Endocrine Drugs




The use of steroids in the critically ill has been the subject of much debate and some research.

Steroids should not be prescribed by registrars, except for those indications listed below as proven, unless this has first been discussed with the duty intensive care specialist.

Proven Indications:

  • Hypoadrenalism (Addison's disease or crisis)
  • Acute severe asthma
  • Panhypopituitarism
  • Haemophilus meningitis in children (discuss with paediatric team first)
  • Pneumocystis Carinii pneumonia (paO2 < 60 mmHg)
  • Collagen vascular diseases
  • Active Immunosuppression (GVHD, solid organ transplant)
  • Myasthenia gravis


Unproven Intensive Care Unit Indications

  • Non-infected (fibroproliferative) ARDS: Meduri protocol = Methylprednisolone 2 mg/kg for 14 days, tapered 1.0-0.5 mg/kg for next 14 days
  • Shock associated with vasodilated states which are refractory to high dose, or prolonged administration of, inotropes
  • Myocarditis
  • Exacerbation of chronic airway obstruction
  • Bronchiolitis obilterans
  • Reduction of cerebral oedema around traumatic CNS lesions
  • Anaphylaxis


Conditions where Steroids are not Indicated or Actively Contra-Indicated

  • Active infection
  • Acute head injury
  • Guillain-Barre syndrome


Relative Steroid Potencies

SteroidEquivalence (mg)Glucocorticoid ActivityMineralocorticoid Activity
Hydrocortisone100 mg11


Apache II Co-morbidity – 15mg/kg/day of Methylprednisolone for 70kg  1gm = 5,000mg hydrocortisone

Page last reviewed: 13 May 2014