Corticosteroid Therapy in Severe Illness

Severe illnesses, trauma, anesthesia, and surgery are accompanied by activation of the hypothalamic–pituitary–adrenal axis, as demonstrated by increased serum corticotropin and cortisol concentrations.17 This activation is an essential component of the general adaptation to stress and contributes to the maintenance of homeostasis.8 The efficacy of replacement doses or high doses of corticosteroids in patients with severe illness, especially those with multiorgan-system diseases, is uncertain.912 The uncertainty is even greater in patients who are already taking corticosteroids. Standard therapy for the latter patients consists of the administration of high doses of corticosteroids during any severe illness and perioperatively. We . . .