Cellular Mechanism of Cortisol Action
Cortisol, like other steroid hormones, exerts its effects by first interacting with intracellular receptors in target cells. Because cortisol is lipid soluble, it can easily diffuse through the cell membrane. Once inside the cell, cortisol binds with its protein receptor in the cytoplasm, and the hormone-receptor complex then interacts with specific regulatory DNA sequences, called glucocorti-coid response elements, to induce or repress gene tran-scription. Other proteins in the cell, called transcriptionfactors, are also necessary for the hormone-receptorcomplex to interact appropriately with the glucocorti-coid response elements.
Glucocorticoids increase or decrease transcription of many genes to alter synthesis of mRNA for the proteins that mediate their multiple physiologic effects. Thus, most of the metabolic effects of cortisol are not immediate but require 45 to 60 minutes for proteins to be synthesized, and up to several hours or days to fully develop. Recent evidence suggests that glucocorticoids, especially at high concentrations, may also have some rapid nongenomic effects on cell membrane ion trans-port that may contribute to their therapeutic benefits.