What are corticosteroids and how do they work. How are corticosteroids different from anabolic steroids. What conditions can be treated with corticosteroids. What are the potential side effects of corticosteroid use.

Understanding Corticosteroids: A Comprehensive Overview

Corticosteroids are a class of synthetic drugs that mimic the action of cortisol, a hormone naturally produced by the adrenal glands. These powerful medications play a crucial role in managing various health conditions by reducing inflammation and suppressing immune system activity. Their versatility has made them indispensable in modern medicine, but their use comes with both benefits and risks that need careful consideration.

The Science Behind Corticosteroids

How do corticosteroids work in the body? These drugs function by inhibiting the production of inflammatory chemicals, effectively reducing swelling and irritation in affected tissues. At higher doses, they also dampen the immune response, which can be beneficial in treating autoimmune disorders. This dual action makes corticosteroids particularly effective in managing a wide range of conditions, from minor allergies to severe systemic diseases.

Medical Applications of Corticosteroids

The versatility of corticosteroids is evident in their wide-ranging medical applications. Healthcare providers prescribe these medications to treat various conditions, including:

• Respiratory disorders (asthma, COPD)
• Skin conditions (eczema, hives)
• Autoimmune diseases (lupus, rheumatoid arthritis)
• Allergic reactions (hay fever)
• Inflammatory bowel diseases
• Multiple sclerosis
• Gout

In cases of severe COVID-19 requiring oxygen therapy, systemic corticosteroids have shown promise in reducing mortality rates. This demonstrates the adaptability of these drugs in addressing emerging health challenges.

Corticosteroids in Autoimmune Disease Management

Why are corticosteroids particularly effective in treating autoimmune diseases? In these conditions, the immune system mistakenly attacks the body’s own tissues. Corticosteroids can help by:

1. Reducing inflammation in affected organs and tissues
2. Modulating the activity of white blood cells
3. Suppressing overall immune system function

This multi-faceted approach helps prevent further damage and alleviates symptoms in conditions such as rheumatoid arthritis, lupus, and multiple sclerosis.

Types and Administration Methods of Corticosteroids

Corticosteroids come in various forms, each tailored to specific medical needs and targeted areas of the body. The two main categories are localized and systemic corticosteroids.

Localized Corticosteroids

These medications target specific areas of the body and can be administered through:

• Topical creams and ointments
• Eye drops
• Ear drops
• Inhalers

Localized corticosteroids are often used to treat conditions such as asthma, skin inflammation, and allergic reactions.

Systemic Corticosteroids

These medications affect the entire body and can be administered via:

• Oral tablets or liquids
• Intramuscular injections
• Intravenous (IV) infusions

Systemic corticosteroids are typically prescribed for more severe conditions like lupus, multiple sclerosis, or severe allergic reactions.

Common Corticosteroid Medications

Several corticosteroid medications are available, each with specific indications and formulations. Some of the most commonly prescribed include:

• Prednisone (Deltalone, Prednicot, Cotolone)
• Prednisolone (Orapred, Omnipred)
• Cortisone (Cortone)
• Hydrocortisone (Cortef, Hydrocort)
• Triamcinolone (Aristocort)
• Dexamethasone (Decadron)
• Mometasone (Nasonex spray)

The choice of medication and dosage depends on the specific condition being treated, its severity, and individual patient factors. Healthcare providers carefully consider these aspects when prescribing corticosteroids to ensure optimal therapeutic outcomes.

Potential Side Effects and Risks of Corticosteroid Use

While corticosteroids offer significant therapeutic benefits, they also carry the risk of side effects, particularly with long-term use or high doses. The severity and likelihood of side effects can vary depending on the type of corticosteroid, route of administration, and duration of treatment.

Side Effects of Oral Corticosteroids

Oral corticosteroids, which affect the entire body, are associated with a higher risk of side effects. These may include:

• Weight gain and fluid retention
• Increased risk of infections
• Osteoporosis and increased fracture risk
• Mood changes and behavioral issues
• High blood pressure
• Glaucoma and cataracts
• Diabetes or worsening of existing diabetes
• Skin thinning and easy bruising
• Muscle weakness

Side Effects of Inhaled Corticosteroids

Inhaled corticosteroids, primarily used for respiratory conditions, generally have fewer systemic side effects but may cause:

• Cough
• Hoarseness or difficulty speaking (dysphonia)
• Oral thrush (fungal infection in the mouth)

Side Effects of Topical Corticosteroids

Topical corticosteroids, applied directly to the skin, can lead to localized side effects such as:

• Skin thinning
• Easy bruising
• Stretch marks
• Acne-like eruptions

It’s important to note that all forms of corticosteroids can potentially increase the risk of fungal infections and may affect blood sugar levels.

