Randomized trial of oral hydrocortisone and its effect on emergency physicians during night duty

To analyze the effects of hydrocortisone (40 mg. p.o.) administered to emergency physicians on their first night shift following a series of day shifts.

Prospective, double-blinded internal crossover study on objective and subjective parameters. Each participant was studied for a minimum of 10 nights.

Four healthy male emergency physicians in their mid to late thirties.

After baseline endocrine assessment, the subjects ingested a capsule containing either 40 mg of hydrocortisone or placebo (lactose) at the start of a first nightshift (starting at 10 pm or 11 pm) after day duty. Subjects self-administered psychological testing one hour after taking an oral capsule by listening to a self-guided audio tape (between 11 and 12 p.m), and again between 4 and 5 am. Blood samples were obtained during the first 4 nights of each subject at 11 pm, 2, 5 and 8 am.

Four emergency physicians entered 42 nights of data. No differences in testing were detected. Plasma cortisol levels were measured and demonstrated cortisol levels consistent with oral replacement therapy. Physicians could subjectively differentiate the difference between hydrocortisone treatment and placebo: of 21 hydrocortisone nights, 17 were identified as "a good night" in reference to fatigue. Of 21 nights without hydrocortisone, 15 were identified as "bad" nights, (p < .001).

Hydrocortisone, administered before a nightshift to day-accommodated workers, recreated the rise of plasma cortisol seen on awakening and was shown to be an effective means of decreasing subjective fatigue of a first nightshift.