Which condition would prevent a patient from starting hydrocortisone therapy?

Hydrocortisone therapy is a corticosteroid used to treat various conditions by reducing inflammation and suppressing the immune response. However, its use can be contraindicated in certain situations, most notably in the case of sepsis.

When a patient is in a state of sepsis, their body is already experiencing a critical and widespread inflammatory response to an infection, which can lead to organ dysfunction. Administering corticosteroids like hydrocortisone in this scenario can further suppress immune function, potentially worsening the infection and the patient's overall clinical condition. The use of corticosteroids in septic patients is controversial and typically reserved for specific circumstances under close medical supervision, particularly when there's an adrenal insufficiency present or if the septic shock is refractory to other treatment measures. Hence, in patients with sepsis, starting hydrocortisone therapy without thorough consideration and monitoring can aggravate the patient's condition.

In contrast, patients with neuromuscular diseases, asthma, or chronic obstructive pulmonary disease (COPD) may require corticosteroid therapy to manage inflammation effectively and alleviate symptoms associated with their conditions. In these cases, the benefits of hydrocortisone can outweigh the risks, making its use appropriate under the right circumstances.