What Is a Cortisone Flare? Causes, Management, and More

What Is A Cortisone Flare?

Cortisol is a hormone produced by your adrenal glands. It’s main function is to regulate blood sugar levels and protect against high temperatures (hyperthermia). Cortisol also helps with the immune system. When cortisol levels are too low or too high, it causes various symptoms including:



Irritability/Aggression (often associated with anxiety)

Insomnia/Nightmares/Delayed Sleep Phase Syndrome (DSPS)

When Cortisol Levels Are Too Low Or Too High…

The body produces less cortisol than normal. This results in a drop in energy level and mood swings. These symptoms may include:

Loss of appetite

Weight loss (especially if dieting)

Depression and sadness (depressed patients often have increased cortisol levels)

These symptoms are caused by a drop in cortisol production. Cortisol levels must remain within certain ranges to prevent these effects from occurring. If they become too low, then the patient will experience many of the same symptoms described above.

If they become too high, then their condition becomes life threatening.

Treating Low Cortisol Levels

If the patient’s cortisol levels are below normal, then they will need cortisol replacement therapy. The patient may also receive a short course of hydrocortisone to increase their energy level and mood while their new cortisol treatment begins working.

Treating High Cortisol Levels

Patients with elevated cortisol levels may experience many dangerous side effects if left untreated. These side effects typically require immediate attention.

Severe low blood sugar


Weight gain (sometimes severe or even obesity)

Muscle loss

Loss of bone density (osteoporosis)

High Blood Pressure

Decreased immune system (increases risk for illness)

The most common way to treat a patient with high cortisol levels is with medication. This is generally a temporary measure until their condition can be treated with a more permanent solution.

Treating Adrenal Insufficiency

If the patient has an underactive adrenal gland, then they will require immediate medical treatment to stabilize their condition. The patient may receive hydrocortisone tablets or an injection of hydrocortisone to increase their blood sugar, decrease stressful events and allow time for their body to heal naturally over time.

Cortisol Replacement

Patients with hypoadrenia may require long-term cortisol replacement to sustain life. These patients will need to take hydrocortisone (cortisol) tablets or an injection of hydrocortisone for the rest of their lives. The dose required is low, but it acts on the entire body.

Adrenal Gland Transplant

Patients with adrenal gland failure may be good candidates for an adrenal gland transplant. The patient’s own healthy adrenal gland will be removed and replaced with a healthy one from a donor. This procedure is major surgery and highly risky.


This relatively new procedure involves surgeons removing the patient’s dysfunctional adrenal glands and treating them with steroids until the body begins to produce its own again. The steroids are then reduced until they can be stopped completely.

Most patients experience an immediate improvement in life quality and suffer few if any long-term side effects. The procedure has proven to be very successful for patients suffering from adrenal insufficiency.

Decreased Anabolic Effects (Female)

Anabolic steroids mimic the effects of male hormones, primarily testosterone. These hormones are responsible for many of the differences between men and women. Women who supplement with anabolic steroids may experience minor masculinizing effects.

Facial Hair Growth

A temporary side effect of anabolic steroids for women is facial hair growth. This can occur on the chin and above the lips, usually in the form of a mustache. This may be shaved off or plucked, but it will continue to grow back unless the woman stops taking anabolic steroids.

Clitoral Enlargement

Anabolic steroids can cause the clitoris to grow in size, much like a male’s genitalia. The clitoris is a highly sensitive organ for women, and the enlargement caused by steroids may make it even more sensitive.

Menstrual Cycle Irregularities

One of the major side effects of steroid use for women is menstrual cycle irregularities. Many women will stop having their period altogether, while others will find that their periods become heavier and longer. Others still may find that their periods become lighter and shorter.

Decreased Fertility

Anabolic steroids can cause permanent infertility in women. This is not necessarily a permanent side effect for all women who use anabolic steroids, but it is a possibility that cannot be avoided.

Masculinizing Effects (Female)

While anabolic steroids mimic the effects of male hormones, they do not remove the female body’s ability to produce estrogen and progesterone naturally. As a result, women who supplement with anabolic steroids will find that their dose needs to be much higher than a man’s in order to achieve the desired effects.

Increased Hair Growth

One of the side effects of anabolic steroids for women is increased body hair growth. Users may find that they grow hair on their chest, underarms, and legs. Some may even grow a beard.

This side effect can be eliminated with the use of a hair removal product.

Blood Clotting Issues

Anabolic steroids can cause users to have issues with blood clotting. This can be very dangerous for women, especially those who are pregnant or who have a history of blood clots. When combined with child birth this may cause excessive bleeding, which can prove fatal for the mother and/or the baby.

Fluid Retention

Anabolic steroids cause the body to retain water, which can result in a great deal of swelling and severe weight gain. Most of this weight gain is due to the fact that muscle cells do not convert excess sugars and lipids into water weight like fat cells do. However, some water retention will still occur.

Nipple Sensitivity

Anabolic steroids have a tendency to cause the nipples to become more sensitive in women. This may cause some women to become uncomfortable, especially during exercise when the nipples rub up against the inside of a shirt. This can be fixed by using tape or a band aid to protect the nipples, or by taking supplement gels that numb the skin.

Sources & references used in this article:

Self‐management strategies used during flares of rheumatoid arthritis in an ethnically diverse population by C Kett, J Flint, M Openshaw, K Raza… – Musculoskeletal …, 2010 – Wiley Online Library

Patient perspectives on the management of atopic dermatitis by T Zuberbier, SJ Orlow, AS Paller, A Taïeb… – Journal of Allergy and …, 2006 – Elsevier

Topical steroid damaged/dependent face (TSDF): An entity of cutaneous pharmacodependence by K Lahiri, A Coondoo – Indian journal of dermatology, 2016 – ncbi.nlm.nih.gov

Flare of autoimmune hepatitis causing acute on chronic liver failure: diagnosis and response to corticosteroid therapy by L Anand, A Choudhury, C Bihari, BC Sharma… – …, 2019 – Wiley Online Library

Handbook of stress by L Goldberger, S Breznitz – 2010 – books.google.com