Cortisol
Systematic (IUPAC) name
11,17,21-trihydroxy-,(11beta)- pregn-4-ene-3,20-dione
Identifiers
CAS number	50-23-7
ATC code	H02AB09 (and others)
PubChem	5754
Chemical data
Formula	C21H30O5
Mol. mass	362.465
Pharmacokinetic data
Bioavailability	?
Metabolism	?
Half life	?
Excretion	?
Therapeutic considerations
Pregnancy cat.	C Image File history File links Cortisol2. ... Image File history File links Download high-resolution version (1100x996, 277 KB) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Cortisol ... IUPAC nomenclature is a system of naming chemical compounds and of describing the science of chemistry in general. ... CAS registry numbers are unique numerical identifiers for chemical compounds, polymers, biological sequences, mixtures and alloys. ... The Anatomical Therapeutic Chemical Classification System is used for the classification of drugs. ... A section of the Anatomical Therapeutic Chemical Classification System. ... PubChem is a database of chemical molecules. ... A chemical formula is a concise way of expressing information about the atoms that constitute a particular chemical compound. ... For other uses, see Carbon (disambiguation). ... This article is about the chemistry of hydrogen. ... This article is about the chemical element and its most stable form, or dioxygen. ... The molecular mass (abbreviated Mr) of a substance, formerly also called molecular weight and abbreviated as MW, is the mass of one molecule of that substance, relative to the unified atomic mass unit u (equal to 1/12 the mass of one atom of carbon-12). ... In pharmacology, bioavailability is used to describe the fraction of an administered dose of unchanged drug that reaches the systemic circulation, one of the principal pharmacokinetic properties of drugs. ... Drug metabolism is the metabolism of drugs, their biochemical modification or degradation, usually through specialized enzymatic systems. ... The biological half-life of a substance is the time required for half of that substance to be removed from an organism by either a physical or a chemical process. ... The kidneys are important excretory organs in vertebrates. ... The pregnancy category of a pharmaceutical agent is an assessment of the risk of fetal injury due to the pharmaceutical, if it is used as directed by the mother during pregnancy. ...
Legal status
Routes	Oral tablets, intravenously, topical

Cortisol is a corticosteroid hormone produced by the Zona fasciculata of the adrenal cortex (in the adrenal gland). It is a vital hormone that is often referred to as the "stress hormone" as it is involved in the response to stress. It increases blood pressure, blood sugar levels and has an immunosuppressive action. In pharmacology, the synthetic form of cortisol is referred to as hydrocortisone, and is used as an antagonist in the treatment of allergies and inflammation as well as substitute supplementation in cortisol production deficiencies. When first introduced as a treatment for rheumatoid arthritis, it was referred to as Compound E. The regulation of therapeutic goods, that is drugs and therapeutic devices, varies by jurisdiction. ... In pharmacology and toxicology, a route of administration is the path by which a drug, fluid, poison or other substance is brought into contact with the body. ... In physiology, corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. ... For other uses, see Hormone (disambiguation). ... In mammals, the adrenal glands (also known as suprarenal glands or colloquially as kidney hats) are the triangle-shaped endocrine glands that sit atop the kidneys; their name indicates that position (ad, near or at + renes, kidneys). They are chiefly responsible for regulating the stress response through the synthesis of... Cortical part of the adrenal gland (on the pointer). ... In medical terms, stress is the disruption of homeostasis through physical or psychological stimuli. ... A sphygmomanometer, a device used for measuring arterial pressure. ... In medicine, blood sugar is a term used to refer to levels of glucose in the blood. ... Immunosuppression is the medical suppression of the immune system. ... Pharmacology (in Greek: pharmakon (φάρμακον) meaning drug, and lego (λέγω) to tell (about)) is the study of how drugs interact with living organisms to produce a change in function. ... Allergy is an abnormal reaction to a substance foreign to the body that is acquired, predictable and rapid. ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... Rheumatoid arthritis (RA) is traditionally considered a chronic, inflammatory autoimmune disorder that causes the immune system to attack the joints. ...