Corticosteroids vs. Anabolic Steroids: Understanding the Difference

A common source of confusion is the distinction between corticosteroids and anabolic steroids. Despite both being referred to as “steroids,” these two classes of drugs have vastly different purposes and effects on the body.

Corticosteroids: Medical Anti-Inflammatory Drugs

Corticosteroids are synthetic versions of cortisol, a hormone produced by the adrenal glands. They are primarily used to reduce inflammation and suppress immune responses in various medical conditions. Key points about corticosteroids include:

• Prescribed for legitimate medical purposes
• Do not build muscle or enhance athletic performance
• Available in various forms (oral, topical, injectable, inhaled)
• Used to treat a wide range of health conditions

Anabolic Steroids: Performance-Enhancing Substances

Anabolic steroids, on the other hand, are synthetic substances related to testosterone. They are designed to promote muscle growth and enhance physical performance. Important facts about anabolic steroids include:

• Primarily used for muscle building and performance enhancement
• Limited legitimate medical uses (e.g., treating hormone deficiencies)
• Banned in competitive sports
• Illegal to possess without a prescription in many countries
• Associated with numerous health risks when abused

Understanding this distinction is crucial for patients and healthcare providers alike to ensure appropriate use and manage expectations regarding treatment outcomes.

Guidelines for Safe Corticosteroid Use

To maximize the benefits of corticosteroid therapy while minimizing risks, it’s essential to follow proper usage guidelines. Here are some key considerations for safe corticosteroid use:

Proper Dosage and Administration

How should corticosteroids be taken to ensure optimal effectiveness and safety? Follow these guidelines:

• Always take the medication exactly as prescribed by your healthcare provider
• Do not abruptly stop taking corticosteroids without medical supervision
• If using inhaled corticosteroids, rinse your mouth after each use to prevent oral thrush
• For topical corticosteroids, apply only to affected areas and avoid overuse

Monitoring and Follow-up

Regular monitoring is crucial when using corticosteroids, especially for long-term therapy. This may include:

• Regular check-ups with your healthcare provider
• Blood tests to monitor blood sugar levels, electrolytes, and other parameters
• Bone density scans to assess the risk of osteoporosis
• Eye examinations to check for glaucoma or cataracts

Lifestyle Considerations

Patients on corticosteroid therapy should be aware of certain lifestyle factors that can help mitigate risks:

• Maintain a healthy diet low in sodium and rich in calcium and vitamin D
• Engage in regular weight-bearing exercise to support bone health
• Avoid smoking and limit alcohol consumption
• Take precautions to prevent infections, such as practicing good hygiene and getting recommended vaccinations

Alternatives to Corticosteroid Therapy

While corticosteroids are highly effective for many conditions, there may be situations where alternative treatments are preferred or necessary. What options are available when corticosteroids are not suitable or when patients wish to explore other treatments?

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs can be effective for managing pain and inflammation in conditions such as arthritis or minor injuries. Examples include:

• Ibuprofen
• Naproxen
• Aspirin

Disease-Modifying Antirheumatic Drugs (DMARDs)

For autoimmune conditions like rheumatoid arthritis, DMARDs can be used to slow disease progression. These include:

• Methotrexate
• Hydroxychloroquine
• Sulfasalazine

Biologic Therapies

Biologic drugs target specific components of the immune system and can be effective in treating various autoimmune and inflammatory conditions. Examples include:

• Tumor Necrosis Factor (TNF) inhibitors
• Interleukin inhibitors
• B-cell depleting agents

Lifestyle and Natural Remedies

For some conditions, lifestyle changes and natural remedies may help manage symptoms:

• Dietary modifications (e.g., anti-inflammatory diets)
• Regular exercise and physical therapy
• Stress reduction techniques (meditation, yoga)
• Herbal supplements (with caution and medical supervision)

It’s important to note that the suitability of these alternatives depends on the specific condition being treated and individual patient factors. Always consult with a healthcare provider before making any changes to your treatment regimen.

The Future of Corticosteroid Research and Development

As medical science advances, researchers continue to explore ways to enhance the efficacy of corticosteroids while minimizing their side effects. What developments can we expect in the field of corticosteroid therapy?

