A 72-year-old man on ICU is being weaned from noradrenaline following septic shock. Current dose is 0.06 mcg/kg/min with MAP 68 mmHg. The morning cort...

Question

A 72-year-old man on ICU is being weaned from noradrenaline following septic shock. Current dose is 0.06 mcg/kg/min with MAP 68 mmHg. The morning cortisol is 350 nmol/L and the Synacthen test shows a peak cortisol of 480 nmol/L (adequate response >500 nmol/L). He is not on any exogenous steroids. What does this suggest?

Accepted Answer

Critical illness-related corticosteroid insufficiency (CIRCI) - consider stress-dose hydrocortisone if vasopressor-dependent

Answer

Normal adrenal function - no intervention needed

Answer

Primary adrenal failure (Addison's disease) - commence lifelong replacement

Answer

The Synacthen test is unreliable in ICU patients

Answer

Adrenal adenoma - investigate with CT abdomen

uk-fficm MCQ (SBA): Critical Illness-Related Corticosteroid Insufficiency