What type of corticosteroid is hydrocortisone?

Hydrocortisone Classification

Hydrocortisone is a glucocorticoid (also called a corticosteroid), specifically a short-acting systemic corticosteroid that is structurally identical to endogenous cortisol. 1

Pharmacological Classification

• Hydrocortisone is classified as a glucocorticoid with both glucocorticoid and mineralocorticoid activity 1, 2
• It is the least potent of the systemic corticosteroids, serving as the reference standard (1x potency) for comparing other corticosteroids 2, 3
• Hydrocortisone is structurally identical to cortisol, the natural hormone produced by the adrenal cortex 1

Potency Comparisons

The following equivalences establish hydrocortisone's relative potency:

• Hydrocortisone 240 mg = Prednisone 60 mg = Methylprednisolone 48 mg = Dexamethasone 10 mg 2
• Prednisone is 4 times more potent than hydrocortisone 2
• Methylprednisolone is 5 times more potent than hydrocortisone 2
• Dexamethasone is 25 times more potent than hydrocortisone 2, 3

Unique Mineralocorticoid Activity

• Hydrocortisone is the only corticosteroid among commonly used systemic steroids with significant mineralocorticoid activity, which is crucial for treating primary adrenal insufficiency 1, 2
• Dexamethasone has no mineralocorticoid activity and is therefore inadequate as stress coverage in primary adrenal insufficiency 1, 2
• Prednisone and methylprednisolone have minimal mineralocorticoid activity 2

Pharmacokinetic Properties

• Hydrocortisone has a short plasma elimination half-life of approximately 90 minutes 1, 2
• Due to this short half-life, hydrocortisone requires dosing every 6-8 hours or continuous infusion to maintain therapeutic levels 1, 2
• It has excellent oral bioavailability and is rapidly absorbed 1
• The active ingredient in topical formulations is hydrocortisone 1% 4

Clinical Context

• Hydrocortisone is classified as a short-acting corticosteroid, in contrast to intermediate-acting agents (prednisone, methylprednisolone) and long-acting agents (dexamethasone) 3
• It is the preferred glucocorticoid for replacement therapy in adrenal insufficiency because it mimics endogenous cortisol 1, 5
• For critical illness, hydrocortisone is recommended at doses <400 mg/day for septic shock 1