Mineralocorticoid Examples
Mineralocorticoids include the natural hormone aldosterone and synthetic agents such as fludrocortisone (9-fludrocortisone), desoxycorticosterone pivalate (DOCP), and desoxycorticosterone (DOC).
Natural Mineralocorticoid
- Aldosterone: The primary endogenous mineralocorticoid hormone produced by the adrenal cortex that regulates sodium and potassium homeostasis and blood pressure 1
Synthetic Mineralocorticoids
Fludrocortisone (9-fludrocortisone)
- Most commonly used synthetic mineralocorticoid for replacement therapy in primary adrenal insufficiency 1
- Standard adult dosing: 0.05-0.2 mg daily, typically taken once in the morning 1
- Possesses both mineralocorticoid and some glucocorticoid activity 1
Desoxycorticosterone (DOC) and Desoxycorticosterone Pivalate (DOCP)
- Pure mineralocorticoid agents without glucocorticoid activity 2
- DOCP is a long-acting injectable formulation used primarily in veterinary medicine but represents a valid mineralocorticoid option 3, 4, 5
Important Clinical Distinctions
Glucocorticoids with mineralocorticoid activity:
- Hydrocortisone (cortisol): Has significant mineralocorticoid effects at replacement doses, which explains its beneficial use in certain conditions like septic shock 6
- Prednisolone: Has less mineralocorticoid activity than hydrocortisone; patients on prednisolone may require more fludrocortisone supplementation 1
- Dexamethasone: Has NO mineralocorticoid activity whatsoever 1, 2
Mineralocorticoid Receptor Antagonists (Not Mineralocorticoids)
While not mineralocorticoids themselves, it's clinically important to distinguish these blockers of mineralocorticoid action:
Steroidal MR Antagonists
- Spironolactone: First-line MRA recommended for primary aldosteronism due to low cost and availability 7
- Eplerenone: More selective MRA with fewer anti-androgen side effects 7
Nonsteroidal MR Antagonists
- Finerenone: Newer agent showing efficacy in heart failure and chronic kidney disease 8
Critical caveat: MR antagonists like spironolactone and eplerenone are absolutely contraindicated in patients receiving mineralocorticoid replacement therapy for adrenal insufficiency, as they would block the therapeutic effect 1.