Physiology

The amount of cortisol present in the blood undergoes diurnal variation, with the highest levels present in the early morning, and the lowest levels present around midnight, 3-5 hours after the onset of sleep. Information about the light/dark cycle is transmitted from the retina to the paired suprachiasmatic nuclei in the hypothalamus. For other uses, see Blood (disambiguation). ... Look up day in Wiktionary, the free dictionary. ... For other uses, see Sleep (disambiguation). ... A circadian rhythm is a roughly-24-hour cycle in the physiological processes of living beings, including plants, animals, fungi and cyanobacteria. ... Human eye cross-sectional view. ... The suprachiasmatic nucleus (SCN) is a region of the brain, located in the hypothalamus, that is responsible for controlling endogenous circadian rhythms. ... The hypothalamus links the nervous system to the endocrine system via the pituitary gland (hypophysis). ...

Changed patterns of serum cortisol levels have been observed in connection with abnormal ACTH levels, clinical depression, psychological stress, and such physiological stressors as hypoglycemia, illness, fever, trauma, surgery, fear, pain, physical exertion or extremes of temperature. Adrenocorticotropic hormone (ACTH or corticotropin) is a polypeptide hormone secreted from corticotropes in the anterior lobe of the pituitary gland in response to corticotropin-releasing hormone (CRH) released by the hypothalamus. ... On the Threshold of Eternity. ... Stress (roughly the opposite of relaxation) is a medical term for a wide range of strong external stimuli, both physiological and psychological, which can cause a physiological response called the general adaptation syndrome, first described in 1936 by Hans Selye in the journal Nature. ... Hypoglycemia (hypoglycaemia in British English) is a medical term referring to a pathologic state produced by a lower than normal level of glucose (sugar) in the blood. ... An analogue medical thermometer showing the temperature of 38. ... “Surgeon” redirects here. ... For other uses, see Fear (disambiguation). ... Pain redirects here. ... For other uses, see Temperature (disambiguation). ...

There is also significant individual variation, although a given person tends to have consistent rhythms.

Effects

See also Medical uses and effects of high dose glucocorticoids

In normal release, cortisol (like other glucocorticoid agents) has widespread actions which help restore homeostasis after stress. (These normal endogenous functions are the basis for the physiological consequences of chronic stress - prolonged cortisol secretion.). It has been proposed that its primary function is to inversely mobilize the immune system to fight potassium losing diarrhea diseases.^[1] Its odd attributes all support this. Glucocorticoids are a class of steroid hormones characterised by an ability to bind with the cortisol receptor and trigger similar effects. ... Glucocorticoids are a class of steroid hormones characterised by an ability to bind with the cortisol receptor and trigger similar effects. ... Homeostasis is the property of either an open system or a closed system, especially a living organism, which regulates its internal environment so as to maintain a stable, constant condition. ... In medical terms, stress is the disruption of homeostasis through physical or psychological stimuli. ... Look up Endogenous in Wiktionary, the free dictionary. ...

Insulin

It counteracts insulin by increasing glycogenolysis (breaking down glycogen) and promotes breakdown of lipids (lipolysis), and proteins, and mobilization of extrahepatic amino acids and ketone bodies. This leads to increased circulating glucose concentrations (in the blood) by increasing gluconeogenesis. There is an increased glycogen breakdown in the liver.^[2] Prolonged cortisol secretion causes hyperglycemia. Cortisol has no effect on insulin ^[3]. The reason why in vivo experiments seem to deny this is that cortisone greatly inhibits insulin . So the cortisone-cortisol equilibrium may explain why in vivo experiments contradict the cortisol effect ^[4]. Cortisol does cause serum glucose to rise, but this is probably an indirect effect caused by stimulation of amino acid degradation, especially that derived from collagen in the skin. Loss of collagen from skin by cortisol is ten times greater than from all other tissue in the rat. ^[5].

Amino acids

Cortisol raises the free amino acids in the serum. It does this by inhibiting collagen formation, decreasing amino acid uptake by muscle, and inhibiting protein synthesis.^[6] Cortisol (as opticortinol) probably inversely inhibits IgA precursor cells in the intestines of calves ^[7]. Cortisol also inhibits IgA in serum, as it does IgM, but not IgE.^[8]

Gastric secretion

Cortisol stimulates gastric acid secretion ^[9]. Gastric acid secretion would increase loss of potassium into the stomach during diarrhea as well as acid loss. Cortisol's only direct effect on the hydrogen ion excretion of the kidneys is to stimulate excretion of ammonium ion by inactivation of renal glutaminase enzyme ^[10]. Net chloride secretion in the intestines is inversely decreased by cortisol in vitro (methylprednisolone) ^[11].

