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[Paths to a rational cortisone therapy via urea supplements--countering cortisone phobia].

Not until corticosteroids came into use did it become possible for modern dermatotherapy to cure numerous skin diseases, and if not cure them, at least rapidly lead to major improvements and the transition to symptom-free intervals. Through indiscriminate use, corticosteroid therapy has become discredited by patient and doctor alike due to the increased incidence of side effects. Due to this intensified rejection--bordering on "cortisone phobia"--corticosteroids today are often not being used when justifiable or even when mandatory. Most side effects can be avoided or reduced if the instructions for use are properly adhered to, thus increasing acceptance. Another way of further improving compliance is the use of low-side effect corticosteroids, such as hydrocortisone, since now the difference in effective strength compared to potent halogenated preparations can be compensated by the addition of 10% urea. With regard to active strength, a hydrocortisone/urea combination preparation should be used like a medium-strength cortisone preparation and is particularly suited for the long-term therapy of chronic dermatosis. Additional properties of urea, such as alleviation of itching and water binding, which are important in the treatment of chronic eczemas, enhance hydrocortisone in combination preparations.

Administration, Topical↗

The effects of cortisone on the interconversion of cortisol and cortisone in the baboon.

In the baboon fetus, the conversion of cortisol (F) to cortisone (E) [80%] exceeds the reverse reaction [15%]. Since the fetus is exposed to high quantities of E throughout most of pregnancy, we determined whether F to E interconversion is altered following acute changes in serum E. Adult female baboons (N = 3) were sedated with ketamine, constantly infused for 180 min via an antecubital vein with 15 microCi[14C]E and 15 microCi[3H]F, and saphenous vein blood samples obtained at 70, 80 and 90 min. At 90 min, an infusion of E (166 micrograms/min) was initiated and blood samples obtained at 160-180 min. This protocol was repeated in the same animals treated 24 and 3 h prior to infusion with 3 mg betamethasone. Metabolic clearance (MCR), transfer constants (%) and serum levels (microgram/dl) of F and E were determined. E increased (P less than 0.05; paired t) MCR-E, and serum F and E levels in control and betamethasone-treated baboons. E also decreased %F to E in betamethasone-treated but not control animals. These findings suggest that acute changes in serum E alter MCR-E, do not influence the conversion of E to F and may decrease the conversion of F to E. Therefore, we suggest that the high conversion of F to E in the baboon fetus is probably not the result of elevated concentrations of E.

Animals↗

Radioimmunoassay of cortisone in serum, urine, and saliva to assess the status of the cortisol-cortisone shuttle.

We have developed a new assay for cortisone (E) in serum, saliva, and urine involving Celite chromatography followed by RIA with 125I-labeled E and scintillation proximity assay. The chromatography step separates cortisol (F) from E, and in combination with their RIAs, permits assessment of the status of the F-E shuttle. We report the results of basal, postcorticotropin (ACTH), and postdexamethasone E and F concentrations and their circadian fluctuations in the serum, saliva, and urine of healthy volunteers. The serum and urine F/E ratios were increased in patients with ectopic ACTH secretion, whereas in adrenal adenoma and Cushing disease only the urinary ratio was increased. In chronic renal insufficiency this ratio was increased in serum (23.5 +/- 3.9) but diminished in saliva (0.38 +/- 0.11), and in apparent mineralocorticoid excess the ratios were high in serum (44.3 +/- 9.3) and urine (5.35 +/- 0.85) compared with those of healthy subjects (serum 9.8 +/- 3.5, urine 0.52 +/- 0.29, saliva 0.52 +/- 0.29).

11-beta-Hydroxysteroid Dehydrogenases↗