Skin disorders – such as psoriasis
• 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 – cortisol-like drugs 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 adrenals from making sufficient hormones, including cortisol. Cortisone 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.

Different forms

Cortisol-like drugs can be administered in a number of forms depending on the condition. Potent synthetic forms include dexamethasone, prednisolone and betamethasone. Common 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 – straight into the affected joint, which prevents many of the side effects that occur when the medication is taken by mouth
• Inhaler – administered to treat inflammation in the lungs or sinuses.

Side effects of cortisol-like drugs

Since cortisol acts on so many organs and tissues of the body, several unwanted side effects can occur during treatment with cortisol-like drugs. It can be dangerous to suddenly stop the medication, 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).

Drug-induced osteoporosis

Cortisol-like drugs can cause a loss of bone density in men and women, especially among postmenopausal women. The bones of the spine are the most vulnerable to fracturing. Cortisol-like drugs interfere with the proper functioning of bone cells and prevent the intestine from properly absorbing calcium.

Symptoms of osteoporosis can include:

• Severe back pain
• Kyphosis (hunching of the upper back)
• Loss of height
• Bone fractures.

Managing the side effects

Suggestions to manage the side effects of cortisol treatment include:

• Reduce the daily dose under strict medical supervision.
• Seek immediate treatment for any infection.
• Eat a high-calcium diet.
• Use vitamin D and calcium supplements.
• Use other medications to maintain bone strength.

High-dose treatments

High doses of cortisol-like drugs over a long period of time can disrupt the workings of the pituitary and the adrenal glands and prompt a severe drop in the body's own cortisol production. This may result in cortisol insufficiency when the drugs are stopped.

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.

Where to get help

• Your doctor

Things to remember

• Cortisol is a hormone made by the two adrenal glands, located one on each kidney.
• Some disorders can be treated with synthetic cortisol-like drugs.
• One of the main side effects of long-term treatment is osteoporosis (thinning of the bones).

You might also be interested in:

• Addison's disease.
  
• Cushing's syndrome.
  

Want to know more?

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This page has been produced in consultation with and approved by:

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Prince Henry's Institute of Medical Research

Last reviewed: August 2011

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Cortisol is a hormone made by the adrenal glands. Conditions such as inflammatory disorders, skin disorders and some cancers can be treated with synthetic cortisol-like compounds, sometimes referred to as corticosteroids. A side effect of this treatment is osteoporosis. High doses of cortisol-like drugs over a long period of time can cause a drop in the body's own cortisol production.

Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your qualified health professional. Content has been prepared for Victorian residence and wider Australian audiences, and was accurate at the time of publication. Readers should note that over time currency and completeness of the information may change. All users are urged to always seek advice from a qualified health care professional for diagnosis and answers to their medical questions.

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