Targeted Delivery Systems

Scientists are working on novel drug delivery systems that could allow for more precise targeting of affected tissues, potentially reducing systemic side effects. These may include:

• Nanoparticle-based delivery systems
• Tissue-specific formulations
• Controlled-release mechanisms

Selective Corticosteroids

Research is ongoing to develop corticosteroids that selectively target specific inflammatory pathways, potentially offering the benefits of current medications with fewer side effects.

Combination Therapies

Exploring combinations of corticosteroids with other drugs may lead to synergistic effects, allowing for lower doses and reduced side effects while maintaining therapeutic efficacy.

Personalized Medicine Approaches

Advancements in genetic testing and biomarker identification may allow for more personalized corticosteroid therapies, optimizing treatment outcomes for individual patients.

These ongoing research efforts hold promise for improving the therapeutic index of corticosteroids, potentially expanding their applications while enhancing safety profiles. As new developments emerge, it’s crucial for healthcare providers and patients to stay informed about the latest advancements in corticosteroid therapy.

Everything You Need to Know About Corticosteroids

Corticosteroids ease swelling and irritation. Doctors often prescribe them to treat conditions like asthma, hives, or lupus. Side effects can depend on the type of corticosteroid, such as inhaled or topical.

Corticosteroids are a class of human-made or synthetic drugs used in almost every medical specialty. They lower inflammation in the body by reducing the production of certain chemicals. At higher doses, corticosteroids also reduce immune system activity.

Corticosteroids resemble cortisol, a hormone naturally produced by our body’s adrenal glands. Cortisol is a major player in a wide range of biological processes, including metabolism, immune response, and stress.

Because corticosteroids ease swelling and irritation, doctors often prescribe them to treat conditions like asthma, hives, or lupus. Corticosteroids can provide substantial relief of symptoms, but come with the risk of serious side effects, especially if used long term.

We’ll explore how this important class of drugs is used to treat a wide range of health conditions, what forms corticosteroids take, and potential side effects.

Corticosteroids are used to treat everything from seasonal allergies to life-threatening organ inflammation.

Health conditions that doctors often treat with corticosteroids include:

• asthma
• hay fever
• hives
• eczema
• chronic obstructive pulmonary disease (COPD)
• gout
• lupus
• inflammatory bowel disease
• multiple sclerosis

Autoimmune diseases are frequently treated with this class of drugs.

Sometimes the immune system doesn’t work correctly, and attacks your body’s own organs, bones, or tissues. Corticosteroids can decrease the inflammation and prevent damage. They also affect how white blood cells work and reduce the activity of the immune system.

When someone with rheumatoid arthritis has a flare, a corticosteroid injection can provide fast relief to an inflamed joint.

Addison’s disease occurs when your body doesn’t make enough cortisol, causing weakness and fatigue among other symptoms. Corticosteroids can make up the difference.

In people who have just had an organ transplant, corticosteroids help suppress the immune system to reduce the chance of your body rejecting the organ.

Corticosteroids can be systemic or localized. Localized steroids target a specific part of the body.

They can be applied through:

• skin creams and ointments
• eye drops
• ear drops
• inhalers

Systemic steroids move through the blood to assist more parts of the body.

They can be delivered through:

• oral medications
• injecting into a muscle
• intravenous (IV) line

Localized steroids are used to treat conditions like asthma or hives. Systemic steroids treat conditions such as lupus and multiple sclerosis.

Among patients hospitalized with COVID-19 who need oxygen treatment, the administration of systemic corticosteroids has been found to reduce mortality rates.

Corticosteroids vs. anabolic steroids

While both are called “steroids,” they are not the same.

Anabolic steroids are based on the human growth hormone testosterone. They can be used productively in hormone replacement therapy, or to treat growth disorders and other diseases.

However, anabolic steroids have been frequently misused in high doses by athletes and the general public to increase muscle. In this usage, they are called performance-enhancing drugs. Anabolic steroids are banned in all athletic competitions. In the United States, it is illegal to possess anabolic steroids without a prescription.

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There are a number of both localized and systemic corticosteroids available. Most of these drugs come in oral, topical, and injectable forms.

