# Glucocorticoids

> Glucocorticoids for NEET-PG Pharmacology: potency and duration classes, equivalent doses, adverse effects, adrenal suppression and withdrawal.

- Canonical URL: https://prepelephant.com/topics/neet-pg/pharmacology/glucocorticoids-pharmacology
- Exam / course: NEET-PG · Subject: Pharmacology
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Glucocorticoids", PrepElephant, https://prepelephant.com/topics/neet-pg/pharmacology/glucocorticoids-pharmacology

## Direct answer

Glucocorticoids bind intracellular steroid receptors and suppress inflammatory and immune gene transcription, producing profound anti-inflammatory and immunosuppressive effects. They are grouped by duration — short-acting hydrocortisone, intermediate-acting prednisolone and methylprednisolone, and long-acting dexamethasone and betamethasone — with dexamethasone having about 25 to 30 times the anti-inflammatory potency of hydrocortisone and negligible mineralocorticoid activity. Therapeutic power comes with a predictable adverse-effect profile (hyperglycaemia, osteoporosis, infection, myopathy, cataract) and suppression of the hypothalamo-pituitary-adrenal axis, so therapy beyond about three weeks must be tapered rather than stopped abruptly.

## What you must remember

- **Equivalent doses:** hydrocortisone 20 mg equals prednisolone 5 mg, methylprednisolone 4 mg and dexamethasone 0.75 mg — exam-standard conversions for switching therapy.
- **Duration and use:** short-acting hydrocortisone for adrenal replacement and adrenal crisis (100 mg intravenous bolus); intermediate prednisolone for most inflammatory disease, often alternate-day to spare the axis; long-acting dexamethasone for cerebral oedema, meningitis and severe COVID-19 hypoxaemia (6 mg daily in the RECOVERY trial).
- **Placental crossing:** dexamethasone and betamethasone cross the placenta — two 12 mg intramuscular doses 24 hours apart for fetal lung maturity in threatened preterm birth; prednisolone is largely inactivated by placental enzymes and is preferred for maternal disease.
- **Adverse effects:** hyperglycaemia and unmasking of diabetes, osteoporosis, peptic ulceration (especially with NSAIDs), infection and tuberculosis reactivation, proximal myopathy, posterior subcapsular cataract, growth suppression in children, hypertension, skin fragility and neuropsychiatric changes.
- **Osteoporosis prophylaxis:** calcium and vitamin D for all; bisphosphonate when prednisolone 7.5 mg or more daily is expected for three months or longer.
- **Adrenal suppression:** therapy beyond three weeks suppresses the HPA axis — withdraw gradually, and double the dose during physiological stress such as fever or surgery to avert an Addisonian crisis.
- **Mineralocorticoid note:** fludrocortisone is the mineralocorticoid used for replacement in primary adrenal insufficiency and orthostatic hypotension; hydrocortisone has mild salt-retaining activity that dexamethasone lacks.

## Common confusion

Dexamethasone versus prednisolone is the recurring puzzle: dexamethasone is long-acting, mineralocorticoid-free and crosses the placenta and blood-brain barrier, which suits cerebral oedema, raised intracranial pressure and fetal lung maturation; prednisolone is intermediate, safer in pregnancy for the mother, and the workhorse for nephrotic syndrome, rheumatological and pulmonary disease. The second classic error is abrupt cessation after prolonged therapy.

## Exam-focused takeaway

NEET-PG stem patterns include the cushingoid patient on long-term steroids asked about complications, dose-equivalence arithmetic, steroid choice in pregnancy (prednisolone for mother, dexamethasone for fetus), prophylaxis against steroid osteoporosis, and the cortisol or dexamethasone suppression logic in Cushing syndrome work-ups. Vignettes also test stress-dose steroid cover for surgery and the caution against live vaccines during immunosuppressive doses. Anchoring potency, duration and mineralocorticoid activity for each molecule resolves nearly every question.

## Frequently asked questions

### What are the dose equivalents among common steroids?

Hydrocortisone 20 mg, prednisolone 5 mg, methylprednisolone 4 mg and dexamethasone 0.75 mg are equipotent anti-inflammatory doses.

### Why is dexamethasone preferred in cerebral oedema?

It is long-acting, has no salt retention, and penetrates the central nervous system well; it reduces vasogenic oedema around tumours and in infections such as tuberculous meningitis.

### Why must long-term steroids be tapered?

Beyond about three weeks the hypothalamo-pituitary-adrenal axis is suppressed, and abrupt withdrawal risks acute adrenal insufficiency with hypotension and shock.

### Which steroids are used for fetal lung maturity?

Intramuscular dexamethasone or betamethasone, 12 mg twice 24 hours apart, because they cross the placenta; prednisolone is largely inactivated by placental enzymes.

### How is steroid-induced osteoporosis prevented?

Calcium and vitamin D supplementation for all, with a bisphosphonate added when 7.5 mg or more prednisolone daily is anticipated for at least three months.