ICU · Endocrine

Critical illness-related corticosteroid insufficiency (CIRCI)

Also known as CIRCI · Critical illness corticosteroid insufficiency · Relative adrenal insufficiency · Septic shock corticosteroids · Corticotropin stimulation test

Critical illness-related corticosteroid insufficiency (CIRCI): inadequate corticosteroid activity for the severity of illness during critical illness. NOT classic adrenal insufficiency (absolute deficiency). In septic shock: inflammatory cytokines suppress HPA axis → reduced cortisol production relative to demand. Diagnosis controversial: random cortisol <276 nmol/L OR cortisol rise <250 nmol/L after 250 mcg ACTH (cosyntropin) stimulation. Treatment: hydrocortisone 200 mg/day (CONTINUOUS infusion or 50 mg IV QDS) for SEPTIC SHOCK not responding to adequate fluid + vasopressor. ADRENAL/CORTICUS trials: hydrocortisone did NOT improve overall survival, but may benefit shock reversal and subgroup (rapid ACTH non-responders). STOP when vasopressors weaned.