Sodium

Cortisol inhibits loss of sodium from small intestines of mammals. ^[12]. However sodium depletion does not affect cortisol ^[13], so cortisol is not used to regulate serum sodium. Cortisol’s purpose may originally had been centered around moving sodium because cortisol is used to stimulate sodium inward for fresh water fish and outward for salt-water fish ^[14].

Potassium

Sodium loads augments the intense potassium excretion by cortisol, and corticosterone is comparable to cortisol in this case ^[15]. In order for potassium to move out of the cell, cortisol moves in an equal number of sodium ions ^[16]. It can be seen that this should make pH regulation much easier, unlike the normal potassium deficiency situation in which about 2 sodium ions move in for each 3 potassium ions that move out, which is closer to the deoxycorticosterone effect. Nevertheless, cortisol consistently causes alkalosis of the serum, while in a deficiency pH does not change. Perhaps this may be for the purpose of bringing serum pH to a value most optimum for some of the immune enzymes during infection in those times when cortisol declines. Potassium is also blocked from loss in the kidneys directly somewhat by decline of cortisol (9 alpha fluorohydrocortisone) ^[17].

Water

Cortisol also acts as a water diuretic hormone. Half the intestinal diuresis is so controlled ^[18]. Kidney diuresis is also controlled by cortisol in dogs. The decline in water excretion upon decline of cortisol (dexamethasone) in dogs is probably due to inverse stimulation of antidiuretic hormone (ADH or arginine vasopressin), the inverse stimulation of which is not overridden by water loading.^[19]. Humans also use this mechanism ^[20] and other different animal mechanisms operate in the same direction.

Copper

It is probable that increasing copper availability for immune purposes is the reason why many copper enzymes are stimulated to an extent which is often 50% of their total potential by cortisol ^[21]. This includes lysyl oxidase, an enzyme which is used to cross link collagen and elastin ^[22]. Particularly valuable for immunity is the stimulation of superoxide dismutase by cortisol ^[23] since this copper enzyme is almost certainly used by the body to permit superoxide to poison bacteria. Cortisol causes an inverse four or five fold decrease of metallothionein, a copper storage protein, in mice ^[24] (however rodents do not synthesize cortisol themselves),. This may be to furnish more copper for ceruloplasmin synthesis or release of free copper. Cortisol has an opposite effect on alpha aminoisobuteric acid than on the other amino acids ^[25]. If alpha aminoisobuteric acid is used to transport copper through the cell wall, this anomaly would possibly be explained.

Immune system

Cortisol can weaken the activity of the immune system . Cortisol prevents proliferation of T-cells by rendering the interleukin-2 producer T-cells unresponsive to interleukin-1 (IL-1), and unable to produce the T-cell growth factor.^[26] Cortisol has a negative feedback effect on interleukin-1 ^[27] which must be especially useful in combating diseases, such as the endotoxin bacteria, that gain an advantage by forcing the hypothalamus to secrete a hormone called CRH. The suppressor cells are not affected by GRMF, ^[28] so that the effective set point for the immune cells may be even higher than the set point for physiological processes. It reflects leukocyte redistribution to lymph nodes, bone marrow, and skin. Acute administration of corticosterone (the endogenous Type I and Type II receptor agonist), or RU28362 (a specific Type II receptor agonist), to adrenalectomized animals induced changes in leukocyte distribution. Natural killer cells are not affected by cortisol ^[29].

Bone metabolism

It lowers bone formation thus favoring development of osteoporosis in the long term. Cortisol moves potassium out of cells in exchange for an equal number of sodium ions as mentioned above.^[30] This can cause a major problem with the hyperkalemia of metabolic shock from surgery.

Memory

It cooperates with epinephrine (adrenaline) to create memories of short-term emotional events; this is the proposed mechanism for storage of flash bulb memories, and may originate as a means to remember what to avoid in the future. However, long-term exposure to cortisol results in damage to cells in the hippocampus. This damage results in impaired learning. The desirability of inhibiting activity during infection is no doubt the reason why cortisol is responsible for creating euphoria, ^[31]. The desirability of not disturbing tissues weakened by infection or of not cutting off their blood supply could explain the inhibition of pain widely observed for cortisol.

