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Adrenal

Adrenal gland: Cortisone or cortisol is produced by the outer, or cortex area (shown at right).

Cortisone (now mainly referred to as cortisol) is the main hormone produced by the adrenal gland, and belongs to a group of hormones called glucocorticoids, which is a class of steroids. Glucocorticoids antagonize or counter the effects of insulin and increase gluconeogenesis--basically they have an overall blood sugar raising effect. [1]

All of us produce extra cortisol daily; it's done shortly before we awaken. The body prepares itself to go into "wake mode" and releases cortisol to ready itself for wake up.

In non-diabetics, it happens virtually unnoticed, as the properly working pancreas produces more insulin to handle the cortisol release. Persons without diabetes are unlikely to be checking their blood glucose values on a regular basis, so any temporary increases would not be measured.

But with diabetes, it can become a problem known as dawn phenomenon; the rise in cortisol levels brings with it a corresponding rise in blood glucose, meaning high morning testing values--even before eating. Everyone with diabetes does not have this occurrence, just as all cats aren't white or all dogs brown.

Cortisol is involved in the response to stress; it increases blood pressure and blood sugar levels and suppresses the immune system. Note that this is why stress is known to raise blood sugar levels and cause hyperglycemia in diabetic pets.

Pets with Cushing's disease are self-administering extra cortisol from the adrenal glands, all the time, leading to hyperglycemia and secondary diabetes.

There is another class of steroids in need of mention here. They are called anabolic steroids, and are related to the male sex hormone, testosterone. [2] Their main uses are for medically supervised weight gain, [3] inappetance, (most commonly Winstrol/Stanozolol) [4] and in treatment of some forms of anemia and cancer. [5]


Why they are usedEdit

The glucosteroids are very helpful for a wide number of medical conditions; in some cases they are the only effective way to treat some problems.[6] At times, they are prescribed as appetite stimulants. [7]

As with anything else, they can come with a price tag: Short-term use can mean a temporary diabetic condition, which (usually) resolves after stopping steroid use.

Long-term use can cause permanent diabetes. For pets and people who are diabetic, the use of oral or injected steroids brings with it higher. blood glucose levels. [8] It can also mean development of urinary tract infections which are hidden and need urine cultures to diagnose. [9][10]

This is not to say that you should totally rule out any use of steroids with a diabetic pet, but need to be watchful regarding them. [11][6] Ask if there is an alternative medication for the problem which is non-steroidal.

If you must use steroids, try to use local or inhaled versions, which are less likely to raise blood sugar. [12][13][14] Ask if there is an alternative medication for the problem which is non-steroidal.

Using steroids--orally, injected or even topically (applied to the skin as an ointment or cream)--can elevate blood glucose levels. During treatment and for a period after treatment with steroids ends, higher doses of insulin may be necessary. [15][16]

Cushing's/Cortisone meds connectionEdit

Like diabetes, Cushing's can be caused by over-use of Cortisone-type medications. [17]

Because the pituitary gland also acts as a sensor, it detects the high levels of cortisol in the body and does not signal the adrenal gland to produce more. The adrenal gland becomes inactive and can atrophy from disuse, much in the way non-used muscles do, losing the ability to function normally.

Exogenous cortisone puts the adrenal gland into a sort-of hibernation. While they are being administered, they furnish the body's cortisol needs in addition to treating the condition they were prescribed for. The adrenal gland needs to be "awakened" from its rest gradually so it can begin full function once again. This is why cortisone and similar drug treatment is slowly and carefully withdrawn. Simply stopping the medication means leaving the body without sufficient cortisone--exogenous or endogenous. [18]

Strength and Duration of SteroidsEdit

Many synthetic glucocorticoids have been created whose potency is greater than that of cortisone/hydrocortisone. [19] The changes in these synthetics can mean longer duration and also less unwanted side effects such as water and sodium retention. [20] The standard to which they are all compared is hydrocortisone which has been given the value of 1.

Many commonly prescribed steroids are listed on the Prescribed Steroids page.


ReferencesEdit

  1. Glucocorticoids. Merck Veterinary Manual.
  2. Anabolic Steroids. Mayo Clinic.
  3. Anabolic Steroids. Mayo Clinic.
  4. Drugs Affecting Appetite. Merck Veterinary Manual.
  5. Anabolic Steroids. Mayo Clinic.
  6. 6.0 6.1 Brooks, Dennis E. (January 2006). Painful Ocular Lesion. Clinician's Brief.
  7. Glucosteroids Stimulate Appetite. Merck Veterinary Manual.
  8. Ask the D Team. Childrenwithdiabetes.com- (2006).
  9. Hormonal Therapy. Merck Veterinary Manual.
  10. Daniels, Joshua B., Chew, Dennis J. (2011). Diagnosis and Treatment of Routine and Difficult Urinary Infections in Dogs. Western Veterinary Conference.
  11. Maddison, Jill (2009). Corticosteroids-Friend Or Foe?. WSAVA.
  12. Non-oral steroids. Natick Pediatrics.
  13. Topical Steroids-Free-Registration Needed. BMJ.
  14. Cohn, L. A., DeClue, A. E., Reinero, C. R. (2008). Endocrine and Immunologic Effects of Inhaled Fluticasone Propionate in Healthy Dogs. Journal of Veterinary Internal Medicine.
  15. Steroid Treatment and Insulin Needs. HealthTouch.
  16. Insulin-Precautions & Side Effects. PetPlace.com.
  17. Brooks, Wendy C.. What Exactly is Cushing's Syndrome?. Veterinary Partner.
  18. Brooks, Wendy C.. What Exactly is Cushing's Syndrome?. Veterinary Partner.
  19. Glucocorticoid. Wikipedia.
  20. Maddison, Jill (2009). Corticosteroids-Friend Or Foe?. WSAVA.
  21. Maddison, Jill (2009). Corticosteroids-Friend Or Foe?. WSAVA.
  22. Glucocorticoid. Wikipedia.
  23. Tritop. 1-800 PetMeds.
  24. Mometamax. Intervet.
  25. Maddison, Jill (2009). Corticosteroids-Friend Or Foe?. WSAVA.


More InformationEdit

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