Cortisone

Cortisone is one of a family of steroid hormones secreted by the cortex (outer layer) of the adrenal gland, which is located on the kidneys. The adrenal cortex is the chief organ of homeostasis (the body's ability to remain internally stable even in the presence of stressful changes in the environment, such as extreme cold, hunger, thirst, and danger). The adrenocortical steroids, called corticosteroids or corticoids, are classified according to what they do. Glucocorticoids control sugar metabolism (the continuous process in living organisms in which matter is broken down into simpler units or waste matter), and mineralocorticoids control the metabolism of minerals and water.

The principal glucocorticoids are corticosterone and hydrocortisone (cortisol) and the principal mineralocorticoid is aldosterone. Cortisone, originally called compound E, is a glucocorticoid, but also has some mineralocorticoid properties. It quickly converts protein to the carbohydrate glucose (sugar), and it helps regulate salt metabolism. The adrenal cortex's production of cortisone and hydrocortisone is controlled by the hormone ACTH (adrenocorticotropic hormone), which is secreted by the pituitary gland (a small, oval gland attached to the base of the brain).

Three scientists won the 1950 Nobel prize in medicine for their work with cortisone and other adrenal hormones. In fact, most of today's information about cortisone is due primarily to the work of Swiss chemist Tadeus Reichstein (1897-) and Americans Edward Calvin Kendall (1886-1972), a biochemist, and Philip Showalter Hench (1896-1965), a medical researcher. Kendall first began work on adrenal cortex hormones because an extract had been used successfully against Addison's disease, which is caused by adrenal gland problems. The original hormone theory, developed by the British physiologists William Bayliss and Ernest Starling, held that each type of gland secreted (released) only one hormone. By the mid-1930s, however, Kendall and others believed that the adrenal gland produced many hormones. In 1936 Reichstein was the first scientist to isolate the hormone that was later named cortisone, making it the first corticosteroid evere described. Kendall isolated a series of adrenal substances and converted one he called "compound E" into an active substance that he believed to be a steroid.

Hench and Kendall studied compound E, thinking it may be useful in treating arthritis because of its anti-inflammatory effect (the ability to prevent or suppress the heat, redness, swelling, and tenderness of inflammation). In 1948 and 1949, Hench and Kendall gave the name cortisone to compound E. The next year Hench and another colleague were the first to use it to successfully treat arthritis.

Corticosteroids Within the Body

Corticosteroids have widespread effects within the body. They influence the metabolism of protein, carbohydrates, and fat, and the functions of the cardiovascular system, the kidneys, skeletal muscle, nervous system, and other organs and tissues. Because of this, they must be used carefully. Longterm corticosteroid treatments have some serious side effects. These include edema (fluid retention), high stomach acidity, slow growth in children, osteoporosis (a bone disease, especially affecting older women, that decreases bone mass and makes bones porous, or full of tiny holes, and weak), and a redistribution of body fat that can result in a disorder called Cushing's syndrome.

Cortisone and other corticosteroids are used mainly in the treatment of deficiencies in the pituitary-adrenal complex. For example, they are used as replacement hormones in Addison's disease, and for people whose adrenal glands have been removed. They are also prescribed to reduce inflammation (swelling) in bronchial asthma, allergies, arthritis, and other connective tissue diseases. Other uses include therapy for some types of kidney disease, diseases resulting in inflammation of the eye, skin irritations, and some diseases of the intestinal tract. Glucocorticoids can be used in some types of cancer therapy, and the glucocorticoid prednisone is used with the drug cyclosporine to help reduce the body's immune response and prevent rejection of transplanted organs.

Scientists have experimented to produce synthetic steroids that can be more specifically prescribed. These synthetics act more specifically to treat the patient without affecting his or her entire hormonal balance. They have replaced natural corticosteroids in many instances.

[See also Cyclosporine ; Hormone ; Steroids ]

Cortisone

Cortisone is a steroid produced in the adrenal glands of the human body. The isolation of cortisone from the mixture of molecules produced in these glands was carried out by American biochemist Edward Kendall and coworkers. Kendall shared the Nobel Prize in physiology or medicine for this work in which he also helped establish the usefulness of cortisone in the treatment of arthritis.

The isolation of cortisone from adrenal glands is a laborious process, so its widespread utility as a medicine awaited the development of synthetic pathways to its production. Percy Julian was the first scientist to accomplish a commercially viable synthesis using protein from soybeans, and since his work an increasing number of applications have been found.

The structure of cortisone is shown above. Like other steroids, the molecule contains four fused rings. It is an example of an anti-inflammatory compound—one that reduces swelling. In many cases, swelling causes pain so the ability to reduce inflammation can be important for pain management, including the case of arthritis. In addition to arthritis, cortisone can be used to treat asthma, dermatological diseases, and tuberculosis and to fight the rejection of organ transplants by the body's immune system.

EDWARD KENDALL (1886–1972)

Edward Kendall recognized that symptoms of one type of arthritis decrease in females during pregnancy. He worked to isolate and identify hormones that could be responsible for this occurrence. It was during this search that cortisone was discovered in adrenyl glands. For this scientific breakthrough, Kendall was awarded the Nobel Prize in 1950.

—Valerie Borek

see also Julian, Percy; Steroids.

Thomas A. Holme

Bibliography

Crappo, L. (1985). Hormones. New York: W. H. Freeman.

Tonegawa, S. (1985). "The Molecules of the Immune System." Scientific American 253:122–131.

cortisone A corticosteroid that is itself biologically inactive and is formed naturally in the adrenal gland from the active hormone cortisol, which is structurally very similar to it. Cortisone is reconverted to the active hormone by metabolism in the liver and other organs. It may be administered therapeutically as an inactive precursor (prodrug) of cortisol.

cortisone Hormone produced by the cortex of the adrenal glands and essential for carbohydrate, protein and fat metabolism, kidney function and disease resistance. Synthetic cortisone is used to treat adrenal insufficiency, rheumatoid arthritis and other inflammatory diseases and rheumatic fever.

cor·ti·sone / ˈkôrtəˌsōn/ • n. Biochem. a hormone produced by the adrenal cortex. One of the glucocorticoids, it is also made synthetically for use as an anti-inflammatory and anti-allergy agent.