The following is the edited text of a winning essay, enhanced with diagrams. The bibliography has been excluded.
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A Winning Essay


Cortisone: The Wonder Drug

by Dharsini Dharmalingam, Rosedale Heights Secondary School, Toronto

Cortisone is an important therapeutic drug which is used to fight many ailments ranging from Addison's disease to rheumatoid arthritis. Ever since the discovery of its antirheumatic properties in 1949, which led to its acclaim as a wonder drug, many derivatives of cortisone with enhanced properties to better fight a specific ailment have been produced. Cortisone belongs to a group of steroids known as corticosteroids. These steroids are produced by the adrenal cortex, which is the outer part of the adrenal glands, near the kidneys. The corticosteroids are divided into two main groups: the glucocorticoids, which control fat, protein, calcium and carbohydrate metabolism, and the mineralocorticoids controlling sodium and potassium levels. Cortisone belongs to the former group. Even though cortisone is naturally available, many schemes have been developed to produce cortisone through partial or total synthesis. These schemes have been constantly modified and improved upon ever since the early days of cortisone development.

Discovery

The discovery of cortisone can be linked with another discovery made by Thomas Addison of Scotland in 1849. He discovered the connection between the adrenal glands and a rare disease, which is now known as Addison's disease. This landmark discovery led many researchers to focus their attention on adrenal glands and their biological function. In 1894, an English physician raised his own son's blood pressure by means of watery extracts from adrenla glands. This enabled others to conclude that there was a new hormone produced in the adrenal cortex, and this hormone was called "cortin". During the early 1930's, Edward C. Kendall went a step further and successfully isolated 5 different compounds from the adrenal cortex; these were named compounds A through E, using the sequence in which they were discovered. In 1936, Thadeus Reichstein isolated as many as 7 substances, which he also identified by using letters of the alphabet, albeit in a different sequence. Kendall followed by demonstrating that his compound E can be converted into an androgen (a male hormone) through certain chemical alterations. This important breakthrough indicated cortin was probably a steroid. And, as much was known about steroids at the time, the discovery of the mysterious hormone of the adrenal cortex seemed only a matter of time. But after 10 years of failures and false hopes, on April 29, 1948, Kendall finally produced a few grams of compound E. A physician named Philip S. Hench joined with Kendall at this point, and together they discovered that compound E could be successfully used to treat patients with rheumatoid arthritis. The wonder drug had finally arrived and it was christened "cortisone" on July 1, 1949. In 1950, Kendall, Reichstein and Hench were awarded the Nobel Prize.

Benefits

Cortisone and its many derivatives are used for a variety of ailments. These include endocrine disorders, trheumatic disorders, collagen diseases, dermatologic diseases, allergic states, ophthalmic diseases, respiratory diseases, hematologic disorders, neoplastic diseases, edematous diseases, gastroinstestinal diseases, etc. Specific examples include rheumatoid arthritis, tuberculosis, Addisom's disease and severe asthma, to name a few. Cortisone also helped to make organ transplants a reality due to its ability to minimize the defense reaction of the body towards foreign proteins present in the implanted organ and thus damage the functionality of the implanted organ.

Problems

As wonderful as cortisone is as a drug, there are some side-effects associated with its use. The major risk is the spread of bacterial infection due to diminished resistance. Depression and peptic ulcers occasionally occur. Psychic derangements may appear when cortisone is used, ranging from euphoria, insomnia, mood swings and personality changes, to frank psychotic manifestations. At high dosage, moon face and buffalo hump can also occur. In addition, cataracts and glaucoma may develop in predisposed patients if cortisone is used for a prolonged period of time.

Conclusion

When cortisone is used correctly, the harmful side-effects are minimized and it lives up to the wonder drug hype. Based on the many types of disorders and diseases against which it is used as a therapeutic drug and the millions of lives is has saved over the years, cortisone more than deserves to be in the Chemistry Hall of Fame.


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