A new study from Karolinska Institutet in Sweden shows that cortisone - a hormone used in certain medicines - increases the risk of acute pancreatitis. The results are published in the scientific journal JAMA Internal Medicine. According to the researchers, they suggest that patients treated with cortisone in some forms should be informed of the risks and advised to refrain from alcohol and smoking.

Acute pancreatitis is the most common disease of the pancreas and is caused by a sudden inflammation of the pancreas. Most patients recover without complications. However in 15 to 20 per cent of patients the disease develops to a life-threatening condition. The most common causes of the disease are gallstones and high alcohol consumption, but in a quarter of patients the causes are unknown.

Previous studies based on individual cases have indicated a link between acute pancreatitis and some medicines, such as preparations containing cortisone. Endogenous cortisone derives from an adrenal hormone and is related to stress and the regulation of the circadian rhythm. The most common form in humans is cortisol (or hydrocortisone). Synthetic cortisone is used to treat a number of medical conditions, such as asthma and autoimmune diseases (e.g. rheumatic diseases).

The present study is the first systematic study to demonstrate the relationship between medical cortisone and acute pancreatitis. Six thousand patients diagnosed with acute pancreatitis between 2006 and 2008 were compared with 61,000 healthy controls. The results show that people treated with cortisone in tablet form ran a 70 per cent higher risk of developing acute pancreatitis. This connection was observed after three days' medication, substantiating the evidence that the causal factor was the cortisone rather than the treated disease per se.

"However, there was no observable increase in risk for people who used aerosol cortisone, such as asthma inhalers," says the study's principal author Dr Omid Sadr-Azodi. "But people who start a course of cortisone are recommended to refrain from drinking and smoking, which are risk factors for acute pancreatitis."

Oral glucocorticoid use is associated with an increased risk of acute pancreatitis - a population-based nested case-control study, Omid Sadr-Azodi, Fredrik Mattsson, Tomas Sjöberg Bexelius, Mats Lindblad, Jesper Lagergren & Rickard Ljung, JAMA Internal Medicine, online 25 February 2013.