WordNet

a corticosteroid hormone (trade name Cortone Acetate) normally produced by the adrenal cortex; is converted to hydrocortisone (同)Cortone Acetate
an adrenal-cortex hormone (trade names Hydrocortone or Cortef) that is active in carbohydrate and protein metabolism (同)cortisol, Hydrocortone, Cortef

PrepTutorEJDIC

コーチゾン(副腎皮質から出るほるもん)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/02/07 12:52:49」(JST)

wiki en

Cortisone (/ˈkɔːrtᵻsoʊn/ or /ˈkɔːrtᵻzoʊn/; 17-hydroxy-11-dehydrocorticosterone) is a 21-carbon steroid hormone. It is one of the main hormones released by the adrenal gland in response to stress. In chemical structure, it is a corticosteroid closely related to cortisol. It is used to treat a variety of ailments and can be administered intravenously, orally, intraarticularly (into a joint), or transcutaneously. Cortisone suppresses the immune system, thus reducing inflammation and attendant pain and swelling at the site of the injury. Risks exist, in particular in the long-term use of cortisone.^[1]^[2]

Effects and uses

Cortisone, a glucocorticoid, and adrenaline are the main hormones released by the body as a reaction to stress. They elevate blood pressure and prepare the body for a fight or flight response.

A cortisone injection can also be used to give short-term pain relief and reduce the swelling from inflammation of a joint, tendon, or bursa in, for example, the joints of the knee, elbow, and shoulder ^[1] and into a broken coccyx.^[3]

Cortisone may also be used to deliberately suppress immune response in persons with autoimmune diseases or following an organ transplant to prevent transplant rejection.^{[citation needed]} The suppression of the immune system may also be important in the treatment of inflammatory conditions.^[4]

Cortisone is a common treatment for a severe sore throat that occurs commonly with EBV infectious mononucleosis. Cortisone does not decrease the duration of the viral infection, but is used purely to increase the comfort of a patient with trouble speaking or swallowing as a result of the mononucleosis-induced swollen throat.

Cortisone is also used by dermatologists to treat keloids,^[5] relieve the symptoms of eczema and atopic dermatitis,^[6] and stop the development of sarcoidosis.^{[medical citation needed]}

Side effects

Oral use of cortisone has a number of potential systemic side-effects: hyperglycemia, insulin resistance, diabetes mellitus, osteoporosis, anxiety, depression, amenorrhoea, cataracts, Cushing's syndrome and glaucoma, among other problems.^[1]^[2]

Local side effects are rare but can include: pain, infection, skin pigment changes, loss of fatty tissue, and tendon rupture.^[7]

History

Cortisone was first identified by the American chemists Edward Calvin Kendall and Harold L. Mason while researching at the Mayo Clinic.^[8]^[9]^[10] Kendall was awarded the 1950 Nobel Prize for Physiology or Medicine along with Philip S. Hench and Tadeus Reichstein for the discovery of adrenal cortex hormones, their structures, and their functions. As it turns out, both Reichstein and the team of O. Wintersteiner and J. Pfiffner had separately isolated the compound prior to Mason/Kendall, but failed to recognize its biological significance.^[9] Dr. Mason's contributions to the crystallization and characterization of the compound have generally been forgotten outside of the Mayo Clinic.^[9]

Cortisone was first produced commercially by Merck & Co. On September 30, 1949, Percy Julian announced an improvement in the process of producing cortisone from bile acids.^{[chronology citation needed]} This eliminated the need to use osmium tetroxide, a rare, expensive, and dangerous chemical. In the UK in the early 1950s, John Cornforth and Kenneth Callow at the National Institute for Medical Research collaborated with Glaxo to produce cortisone from hecogenin from sisal plants.^[11]

Production

Cortisone is one of several end-products of a process called steroidogenesis. This process starts with the synthesis of cholesterol, which then proceeds through a series of modifications in the adrenal gland (suprarenal) to become any one of many steroid hormones. One end-product of this pathway is cortisol. For cortisol to be released from the adrenal gland, a cascade of signaling occurs. Corticotropin-releasing hormone released from the hypothalamus stimulates corticotrophs in the anterior pituitary to release ACTH, which relays the signal to the adrenal cortex. Here, the zona fasciculata and zona reticularis, in response to ACTH, secrete glucocorticoids, in particular cortisol. In the peripheral tissues, cortisol is converted to cortisone by the enzyme 11-beta-steroid dehydrogenase. Cortisol has much greater glucocorticoid activity than cortisone, and, thus, cortisone can be considered an inactive metabolite of cortisol. However, 11-beta-steroid dehydrogenase can catalyze the reverse reaction as well, and, thus, cortisone is also the inactive precursor molecule of the active hormone cortisol. Cortisone is activated through hydrogenation of the 11-keto-group, and cortisol is, thus, sometimes referred to as hydrocortisone.^{[citation needed]}

