Hydrocortisone
The natural adrenal hormone cortisol given as a drug: the first choice to replace it in adrenal insufficiency, and also used for inflammation.
Also called cortisol (name of the natural hormone).
Drug card
- Class
- Glucocorticoid
- How it works
- Activating glucocorticoid receptors, which switch off inflammatory genes
- Used for
- Adrenal insufficiency, such as Addison's disease
- Rheumatoid arthritis flares (short-term)
- Severe allergic conditions
- Ulcerative colitis and proctitis
- Known for
- Salt and water retention with raised blood pressure
- Adrenal suppression; stopping suddenly is dangerous
- Cushingoid features: moon face, central fat
- Its name
- -cort- means a corticosteroid (cortisone type)
Study it as a flashcard, and it comes back before you forget it.
Mechanism of action
How does hydrocortisone work?
The same molecule as cortisol, the main glucocorticoid of the adrenal cortex. It binds glucocorticoid receptors, promoting gluconeogenesis and protein breakdown and damping immune and inflammatory responses, and it keeps some salt-retaining (mineralocorticoid) activity. That mix is why it, or cortisone, is the first choice for replacement in adrenal insufficiency.
Like other glucocorticoids: They enter cells and bind the glucocorticoid receptor; the activated complex moves to the nucleus, binds glucocorticoid response elements and changes which genes are read. Inflammatory cytokines and NF-kB signaling are damped, lymphocytes and eosinophils fall, and gluconeogenesis and protein breakdown rise. With long use they suppress ACTH release and so the adrenal glands' own output.
Uses
What is hydrocortisone used for?
- Adrenal insufficiency, such as Addison's disease
- Rheumatoid arthritis flares (short-term)
- Severe allergic conditions
- Ulcerative colitis and proctitis
Side effects
Side effects of hydrocortisone
- Salt and water retention with raised blood pressureKnown for
- Adrenal suppression; stopping suddenly is dangerousKnown forSerious
- Cushingoid features: moon face, central fatKnown for
- Low potassium (hypokalemia)
- Swollen ankles
- Infections, with their signs maskedSerious
- High blood sugar
- Osteoporosis and fracturesSerious
- Peptic ulcer, which can bleed or perforateSerious
- Mood changes
- Headache
- Dizziness
Known for marks what an exam expects you to know it for.
Watch for
Cautions and what sets it apart
- In adrenal insufficiency it must not be stopped, and doses are raised during illness, injury or surgery to prevent an adrenal crisis.
- Watch blood pressure, swelling and potassium, because it retains salt and water and wastes potassium, above all in heart failure.
- Contraindicated in systemic fungal infections; screen for hepatitis B, and watch for latent TB, before long immunosuppressive use.
- Avoid live vaccines on immunosuppressive doses; chickenpox and measles can be severe in people who are not immune.
Good to know: The first choice for cortisol replacement in adrenal insufficiency; unlike dexamethasone, it has clear salt-retaining activity.
Remember it
A way to remember it
STEROIDS
- S
- Suppression of the adrenal glands
- T
- Thin bones (osteoporosis)
- E
- Eyes: cataracts and glaucoma
- R
- Raised blood sugar and blood pressure
- O
- Obesity of the trunk and a moon face (Cushingoid features)
- I
- Infections, with signs masked
- D
- Depression and other mood changes
- S
- Stomach (peptic) ulcers
Written for biofideX
Its name
-cort- means corticosteroid (cortisone type)
Found in cortisone, hydrocortisone and fludrocortisone. WHO keeps prednisolone relatives under pred instead.
- Every drug name stem
Its class
Glucocorticoids
Other glucocorticoids with a card:
Easily mixed up with inhaled corticosteroids and non-steroidal anti-inflammatory drugs.
Sources
Checked against
Written for biofideX in plain words, after checking these references:
- Hydrocortisone tablets: label (DailyMed)
- Hydrocortisone rectal foam: label (DailyMed)
- Therapeutic Hydrocortisone (NCI Thesaurus)
- About hydrocortisone tablets (NHS)
- Dexamethasone tablets: label (DailyMed)
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Thyroid, steroids and bones
Hydrocortisone is one of 9 drugs practiced together here: their classes, how they work, what they treat and what they're known for.
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