Cortisone Associated Diseases and Disorders

🧪 Cortisone-Associated Diseases

While cortisone itself is less active than cortisol, problems can arise from:

  • Impaired cortisone↔cortisol conversion
  • Excessive or insufficient cortisone exposure (natural or synthetic)
  • Enzyme defects in 11β-HSD1 or 11β-HSD2

🔺 1. Apparent Mineralocorticoid Excess (AME)

🧬 Cause:

  • Deficiency of 11β-HSD2 enzyme → can’t convert cortisol to cortisone in the kidney
  • Excess cortisol binds mineralocorticoid receptors, mimicking aldosterone

🩺 Symptoms:

  • Hypertension (especially in children)
  • Hypokalemia
  • Low plasma renin and aldosterone
  • Normal or elevated cortisol/cortisone ratio

🧪 Can be genetic or acquired (e.g., excessive licorice intake, which inhibits 11β-HSD2)

🔻 2. 11β-HSD1 Deficiency or Dysfunction

🧬 Cause:

  • Reduced conversion of cortisone to cortisol in liver, fat, and brain
  • Can affect local cortisol levels → impacts metabolic control, inflammation, and stress response

🧠 Associated issues (theoretical or research-based):

  • Impaired stress adaptation
  • Altered glucose metabolism
  • Reduced inflammatory resolution

Note: This is more experimental than fully clinical.

💉 3. Cortisone Therapy – Associated Side Effects

Used to treat inflammation (e.g., arthritis, asthma), but prolonged cortisone use can lead to:

➕ Cushingoid Effects (Iatrogenic Cushing’s Syndrome)

  • Moon face, weight gain, muscle wasting
  • Osteoporosis, diabetes, hypertension
  • Adrenal suppression (↓ ACTH, atrophy of adrenal glands)

âž– Adrenal Insufficiency (After Withdrawal)

  • Abrupt stopping of cortisone → low ACTH and adrenal atrophy
  • Symptoms: fatigue, hypotension, nausea, weakness

🧬 4. Cortisone-Cortisol Imbalance in Adrenal Disorders

  • In Addison’s disease or secondary adrenal insufficiency, cortisone (like cortisol) is low
  • May require glucocorticoid replacement therapy (often with hydrocortisone or cortisone acetate)

📊 Summary Table

ConditionCortisone RoleKey Features
AME (Apparent Mineralocorticoid Excess)↓ Cortisone (in kidney)HTN, hypokalemia
Cortisone therapy (chronic)↑ CortisoneCushingoid features
Cortisone withdrawal↓ Cortisone/cortisolAdrenal insufficiency
11β-HSD1 dysfunction↓ Cortisone → cortisolWeak glucocorticoid activity
Addison’s disease↓ Cortisone & cortisolFatigue, hypotension, hyperpigmentation