References

Notes

^ ^a ^b ^c "Cortisone shots". MayoClinic.com. 2010-11-16. Retrieved July 31, 2013.
^ ^a ^b "Prednisone and other corticosteroids: Balance the risks and benefits". MayoClinic.com. 2010-06-05. Retrieved 2011-09-03.
^ http://www.coccyx.org/treatmen/inflamm.htm
^ Driver, Catherine; Shiel, William. "Cortisone Injection (Corticosteroid Injection) of Soft Tissues & Joints". MedicineNet.com. Retrieved August 7, 2013.
^ Zanon, E; Jungwirth, W; Anderl, H (1992). "Cortisone jet injection as therapy of hypertrophic scars and keloids". Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V 24 (2): 100–2. PMID 1582609.
^ "All About Atopic Dermatitis". National Eczema Association.
^ Cole, BJ; Schumacher (Jan–Feb 2005). "Injectable Corticosteroids in Modern Practice". Journal of the American Academy of Orthoepaedic Surgeons 13: 37–46.
^ "Cortisone Discovery and the Nobel Prize". Retrieved 2009-07-04.
^ ^a ^b ^c "I Went to See the Elephant" autobiography of Dwight J. Ingle, published by Vantage Press (1963), pg 94, 109
^ (PDF) http://www.jbc.org/content/114/3/613.full.pdf. Retrieved 2014-09-07. Missing or empty |title= (help)
^ Quirke, Viviane (2005). "Making British Cortisone: Glaxo and the development of Corticosteroids in Britain in the 1950s–1960s". Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 36 (4): 645. doi:10.1016/j.shpsc.2005.09.001.

Bibliography

Bonagura J., DVM.; et al. (2000). Current Veterinary Therapy 13. pp. 321–381.
Ingle DJ (October 1950). "The biologic properties of cortisone: a review". J. Clin. Endocrinol. Metab. 10 (10): 1312–54. doi:10.1210/jcem-10-10-1312. PMID 14794756.
Woodward R. B., Sondheimer F., Taub D. (1951). "The Total Synthesis of Cortisone". Journal of the American Chemical Society 73 (8): 4057–4057. doi:10.1021/ja01152a551.

External links

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. まれな先天性副腎過形成 uncommon congenital adrenal hyperplasias
2. ステロイドの薬理学的使用 pharmacologic use of glucocorticoids
3. 思春期における多嚢胞性卵巣症候群の診断的評価 diagnostic evaluation of polycystic ovary syndrome in adolescents
4. 内因性および外因性ステロイドの尿中排泄の測定 measurement of urinary excretion of endogenous and exogenous glucocorticoids
5. 成人における副腎不全の治療 treatment of adrenal insufficiency in adults

English Journal

PMID 25643980

Adrenal Insufficiency in Australia: Is it Possible that the Use of Lower Dose, Short-Acting Glucocorticoids has Increased the Risk of Adrenal Crises?

Rushworth RL1, Torpy DJ2.
Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et métabolisme.Horm Metab Res.2015 Jun;47(6):427-32. doi: 10.1055/s-0034-1395680. Epub 2015 Mar 4.
Morbidity from adrenal insufficiency (AI) in Australia is poorly described. The objective of this study was to evaluate AI morbidity patterns in adults between 1999/2000 and 2011/2012 using national databases. A descriptive study of hospitalisations for AI and adrenal crises (AC) in adults and trend
PMID 25738995

Cortisone and hydrocortisone inhibit human Kv1.3 activity in a non-genomic manner.

Yu J1, Park MH, Choi SY, Jo SH.
Naunyn-Schmiedeberg's archives of pharmacology.Naunyn Schmiedebergs Arch Pharmacol.2015 Jun;388(6):653-61. doi: 10.1007/s00210-015-1109-2. Epub 2015 Mar 7.
Glucocorticoids are hormones released in response to stress that are involved in various physiological processes including immune functions. One immune-modulating mechanism is achieved by the Kv1.3 voltage-dependent potassium channel, which is expressed highly in lymphocytes including effector memor
PMID 25743574

Aplastic anemia as a feature of systemic lupus erythematosus: a case report and literature review.

