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Substances produced by the adrenal glands, and the drugs that are
synthesized as pharmaceuticals to mimic them, are corticosteroids.
Corticosteroids produced in the body fall into two categories:
glucocorticoids, such as cortisol, the body's natural glucocorticoid, and
mineralocorticoids, such as aldosterone.
These are the commonly used glucocorticoids:
Hydrocortisone (HC) and Cortisone
• Bioidentical
• Short acting
• Best to mimic the natural diurnal curve of cortisol
• Less effective for inflammation
Prednisone and Prednisolone
• Intermediate acting*
• Four times the strength of HC (1 mg = 4 mg HC)
• More effective for inflammation than HC
• Less mineralocorticoid effect
Methylprednisolone (brand name Medrol®)
• Intermediate acting*
• Five times the strength of HC (1 mg = 5 mg HC)
• May limit fluid retention in some individuals
• Potent, long acting
• 26.6 times more potent than HC
• 6.7 times more potent than prednisone
There is a tremendous amount of concern about taking glucocorticoids.
This has arisen from the unpleasant and dangerous side effects
caused by long-term, large pharmacologic doses of synthetic
glucocorticoids used for many inflammatory, autoimmune and allergic
Pharmacologic doses of glucocorticoids are not used for adrenal
fatigue. Adrenal fatigue that requires glucocorticoids is addressed with
physiologic replacement doses which mimic a healthy body's own
production of cortisol.
*Intermediate-acting glucocorticoids are slower absorbed and slower released
than HC, and so do not need to be dosed as often. However, most people
benefit from multi-dosing them.