Hydrocortisone

Mechanism of action

Glucocorticoid receptor agonist (corticosteroid)

In plain language

The lab-made version of the body's own natural stress hormone, cortisol, used to replace what the body isn't making or to calm inflammation and an overactive immune system.

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ClinicalPlain language

How it works

Hydrocortisone is the pharmaceutical form of cortisol, the glucocorticoid naturally produced by the adrenal cortex, and it retains meaningful mineralocorticoid (salt-retaining) activity alongside its glucocorticoid effects. Like its synthetic analogs, it binds the cytosolic glucocorticoid receptor; the receptor-ligand complex translocates to the nucleus, where it alters transcription of genes governing inflammation and immune function, inducing anti-inflammatory mediators such as lipocortin-1 while suppressing cytokines, prostaglandins, and leukotrienes. Because it is chemically identical to the body's own hormone, the label identifies hydrocortisone (or cortisone) as the first choice for replacement therapy in primary or secondary adrenocortical insufficiency, where synthetic analogs lacking mineralocorticoid activity would require separate mineralocorticoid supplementation. At higher, pharmacologic doses it produces the same broad anti-inflammatory and immunosuppressive effects, and profound metabolic changes, described for other glucocorticoids.

Therapeutic applications

Indicated for adrenocortical insufficiency (primary or secondary), for which the label identifies hydrocortisone as the first-choice replacement therapy, as well as congenital adrenal hyperplasia and nonsuppurative thyroiditis. As with other systemic corticosteroids, it is also indicated as short-term adjunctive therapy for acute flares of rheumatic and collagen-vascular diseases (rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis), for severe dermatologic and allergic conditions unresponsive to conventional treatment, and for severe ophthalmic inflammation. Additional indications include respiratory conditions such as symptomatic sarcoidosis, hematologic disorders like idiopathic thrombocytopenic purpura and autoimmune hemolytic anemia, palliative management of leukemias and lymphomas, edematous states such as nephrotic syndrome, and gastrointestinal flares of ulcerative colitis and regional enteritis.

Class

Small molecule

Therapeutic area

Endocrine / Anti-inflammatory

Source

PubChem CID 5754 ↗FDA label (DailyMed) ↗