Letter to Editorial
Mineralocorticoid effect of hydrocortisone – an important clinical problem

Adverse drugs reactions are a highly complex clinical problem. The International Conference on Harmonization Requirements for Registration of Pharmaceuticals for Human Use (ICH) defines an adverse drug reaction regarding marketed medical product as “a response to a drug, which is noxious and unintended and which occurs at doses normally used for prophylaxis, diagnosis, or therapy of disease or for modification of physiological function” [1]. Adverse drug reactions include, among others, expected adverse reactions dependent on the pharmacological properties of a medical product, such as toxic symptoms, side effects, secondary or indirect symptoms (directly dependent on drug, associated with a particular disease) and drug interactions [2]. In Poland, safety of pharmacotherapy is monitored by the Department of Monitoring Adverse Medicinal Products cooperating with the WHO. To register and harmonize adverse drug reactions, the European Academy of Allergology and Clinical Immunology Interest Group on Drug Hypersensitivity and the European Network of Drug Allergy have developed a questionnaire whose Polish version was elaborated by researchers from the Department of Dermatology, Poznan Medical University [1, 3].

Glucocorticoids, which have been used for many years in dermatology, are the mainstay therapy of a wide range of dermatoses, both with an acute and chronic course. The mechanism of action of these drugs is omnidirectional, and their main therapeutic effect is associated with inflammatory and immunosuppressive properties [4]. Glucocorticoids, as is well known, are not without side effects, the severity and type of which depend on the dose and duration of therapy.

In cases requiring an immediate therapeutic effect (during hospitalization) commonly used steroids are water-soluble hydrocortisone hemisuccinate (Hydrocortisonum hemisuccinatum) and one of the strongest glucocorticoids, dexamethasone (Dexamethasonum). Regarding their side effects, there is a close dependence on the chemical structure. In the case of dexamethasone the presence of fluorine in position 9 enhances its anti-inflammatory properties (as compared to hydrocortisone for more than 25 times), and the addition of a methyl group (at position 16) minimizes its impact on electrolytes. A well-known fact is that mineralocorticoid properties may be observed during long and high-dose administration [5].

The purpose of this report is to present the...


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