Additional effects

• It increases blood pressure by increasing the sensitivity of the vasculature to epinephrine and norepinephrine. In the absence of cortisol, widespread vasodilation occurs.

• It inhibits the secretion of corticotropin-releasing hormone (CRH), resulting in feedback inhibition of ACTH secretion. Some researchers believe that this normal feedback system may break down when animals are exposed to chronic stress.

• It increases the effectiveness of catecholamines.

• It allows for the kidneys to produce hypotonic urine.

• It has anti-inflammatory effects by reducing histamine secretion and stabilizing lysosomal membranes. The stabilization of lysosomal membranes prevents their rupture, thereby preventing damage to healthy tissues.

• It stimulates hepatic detoxification by inducing tryptophan oxygenase (to reduce serotonin levels in the brain), glutamine synthase (reduce glutamate and ammonia levels in the brain), cytochrome P-450 hemoprotein (mobilizes arachidonic acid), and metallothionein (reduces heavy metals in the body).

• In addition to the effects caused by cortisol binding to the glucocorticoid receptor, because of its molecular similarity to aldosterone, it also binds to the mineralocorticoid receptor. Aldosterone and cortisol have similar affinity for the mineralocorticoid receptor however, glucocorticoids circulate at roughly 100 times the level of mineralocorticoids. An enzyme exists in mineralocorticoid target tissues to prevent overstimulation by glucocorticoids and allow selictive mineralocorticoid action. This enzyme, 11-beta hydroxysteroid dehydrogenase type II (Protein:HSD11B2), catalyzes the deactivation of glucocorticoids to 11-dehydro metabolites.

