Enhancement of the Anti-inflammatory Action of Hydrocortisone by Estrogen

Abstract

Thirteen female patients with various severe and chronic inflammatory diseases were treated for 11/2 to 4 yr with either estrogens or hydrocortisone or with a combination of hydrocortisone and estrogens. Estrogen therapy alone did not influence significantly the inflammatory skin disease. However, addition of estrogens to the corticosteroid therapy produced a 3- to 20-fold reduction of the previously established requirement of corticosteroids for the successful control of the skin diseases. Experimental studies with female guinea pigs revealed a suppression of granuloma formation, induced by carrageenin, when the animals were treated with either hydrocortisone, estrogen or a combination of estrogen and hydrocortisone. In the last case an additive effect of the anti-inflammatory activities of both the hydrocortisone and the estrogen became evident. The plasma concentrations of the cortisol-binding globulin were elevated in both the patients and the guinea pigs treated with estrogens. The plasma concentrations of the unconjugated corticosteroids in the patients on estrogen were also elevated. It is possible that the anti-inflammatory effect of estrogen is mediated through the rise in CBG levels in blood. Such a rise may prolong the halflife of hydrocortisone, through the formation of the CBG-hydrocortisone complex, thus reducing the rapid metabolism of this hormone.