Some of the common generic and brand names include:

• Prednisone (Deltalone, Prednicot, Cotolone)
• Prednisolone (Orapred, Omnipred)
• Cortisone (Cortone)
• Hydrocortisone (Cortef, Hydrocort)
• Triamcinolone (Aristocort)
• Dexamethasone (Decadron)
• Mometasone (Nasonex spray)

As you can see, corticosteroids are a versatile group of drugs. Dosages vary widely depending on what condition the doctor is treating you for, and your overall health.

Some side effects can occur with topical, inhaled, and injected steroids. However, most side effects come from oral steroids.

All corticosteroid types can put you at risk of developing fungal infections. Some may also cause high blood sugar, or hyperglycemia.

Side effects from oral steroids may include:

• skin and muscle atrophy
• increased risk of infections
• high blood pressure
• mood or behavioral changes
• osteoporosis
• glaucoma
• diabetes

Long-term use is associated with:

• weight gain
• facial swelling or puffiness (fluid retention)
• depression
• nausea and vomiting
• other types of stomach irritation
• bone fractures

Side effects from inhaled corticosteroids may include:

• cough
• difficulty speaking (dysphonia)
• oral thrush

Side effects from topical corticosteroids may include:

• acne
• rosacea
• atrophy
• stretch marks
• perioral dermatitis
• delayed wound healing (rare)

Side effects from injected corticosteroids may include:

• temporary pain and soreness
• loss of skin color at injection site
• high blood sugar
• facial flushing
• insomnia
• infection

Not everyone will develop side effects from taking corticosteroids. Side effects are more likely if corticosteroids are taken at a high dose over a long period of time.

It’s important to talk to your doctor about pros and cons of using corticosteroid medication.

Corticosteroids can be a life changing or even lifesaving treatment, but long-term use in particular can cause serious health risks.

Here are a few complications associated with long-term corticosteroid use:

• Adults and older adults are more likely to develop issues with high blood pressure and osteoporosis. Women have a higher chance of developing this bone disease.
• Children may experience stunted growth. Because they suppress the immune system, corticosteroids can also cause infections like the measles or chickenpox to be more severe.
• Pregnant or breastfeeding people should use steroids with caution. The drugs can pass from parent to child in the womb or through breastfeeding. However, most corticosteroid inhalers and injections are considered safe.

Certain medical conditions may affect the use of a corticosteroid medication. Tell your doctor if you have any preexisting health conditions.

It’s particularly important to tell them if you have:

• HIV or AIDS
• herpes simplex infection of the eye
• tuberculosis
• gastrointestinal problems
• diabetes
• glaucoma
• high blood pressure
• any kind of infection (viral, bacterial, fungal)
• a disease of the heart, liver, thyroid, or kidney
• have had a recent surgery or serious injury

Corticosteroids can also alter the effects of other medications. However, the likelihood of interactions happening with steroid sprays or injections is low.

Be careful what you eat when taking corticosteroids. Certain steroids shouldn’t be taken with food, as interactions may occur.

Tobacco and alcohol can also cause interactions with certain medications, including corticosteroids. If you regularly drink or smoke, talk to your doctor about the effect this may have on your treatment.

While there are risks and complications associated with corticosteroids, there are also ways to reduce or address side effects.

Here are some tips to consider:

• always take your medication as directed
• talk to your doctor about low or intermittent dosing
• maintain a healthy diet
• find an exercise routine that works for you
• attend regular health checkups

High blood sugar (hyperglycemia) is a symptom of some corticosteroids. High blood sugar can cause fatigue, thirst, and frequent urination among other symptoms. Corticosteroids can also interfere with many other bodily processes, from your bones to your blood pressure.

Here’s a breakdown of some dietary guidelines that can help you maintain a balanced diet, and reduce your risk of side effects:

Foods to avoid	Eat more of
Sweets and foods high in sugar increase risk of high blood sugar. Candy, soda, cookies, and ice cream are high in concentrated sweets.	High-potassium foods help replenish lost potassium in the bloodstream. This includes bananas, avocados, potatoes, spinach, whole grain bread, and dark chocolate.
High-sodium foods can raise blood pressure and cause fluid retention. This includes cured meats, snacks like chips, and certain sauces.	High-calcium foods help prevent osteoporosis, which weakens bones. Prioritize milk, yogurt, cheese, nuts and seeds, and dark, leafy greens.
Fried foods raise cholesterol and triglycerides (lipids). Try to limit products that are high in fat and cholesterol, including heavy creams and fatty cuts of meat.	High-protein foods keep muscle tissues healthy. Meat, seafood, eggs, legumes, and tofu can help keep muscles strong.

