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. When cortisol levels are low, the pituitary secretes the stimulating hormone adrenocorticotropin (ACTH) to prompt the adrenal glands to make more cortisol. High cortisol levels are dropped when the pituitary gland slows its output of ACTH. Some disorders can be treated with synthesised cortisol, called cortisone or corticosteroids. One of the main side effects of long term treatment is 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.
- Addison's disease - an autoimmune disorder that stops the adrenals from making sufficient hormones, including cortisol.
- Organ transplant - cortisol-like drugs are used to inhibit the body's immune response so that a transplanted organ is not rejected.
Different forms
Cortisol-like drugs can be administered in various ways, depending on the condition. Some of the forms cortisol treatment may take include:
- Creams - applied to the affected areas of the skin.
- Tablets - dosage varies, but generally is kept to less than 10mg per day.
- Injections - straight into the affected joint, which prevents many of the side effects that occur when the medication is taken by mouth.
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:
- Fluid retention (oedema)
- 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)
- Bone fractures, particularly in the spine and ribs.
Drug-induced osteoporosis
Cortisol-like drugs can cause a loss of bone density, especially amongst postmenopausal women and young men. The bones of the spine and ribs are the most vulnerable to fracturing. Cortisol-like drugs interfere with the proper functioning of the 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
- Consider using hormone replacement therapy (HRT) to prevent osteoporosis if you are a postmenopausal woman.
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. 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
Things to remember
- Cortisol is a hormone made by the two adrenal glands, located one on each kidney.
- Some disorders can be treated with synthesised cortisol, called cortisone or corticosteroids.
- One of the main side effects of long term treatment is osteoporosis (thinning of the bones).
You might also be interested in:
Cushing's syndrome.
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