Hydrocortisone and Mineralocorticoid activity

Q: What is the ratio of Mineralocorticoid: Glucocorticoid activity in hydrocortisone? - select one

A) 1:1

B) 1:2

C) 1:3

D) 1:4

Answer: A

Hydrocortisone continues to be the favored drug in ICUs for stress dose steroids in sepsis and other clinical situations where adrenal insufficiency is suspected. This is due to a 1:1 ratio of mineralocorticoid: glucocorticoid activity.

Dexamethasone has the least, rather negligible, mineralocorticoid activity.

#pharmacology

#endocrinology

References:

1. Ekman B, Quinkler M, Zhang P, Isidori AM, Murray RD, Wahlberg J; EU-AIR investigators. Mineralocorticoid effects of fludrocortisone and hydrocortisone in primary adrenal insufficiency: EU-AIR patient data. J Endocrinol Invest. 2025 Oct;48(10):2381-2392. doi: 10.1007/s40618-025-02657-7. Epub 2025 Sep 6. PMID: 40913682; PMCID: PMC12518465.

2. Venkatesh B, Cohen J. Hydrocortisone in Vasodilatory Shock. Crit Care Clin. 2019 Apr;35(2):263-275. doi: 10.1016/j.ccc.2018.11.005. Epub 2019 Jan 28. PMID: 30784608.

3. Sattar NA, Gaw A. Mineralocorticoid effects of high dose hydrocortisone. BMJ. 1995 Jul 22;311(6999):260. doi: 10.1136/bmj.311.6999.260b. PMID: 7627063; PMCID: PMC2550311.