Corticosteroids are powerful anti-inflammatory medications that mimic our naturally occurring hormone cortisol. These drugs come in oral, topical, and injectable forms, and have benefits for a wide variety of health conditions.

Local corticosteroids can treat asthma and skin allergies. Systemic corticosteroids can help lower inflammation for those with lupus, inflammatory bowel disease, or in people recovering from an organ transplant. Some health conditions require long-term treatment with corticosteroids, while others only need a very short course.

Corticosteroids can come with serious side effects, including high blood pressure, weight gain, and increased risk of infections. This risk increases if you use them long term.

Talk to your doctor about the pros and cons of corticosteroids. Communicate any preexisting conditions you have, and any medications you take, to your healthcare team in order to minimize risk of side effects.

Types, side effects, and how they work

Corticosteroids, such as prednisone and cortisone, are a class of drugs that can effectively reduce inflammation. However, they also cause a range of side effects that limit their use.

Corticosteroids are different than the performance-enhancing drugs that some athletes and bodybuilders use. Those are anabolic steroids.

In this article, we take a look at the types of corticosteroids and their uses. We also look at how these drugs work and the possible risks of using them.

Share on PinterestCorticosteroids may help treat asthma, allergies, and eczema.

Corticosteroids have several different effects on the body, which means that they can treat a range of medical conditions. They can reduce inflammation, suppress overactive immune system responses, and help with hormonal imbalances.

Corticosteroids are fast-acting in the body, which makes them useful for treating sudden, severe symptoms. For example, they can effectively manage allergic responses.

These drugs can also suppress the immune system, which makes them helpful for treating autoimmune diseases.

Some conditions that corticosteroids can help treat include:

• asthma
• allergies
• eczema
• hives
• psoriasis
• chronic obstructive pulmonary disease (COPD)
• inflammatory bowel disease, which includes Crohn’s disease and ulcerative colitis
• multiple sclerosis (MS)
• lupus
• Addison’s disease
• rheumatoid arthritis

Doctors may also use them to treat people who are recovering from an organ transplant.

Corticosteroids have a long history of use in the United States. Most are now available in generic forms, including:

• cortisone
• prednisone
• prednisolone
• methylprednisolone
• dexamethasone
• betamethasone
• hydrocortisone

Corticosteroids can come in the form of:

• tablets
• capsules
• eye drops
• lotions, creams, ointments, or gels
• nasal or mouth sprays
• injections

A doctor will prescribe different forms of corticosteroids, depending on the problem. For example, they may prescribe a cream, lotion, ointment, or gel to treat skin conditions.

Long-term use of corticosteroids can have side effects that include:

• acne
• weight gain
• bruising
• mood disorders, including depression
• high blood pressure
• diabetes
• osteoporosis
• cataracts
• glaucoma
• liver damage

Long-term corticosteroid use can cause the adrenal glands to stop producing the hormone cortisol. After stopping corticosteroid use, it may take some time for the body to start making cortisol at a normal rate.

Short-term use of corticosteroids is safer, but there are still risks. For example, these drugs can cause changes in sleep, mood, and appetite.

There are also signs that short-term use can have more serious side effects. A 2017 study involving 327,452 adults who received a prescription for corticosteroids found that within 30 days of using them, there was an increase in the risk of sepsis, blood clots, and bone fractures.

Corticosteroids mimic the effects of hormones, such as cortisol. A doctor will prescribe corticosteroids to either increase the action of these hormones above a normal level or return it to a normal level.

A person with Addison’s disease, for example, can benefit from this treatment as their body will not produce enough cortisol.

The increase in hormonal activity suppresses the immune system, which is responsible for activating inflammation in the body. By suppressing immune system activity, corticosteroids can reduce inflammation.

Corticosteroids can have substantial effects on the body by suppressing the immune system. Doctors typically use corticosteroids if other treatments are not working, or they require a rapid response.

Taking corticosteroids can cause spikes in blood sugar levels, which can be dangerous for people with diabetes.

Corticosteroids could be harmful in people with:

• diabetes
• depression
• obesity
• substance use disorder
• glaucoma or cataracts
• ulcers
• a recent heart attack or heart failure
• high blood pressure
• liver problems
• epilepsy
• ongoing infections
• large wounds

It is possible to use corticosteroid medications during pregnancy, but there are always risks with corticosteroid use. Therefore, doctors may avoid prescribing them to women who are pregnant when possible.