Not to be confused with inulin. ... Glycogen Glucose Glucose-6-phosphate Glycogenolysis is the catabolism of glycogen by removal of a glucose monomer and addition of phosphate to produce glucose-1-phosphate. ... Glycogen Structure Segment Glycogen is a polysaccharide of glucose (Glc) which functions as the primary short term energy storage in animal cells. ... Some common lipids. ... Lipolysis is the breakdown of fat stored in fat cells. ... A representation of the 3D structure of myoglobin showing coloured alpha helices. ... Glucose (Glc), a monosaccharide (or simple sugar), is an important carbohydrate in biology. ... Glycogen Structure Segment Glycogen is a polysaccharide of glucose (Glc) which functions as the primary short term energy storage in animal cells. ... For the bird, see Liver bird. ... Hyperglycemia or High Blood Sugar is a condition in which an excessive amount of glucose circulates in the blood plasma. ... IGA may stand for: Koji Igarashi, a video game producer Interactive genetic algorithm International Geothermal Association Independent Glass Association International Gothic Association International Gamers Award International Goat Association Irish Games Association Irish Geological Association ImmunoGlobulin A - see IgA nephritis which is a renal disease IGA (supermarkets) Independent Grocers Association or... IGM might be an acronym or abbreviation for: The polymeric immunoglobulin, IgM International Grandmaster, a chess ranking intergalactic medium Intragroup medium - see: Intracluster medium IG Metall - the dominant German metalworkers union IGM is an acronym created by Robinson Technologies for several early BBS door games, including Legend of the Red... IGE (Internet Gaming Entertainment) is the largest MMORPG services company world-wide, with offices in Los Angeles, Hong Kong, and Miami. ... Methylprednisolone (molecular weight 374. ... Corticosterone is a 21 carbon steroid hormone of the corticosteroid type produced in the cortex of the adrenal glands. ... For other uses, see PH (disambiguation). ... Deoxycorticosterone Deoxycorticosterone is a steroid hormone produced by the adrenal gland that posses mineralocorticoid activity and acts as a precursor to aldosterone. ... Alkalosis refers to a condition reducing hydrogen ion concentration of arterial blood plasma. ... This illustration shows where some types of diuretics act, and what they do. ... Antidiuretic hormone (ADH), or arginine vasopressin (AVP), is a peptide hormone produced by the hypothalamus, and stored in the posterior part of the pituitary gland. ... Antidiuretic hormone (ADH), or arginine vasopressin (AVP), is a peptide hormone produced by the hypothalamus, and stored in the posterior part of the pituitary gland. ... Elastin is a protein in connective tissue that is elastic and allows many tissues in the body to resume their shape after stretching or contracting. ... Metallothioneins (MTs) is a family of Cys-rich, low molecular weight (MW ranging from 3500 to 14000 Da) proteins. ... A scanning electron microscope image of a single neutrophil (yellow), engulfing anthrax bacteria (orange). ... Interleukin-2 (IL2) is an interleukin, a type of biological response modifier that can improve the bodys natural response to disease. ... T cells belong to a group of white blood cells known as lymphocytes and play a central role in cell-mediated immunity. ... Interleukin-1 (IL-1) is one of the first cytokines ever described. ... Endotoxins are potentially toxic, natural compounds found inside pathogens such as bacteria. ... The hypothalamus links the nervous system to the endocrine system via the pituitary gland (hypophysis). ... Corticotropin-releasing hormone (CRH), also called corticotropin-releasing factor (CRF) or corticoliberin, is a polypeptide hormone involved in the stress response. ... White Blood Cells is also the name of a White Stripes album. ... This article does not cite any references or sources. ... For other uses, see Skin (disambiguation). ... Corticosterone is a 21 carbon steroid hormone of the corticosteroid type produced in the cortex of the adrenal glands. ... RU28362 is a molecule which binds the glucocorticoid receptor (Corticoid Type II Receptor) but not the mineralocorticoid receptor (Corticoid Type I Receptor). ... This article is about the skeletal organs. ... General Name, symbol, number potassium, K, 19 Chemical series alkali metals Group, period, block 1, 4, s Appearance silvery white Standard atomic weight 39. ... For sodium in the diet, see Salt. ... Hyperkalemia is an elevated blood level (above 5. ... Adrenaline redirects here. ... For computer memory, see computer storage. ... A flashbulb memory is a memory laid down in great detail during a highly personally significant event. ... For other uses, see Hippocampus (disambiguation). ... A sphygmomanometer, a device used for measuring arterial pressure. ... The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... Corticotropin-releasing hormone (CRH), also called corticotropin-releasing factor (CRF) or corticoliberin, is a polypeptide hormone involved in the stress response. ... This article does not cite any references or sources. ... Adrenocorticotropic hormone (ACTH or corticotropin) is a polypeptide hormone secreted from corticotropes in the anterior lobe of the pituitary gland in response to corticotropin-releasing hormone (CRH) released by the hypothalamus. ... tyrosine is the precursor of catecholamines epinephrine norepinephrine dopamine Synthesis Catecholamines are chemical compounds derived from the amino acid tyrosine containing catechol and amine groups. ... Tonicity is a measure of effective osmolarity or effective osmolality. ... This article or section does not cite any references or sources. ... Various organelles labeled. ... Detox, short for detoxification, in general is the removal of toxic substances from the body. ... For the professional wrestling stable, see Ravens Nest#Serotonin. ... Glutamate is the anion of glutamic acid. ... For other uses, see Ammonia (disambiguation). ... Arachidonic acid (AA) is an omega-6 fatty acid 20:4(ω-6). ... For other uses, see Heavy metal (disambiguation). ... The ‘’’glucocorticoid receptor’’’ (GR) is a ligand-activated intracytoplasmatic transcription factor that interacts with high affinity to cortisol and other glucocorticoids. ... Aldosterone is a steroid hormone (mineralocorticoid family) produced by the outer-section (zona glomerulosa) of the adrenal cortex in the adrenal gland to regulate sodium and potassium balance in the blood. ... The mineralocorticoid receptor (MR, MLR, MCR), also aldosterone receptor, is officially labelled nuclear receptor subfamily 3, group C, member 2, (NR3C2) and is a receptor with high affinity for mineralocorticoids. ...

Binding

Most serum cortisol, all but about 4%, is bound to proteins including corticosteroid binding globulin (CBG), and serum albumin. Only free cortisol is available to most receptors. Transcortin, also corticosteroid binding protein or CBG, is an alpha-globulin that has high affinity for binding cortisol. ... You may be looking for albumen, or egg white. ...

