Cortisone

Cortisone is the inactive form of the corticosteroid hormone cortisol, which is produced naturally by the adrenal glands.  Cortisone is inactivated peripherally.   While it is considered inactive, testing for cortisone levels may provide valuable information regarding the diurnal fluctuations and total cortisol levels in the body.  

Cortisol, the active form of this hormone, serves critical functions in regulating various physiological processes in the body. From managing inflammation and immune response to controlling metabolism and stress, it plays a pivotal role in maintaining homeostasis. 

Cortisone shots, or corticosteroid injections, are commonly used medical interventions to alleviate pain and inflammation associated with various conditions, ranging from arthritis and tendonitis to bursitis and allergies. 

Topical cortisone products are also used to suppress inflammation, often in the setting of inflammatory dermatological conditions such as eczema.  

Understanding Cortisone

What is Cortisone?

Cortisone is the inactive form of the adrenal steroid hormone cortisol.  For more information on cortisol including its function as the active form of cortisone, click here.

Where is Cortisone Produced?

The primary site of cortisol conversion to cortisone is in the kidneys.  However, this conversion also occurs in the liver, salivary glands, adipose tissue and colon.  [6.]  

The enzyme 11-beta-hydroxysteroid dehydrogenase (11beta-HSD) is the primary enzyme responsible for the cortisol/cortisone interconversion.  [9.] It has also been shown to be active in the human placenta, possibly to protect the fetus from the effects of excessive maternal glucocorticoid production.  [8.]

Physiological Functions of Cortisone

Cortisone is the inactive form of cortisol; its physiological effects are apparent when cortisone is converted to active cortisol.  For more information on the functions of cortisol, click here.

Testing Methods for Cortisone Levels

Why Test for Cortisone Levels?

Testing for cortisone may be appropriate in settings where additional insight into adrenal function is desired.  Assessing cortisone levels may help with:

• Shedding light on the diurnal rhythm of cortisol
• Providing additional clinically relevant insights surpassing those obtained from the cortisol pattern alone
• Confirmation of cortisol levels on adrenal testing by comparing levels of cortisol and cortisone

Blood, saliva and urine tests are all available to assess cortisone.  It is important to note that experts vary on whether blood tests demonstrate the diurnal rhythm of cortisone, but urine and saliva tests do demonstrate a diurnal variation.  [4., 10.]

Blood Test for Cortisone

Blood tests for cortisone are commonly used in clinical settings to assess adrenal function and diagnose conditions related to cortisol dysregulation.  These tests typically involve drawing a blood sample, usually in the morning when cortisol levels are naturally higher, to measure cortisone levels.  [4.]

Specifically, this test is used to diagnose a rare genetic recessive cause of hypertension, apparent mineralocorticoid excess (AME). AME is characterized by childhood onset of hypertension, hypokalemic alkalosis, and low plasma renin and aldosterone levels.  [2., 6.]

Saliva Test for Cortisone 

Saliva tests are non-invasive methods used to measure cortisone levels by collecting saliva samples. These tests are convenient and can be performed at home or in a clinical setting.  [3.]

Saliva samples are typically collected at specific times throughout the day, generally upon waking, before lunch, before dinner, and before bedtime, to assess the diurnal variation of cortisol secretion and relative conversion to cortisone. 

Saliva tests are useful for evaluating the free, biologically active fraction of cortisol, providing insights into the body's stress response and HPA axis function. However, cortisone is not an active hormone, so its clinical relevance lies in its ability to more fully describe cortisol production across a specific time period.

Saliva tests are often employed in assessing adrenal function, diagnosing conditions like adrenal fatigue or stress-related disorders, and monitoring cortisol levels in individuals undergoing stress management or hormone therapy.  

Urine Test for Cortisone

Urine tests for cortisone measurement involve collecting urine samples over a specified period, usually 24 hours, to assess total cortisol excretion. These tests provide a comprehensive picture of cortisol production and metabolism over an extended period, especially when compared with cortisone levels across the same time period.

Urine tests are valuable for diagnosing conditions such as Cushing's syndrome, where cortisol levels are consistently elevated, as well as monitoring cortisol levels in response to treatment or medication adjustments. Additionally, urine tests can help identify potential cortisol contamination from medications containing cortisone, such as topical creams or nasal sprays, aiding in a more accurate interpretation of cortisol levels.  [7.]

Cortisone Shots: Overview and Applications

Cortisone shots, also known as corticosteroid injections, are commonly used to relieve pain and inflammation in various musculoskeletal conditions. These injections deliver a potent anti-inflammatory medication, usually a synthetic corticosteroid such as triamcinolone or methylprednisolone, directly into the affected area. 

The primary goal of cortisone shots is to reduce pain, swelling, and inflammation associated with conditions like arthritis, tendonitis, bursitis, and other inflammatory joint disorders. They can be administered into joints, soft tissues, or around nerves, depending on the specific condition being treated.

Mechanism of Action: What Does a Cortisone Shot Do?

Cortisone shots exert their therapeutic effects through several mechanisms. 

Corticosteroids bind to intracellular glucocorticoid receptors within target cells, leading to the activation or repression of various genes involved in inflammation and immune responses. 

This results in the suppression of pro-inflammatory mediators, such as cytokines and prostaglandins, and inhibition of leukocyte migration to the inflamed site. 