Corticosteroids can reduce the effectiveness of some medications and make others more potent. Before using corticosteroids, people should tell a doctor if they are taking any medications to treat the following:

• excessive blood clotting
• seizures
• diabetes
• HIV

Certain vaccines, such as those for measles, mumps, and tuberculosis, can have dangerous interactions with corticosteroids. Other vaccines, such as those for flu or pneumonia, may not work as well if a person is also taking a high dosage of a corticosteroid.

It can also be harmful to use corticosteroids alongside nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil).

The side effects may differ depending on the specific form of corticosteroid. For example, a corticosteroid cream that a person applies to the face might have different side effects than a corticosteroid tablet or injection.

Taking lower dosages over shorter periods will reduce the risk of side effects from corticosteroids. Doctors will always try to prescribe the lowest dosage that will still provide effective treatment.

Some tips to reduce the risk of problems when taking corticosteroids include:

• avoiding interactions by making sure that the doctor is aware of all other medications and supplements
• being careful to prevent infections where possible, such as by getting a flu vaccine and keeping open wounds clean and protected
• keeping the bones healthy through proper exercise, a healthful diet, and, for older adults, calcium and vitamin D supplements
• taking precautions to avoid becoming pregnant, if possible
• having regular eye exams
• watching out for signs of water retention, such as swollen ankles
• taking doses according to the doctor’s prescription
• applying a retinoid cream at the same time as corticosteroid creams, gels, or lotions to reduce the risk of thin skin
• avoiding sudden changes in dosage to reduce the risk of complications, such as withdrawal symptoms

Corticosteroids are effective in suppressing the immune system and reducing inflammation. They are useful for a variety of conditions, particularly when prompt treatment is necessary.

Both long-term and short-term use of corticosteroids can have side effects, some of which are serious. It is important only to take corticosteroids if there are no viable alternatives.

When using corticosteroids, a person should take note of any side effects or changes in symptoms. They should also make sure that their doctor is aware of any other medications and supplements that they are taking. The doctor can help them avoid harmful interactions.

Cortisone instructions for use: indications, contraindications, side effects – description of Cortisone Tablets (21875)

Cortisol, cortisone, 6‑hydroxycortisol and their ratios in urine

Cortisol (hydrocortisone) is a steroid hormone belonging to the class of glucocorticoid hormones. Produced by the fascicular zone of the adrenal cortex. The biological metabolite of cortisol is 6-β-hydroxycortisol, which is formed in the liver under the action of the CYP3A4 isoenzyme localized in the liver and in the cells of the small intestine. The main processes of biotransformation of xenobiotics, including drugs, occur in the liver with the participation of enzymes of the cytochrome P450 system, in particular, the CYP3A4 isoenzyme. In clinical practice, the cortisol/cortisone ratio is used to indirectly assess the activity of the 11-hydroxysteroid dehydrogenase system (11α-HSD and 11β-HSD), and the 6-hydroxycortisol/cortisol ratio is used to determine the activity of the CYP3A4 isoenzyme. The definition of cortisol has an independent diagnostic value.

Parameters to be determined:

• Cortisol
• Cortisone (clinically relevant in calculating the cortisol/cortisone ratio)
• 6-Hydroxycortisol

Ratios:

• Cortisol/cortisone
• 6-hydroxycortisol/cortisol

Test Method

Gas Chromatography-Mass Spectrometry (GC-MS).

Units

Mcg/day (micrograms per day).

What biomaterial can be used for research?

Daily urine.

How to properly prepare for the examination?

• Exclude physical and emotional overexertion within 24 hours prior to the study.
• Exclude physical and emotional overstrain during the collection of daily urine (during the day).

General information about the study

Cortisol (hydrocortisone) is a steroid hormone belonging to the class of glucocorticoid hormones. It is produced by the fascicular zone of the adrenal cortex under the control of the hypothalamus and adrenocorticotropic hormone (ACTH), synthesized by the anterior pituitary gland. Cortisol stimulates proteolysis (breakdown of proteins into amino acids) mainly in muscle tissue and activates gluconeogenesis in the liver (synthesis of glucose from amino acid residues).

