No blood testing in relative adrenal insufficiency: just treat!

In their recent article, Djillali Annane and colleagues report that 83.5% of the septic patients they studied with the cosyntropin and metyrapone stimulation tests have primary or secondary adrenal insufficiency (respectively, 12.5 and 71%) (1). In their editorial in the same issue, Nuala J. Meyer and Jesse B. Hall conclude that we now have been provided with an elegant algorithm for the diagnosis of (relative) adrenal insufficiency in severe sepsis and septic shock (2). Given the fact that more than 80% of the septic patients studied appear to have (relative) adrenal insufficiency and that low-dose steroids have beneficial effects on hemodynamics and few side effects, we think it is even easier to skip these stimulation tests and just start low-dose steroid treatment (3–5)!