Chalayer É1, Ffrench M, Cathébras P.
Rheumatology international.Rheumatol Int.2015 Jun;35(6):1073-82. doi: 10.1007/s00296-014-3162-4. Epub 2014 Oct 30.
Peripheral cytopenias are common in systemic lupus erythematosus, but bone marrow involvement is rarely reported. Aplastic anemia is the result of immune-mediated destruction of hematopoietic stem cells causing pancytopenia and characterized by an empty bone marrow. This rare but serious disease has
PMID 25354463

Japanese Journal

Efficacy of aerosolized liposomal amphotericin B against murine invasive pulmonary mucormycosis

Mihara Tomo,Kakeya Hiroshi,Izumikawa Koichi,Obata Yoko,Nishino Tomoya,Takazono Takahiro,Kosai Kosuke,Morinaga Yoshitomo,Kurihara Shintaro,Nakamura Shigeki,Imamura Yoshifumi,Miyazaki Taiga,Tsukamoto Misuzu,Yamamoto Yoshihiro,Yanagihara Katsunori,Tashiro Takayoshi,Kohno Shigeru
Journal of Infection and Chemotherapy 20(2), 104-108, 2014-02
… ICR female mice were immunosuppressed with cortisone acetate and cyclophosphamide and challenged on day 0 with 1 × 106 conidia of Rhizopus oryzae (TIMM 1327) intratracheally. …
NAID 120005477014

High cortisol and cortisone levels are associated with breast milk dioxin concentrations in Vietnamese women

Kido Teruhiko,Tung Dao Van,Manh Ho Dung,Nhu Dang Duc,Ngoc Pham Thien,Naganuma Rie,Tai Pham The,Maruzeni Shoko,Nishijo Muneko,Nakagawa Hideaki,Honma Seijiro,Son Le Ke,Hung Nguyen Ngoc
European Journal of Endocrinology 170(1), 131-139, 2014-01
… Methods: Cortisol, cortisone, DHEA, androstenedione, estrone, and estradiol levels in serum and saliva were determined by liquid chromatography-tandem mass spectrometry; … Salivary and serum cortisol and cortisone levels in women from the dioxin hot spot were significantly higher than those in women from the nonexposed area (P<0.001) and those in all the subjects were positively associated with dioxin concentrations in Vietnamese women (P<0.01). …
NAID 120005368206

Mechanism of repression of 11β-hydroxysteroid dehydrogenase type 1 by growth hormone in 3T3-L1 adipocytes

, , , ,
Endocrine Journal 61(7), 675-682, 2014
… 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) is an NADPH-dependent reductase that converts cortisone to cortisol in adipose tissue. …
NAID 130004443977

ヒト唾液中コルチゾール及びコルチゾンの分散液液マイクロ抽出/HPLC分析

玉嶋江莉奈,甲斐知美,轟木堅一郎,川見祐介,糸山美紀,巴山忠,吉田秀幸,山口政俊,能田均
分析化学 = Japan analyst 62(8), 719-723, 2013-08-05
NAID 10031178770

Related Pictures

Cortisone maximum strength (CVS Pharmacy) HYDROCORTISONE 1g in 100g cream Can I Give My Dog Cortisone? Cortisone Injections: Cortisone can be effective in reducing pain Cortisone Dosage & Drug Information | MIMS.com Myanmar Cortizone 10 Maximum Strength Hydrocortisone Anti-Itch Cream | Walgreens The best ways to do away with Acne Scars Fast - Witch Hazel Cortisone Cream Side Effects | IYTmed.com

★リンクテーブル★

リンク元	「糖質コルチコイド」「コルチゾン」「コーチゾン」
拡張検索	「hydrocortisone aceponate」「hydrocortisone cypionate」「hydrocortisone butyrate」「cortisone reductase」「9α-fluorohydrocortisone」

