Cortisone

Not to be confused with cortisol.

Cortisone (/krtson/ or /krtzon/; 17-hydroxy-11-
dehydrocorticosterone) is a 21-carbon steroid hormone.
It is one of the main hormones released by the adrenal
gland in response to stress. In chemical structure, it is
a corticosteroid closely related to cortisol. It is used
to treat a variety of ailments and can be administered
intravenously, orally, intraarticularly (into a joint), or
transcutaneously. Cortisone suppresses the immune sys-
tem, thus reducing inammation and attendant pain and
swelling at the site of the injury. Risks exist, in particular
in the long-term use of cortisone.
[1][2]
1 History
Cortisone was rst identied by the American chemists
Edward Calvin Kendall and Harold L. Mason while re-
searching at the Mayo Clinic.
[3][4][5]
Kendall was awarded
the 1950 Nobel Prize for Physiology or Medicine along
with Philip S. Hench and Tadeus Reichstein for the dis-
covery of adrenal cortex hormones, their structures, and
their functions. As it turns out, both Reichstein and the
team of O. Wintersteiner and J. Pner had separately
isolated the compound prior to Mason/Kendall, but failed
to recognize its biological signicance.
[4]
Dr. Masons
contributions to the crystallization and characterization
of the compound have generally been forgotten outside
of the Mayo Clinic.
[4]
Cortisone was rst produced com-
mercially by Merck & Co. On September 30, 1949,
Percy Julian announced an improvement in the process
of producing cortisone from bile acids. This eliminated
the need to use osmium tetroxide, a rare, expensive, and
dangerous chemical. In the UK in the early 1950s, John
Cornforth and Kenneth Callow at the National Institute
for Medical Research collaborated with Glaxo to produce
cortisone from hecogenin from sisal plants.
[6]
2 Production
Cortisone is one of several end-products of a process
called steroidogenesis. This process starts with the syn-
thesis of cholesterol, which then proceeds through a se-
ries of modications in the adrenal gland (suprarenal) to
become any one of many steroid hormones. One end-
product of this pathway is cortisol. For cortisol to be
released from the adrenal gland, a cascade of signaling
occurs. Corticotropin-releasing hormone released from
the hypothalamus stimulates corticotrophs in the anterior
pituitary to release ACTH, which relays the signal to the
adrenal cortex. Here, the zona fasciculata and zona retic-
ularis, in response to ACTH, secrete glucocorticoids, in
particular cortisol. In the peripheral tissues, cortisol is
converted to cortisone by the enzyme 11-beta-steroid de-
hydrogenase. Cortisol has much greater glucocorticoid
activity than cortisone, and, thus, cortisone can be con-
sidered an inactive metabolite of cortisol. However, 11-
beta-steroid dehydrogenase can catalyze the reverse reac-
tion as well, and, thus, cortisone is also the inactive pre-
cursor molecule of the active hormone cortisol. Corti-
sone is activated through hydrogenation of the 11-keto-
group, and cortisol is, thus, sometimes referred to as
hydrocortisone.
3 Eects and uses
Cortisone, a glucocorticoid, and adrenaline are the main
hormones released by the body as a reaction to stress.
They elevate blood pressure and prepare the body for a
ght or ight response.
A cortisone injection can also be used to give short-term
pain relief and reduce the swelling from inammation of
a joint, tendon, or bursa in, for example, the joints of the
knee, elbow, and shoulder.
[1]
Cortisone may also be used to deliberately suppress im-
mune response in persons with autoimmune diseases or
following an organ transplant to prevent transplant rejec-
tion. The suppression of the immune system may also be
important in the treatment of inammatory conditions.
[7]
Cortisone is a common treatment for a severe sore throat
that occurs commonly with EBV infectious mononucleo-
sis. Cortisone does not decrease the duration of the viral
infection, but is used purely to increase the comfort of a
patient with trouble speaking or swallowing as a result of
the mononucleosis-induced swollen throat.
Cortisone is also used by dermatologists to treat
keloids,
[8]
relieve the symptoms of eczema and atopic
dermatitis,
[9]
and stop the development of sarcoidosis.
4 Side eects
Oral use of cortisone has a number of potential systemic
side-eects: hyperglycemia, insulin resistance, diabetes
1
2 7 EXTERNAL LINKS
mellitus, osteoporosis, anxiety, depression, amenorrhoea,
cataracts and glaucoma, among other problems.
[1][2]
Local side eects are rare but can include: pain, infec-
tion, skin pigment changes, loss of fatty tissue, and tendon
rupture.
[10]
5 See also
Central serous retinopathy
Corticosterol
6 References
6.1 Notes
[1] Cortisone shots. MayoClinic.com. 2010-11-16. Re-
trieved July 31, 2013.
[2] Prednisone and other corticosteroids: Balance the risks
and benets. MayoClinic.com. 2010-06-05. Retrieved
2011-09-03.
[3] Cortisone Discovery and the Nobel Prize. Retrieved
2009-07-04.
[4] I Went to See the Elephant autobiography of Dwight J.
Ingle, published by Vantage Press (1963), pg 94, 109
[5] http://www.jbc.org/content/114/3/613.full.pdf. Re-
trieved 2014-09-07. Missing or empty |title= (help)
[6] Quirke, Viviane (2005). Making British Cortisone:
Glaxo and the development of Corticosteroids in Britain
in the 1950s1960s. Studies in History and Philoso-
phy of Science Part C: Studies in History and Philoso-
phy of Biological and Biomedical Sciences 36 (4): 645.
doi:10.1016/j.shpsc.2005.09.001.
[7] Driver, Catherine; Shiel, William. Cortisone Injec-
tion (Corticosteroid Injection) of Soft Tissues & Joints.
MedicineNet.com. Retrieved August 7, 2013.
[8] Zanon, E; Jungwirth, W; Anderl, H (1992). Cortisone
jet injection as therapy of hypertrophic scars and keloids.
Handchirurgie, Mikrochirurgie, plastische Chirurgie : Or-
gan der Deutschsprachigen Arbeitsgemeinschaft fur Hand-
chirurgie : Organ der Deutschsprachigen Arbeitsgemein-
schaft fur Mikrochirurgie der Peripheren Nerven und
Gefasse : Organ der V 24 (2): 1002. PMID 1582609.
[9] All About Atopic Dermatitis. National Eczema Associ-
ation.
[10] Cole, BJ; Schumacher (JanFeb 2005). Injectable Corti-
costeroids in Modern Practice. Journal of the American
Academy of Orthoepaedic Surgeons 13: 3746.
6.2 Bibliography
Bonagura J., DVM. et al. (2000). Current Veteri-
nary Therapy 13. pp. 321381.
Ingle DJ (October 1950). The biologic properties
of cortisone: a review. J. Clin. Endocrinol. Metab.
10 (10): 131254. doi:10.1210/jcem-10-10-1312.
PMID 14794756.
Woodward R. B., Sondheimer F., Taub D. (1951).
The Total Synthesis of Cortisone. Journal of
the American Chemical Society 73 (8): 40574057.
doi:10.1021/ja01152a551.
7 External links
Cortisone: The Wonder Drug
How Hormone Team Is Saving Lives , by John E.
Pleier 1951 article on the new drug cortisone and
how it works
3
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