physiologic steroid
Short-acting corticosteroid with both glucocorticoid and mineralocorticoid activity (1:1 ratio). The drug of choice for acute Adrenal Insufficiency and coverage in Myxoedema Coma/Thyroid Storm.
- Mechanism: Agonist at glucocorticoid and mineralocorticoid receptors. Mimics endogenous cortisol.
- Dosing: - Adrenal Crisis / Stress Dose: 100 mg IV q8h (mimics max adrenal output). - Physiologic Replacement: 15–25 mg/day PO (divided 2/3 AM, 1/3 PM).
- PK: Half-life: 8–12 hours (biologic).
indications
- Primary Adrenal Insufficiency (Addison’s): Replacement therapy (often with fludrocortisone).
- Myxoedema Coma: Empiric coverage for co-existing adrenal failure.
- Thyroid Storm: Blocks T4 T3 conversion and treats relative adrenal insufficiency.
- Septic Shock: “Stress dose” (200mg/day) in refractory shock.
adverse effects
- Hyperglycemia, Hypertension, Fluid retention.
- Long-term: Cushingoid features, Osteoporosis, Immunosuppression.
related pages: Prednisone, Myxoedema Coma, Thyroid Storm