「糖質コルチコイド」

Cortisone
Names
	IUPAC name (8S,9S,10R,13S,14S,17R)-17-Hydroxy-17-(2-hydroxyacetyl)-10,13-dimethyl-1,2,6,7,8,9,12,14,15,16-decahydrocyclopenta[a]phenanthrene-3,11-dione
Identifiers
CAS Number	53-06-5
ChEBI	CHEBI:16962
ChEMBL	ChEMBL111861
ChemSpider	193441
IUPHAR/BPS	5171
Jmol interactive 3D	Image
KEGG	D07749
MeSH	Cortisone
PubChem	222786
	InChI InChI=1S/C21H28O5/c1-19-7-5-13(23)9-12(19)3-4-14-15-6-8-21(26,17(25)11-22)20(15,2)10-16(24)18(14)19/h9,14-15,18,22,26H,3-8,10-11H2,1-2H3/t14-,15-,18+,19-,20-,21-/m0/s1 Key: MFYSYFVPBJMHGN-ZPOLXVRWSA-N ; InChI=1/C21H28O5/c1-19-7-5-13(23)9-12(19)3-4-14-15-6-8-21(26,17(25)11-22)20(15,2)10-16(24)18(14)19/h9,14-15,18,22,26H,3-8,10-11H2,1-2H3/t14-,15-,18+,19-,20-,21-/m0/s1 Key: MFYSYFVPBJMHGN-ZPOLXVRWBW ;
	SMILES O=C(CO)[C@@]3(O)CC[C@H]2[C@@H]4CC\C1=C\C(=O)CC[C@]1(C)[C@H]4C(=O)C[C@@]23C ;
Properties
Chemical formula	C21H28O5
Molar mass	360.45 g·mol−1
Melting point	220 to 224 °C (428 to 435 °F; 493 to 497 K)
Pharmacology
ATC code	H02AB10; S01BA03
	Except where otherwise noted, data are given for materials in their standard state (at 25 °C [77 °F], 100 kPa).
	verify (what is ?)
	Infobox references

　　[★]

英: glucocorticoid (Z), glucocorticoids
関: グルココルチコイド
関: 副腎皮質、副腎皮質ホルモン

以下、内的に合成される糖質コルチコイドについて述べる

種類

ステロイドホルモン

分類

副腎皮質ホルモン

性状

ステロイド

産生組織

副腎皮質索状層

標的組織

生理作用

1. エネルギー代謝

糖新生においてグルコースの前駆体となるアミノ酸を肝臓に供給すべく動員する作用 (SP.894)

a. 糖代謝作用

糖新生の亢進

血糖上昇

肝細胞以外のグルコースの取り込みを抑制 (SP.894) ←　末梢でインスリンの作用に拮抗

グルコース-6-ホスファターゼの活性亢進 (SP.894)

グリコーゲンの合成亢進

血糖値の上昇に伴い、肝臓などでグルコースからグリコーゲンが作られる (SP.894)

b. タンパク質代謝作用

肝臓での糖新生の基質を末梢から供給する作用

肝細胞以外でのアミノ酸取り込み阻害 (SP.894)

特定のアミノ酸合成を阻害 (SP.894)

生理的範囲：(肝臓)同化作用が起こる、(肝臓以外)異化作用が起こる

ステロイド大量投与時：ほとんど異化作用が起こる→副作用につながる

c. 脂質代謝作用

脂肪細胞に対して、インスリンの拮抗作用を持つが、一方で糖質コルチコイドにより血糖値が上昇する

脂肪分解↑→血糖値↑　…(1)

脂肪細胞に対してグルコースの取り込みを抑制し、中性脂肪の生合成を抑制し、さらに大量の遊離脂肪酸とグリセロールを放出させる。肝臓でグリセロールからグルコースが合成される。 (SP.894)

血糖値↑→脂肪合成↑　…(2)

血糖値の上昇によりインスリンが分泌され、脂肪細胞で脂肪の合成が促進される (SP.894)

(1)、(2)のいずれの反応が起こるかは体の部位によって異なり、脂肪分布の変化が生じる。

中心性肥満、満月様顔貌、バッファローハンプ

2. 電解質代謝作用

糖質コルチコイドの電解質コルチコイド様作用。

Na+再吸収↑、K+排泄↑

コルチゾールの電解質作用はアルドステロンの約１／４００

コルチゾールの量　　　　はアルドステロンの約　２００倍

ゆえに、電解質コルチコイドの１／２の作用力を持つ

3. 水代謝作用

GFR↑、ADHに拮抗、細胞内への水移動の抑制→水利尿作用を有する。　　尿崩症 + 副腎不全　→　多尿がいくらか改善されると考えて良いと思われる。仮面尿崩症

4. 骨・軟骨に対する作用

a. ビタミンDと拮抗して腸管からのCa吸収阻害 (SP.894)
b. 腎尿細管におけるCa再吸収阻害 (SP.894)
c. 骨芽細胞の分化・増殖を抑制 (SP.894)

