Should corticotropin stimulation testing guide steroid therapy in septic shock?
• Peter C. Minneci, MD • Katherine J. Deans, Steven M. Banks, Peter Q. Eichacker, and Charles Natanson Critical Care Medicine Department, National Institutes of Health Letter to the Editor The accompanying editorial to our meta-analysis examining the clinical trials of low dose steroid therapy in sepsis raises concerns about our recommendation to administer low dose glucocorticoids to all patients with vasopressor-dependent septic shock. (1, 2) In Dr. Luce’s commentary, he concludes that the results of the clinical sepsis trials of low dose steroids only support administering steroids to patients with “proven adrenal insufficiency”. (1) As cited by Dr. Luce, a recent report by Hamrahian and colleagues demonstrated that in critically ill patients, variations in total serum cortisol measurements may be explained by differences in the concentration of serum binding proteins, and only free serum cortisol measurements accurately reflect adrenal function in these patients. (3) In light of th