Regulation

The primary control of cortisol is the pituitary gland peptide, adrenocorticotropic hormone (ACTH). ACTH probably controls cortisol by controlling movement of calcium into the cortisol secreting target cells.^[32]. ACTH is in turn controlled by the hypothalamic peptide, corticotropin releasing hormone (CRH), which is under nervous control. CRH acts synergisticly with arginine vasopressin, angiotensin II, and epinephrine ^[33]. When activated macrophages start to secrete interleukin-1 (IL-1), which synergistically with CRH increases ACTH, ^[34] T-cells also secrete glucosteroid response modifying factor (GRMF or GAF) as well as IL-1, both of which increase the amount of cortisol required to inhibit almost all the immune cells ^[35]. Thus immune cells take over their own regulation, but at a higher cortisol set point. Even so, the rise of cortisol in diarrheic calves is minimal over healthy calves and drops below with time. ^[36] The cells do not lose all of the fight or flight override because of interleukin-1's synergism with CRH. Cortisol even has a negative feedback effect on interleukin-1 ^[37] which must be especially useful against those diseases which gain an advantage by forcing the hypothalamus to secrete too much CRH, such as the endotoxin bacteria..The suppressor immune cells are not affected by GRMF, ^[38] so that the effective set point for the immune cells may be even higher than the set point for physiological processes. GRMF (called GAF in this reference) primarily affects the liver rather than the kidneys for some physiological processes ^[39]. Located at the base of the skull, the pituitary gland is protected by a bony structure called the sella turcica. ... Adrenocorticotropic hormone (ACTH or corticotropin) is a polypeptide hormone secreted from corticotropes in the anterior lobe of the pituitary gland in response to corticotropin-releasing hormone (CRH) released by the hypothalamus. ... Corticotropin-releasing hormone (CRH), also called corticotropin-releasing factor (CRF) or corticoliberin, is a polypeptide hormone involved in the stress response. ... Antidiuretic hormone (ADH), or arginine vasopressin (AVP), is a peptide hormone produced by the hypothalamus, and stored in the posterior part of the pituitary gland. ... Angiotensinogen, angiotensin I and angiotensin II are peptides involved in maintenance of blood volume and pressure. ... Adrenaline redirects here. ... Interleukin-1 (IL-1) is one of the first cytokines ever described. ... T cells are a subset of lymphocytes that play a large role in the immune response. ... The hypothalamus links the nervous system to the endocrine system via the pituitary gland (hypophysis). ... Endotoxins are potentially toxic, natural compounds found inside pathogens such as bacteria. ...

A high potassium media, which stimulates aldosterone secretion in vitro, also stimulates cortisol secretion from the fasciculata zone of dog adrenals ^[40] unlike corticosterone, upon which potassium has no affect ^[41]. Potassium loading increases ACTH and cortisol in people also ^[42]. This is no doubt the reason why a potassium deficiency causes cortisol to decline (as just mentioned) and why a potassium deficiency causes a decrease in conversion of 11deoxycortisol to cortisol ^[43]. This probably contributes to the pain in rheumatoid arthritis since cell potassium is always low in that disease ^[44] Corticosterone is a 21 carbon steroid hormone of the corticosteroid type produced in the cortex of the adrenal glands. ...

Diseases and disorders

• Hypercortisolism: Excessive levels of cortisol in the blood result in Cushing's syndrome.

• Hypocortisolism, or adrenal insufficiency: If on the other hand the adrenal glands do not produce sufficient amounts of cortisol, Addison's disease is the consequence.

The relationship between cortisol and ACTH is as follows: In medicine, adrenal insufficiency (or hypocortisolism) is the inability of the adrenal gland to produce adequate amounts of cortisol in response to stress. ... Addisons disease(also known as chronic adrenal insufficiency, hypocortisolism or hypocorticism) is a rare endocrine disorder in which the adrenal gland produces insufficient amounts of steroid hormones (glucocorticoids and often mineralocorticoids). ...

Pharmacology

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Hydrocortisone is the chemical form of cortisol used for oral administration or intravenous injection. It is used as an immunosuppressive drug, given by injection in the treatment of severe allergic reactions such as anaphylaxis and angioedema, in place of prednisolone in patients who need steroid treatment but cannot take oral medication, and peri-operatively in patients on long-term steroid treatment to prevent an Addisonian crisis. Image File history File links Broom_icon. ... For a list of immunosuppressive drugs, see the transplant rejection page. ... Anaphylaxis is an acute systemic (multi-system) and severe Type I Hypersensitivity allergic reaction in humans and other mammals. ... Angioedema (BE: angiooedema), also known by its eponym Quinckes edema, is the rapid swelling (edema) of the skin, mucosa and submucosal tissues. ... Prednisolone is the active metabolite of prednisone. ... Addisons disease(also known as chronic adrenal insufficiency, hypocortisolism or hypocorticism) is a rare endocrine disorder in which the adrenal gland produces insufficient amounts of steroid hormones (glucocorticoids and often mineralocorticoids). ...

