Hypocortisolaemia and adrenocortical responsiveness at onset of septic shock

Intensive Care Med. 1994 Aug;20(7):489-95. doi: 10.1007/BF01711901.


Objective: To characterise the plasma cortisol profile and adreno-cortial responsiveness (short Synacthen test) of patients in septic shock.

Design: Retrospective assessment using case-notes and ICU charts.

Setting: University teaching hospital ICU.

Patients: 68 septic shock patients with plasma cortisol and/or short Synacthen test measured at ICU-admission or onset of shock post ICU-admission. Patients were identified from a total population of 155 patients who had PCL and/or SST measured over a 4.5 year period.

Intervention: None.

Measurements and results: Patients with septic shock had a plasma cortisol ranging from 210-8900 nmol/l and mortality of 56%. There were 22 (32%) below (low) and 46 (68%) above (high) a 'critical' plasma cortisol of 500 nmol/l. Using stepwise logistic regression, mortality was adequately predicted by and increased with, increasing plasma cortisol and onset of shock remote from ICU-admission. Short Synacthen tests were available in 33 patients: 11 responders (cortisol increment > 200 nmol/l above baseline 30 min after 0.25 mg intravenous Synacthen) and 22 hypo-responders. Mortality in patients was adequately predicted by and increased with a decrease in cortisol increment post-Synacthen. Thirteen patients (plasma cortisol 606 +/- [SD] 297 nmol/l) had complete haemodynamic profiles before inotropic therapy; no relationship was demonstrated between plasma cortisol and circulatory variables. Follow-up revealed no cases of Addison's disease.

Conclusions: In septic shock, 'hypocortisolaemia' is not uncommon and does not predict a high mortality; adrenocortical hypo-responsiveness may be associated with poor outcome.

MeSH terms

  • Adrenal Cortex / metabolism
  • Adrenocorticotropic Hormone
  • Aged
  • Blood Chemical Analysis
  • Female
  • Hemodynamics
  • Humans
  • Hydrocortisone / blood*
  • Hydrocortisone / metabolism
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Reference Values
  • Retrospective Studies
  • Shock, Septic / blood*
  • Shock, Septic / mortality


  • Adrenocorticotropic Hormone
  • Hydrocortisone