Adrenal insufficiency during septic shock*

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Abstract
Objective To determine whether a baseline (random) cortisol concentration p < .0001). Ninety-five percent of steroid-responsive patients had a baseline cortisol concentration <25 μg/dL. Fifty-four percent of steroid responders had a diagnostic low-dose test and 22% a diagnostic high-dose test. Receiver operating characteristic curve analysis revealed that a stress cortisol concentration of 23.7 μg/dL was the most accurate diagnostic threshold for determination of the hemodynamic response to glucocorticoid therapy. Conclusions Adrenal insufficiency is common in patients with septic shock, the incidence depending largely on the diagnostic test and criteria used to make the diagnosis. There is clearly no absolute serum cortisol concentration that distinguishes an adequate from an insufficient adrenal response. However, we believe that a random cortisol concentration of <25 μg/dL in a highly stressed patient is a useful diagnostic threshold for the diagnosis of adrenal insufficiency.