It may be used topically for allergic rashes, eczema, psoriasis and certain other inflammatory skin conditions. It may also be injected into inflamed joints resulting from diseases such as gout. For the beetle, see Exema. ...

Compared to prednisolone, hydrocortisone is about 1/4 the strength for the anti-inflammatory effect, while Dexamethasone is about 40 times as strong as hydrocortisone. For side effects, see corticosteroid and prednisolone. Prednisolone is the active metabolite of prednisone. ... Anti-inflammatory refers to the property of a substance or treatment that reduces inflammation. ... Dexamethasone is a potent synthetic member of the glucocorticoid class of steroid hormones. ... In physiology, corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. ... Prednisolone is the active metabolite of prednisone. ...

Hydrocortisone creams and ointments are available without prescription in strengths ranging from 0.5% to 2.5%, depending on local regulations, with stronger forms available with prescriptions only.

Biochemistry

Biosynthesis

Steroidogenesis, showing cortisol at right.

Cortisol is synthesized from cholesterol. The synthesis takes place in the zona fasciculata of the cortex of the adrenal glands. (The name cortisol comes from cortex.) While the adrenal cortex also produces aldosterone (in the zona glomerulosa) and some sex hormones (in the zona reticularis), cortisol is its main secretion. The medulla of the adrenal gland lies under the cortex and mainly secretes the catecholamines, adrenaline (epinephrine) and noradrenaline (norepinephrine) under sympathetic stimulation (more epinephrine is produced than norepinephrine, in a ratio 4:1). Image File history File links Size of this preview: 462 × 600 pixel Image in higher resolution (804 × 1044 pixel, file size: 19 KB, MIME type: image/gif)self created I, the creator of this work, hereby grant the permission to copy, distribute and/or modify this document under the terms... Image File history File links Size of this preview: 462 × 600 pixel Image in higher resolution (804 × 1044 pixel, file size: 19 KB, MIME type: image/gif)self created I, the creator of this work, hereby grant the permission to copy, distribute and/or modify this document under the terms... Steroidogenesis is the process of steroid production in living organism. ... Cholesterol is a sterol (a combination steroid and alcohol). ... In mammals, the adrenal glands (also known as suprarenal glands or colloquially as kidney hats) are the triangle-shaped endocrine glands that sit atop the kidneys; their name indicates that position (ad, near or at + renes, kidneys). They are chiefly responsible for regulating the stress response through the synthesis of... Cortical part of the adrenal gland (on the pointer). ... Aldosterone is a steroid hormone (mineralocorticoid family) produced by the outer-section (zona glomerulosa) of the adrenal cortex in the adrenal gland to regulate sodium and potassium balance in the blood. ... Sex hormones are hormones that affect the reproductive system. ...

The synthesis of cortisol in the adrenal gland is stimulated by the anterior lobe of the pituitary gland with adrenocorticotropic hormone (ACTH); production of ACTH is in turn stimulated by corticotropin-releasing hormone (CRH), released by the hypothalamus. ACTH increases the concentration of cholesterol in the inner mitochondrial membrane (via regulation of STAR (steroidogenic acute regulatory) protein). The cholesterol is converted to pregnenolone, catalysed by Cytochrome P450SCC (side chain cleavage). The anterior pituitary (also called the adenohypophysis, from Greek adeno, gland; hypo, under; physis, growth; hence, glandular undergrowth) comprises the anterior lobe of the pituitary gland and is part of the endocrine system. ... | Latin = hypophysis, glandula pituitaria | GraySubject = 275 | GrayPage = 1275 | Image = Gray1180. ... Pronunciation (IPA): /əˈdrinoʊˌkɔrtɪkoʊˈtrɒpɪk ˈhɔrmoʊn, əˈdrinoʊˌkɔrtɪkoʊˈtroʊpɪk ˈhɔrmoʊn/ Adrenocorticotropic hormone (ACTH or corticotropin) is a polypeptide hormone produced and secreted by the pituitary gland. ... Corticotropin-releasing hormone (CRH), also called corticotropin-releasing factor (CRF) or corticoliberin, is a polypeptide hormone involved in the stress response. ... The hypothalamus links the nervous system to the endocrine system via the pituitary gland (hypophysis). ...

