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SSC Hydrocortisone Clinical Not Cortisol — FRCA Final MCQ

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ModerateIntensive Care MedicineSSC Hydrocortisone Clinical Not CortisolFRCA Final

A 72-year-old man in ICU with community-acquired pneumonia and septic shock is on noradrenaline. His cortisol is checked. A random cortisol of 250 nmol/L is obtained. According to SSC 2021, should stress-dose hydrocortisone be given?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Only if cortisol is <100 nmol/L

SSC 2021 recommends hydrocortisone 200 mg/day for adults with septic shock requiring ongoing vasopressor therapy to maintain MAP ≥65 mmHg. The decision is based on CLINICAL criteria (vasopressor dependence), NOT cortisol levels or Synacthen test results. Random cortisol levels are unreliable in critical illness (altered protein binding, circadian rhythm disruption) and should NOT be used to guide treatment decisions.

Reference: SSC – 2021 – Sepsis guidelines; Sprung CL – 2008 – CORTICUS trial