Recently it striked me the prevalence of use of Cortisone, secondary to prevalence of collagen and autoimmune diseases, and inflammatory or allergic  conditions. Maybe the incidence is the same, but it’s just the advance of diagnosis and investigations, but the end result is the same, Cortisone is highly used nowadays in many, many conditions.

Well, to understand the side effects (especially of prolonged use of Cortisone), a quick reference to the actions of Glucocorticoids is a must:

1. Maintains metabolic homeostasis:

A. Regulates blood glucose level/permissive effects on gluconeogenesis/increases glycogen synthesis

B. Raises Insulin levels/permissive effects on lipolytic hormones

C. Increases catabolism/decreases anabolism (except fat)/inhibits growth hormone axis

D. Inhibits reproductive axis

E. Mineralocorticoid activity of cortisol

2. Affects connective tissues:

A. Causes loss of collagen & connective tissue

3. Affects calcium homeostasis:

A. Stimulates osteoclasts/inhibits osteoblasts

B. Reduces intestinal calcium absorption/stimulates PTH release/increases urinary calcium excretion/decreases reabsorption of phosphate

4. Maintains cardiovascular function:

A. Increases cardiac output

B. Increases vascular tone

C. Permissive effects on pressor hormones/increases sodium retention

5. Affects behavior and cognitive function

6. Affects immune system:

A. Increases intravascular leukocyte concentration

B. Decreases migration of inflammatory cells to sites of injury

C. Decreases antigen-antibody reaction

D. Suppresses immune system (thymolysis, suppression of cytokines, kinins, serotonin, histamine, collagenase, and plasminogen activator)

7. Antistress/Antishock

About side effects of prolonged use:

1. Edema

2. Hypertension

3. Heart failure

4. Cushing’s syndrome

5. Psychosis

6. Osteoporosis

7. Growth retardation in children

8. Delayed healing of wounds

9. Increases intraocular pressure (glaucoma)

10. May precipitate diabetes mellitus

11. Perforation of peptic ulcer

12. Infections: e.g. Activation of tuberculosis, fungal infection

13. Hirsutism, menstrual irregularities

14. Sudden withdrawal —> Acute adrenocortical insuffieciency/Addisonian crisis