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What is cortisol? (also known as hydrocortisone)
Cortisol is a hormone made by the adrenal glands which sit on top of each kidney.
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The adrenal gland makes several hormones. The inner zone (medulla) makes adrenaline. The outer zone (cortex) supplies cortisol as well as other hormones controlling salt balance (aldosterone) and sexual development (sex steroids). |
Of these hormones, only cortisol is essential to life, though the salt balance hormone (aldosterone or its substitute, fludrocortisone) may be needed to assist the action of hydrocortisone in some people with inadequate adrenal gland activity.
There are many different types of hormones and many endocrine glands which make their own special hormones.
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Cortisol is secreted into the blood stream in response to the regulating hormone called ACTH
which is in turn produced by the
pituitary gland under the brain.
If too much cortisol is secreted, the pituitary hormone output is reduced. Apart from regulating the secretion of the adrenal glands, ACTH has no other known function although it does darken the skin if the blood level is abnormally high for long periods of time. |
Adrenal Gland Atrophy
For some reason, often unknown, the adrenal gland wastes away and can no longer respond to ACTH. This happens in Addison's disease, and people with this disorder will require hydrocortisone and other hormone treatment (e.g. fludrocortisone or florinef) for the rest of their lives. The commonest cause of adrenal failure is a problem with the body's immune system. Occasionally it can result from tuberculosis of the adrenal glands.
Disorders of Synthesis
In this case the adrenal gland is present and active, but lacks the ability to make the final product (cortisol/hydrocortisone). Immature forms of the hormone are made instead and these can lead to abnormal developments (rapid growth in children, excessive sex hair and premature male development, infertility etc) if not controlled. This condition is called congenital adrenal hyperplasia and requires treatment with hydrocortisone for life. These people sometimes need fludrocortisone also to normalize the salt balance of the body.
Removal by Surgery
The adrenal glands may have been removed by surgical operation. Hydrocortisone and probably fludrocortisone treatment will be needed for life.
Lack of ACTH from the pituitary
If the pituitary gland cannot make ACTH then a lack of cortisol develops because ACTH controls the activity of the adrenal glands. This can happen if the base of the brain is damaged, or if the pituitary gland is squashed or has to be removed for any reason. This condition is treated with hydrocortisone, usually required for life or until the pituitary can recover sufficiently to make enough ACTH. If the pituitary gland is not working properly there may be a number of other hormones which will need to be replaced. Your doctor will instruct you on the need for checks to assess this.
It is especially important in helping the body to combat stress or recover from any shock or illness.
It controls metabolism - the supply of glucose and energy, allows the muscles to perform efficiently, helps to regulate blood pressure and to fight off infections. Cortisol also helps to maintain appetite and body weight.
Cortisone acetate - similar in action to hydrocortisone, comes in 5mg and 25mg tablet form.
Other hormone medications with a similar action are prednisone and dexamethasone.
If you were taking too much hydrocortisone the signs are harder to detect until well developed. Weight gain, rounding of the face, bruising, ankle swelling, high blood pressure and eventually muscle weakness, thinning of the bones and mood changes can occur.
This response of the adrenal glands helps the body to ward off the infection and assists prompt recovery. If the adrenal glands for some reason cannot increase their output, there is a danger of collapse and severe shock developing unless extra hydrocortisone is given.
For this reason all people (dependent on cortisol) should wear a medic-alert bracelet or emblem so that extra hormone can be given in an emergency, especially if consciousness is impaired.
Make sure you have a Medic-Alert bracelet and always wear it!
If vomiting or unable to swallow your tablets contact your doctor URGENTLY. Usually you will be given an injection of hydrocortisone (50 - 100mg). This may be repeated in 6-8 hours if you are still unable to swallow pills.
If vomiting and/or diarrhoea continues for longer than 8 - 12 hours you MUST BE ADMITTED TO HOSPITAL and kept under close medical observation.
If you live far away from a medical centre you may need to have a supply of injectable hydrocortisone, syringes and needles in case of emergency. This can be arranged through your specialist or G.P.
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| Canterbury Health Laboratories |