Metabolism

The half-life of cortisol in the body is about 90 minutes. It is reversibly metabolized by the 11-hydroxysteroid dehydrogenase (11-HSD) system, which is represented by two enzymes: 11α-HSD catalyzes the conversion of cortisol to cortisone, and 11β-HSD back. Cortisone is the main metabolite of cortisol with weak glucocorticoid activity. The adrenal glands and kidneys are the main organs where cortisol inactivation occurs with the participation of 11α-HSD. Cortisone is also considered as a “temporary” depot to quickly replenish the body’s needs for cortisol. The 11β-HSD enzyme converts inert cortisone back into biologically active cortisol. The maximum activity of 11β-HSD is observed in the liver and to a much lesser extent in adipose tissue, gonads, CNS and muscles. In obesity, insulin resistance, and metabolic syndrome, 11β-HSD activity in adipose tissue increases, which enhances the reversal of cortisone to cortisol. Cortisol and cortisone under the action of 5β-reductase are metabolized in the liver (to a lesser extent in the adrenal glands) into inactive tetrahydrocortisol and tetrahydrocortisone. The levels of cortisol and cortisone in the body depend on the activity of 5β-reductase. Over 95% of tetrahydro derivatives of cortisol and cortisone metabolites form conjugates in the liver with glucuronic and sulfuric acid residues and are rapidly excreted in the urine.

6-Hydrocortisol is formed from cortisol by the action of the CYP3A4 isoenzyme localized in the endoplasmic reticulum of liver and intestinal cells. This isoenzyme, which is part of the cytochrome P450 system, is responsible for the metabolism of many substances of both endogenous origin (steroid hormones, lipids, bile acids) and xenobiotics, including drugs, environmental toxic substances, and natural compounds found in food. This isoenzyme is considered the main of all isoenzymes of the CYP family; it is found not only in the liver, but also in the prostate, mammary glands, epithelial cells of the small and large intestines, and even in brain cells. CYP3A4 metabolizes more than half of the drugs used today, including antitumor drugs, immunosuppressants, antifungals, macrolides, tricyclic antidepressants, etc. xenobiotics from the environment and food (for example, natural compounds in grapefruit juice inhibit CYP3A4 activity).

Laboratory diagnostics

Simultaneous determination of these steroids in daily urine is most informative for diagnostics.

Determination of cortisol has independent diagnostic value.

Cortisone is an auxiliary analyte for the laboratory diagnosis of adrenal pathology: for calculating the cortisol/cortisone ratio. In clinical practice, this ratio is used to indirectly assess the activity of 11α-HSD. Its increase is due to reduced 11α-HSD activity, or increased 11β-HSD activity, or a combination of the two.

With 11β-HSD deficiency, the cortisone/cortisol ratio is greater than 1. In the absence of pathology, as a rule, 1:2 – 1:3. Actually reference values ​​for cortisone in daily urine, which are given below, are indicative and their independent diagnostic value is low.

In clinical practice, the determination of the ratio of 6-hydroxycortisol and cortisol is used to determine the activity of the CYP3A4 isoenzyme, which, along with the conversion of cortisol to 6-hydroxycortisol, is involved in the metabolism of xenobiotics, including drug compounds. Tetrahydrocortisol and tetrahydrocortisone are the end products of cortisol and cortisone metabolism, and measuring their levels allows you to more accurately determine the disturbances in the metabolism of this group of hormones that perform many important functions in the body.

An increase in the tetrahydrocortisol/tetrahydrocortisone ratio is a marker of hypertensive disorders resulting from the suppression of 11-beta-hydroxysteroid dehydrogenase by pharmacological preparations or foods containing glycyrrhizic acid, or due to a genetic defect in this enzyme.

The 6-hydroxycortisol/cortisol ratio measures the activity of the CYP3A4 enzyme, which is part of the cytochrome P450 enzyme system that detoxifies various compounds.

When is the test scheduled?

• Identification of acquired dysfunction of the adrenal cortex.
• Subclinical form of Itsenko-Cushing’s syndrome/disease.
• Obesity.
• Chronic renal failure.
• Differential diagnosis of dysfunction of the adrenal cortex.
• Violation of spermatogenesis and fertility in men.
• Hypogonadism, delayed sexual development.
• Recurrent miscarriage, infertility in women.
• Polycystic ovary syndrome.
• Hormone-producing tumors of the adrenal cortex, ovaries and testicles.
• Control during treatment with glucocorticoid drugs.

What do the results mean?

Reference values ​​

Cortisone: for cortisol/cortisone ratio calculation only. Self-diagnostic value is low.

Clinical significance