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Hydrocortisone: Uses, Effects & Side Effects

Hydrocortisone is a naturally occurring steroid hormone and medication used to treat inflammation, allergic reactions, and adrenal insufficiency.

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Things worth knowing about "Hydrocortisone"

Hydrocortisone is a naturally occurring steroid hormone and medication used to treat inflammation, allergic reactions, and adrenal insufficiency.

What is Hydrocortisone?

Hydrocortisone, also known as cortisol, is a glucocorticoid hormone naturally produced by the adrenal cortex. It is the body's primary stress hormone and plays a central role in regulating metabolism, immune function, and the stress response. As a pharmaceutical drug, hydrocortisone is produced synthetically and is available in various forms, including tablets, injections, creams, and ointments.

Mechanism of Action

Hydrocortisone binds to intracellular glucocorticoid receptors, which then act as transcription factors to regulate gene expression. Its main pharmacological effects include:

Anti-inflammatory: It suppresses the release of pro-inflammatory mediators such as prostaglandins and leukotrienes, and reduces immune cell activity.
Immunosuppressive: It dampens overactive immune responses seen in autoimmune diseases and severe allergic reactions.
Metabolic: It regulates carbohydrate, fat, and protein metabolism, raises blood glucose levels, and mobilizes energy stores.
Vasopressor support: It helps maintain vascular tone and blood pressure, particularly in states of shock or adrenal crisis.

Indications

Hydrocortisone is used in the treatment of a wide range of conditions:

Adrenal insufficiency (Addison's disease, congenital adrenal hyperplasia): hormone replacement therapy
Inflammatory conditions: rheumatoid arthritis, Crohn's disease, ulcerative colitis
Allergic reactions: anaphylaxis, urticaria, allergic asthma
Dermatological conditions: eczema, psoriasis, contact dermatitis (topical application)
Ocular conditions: uveitis, allergic conjunctivitis (eye drops)
Adrenal crisis: life-threatening adrenal insufficiency (high-dose intravenous administration)

Dosage and Administration

The dosage of hydrocortisone varies greatly depending on the indication and route of administration:

Replacement therapy: Typically 15–25 mg per day orally, divided into 2–3 doses to mimic the natural diurnal cortisol rhythm.
Adrenal crisis: 100 mg hydrocortisone administered intravenously as a bolus, followed by further doses based on clinical response.
Topical use: Creams and ointments containing 0.5–2.5% hydrocortisone are applied thinly to the affected skin area, usually once or twice daily.

The appropriate dosage should always be determined by a healthcare professional.

Side Effects

Short-term or topical use of hydrocortisone is generally well tolerated. However, prolonged or high-dose use may cause the following side effects:

Weight gain and redistribution of body fat (Cushing's syndrome)
Elevated blood glucose levels, potentially leading to steroid-induced diabetes mellitus
Osteoporosis due to inhibition of bone formation
High blood pressure (hypertension)
Increased susceptibility to infections due to immunosuppression
Skin changes: skin thinning (atrophy), stretch marks, delayed wound healing
Psychological effects: insomnia, mood swings, euphoria, or depression
Suppression of the HPA (hypothalamic-pituitary-adrenal) axis with long-term use

Contraindications and Interactions

Hydrocortisone should be used with caution or avoided in the following situations:

Systemic fungal infections
Live vaccinations (increased risk of infection)
Severe osteoporosis
Uncontrolled diabetes mellitus

Notable drug interactions include:

Non-steroidal anti-inflammatory drugs (NSAIDs): increased risk of gastrointestinal bleeding
Antidiabetic agents: hydrocortisone may increase blood glucose and reduce the efficacy of diabetes medications
CYP3A4 inhibitors (e.g., ketoconazole): may increase plasma levels of hydrocortisone

References

Nieman, L. K. - Glucocorticoid therapy. In: UpToDate (2023). Wolters Kluwer.
Bornstein, S. R. et al. - Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology & Metabolism, 101(2), 364–389 (2016).
World Health Organization (WHO) - Model Formulary 2023: Corticosteroids. Geneva: WHO Press.

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