Hydrocortisone

How it works

It binds glucocorticoid receptors to modulate gene transcription, producing broad anti-inflammatory and immunosuppressive effects, and provides physiological corticosteroid replacement in adrenal insufficiency.

Prescribing in practice

• In suspected adrenal crisis, give parenteral hydrocortisone without delay alongside fluid resuscitation, as treatment is life-saving and should not await confirmatory tests.
• In anaphylaxis it is a slow-onset adjunct only and must not delay intramuscular adrenaline.
• It can cause hyperglycaemia, fluid retention, hypokalaemia and, with repeated use, adrenal suppression that must not be stopped abruptly.

Monitoring

Monitor blood glucose, blood pressure, fluid balance and electrolytes, and the clinical response to treatment.

Counselling the patient

• This steroid is being given urgently to treat a serious reaction or low cortisol level.
• If you take long-term steroids, never stop them suddenly and carry a steroid alert card.
• Tell us if you have an infection, as steroids can mask its signs.

Evidence & guidelines

Parenteral hydrocortisone for adrenal crisis is supported by Society for Endocrinology and NICE guidance.