Will hydrocortisone (cortisol) affect cortisol levels?

From the Guidelines

Hydrocortisone will significantly affect cortisol levels in the body, as it is the pharmaceutical name for cortisol and directly supplements the body's natural cortisol production. When taken orally or applied topically, hydrocortisone introduces additional cortisol into the system, which is crucial for patients with adrenal insufficiency who cannot produce adequate cortisol on their own 1. For such patients, hydrocortisone replacement therapy, typically administered in divided doses of 15-25 mg daily, helps maintain normal physiological function. However, in individuals with normal adrenal function, taking hydrocortisone can suppress the body's natural cortisol production through negative feedback on the hypothalamic-pituitary-adrenal axis, emphasizing the importance of monitoring cortisol levels before starting hydrocortisone therapy and avoiding abrupt cessation of the medication to prevent adrenal crisis 1.

Key Considerations

• Hydrocortisone replacement therapy is essential for patients with adrenal insufficiency to maintain normal physiological function.
• The therapy should be tailored to the individual's needs, with considerations for stress dosing and potential interactions with other medications.
• Education on stress dosing, emergency injectables, and the importance of a medical alert bracelet is crucial for patients on hydrocortisone therapy.
• Endocrine consultation is recommended for planning before surgery or high-stress treatments and for managing potential complications of hydrocortisone therapy.

Dosage and Administration

• The typical dosage of hydrocortisone for replacement therapy is 15-25 mg daily in divided doses.
• For patients with severe symptoms or life-threatening consequences, IV stress dose steroids such as hydrocortisone 50-100 mg Q 6-8 hours may be necessary, with tapering down to oral maintenance doses over 5-7 days 1.
• It is essential to consider the diurnal rhythm of cortisol when administering hydrocortisone, with 2/3 of the dose given in the morning and 1/3 in the early afternoon.

Monitoring and Follow-Up

• Regular monitoring of cortisol levels and assessment of the patient's health and well-being are necessary to adjust the hydrocortisone dosage as needed.
• Patients should be educated on the signs of adrenal crisis and the importance of seeking medical attention promptly if symptoms occur.
• Endocrine consultation should be part of the ongoing management plan for patients on hydrocortisone therapy, especially when planning for surgery or other high-stress treatments.

From the FDA Drug Label

ACTIONS Naturally occurring glucocorticoids (hydrocortisone and cortisone), which also have salt-retaining properties, are used as replacement therapy in adrenocortical deficiency states. The answer is yes, hydrocortisone (cortisol) will affect cortisol levels, as it is a naturally occurring glucocorticoid used as replacement therapy in adrenocortical deficiency states, implying it will increase cortisol levels in the body 2.

From the Research

Hydrocortisone and Cortisol Levels

• Hydrocortisone therapy can significantly increase plasma cortisol levels, with total and free cortisol levels increasing 4.2- and 8.5-fold, respectively, after initiation of therapy 3.
• The increase in cortisol levels is initially high, but subsequently declines despite continuous administration of a constant dose of hydrocortisone 3.
• The effect of hydrocortisone on cortisol levels can vary depending on the individual's underlying condition, such as adrenal insufficiency, and the dose and duration of treatment 4, 5, 6, 7.

Adrenal Insufficiency and Cortisol Levels

• Adrenal insufficiency can occur due to exogenous corticosteroid therapy, including hydrocortisone, which can disrupt normal hypothalamic and anterior pituitary function 6.
• The risk of adrenal insufficiency varies according to the dose and duration of corticosteroid treatment, with higher doses and longer treatment durations posing a greater risk 7.
• Patients with adrenal insufficiency may require individualized cortisol replacement therapy to prevent adrenal crises and improve outcomes 4, 5.

Clinical Implications

• The use of hydrocortisone can have significant effects on cortisol levels, and clinicians should be aware of these effects when managing patients with adrenal insufficiency or other conditions requiring corticosteroid therapy 3, 4, 5, 6, 7.
• Regular monitoring of cortisol levels and adjustment of hydrocortisone doses may be necessary to prevent over- or under-treatment and minimize the risk of adverse events 4, 5.