The secretion of cortisol is mainly controlled by three inter-communicating regions of the body, the hypothalamus in the brain, the pituitary gland and the adrenal gland . This is called the hypothalamic–pituitary–adrenal axis. When cortisol levels in the blood are low, a group of cells in a region of the brain called the hypothalamus releases corticotrophin-releasing hormone , which causes the pituitary gland to secrete another hormone, adrenocorticotropic hormone , into the bloodstream. High levels of adrenocorticotropic hormone are detected in the adrenal glands and stimulate the secretion of cortisol, causing blood levels of cortisol to rise. As the cortisol levels rise, they start to block the release of corticotrophin-releasing hormone from the hypothalamus and adrenocorticotropic hormone from the pituitary. As a result the adrenocorticotropic hormone levels start to drop, which then leads to a drop in cortisol levels. This is called a negative feedback loop.
A small and very rare risk is that the injected joint becomes infected (1 in 15,000). Patients who experience a very painful, red, or swollen joint after injection should seek medical attention immediately. Thankfully, the most common cause of these symptoms is not a concerning infection but a reaction to the injected steroid (called steroid flare ) that occurs in 2-5% of patients. A steroid flare usually begins 6-12 hours after the injection and can last for 2-3 days. Regardless of the cause, it is important for patients with symptoms of infection to see a doctor because infections require immediate treatment.
Depending on the number and character of their functional groups, steroid molecules may show diverse reactivities. Moreover, the reactivity of a functional group varies according to its location within the molecule (for example, esters are formed readily by 3-OH groups but only with difficulty by the 11β-OH group). An important property of steroids is polarity —., their solubility in oxygen-containing solvents (., water and alcohols ) rather than hydrocarbon solvents (., hexane and benzene ). Hydroxyl, ketonic, or ionizable (capable of dissociating to form electrically charged particles) groups in a steroid molecule increase its polarity to an extent that is strongly influenced by the spatial arrangement of the atoms within the molecule.