Hydrocortisone

Hydrocortisone is prescribed for several endocrine and inflammatory disorders where systemic glucocorticoid activity is required.

• Replacement therapy for primary or secondary adrenal insufficiency, such as Addison's disease.
• Management of congenital adrenal hyperplasia to suppress excess androgen production.
• Treatment of severe inflammatory or autoimmune diseases that need short‑term systemic glucocorticoid control.
• Adjunct therapy in certain allergic reactions or asthma exacerbations when oral steroids are indicated.
• Supportive care in patients undergoing stress, surgery, or trauma who have impaired cortisol production.

• Hydrocortisone acts as an agonist at intracellular glucocorticoid receptors, forming a hormone‑receptor complex that translocates to the nucleus. This complex binds glucocorticoid response elements on DNA, altering transcription of multiple genes. The result is up‑regulation of anti‑inflammatory proteins and down‑regulation of pro‑inflammatory cytokines, chemokines, and adhesion molecules, leading to suppression of immune cell activation and reduced inflammatory mediator production.

Hydrocortisone can cause a range of adverse reactions, from mild to potentially life‑threatening.

Common

• Increased appetite and weight gain.
• Fluid retention causing mild edema.
• Elevated blood glucose levels, especially in diabetic patients.
• Mood changes such as irritability or insomnia.
• Gastrointestinal discomfort or dyspepsia.
• Skin thinning or easy bruising.

Serious

• Severe hyperglycemia or new‑onset diabetes mellitus.
• Hypertension or worsening of existing cardiovascular disease.
• Opportunistic infections due to immunosuppression.
• Osteoporosis or pathological fractures with long‑term use.
• Adrenal crisis on abrupt discontinuation.
• Psychiatric disturbances including psychosis or severe depression.

Before initiating hydrocortisone therapy, several safety considerations should be reviewed.

• Assess for active infections; glucocorticoids can exacerbate bacterial, viral, or fungal diseases.
• Evaluate blood glucose and blood pressure, as the drug may worsen hypertension or hyperglycemia.
• Screen for a history of peptic ulcer disease, since gastric irritation can increase ulcer risk.
• Monitor bone health, especially in patients with risk factors for osteoporosis.
• Use the lowest effective dose for the shortest duration to limit systemic side effects.
• Counsel patients on the need for gradual tapering to avoid adrenal insufficiency after prolonged use.

Hydrocortisone may interact with several medication classes, affecting efficacy or safety.

Avoid

• Strong CYP3A4 inducers (e.g., rifampin, phenytoin) that can reduce hydrocortisone plasma levels.
• Live vaccines, as immunosuppression may diminish vaccine effectiveness and increase infection risk.
• Non‑steroidal anti‑inflammatory drugs (NSAIDs) that together raise the chance of gastrointestinal bleeding.

Use with caution

• Antidiabetic agents, because hydrocortisone can raise blood glucose and may require dose adjustments.
• Antihypertensive drugs, as fluid retention may counteract blood pressure control.
• Anticoagulants, since glucocorticoids can affect platelet function and clotting factors.
• Other systemic steroids, to avoid additive immunosuppressive effects.