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Relative adrenal insufficiency

Purpose of reviewThis article will review the clinical presentation, diagnosis, and treatment of acute adrenal insufficiency and explore the concept of ‘relative adrenal insufficiency’ in the critically ill. Recent findingsCurrent dogma suggests that as many as 70% of patients in intensive care units with the clinical syndromes of sepsis or cardiogenic shock have ‘relative adrenal insufficiency’. This article will explore how this concept came into being and why the concept has no clinical utility. SummaryThis article will provide an approach to critically ill patients that will identify adrenal insufficiency when it is part of the pathophysiology of a given patient and, at the same time, prevent the unnecessary treatment of critically ill patients with high doses of glucocorticoids for ‘stress’ when adrenal insufficiency is not a factor in the illness.