Metabolism

Cortisol is metabolized by the 11-beta hydroxysteroid dehydrogenase system (11-beta HSD), which consists of two enzymes: 11-beta HSD1 and 11-beta HSD2. 11-Beta Hydroxysteroid Dehydrogenase (HSD11B) is the name of a family of enzymes that catalyzes the conversion of inert 11 keto-products (cortisone) to active cortisol, or vice versa, thus regulating the access of glucocorticoids to the steroid receptors. ... Protein:HSD11B1 (also known as 11β-hydroxysteroid dehydrogenase type 1) is an NADPH-dependent enzyme highly expressed in key metabolic tissues including liver, adipose tissue, and the central nervous system. ... An NAD+-dependent enzyme expressed in aldosterone-selective tissues. ...

• 11-beta HSD1 utilizes the cofactor NADPH to convert biologically inert cortisone to biologically active cortisol.
• 11-beta HSD2 utilizes the cofactor NAD+ to convert cortisol to cortisone.

Overall the net effect is that 11-beta HSD1 serves to increase the local concentrations of biologically active cortisol in a given tissue, while 11-beta HSD2 serves to decrease the local concentrations of biologically active cortisol. The CA3 area of hippocampus (memory) is affected by cortisol.^{[citation needed]} For other uses, see Hippocampus (disambiguation). ...

An alteration in 11-beta HSD1 has been suggested to play a role in the pathogenesis of obesity, hypertension, and insulin resistance, sometimes referred to the metabolic syndrome.^{[citation needed]} Pathogenesis is the mechanism by which a certain etiological factor causes disease (pathos = disease, genesis = development). ... For other forms of hypertension, see Hypertension (disambiguation). ... Insulin resistance is the condition in which normal amounts of insulin are inadequate to produce a normal insulin response from fat, muscle and liver cells. ... Metabolic syndrome is a combination of medical disorders that increase ones risk for cardiovascular disease and diabetes. ...

An alteration in 11-beta HSD2 has been implicated in essential hypertension and is known to lead to the syndrome of apparent mineralocorticoid excess (SAME).^{[citation needed]} Essential hypertension is a subtype of arterial hypertension in which no one specific etiology can be isolated as the cause of increased blood pressure. ... Apparent mineralocorticoid excess is inherited in an autosomal recessive fashion Apparent mineralocorticoid excess is an autosomal recessive cause of hypertension and hypokalaemia which responds to glucocorticoid treatment. ...

See also

• ACTH stimulation test
• Corticotropin-releasing hormone
• Cushing's syndrome
• HPA axis
• Hypopituitarism
• Post-traumatic stress disorder
• Central serous retinopathy
• CortiSlim
• Relacore, a pill which claims to reduce Cortisol.

Corticotropin-releasing hormone (CRH), also called corticotropin-releasing factor (CRF) or corticoliberin, is a polypeptide hormone involved in the stress response. ... The hypothalamic-pituitary-adrenal axis (HPA axis) is a major part of the neuroendocrine system that controls reactions to stress. ... Hypopituitarism is a medical term describing deficiency (hypo) of one or more hormones of the pituitary gland. ... Post-traumatic stress disorder (PTSD) is a term for certain severe psychological consequences of exposure to, or confrontation with, stressful events that the person experiences as highly traumatic. ... Central serous retinopathy or CSR is a visual impairment, often temporary, usually in one eye, affecting males in the age group 20 to 50. ... CortiSlim is a weight loss system marketed by Window Rock Enterprises. ... Relacore is a diet pill advertised as reducing cortisol, supposedly therefore reducing body fat in women over 30. ...

Additional images

11-Deoxycortisol Image File history File links No higher resolution available. ... 11-Deoxycortisol (or cortodoxone) is a steroid, and an immediate precursor to the production of cortisol. ...

References

1. ^ Weber CE (1998) "Cortisol's purpose." Medical Hypotheses 51; 289-292.
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