What are the guidelines on the workup and treatment for critical illness–related corticosteroid insufficiency (CIRCI)?

Updated: Oct 11, 2018
  • Author: Kevin M Klauer, DO, EJD, FACEP; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

The task force was unable to reach agreement on a single test that can reliably diagnose CIRCI, although delta cortisol (change in baseline cortisol of 10 μg/dL may be used by clinicians. The guidelines also state the following [16] :

  • Suggest against using plasma-free cortisol or salivary cortisol level over plasma total cortisol
  • For treatment of specific conditions, suggest using IV hydrocortisone
  • Suggest not using corticosteroids in adult patients with sepsis without shock
  • Suggest the use of IV methylprednisolone 1 mg/kg/day in patients with early moderate to severe acute respiratory distress syndrome (PaO 2/FiO 2<200 and within 14 days of onset)
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