What is hydrocortisone (cortisol)?

From the Guidelines

Hydrocortisone is a corticosteroid medication that mimics the effects of cortisol, a natural hormone produced by the adrenal glands, and is commonly used to treat inflammatory conditions, allergic reactions, adrenal insufficiency, and autoimmune disorders. It's available in various forms including oral tablets, topical creams, ointments, and injectable solutions. For topical use, it typically comes in strengths ranging from 0.5% to 2.5% and should be applied thinly to affected areas 2-4 times daily. For oral administration, dosages vary widely based on the condition being treated, from 15–25 mg of hydrocortisone daily in split doses for replacement therapy in patients with primary adrenal insufficiency, as recommended by 1.

Key Points

• Hydrocortisone works by suppressing the immune system's inflammatory response, reducing redness, swelling, itching, and allergic reactions.
• It achieves this by preventing the release of substances in the body that cause inflammation.
• Side effects may include skin thinning with topical use or, with systemic use, increased blood sugar, fluid retention, mood changes, and increased susceptibility to infections.
• Long-term use requires medical supervision due to potential adrenal suppression, and patients with adrenal insufficiency should wear Medic Alert identification jewellery and carry a steroid/alert card, as recommended by 1.
• In cases of adrenal crisis, hydrocortisone is administered intravenously at a dose of 100 mg, followed by 100 mg every 6-8 hours until recovery, as recommended by 1 and 1.

Dosage and Administration

• The dosage of hydrocortisone varies depending on the condition being treated and the patient's response to the medication.
• For patients with primary adrenal insufficiency, the recommended daily dose is 15–25 mg of hydrocortisone in split doses, with the first dose taken immediately after waking and the last dose taken not less than 6 hours before bedtime, as recommended by 1.
• In the perioperative period, patients with adrenal insufficiency may require stress-dose steroid administration, with hydrocortisone being the drug of choice, as recommended by 1 and 1.

From the FDA Drug Label

Hydrocortisone Tablets, USP contain hydrocortisone which is a glucocorticoid. Glucocorticoids are adrenocortical steroids, both naturally occurring and synthetic, The chemical name for hydrocortisone is pregn-4-ene-3,20-dione,11,17,21-trihydroxy-,(11β)-. Hydrocortisone is a glucocorticoid, which is a type of adrenocortical steroid. It is available in oral form as hydrocortisone tablets, and its chemical name is pregn-4-ene-3,20-dione,11,17,21-trihydroxy-,(11β)- 2.

• Key characteristics: white to practically white, odorless, crystalline powder
• Solubility: very slightly soluble in water and in ether; sparingly soluble in acetone and in alcohol; slightly soluble in chloroform
• Molecular weight: 362.46

From the Research

Definition of Hydrocortisone

• Hydrocortisone is a type of corticosteroid, which is a class of steroid hormones that are produced in the adrenal gland 3.
• It is a short-acting product and is considered the least potent among corticosteroids, with prednisone and methylprednisolone being four to five times more potent 3.
• Hydrocortisone is used in the treatment of various medical conditions, including COVID-19, where it is used alone or in combination with other corticosteroids for the treatment of moderate, severe, and critically infected patients 4.

Medical Uses of Hydrocortisone

• Hydrocortisone is used to treat active Crohn's disease, and when used correctly, it is a highly effective, well-tolerated, cheap, and generally safe treatment 5.
• It is also used as an adjunctive treatment of critical illness-related corticosteroid insufficiency in patients with septic shock, particularly in oncology patients 6.
• Hydrocortisone has potent anti-inflammatory and immunosuppressive effects, reducing the generation of proinflammatory cytokines and chemokines and lowering the activation of T cells, monocytes, and macrophages 4.

Comparison with Other Corticosteroids

• Hydrocortisone is less potent than other corticosteroids such as dexamethasone, methylprednisolone, and prednisone 3, 4.
• In a study comparing hydrocortisone with methylprednisolone in oncology patients with septic shock, no differences were seen in time to shock reversal or incidence of steroid-related adverse effects between the two groups 6.
• However, patients who received methylprednisolone had higher rates of mechanical ventilation and longer intensive care unit and hospital lengths of stay compared to those who received hydrocortisone 6.