糖質コルチコイドの大量投与→軟骨↓骨成長↓(活性型ビタミンD₃に拮抗・尿細管Ca再吸収↓→PTH↑、骨芽細胞の分化抑制、タンパク質の異化作用↑)→骨粗鬆症、骨壊死 or 骨端線閉鎖を促進(←？要調査)

b.の機序で尿に排泄されるカルシウムが増加　　→　　高カルシウム尿症　→　尿路結石

5. 抗炎症作用

胸腺やリンパ組織を萎縮させる　→　炎症反応や免疫反応を抑制

リンパ球数の減少、白血球の遊走抑制、抗体産生低下、ヒスタミン放出抑制(局所の毛細血管拡張抑制) (SP.894)

末梢好中球数は増加する(YN.F-78)　→　白血球増多症

SPC.330

a) 核内受容体を介してlipocortinを発現させ、これがphospholipase A2を阻害する。これにより、アラキドン酸の産生が抑制され、炎症を促進するロイコトリエンの産生も抑制される。
b) 末梢血Tリンパ球、単球、好酸球、好塩基球：骨髄からの放出減少と再分配(?)のため末梢血中では減少する。
c) 末梢血好中球：炎症部位への集合が抑制され(血管外への遊走が抑制される(GOO.1600))、末梢血中では増加する。
d) Bリンパ球はヘルパーT細胞が抑制されるために抗体産生能が減少する。
e) リンパ球などの細胞表面の立体構造を換えて抗体や補体の結合を抑制する。
f) 毛細血管(毛細管)の収縮により、血管の透過性は低下する。

6. 循環器

カテコールアミン・アンジオテンシンIIによる血管収縮作用の許容作用　→　糖質コルチコイドなしではその作用を十分に及ぼし得ない

欠乏症では血管のカテコールアミン・アンジオテンシンIIに対する感受性低下

7. 中枢神経系

認知機能や情動を修飾 (SP.895)

8. 成長発達

胎児期の消化酵素・リン脂質(肺胞表面の張力に関与)の合成に関与 (SP.895)
小児期で骨や熱強訴域に直接作用して身長の伸びを抑制する (SP.895)

作用機序

免疫抑制(GOO. 657,674,1600)

COX-2の抑制
phospholipase A₂の抑制

糖質コルチコイドはリポコルチンを産生→リポコルチンはホスホリパーゼA₂の活性を修飾→アラキドン酸産生↓

分泌調節

1. 概日リズム
2. フィードバック制御
- 糖質コルチコイドがACTHやCRHを抑制
3. ストレス反応

臨床関連

クッシング症候群(糖質コルチコイド過剰) (SP.894)

合成ステロイドホルモン

用量

低用量から中等量：40mg未満

Low-to-moderate doses — Doses of 1 mg/kg per day of prednisone in children or 40 mg per day in adults may be considered an approximate threshold at which significant toxicities begin to appear with extended use in most individuals.

副作用

副腎皮質ホルモン剤

副腎機能の低下、骨粗鬆症(無菌性大腿骨頭壊死)、高脂血症、高血圧、筋力低下、筋肉痛、白内障、緑内障
ニューモシスチス肺 PCP

Patients receiving a glucocorticoid dose equivalent to ≥20 mg of prednisone daily for one month or longer who also have another cause of immunocompromise (eg, certain hematologic malignancies or a second immunosuppressive drug)

https://www.uptodate.com/contents/treatment-and-prevention-of-pneumocystis-pneumonia-in-hiv-uninfected-patients?

0.5mg/kg以上のプレドニゾロン(PSL)を3週間以上投与され、かつST予防投与されていない間質性肺炎74例中7例(9.5％)でPCPを発症(榎本達治，他．ステロイド療法中の間質性肺炎患者に発症したニューモシスチス肺炎の臨床的検討．日呼吸会誌 2005: 43: 725-30)

Table 59–2 Relative Potencies and Equivalent Doses of Representative Corticosteroids
COMPOUND	ANTIINFLAMMATORY POTENCY	Na+-RETAINING POTENCY	DURATION OF ACTION*	EQUIVALENT DOSE, MG
cortisol	1	1	S	20
cortisone	0.8	0.8	S	25
fludrocortisone	10	125	I	‡
prednisone	4	0.8	I	5
prednisolone	4	0.8	I	5
6α-methylprednisolone	5	0.5	I	4
triamcinolone	5	0	I	4
betamethasone	25	0	L	0.75
dexamethasone	25	0	L	0.75