Intended for healthcare professionals


Glucocorticoid replacement

BMJ 2014; 349 doi: (Published 30 July 2014) Cite this as: BMJ 2014;349:g4843
  1. Anjali Amin, clinical research fellow,
  2. Amir H Sam, senior lecturer in endocrinology,
  3. Karim Meeran, professor of endocrinology
  1. 1Imperial Centre for Endocrinology, Imperial College London, UK
  1. Correspondence to: K Meeran, Endocrinology Department, Charing Cross Hospital, London W6 6RF, UK k.meeran{at}

Pending further studies of new agents, the old treatments are still the best

Steroids are among the most commonly prescribed drugs. Synthetic glucocorticoids such as prednisolone and dexamethasone are commonly used as anti-inflammatory or immunosuppressive agents in supra-physiological doses and have longer half lives than the naturally occurring hydrocortisone.

Patients with primary adrenal insufficiency require replacement of both mineralocorticoid, in the form of fludrocortisone, and glucocorticoid. All healthcare professionals should know how to manage patients with hypocortisolaemia, some of whom will be at risk of life threatening adrenal crises.1

In the United Kingdom, hydrocortisone is the most commonly prescribed glucocorticoid for replacement therapy in both primary and secondary hypocortisolaemia. Other glucocorticoids are more often used for other conditions. Dexamethasone is the most potent and is mainly used in intracranial and oncological conditions. Prednisolone is the standard treatment for most inflammatory conditions. Prednisone is also available as a delayed release preparation and is converted to active prednisolone by first pass metabolism in the liver.

In healthy humans, cortisol is secreted …

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