Adrenal Insufficiency in Septic Shock

Inclusion Criteria:

• Patients who are 18 years of age or older
• Patients who sign informed consent or are represented by a legally authorized representative to provide consent on behalf of the patient
• Patients with septic shock meeting the ACCM/SCCM consensus conference definitions for septic shock

Exclusion Criteria:

• Patients with documented allergic or anaphylactic reactions to corticosteroids
• Patients who have received steroid therapy within 6 months of presentation
• Patients who have received steroids during their hospital admission, with the exception of a single dose of dexamethasone
• Patients who have received etomidate in the preceding 12 hours
• Patients who have had a prior adrenalectomy or a known history of adrenal disease (documented adrenal insufficiency or Cushing syndrome).
• Documented Human Immunodeficiency Virus (HIV) infection
• Pregnancy
• Allergies to adrenocorticotropic hormone (ACTH) or corticosteroids

• Administration of additional medications which may suppress the hypothalamic-pituitary axis:

  • Ketoconazole
  • Aminoglutethimide
  • Mitotane
  • Megestrol acetate
  • Suramin