Glucocorticoid·Endocrinology - Systemic Corticosteroids

Hydrocortisone

Adrenal insufficiency (Addison's disease), adrenal crisis, refractory shock, severe acute asthma (IV)

Authority requiredPBSSTEROIDSolu-Cortef (IV), Hysone (Oral)4 mg tablet+2

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At a glance

Max Dose

400 mg/day (Crisis)

Half-life

1.5 h

Caution: Mineralo. Effect

HIGH

Adrenal Crisis

1ST LINE

Cautions

Avoid / Cautions

Systemic fungal infections (unless life-threatening adrenal crisis, where there are zero absolute contraindications). Pregnancy Category A. Hydrocortisone is heavily inactivated by placental enzymes, protecting the fetus from high doses.

Where it stands

Rapid Summary

Overview

Short-acting glucocorticoid. Synthetically identical to endogenous human cortisol. Contains equal parts glucocorticoid (anti-inflammatory) and mineralocorticoid (salt-retaining) activity.

Clinical Focus

The absolute life-saving drug for acute adrenal insufficiency or severe refractory septic shock.

Bottom Line

Hydrocortisone is a physiological corticosteroid for adrenal crisis, acute asthma, and inflammatory conditions, but requires stress dosing in adrenal insufficiency and long-term use causes adrenal suppression.

Formulation & Access

Brand Names

Solu-Cortef (IV), Hysone (Oral)

Oral Routes

Tablets (4 mg, 20 mg).

Parenteral

Vials (100 mg powder) for IV / IM use.

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Adrenal insufficiency (Addison's disease), adrenal crisis, refractory shock, severe acute asthma (IV).

Clinical Place

The physiological baseline. Replaces what the body cannot make during stress.

Quick reference

Class & Role

Glucocorticoid — Short-acting glucocorticoid.

Route / Formulation

Tablets (4 mg, 20 mg). (Solu-Cortef (IV), Hysone (Oral))

Usual Dose & Max

IV 100 mg STAT, followed by 50-100 mg q6h until stable. Max 400 mg/day (Used IV during acute Addisonian crisis).

Key Indication Doses

Acute Adrenal Crisis: IV 100 mg STAT, followed by 50-100 mg q6h until stable. Refractory Septic Shock: IV 200 mg/day (often as a continuous infusion or 50 mg q6h) to restore vascular tone. Replacement Therapy: PO 10-20 mg in the morning, and 5-10 mg in the late afternoon (to mimic physiological cortisol rhythms).

Best Uses

Key Risks

Metabolic: Hyperglycemia, hypernatremia, hypokalemia, fluid retention, weight gain. Cardiovascular: Hypertension (due to mineralocorticoid fluid retention). Immunological: Immunosuppression, impaired wound healing.

Key Interactions

Loop/Thiazide Diuretics (Synergistic hypokalemia). NSAIDs (GI bleeding).

Monitoring

'Sick Day Rules'. Patients on oral replacement MUST double or triple their oral dose if they get a fever, infection, or surgery. Failure to do so will result in a fatal adrenal crisis. Monitor BSL and U&E (potassium drops, sodium rises).

Clinical Pearl

Unlike Dexamethasone (which is pure anti-inflammatory), Hydrocortisone strongly retains salt and water. This makes it vastly superior in septic shock, where you desperately need to fill the blood vessels with fluid to raise the BP.

Access

Authority requiredSolu-Cortef (IV), Hysone (Oral)4 mg tablet

Brand: Solu-Cortef (IV), Hysone (Oral)
PBS status: Authority required
Formulation: Tablets (4 mg, 20 mg).

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