CORTISONE

a steroid hormone produced by the adrenal cortex. Introduced in 1948 for its anti-inflammatory effect in the treatment of rheumatoid arthritis, it has been largely replaced by related compounds that do not produce certain undesirable side effects. Cortisone and numerous other steroids were isolated from secretions of the adrenal cortex in the period 193548 by the American biochemist Edward C. Kendall following earlier observations that the secretions of the adrenal cortex are essential to life. Amounts of these substances available from natural sources were too small for clinical evaluation, but a useful amount of cortisone was produced from deoxycholic acid, a bile constituent. In 1948 Kendall and Philip S. Hench tried out cortisone on patients suffering from rheumatoid arthritis. Their clinical trials were dramatically successful, and refinements of the preparative process reduced the cost of the drug from $200 per gram in 1949 to 50 cents in 1965. Cortisone is active primarily as an agent for the rapid conversion of proteins to carbohydrates (a glucocorticoid) and to some extent regulates the salt metabolism of the body (a mineralocorticoid). The therapeutic dose, however, when used as an anti-inflammatory drug, is much larger than the amount normally present in the body, and the minor functions of the hormone become exaggerated, leading to edema (swelling), increased gastric acidity, and imbalances in metabolism of sodium, potassium, and nitrogen. Continued research has resulted in drugs in which the glucocorticoid activity is enhanced and undesirable actions are practically eliminated.