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Relative AI in Sepsis — RACP Adult Medicine MCQ

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ModerateEndocrinologyRelative AI in SepsisRACP Adult Medicine

A 60-year-old man on prednisolone 20 mg daily for polymyalgia rheumatica for 2 years is admitted with septic shock from community-acquired pneumonia. He receives IV antibiotics and fluid resuscitation but remains hypotensive despite vasopressors. His random cortisol is 250 nmol/L (inadequate stress response). What should be administered immediately?

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Correct answer: C — IV hydrocortisone 100 mg stat then 50 mg q6-8h + IV normal saline

Relative adrenal insufficiency in critical illness (inadequate cortisol response to stress in a patient with chronic exogenous steroid use) presenting as vasopressor-refractory septic shock requires IV stress-dose hydrocortisone (100 mg stat then 50 mg q6-8h). This is separate from the SSC recommendation for hydrocortisone in refractory septic shock (ADRENAL/APROCCHSS trials). In steroid-dependent patients, the physiological stress response is suppressed by chronic HPA axis suppression.

Reference: Endocrine Society – 2016 – AI; Surviving Sepsis 2021