Glucocorticoids are endogenous (hydrocortisone) and synthetic (prednisolone, methylprednisolone, dexamethasone) steroid hormones with metabolic, anti-inflammatory, and immunosuppressive effects. They bind to specific intracellular receptors and translocate into the nucleus, where they regulate gene expression in a tissue-specific manner.

Corticosteroids have multiple indications including:

  • Replacement in adrenal suppression or other cortisol-deficient states
  • Autoimmune disorders
  • Anaphylaxis and atopic disorders, including asthma
  • Hypercalcaemia
  • Chemotherapy
  • Immunosuppression following transplantation

Common Features

System Effect
Resp ↑ Bronchial smooth muscle response to circulating catecholamines, ↓ airway oedema
CVS ↑ Inotropy, ↑ vascular smooth muscle response to circulating catecholamines (↑ receptor expression), ↑ BP secondary to mineralocorticoid effects
CNS Mood changes, sleep disturbance, psychosis
MSK Atrophy, thinning of skin
Renal Glycosuria, Na+ and fluid retention (mineralocorticoid effect), hypokalaemia
GIT Gastric ulceration
Metabolic ↑ Gluconeogenesis, diabetes, ↑ protein catabolism, fat redistribution, adrenal suppression (negative feedback on ACTH), ↑ lipolytic response to circulating catecholamines
Immune ↓ Transudate production, ↓ production of inflammatory mediators, ↓ macrophage function, ↓ transport of lymphocytes, ↓ T-cell function, ↓ antibody production, ↑ susceptibility to infection,
Toxic Effects Relative steroid deficiency in adrenal suppressed individuals with infection or surgery

Comparison of Corticosteroids

Property Hydrocortisone Prednisolone Methylprednisolone Dexamethasone
Route of Administration IV/PO PO PO/IV/IM IV
Relative Dose Equivalents 100mg 25mg 20mg 4mg
Absorption 50% PO bioavailability 100% PO bioavailability 60% PO bioavailability
Distribution Variable protein binding depending on concentration, VD 0.5 Variable protein binding depending on concentration, VD 0.5 VD 1
Metabolism Hepatic Hepatic Hepatic Hepatic
Elimination Elimination t0.5 is 2 hours Elimination t0.5 is 3 hours Elimination t0.5 is 3 hours Elimination t0.5 is 4 hours
Relative mineralocorticoid effect +++ ++ + +


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  2. Smith S, Scarth E, Sasada M. Drugs in Anaesthesia and Intensive Care. 4th Ed. Oxford University Press. 2011.
  3. Nieman LK, Lacroix A, Martin KA. Pharmacologic use of glucocorticoids. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA, 2017.
  4. Petkov V. Essential Pharmacology For The ANZCA Primary Examination. Vesselin Petkov. 2012.
Last updated 2019-07-18

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