pillen-poeder

Cortisol Corticosteroids

lijst

Cortisol is a corticosteroid; it is a hormone that is made in the adrenal cortex from cholesterol. If a person has a chronic amount of stress (
oxidative stress
) both physically and emotionally, it may be that the adrenal cortex becomes depleted, which weakens the immune system and causes diseases, inflammation. In addition, adrenaline and norepinephrine overrule the “Feel Good” neurotransmitter serotonin.
When used as a medicine, it is usually called hydrocortisone. It can be used as an anti-inflammatory (it inhibits the activity of the immune system) in allergic reactions, in lung diseases (COPD) and numerous dermatological conditions such as severe forms of eczema.

Cortisol plays a role in:

  • digestion of food
  • sleep-wake rhythm
  • Immune system

Cortisol is sometimes called the stress hormone because it is released in any form of stress, both physically and psychologically. prolonged exposure creates oxidative stress It causes certain proteins in muscles to break down, releasing amino acids. Glucose (energy) can be made from this. This energy is used to bring the body back into homeostasis; At the time of stress, adrenaline and norepinephrine is released to make the body more alert and ready to fight/flee. Cortisol compensates for this loss of energy. Therefore, a better term would be : ‘stress-response hormone’.

The production of cortisol in the body follows a circadian rhythm, i.e. the production is not the same at any time of the day. During awakening, more cortisol is released. This makes for a feeling of hunger.

Corticosteroids

Corticosteroids are drugs that resemble the hormones that the adrenal cortex makes. Examples of corticosteroids include:

  • Predniso
  • Dexamethasone
  • (Hydro)cortisone
  • Triamcinolone
  • Betametason
  • Fluticason

Doctors prescribe corticosteroids when treating various conditions. They can be used in various ways: as a tablet, in ointments, as local injection, in eye and ear drops, as enema, in infusions or as inhalation.

Operation and properties

Corticosteroids work the same as adrenal cortex hormones. Depending on which species is used, there is more or less effect on:

  • Immune system: this is suppressed.
  • Inflammatory reactions: these are inhibited.
  • Water and moisture management of the body.
  • Metabolism of sugars, proteins and fats.

The action of corticosteroids therefore differs. This applies to the strength, the form of administration and the degree of side effects. A doctor may prescribe corticosteroids as a cure. Then the patient receives a high dose in a short period of five to ten days. But corticosteroids can also be taken for a long time as a maintenance treatment.

Application

The reasons for using corticosteroids are diverse. Here are some possible applications:

  • Replacement of adrenal cortex hormones. If the adrenal cortex makes too few hormones (adrenal cortex insufficiency), or if the pituitary gland does not stimulate the adrenal glands too little (hypopituitarism), people will have to take corticosteroids for life.
  • Suppressing the immune system. Because of this quality, corticosteroids are used in autoimmune diseases. These are disorders in which the immune system attacks its own organs and tissue. For example: rheumatism, psoriasis, Crohn’s disease, nephrotic syndrome and MS. Corticosteroids are also given in allergic reactions to external stimuli, such as asthma, hay fever or eczema. After a transplant, it is necessary to suppress the immune system to prevent rejection. Corticosteroids are used for this purpose.
  • For example, anti-inflammatory Corticosteroids are used in the play-off of bronchitis in COPD, or in musculoskeletal disorders such as bursitis or tendonitis. Also, a doctor may prescribe corticosteroids in case of inflammation to the eyes or in the ears.
  • In cancer treatment. Corticosteroids are often added to chemotherapy treatments, for example in leukaemia, breast cancer, brain tumors or lymph node cancer. They prevent vomiting, improve appetite and reduce swelling from the tumor. Corticosteroids are also commonly used in palliative care in the last phase of life.

Side effects

Corticosteroids have many side effects, especially if used for a long time. Therefore, a doctor will try to dosing as short and as low as possible. Drugs used locally have less side effect than tablets. Think of drops or inhalations.
Known side effects of corticosteroids include:

  • Increased susceptibility to infection
  • Thin skin with stretch marks (growth stripes)
  • Quick bruising
  • Badly healing wounds
  • Fluid accumulation
  • Weight gain (especially with a big belly)
  • Typical bulbous cheeks and bull neck
  • Excessive hair growth and acne
  • Ulcer
  • Muscle weakness
  • Onset or disruption of diabetes
  • Bone decalcification
  • Stare at the eyes
  • Lack of menstruation
  • Mood swings or psychosis
  • Lagging behind growth in children

The patient and his doctor therefore always weigh whether it is necessary to continue with corticosteroids and to increase side effects on sale.

Stop corticosteroids

An important focus of attention in the use of corticosteroids is the way of stopping this drug. If corticosteroids are used for more than two weeks, it should never be stopped suddenly. These medicines stop the adrenal cortex. If someone suddenly stopped taking corticosteroids, there would be no adrenal cortex hormones. That could lead to an Addison’s crisis, and that can be life-threatening. To prevent this, the drugs need to be phased out slowly.

Long-term use of corticosteroids

People who use long-term corticosteroids should be alert to stressful events for the body. For example infection, accident, fever, childbirth, strenuous physical exertion, emotional stress or surgery.

The body needs temporarily extra adrenal cortex hormone during stressful events. Normally, the adrenal glands regulate this themselves, but not if they are suppressed by corticosteroids. A stress situation can also lead to an Addison crisis. To prevent this, it is advisable to temporarily take additional corticosteroids.

People who use long-term corticosteroids would be wise to learn to recognize the signals of an inciping crisis. With prolonged use of corticosteroids, it is wise to discuss this with the attending physician. An SOS badge that mentions these medications is recommended.