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Cortisone Use and Acute Pancreatitis, What’s Your Risk

Cortisone and acute pancreatitis

Cortisone is often prescribed to treat inflammatory conditions, but its use may also increase the risk of acute pancreatitis, which ironically is an inflammatory disease. Results of a new study point out what you should know about the risks to the pancreas when using certain forms of cortisone.

Cortisone is a widely used drug

Cortisone is a steroid (glucocorticoid) commonly prescribed to treat inflammatory conditions such as allergic disorders, arthritis, breathing problems (e.g., asthma), lupus, psoriasis, skin disorders, and ulcerative colitis. The drug works by preventing the release of substances that cause inflammation.

Cortisone can be given either by injection (into joints), intravenously, orally, or under the skin, and it is also available in creams and in aerosol form for asthma. Each form of cortisone can cause certain side effects, although oral cortisone is generally associated with a broader range of reactions than the other forms.

Cortisone and acute pancreatitis
Researchers from Karolinska Institutet in Sweden have found that individuals treated with certain forms of cortisone appear to be at increased risk of acute pancreatitis, or inflammation of the pancreas. Acute pancreatitis is the most common disease of the pancreas.

The study represents the first systematic approach to illustrating a link between the medical use of cortisone and the development of acute pancreatitis. In the study, reviewers compared data from 6,161 individuals diagnosed with acute pancreatitis with 61,637 healthy controls (nonusers of cortisone).

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The authors noted a connection between use of oral cortisone and the development of acute pancreatitis within a few days of starting treatment. Specifically, those who took oral cortisone had a 70 percent higher risk of developing acute pancreatitis.

The risk of developing acute pancreatitis was highest from days 4 to 14 after cortisone was dispensed. Individuals who used aerosol cortisone did not show this increased risk.

Known risk factors for acute pancreatitis include drinking alcohol, smoking, presence of gallstones, family history of pancreatitis, high levels of calcium in the blood (hypercalcemia), high triglycerides, high levels of parathyroid hormone in the blood (hyperparathyroidism), abdominal injury or trauma, and use of certain medications (e.g., diabetes drugs). Approximately 15 to 20 percent of cases of acute pancreatitis involve serious complications that can be life-threatening, such as infection, kidney failure, and pancreatic cancer.

Use of oral cortisone has been associated with an increased risk of osteoporosis, elevated triglycerides and/or blood glucose, fat redistribution (especially to the face and abdomen), nausea, headache, sleep disorders, weight gain, and a compromised immune system, which increases the risk of infection.

The latest study now adds the risk of acute pancreatitis to the list of potential side effects or complications associated with the use of oral cortisone. According to Dr. Omid Sadr-Azodi, the study’s main author, “people who start a course of cortisone are recommended to refrain from drinking and smoking, which are risk factors for acute pancreatitis.”

National Institutes of Health
Sadr-Azodi O e tal. Association of oral glucocorticoid use with an increased risk of acute pancreatitis. A population-based nested case-control study. Glucocorticoid use and risk of acute pancreatitis. JAMA Internal Medicine 2013. DOI:10.1001/jamainternmed.2013.2737

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