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Glucocorticoid therapy in septic shock

David A Kaufman, MD
Jordi Mancebo, MD
Section Editor
Polly E Parsons, MD
Deputy Editor
Geraldine Finlay, MD


Interest in the role of glucocorticoids in the pathophysiology of critical illness has existed since the early part of the 20th century, when investigators observed that the adrenal glands are crucial to survival under conditions of physiologic stress [1,2]. The subsequent development of cortisone for clinical use was followed by clinical studies exploring the potential therapeutic role of corticosteroids in the treatment of severe infections [3-7].

The following issues are discussed in this topic review:

Effects of critical illness on the hypothalamic-pituitary-adrenal axis. (See 'Effects of critical illness' below.)

Methods of evaluating adrenal reserve (random cortisol levels, synthetic adrenocorticotropic hormone [ACTH] stimulation tests, free cortisol levels) and the impact of each on prognosis. (See 'Assessing adrenal reserve' below.)

The concept of relative adrenal insufficiency. (See 'Relative adrenal insufficiency' below.)

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Literature review current through: Nov 2017. | This topic last updated: Oct 18, 2016.
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