Management of Adrenal Insufficiency in Sepsis

Diagnosis and Treatment of Adrenal Insufficiency in Sepsis

The Society of Critical Care Medicine recommends administering intravenous hydrocortisone at a dose of 200 mg/day for 7 days, followed by a gradual reduction when vasopressors are no longer required to avoid secondary adrenal insufficiency in patients with septic shock who do not respond adequately to fluid resuscitation and vasopressors 1, 2, 3
The use of corticosteroids is not recommended for routine use in all sepsis patients, but should be considered only when adequate fluid resuscitation and vasopressor therapy fail to restore hemodynamic stability (grade 2C) 1, 2, 4
The American College of Critical Care Medicine suggests that hydrocortisone therapy should be considered only when hemodynamic stability is not achieved with fluid and vasopressor therapy, and the ACTH stimulation test is not necessary to identify patients who should receive hydrocortisone (grade 2B) 2, 4

The British Medical Journal recommends administering intravenous hydrocortisone at a dose of 200-300 mg/day, given in divided doses every 6 hours or as a continuous infusion 5, 6
The duration of treatment is typically 7-14 days, or less for those who improve rapidly 6, 7
The administration of hydrocortisone as a continuous infusion is recommended (grade 2D) 2, 3

The Society of Critical Care Medicine recommends gradually reducing hydrocortisone when vasopressors are no longer required (grade 2D) 2, 4
Abrupt cessation of corticosteroids can lead to recurrence of inflammation and signs of adrenal insufficiency 6, 8
Corticosteroid-induced adrenal suppression likely depends on the duration of treatment 7, 9

Patients should be monitored for signs of recurrent inflammation or shock 6, 8
In patients who deteriorate after stopping corticosteroids, consider restarting corticosteroid therapy 6, 7

The British Medical Journal recommends monitoring for hyperglycemia and treating as necessary 7, 8
Electrolyte disturbances, such as hypernatremia and hypokalemia, should be monitored 8, 9
Patients with prolonged treatment (>14 days) are at higher risk of adrenal suppression 7
Patients with recurrent sepsis episodes should be closely monitored during and after suspension 6