Additionally, corticosteroids decrease the production of inflammatory chemicals and enzymes, thereby alleviating pain and reducing tissue damage. The anti-inflammatory properties of cortisone shots make them effective in managing acute and chronic inflammatory conditions of the musculoskeletal system.

Conditions Treated with Cortisone Shots

Cortisone shots are commonly used to manage a variety of musculoskeletal conditions characterized by inflammation and pain, including some autoimmune conditions. Some of the conditions treated with cortisone shots include:

Osteoarthritis: Cortisone shots can provide relief from pain and inflammation associated with osteoarthritis, particularly in weight-bearing joints such as the knee, hip, and shoulder.

Tendinitis and Tendinopathy: Inflammation of tendons, such as tennis elbow (lateral epicondylitis), golfer's elbow (medial epicondylitis), Achilles tendinitis, and rotator cuff tendinitis, can be alleviated with cortisone injections.

Bursitis: Inflamed bursae, small fluid-filled sacs that cushion and lubricate joints, can be treated with cortisone shots to reduce swelling and pain.

Rheumatoid arthritis: Cortisone injections may be used as adjunctive therapy to manage acute flare-ups or localized inflammation in rheumatoid arthritis.

Carpal Tunnel Syndrome: Cortisone shots may be used as a conservative treatment option for carpal tunnel syndrome, injecting corticosteroids into the carpal tunnel to alleviate inflammation and relieve pressure on the median nerve.

Trigger thumb and finger: cortisone shots are commonly employed for trigger thumb and finger, aiming to reduce inflammation and swelling around the affected tendon sheath, thereby alleviating pain and improving movement.
Herniated Disk: Also known as slipped, ruptured, or bulging disk, this condition occurs when the soft, gel-like center of a disk pushes through a crack in the outer layer, potentially pressing on nearby spinal nerves.

Degenerative Disk Disease: Characterized by the wearing away of cushioning between the vertebrae in the back, this condition can cause inflammation in the spinal nerve roots.

Spinal Stenosis: Involving the narrowing of spaces within the spine, this condition reduces the available space for spinal nerve roots, potentially leading to irritation or pinching of nerves, especially during activities like walking.

Localized Back Pain (axial back pain): Varied in intensity and frequency, this pain may be sharp or dull and can range from mild to severe.

Neurogenic claudication: Caused by compression of spinal nerves in the spine, this condition can lead to pain or tingling in the arms, low back, legs, hips, and buttocks, particularly when standing or walking.

Efficacy and Duration of Cortisone Shots

How Long Does a Cortisone Shot Take to Work?

The onset of action for a cortisone shot varies depending on the condition being treated and individual response. Typically, patients may start to experience relief within a few days to a week after the injection, as the corticosteroid begins to reduce inflammation and alleviate symptoms such as pain and swelling.

It is important to understand that there may be a short flare-up in pain for a few days following the injection, which typically subsides.  

Duration of Relief: How Long Does a Cortisone Shot Last?

The duration of relief from a cortisone shot also varies widely depending on factors such as the specific condition being treated, the dosage and type of corticosteroid used, and individual response. 

For some individuals, the effects of a cortisone shot may last for several weeks or even months, providing long-lasting relief from symptoms. However, in other cases, the benefits may be more short-lived, requiring repeat injections for sustained relief.

The individual’s response will be assessed to minimize the number of annual injections required. 

Frequency of Administration: How Often Can You Get a Cortisone Shot?

The frequency of administration for cortisone shots depends on several factors, including the underlying condition being treated, the individual patient's response to the injections, and the recommendations of the healthcare provider. 

In general, cortisone shots are not intended for long-term use due to the potential for side effects, so healthcare providers typically limit the number of injections given over a certain period. 

However, for certain conditions such as chronic joint pain or inflammation, periodic cortisone injections may be recommended as part of a comprehensive treatment plan to manage symptoms and improve quality of life.

Risks and Complications

Cortisone shots are not without risks.  Risk of developing side effects increases with larger doses and more frequent use. 

Side effects can include:

• Cartilage damage, which may exacerbate joint problems over time.
• Death of nearby bone, leading to weakened bones and increased fracture risk.
• Joint infection, posing a serious risk of systemic infection if left untreated.
• Nerve damage, resulting in pain, numbness, or weakness in the affected area.
• Short-term facial flushing, a common but temporary reaction to corticosteroid administration.
• Short-term flare of pain, swelling, and irritation in the joint, typically subsiding after a few days.
• Short-term increase in blood sugar levels, particularly concerning for individuals with diabetes.
• Tendon weakening or rupture, potentially impairing joint function and mobility.
• Thinning of nearby bone (osteoporosis), increasing susceptibility to fractures and structural instability.
• Thinning of the skin and soft tissue around the injection site, leading to skin fragility and delayed wound healing.
• Whitening or lightening of the skin around the injection site, which may be permanent in some cases.

Nerve Injury: What Happens When a Cortisone Shot Hits a Nerve?

When a cortisone shot inadvertently hits a nerve during administration, it can potentially cause nerve injury and subsequent complications. 

Nerve injury from a cortisone injection can lead to symptoms such as pain, numbness, tingling, or weakness in the affected area. In severe cases, nerve damage may result in long-term or permanent sensory or motor deficits. 

Additionally, hitting a nerve with a cortisone injection can exacerbate existing nerve-related conditions or trigger new ones.