Wiener medizinische Wochenschrift
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Adequate adrenocortical function is essential to survive critical illness. Most critically ill patients display an elevated plasma Cortisol level, reflecting activation of the pituitary-adrenal axis, which is considered to be a homeostatic adaptation. In the setting of critical illness, the failure of an appropriate neuroendocrine response can lead to the picture of vasopressor-dependent refractory hypotension. ⋯ Several controlled studies have shown that stress doses of hydrocortisone given in patients with septic shock reduce the time to shock reversal and decrease mortality. A multicenter large-scale trial (CORTICUS) is on the way investigating the benefit of stress doses of hydrocortisone on the mortality of septic shock. In this review glucocorticoid physiology and regulation during septic shock and the effects of hydrocortison administration in the course of septic shock are being discussed.