Critical Illness Related Corticosteroid Insufficiency (CIRCI)

Abstract

Critical illness-related corticosteroid insufficiency (CIRCI) is a relative adrenal insufficiency in critically ill patients characterized by dysregulated systemic inflammation resulting in inadequate glucocorticoid activity for the severity of the patient’s illness (Annane et al., Crit Care Med. 45:2078–88, 2017). CIRCI may be secondary to dysregulation of the hypothalamic pituitary adrenal axis (HPA) and/or tissue resistance to glucocorticoids. CIRCI is associated with a broad spectrum of critical illness such as septic shock, community acquired pneumonia (CAP), cardiopulmonary bypass surgery, cardiac arrest, and trauma. CIRCI should be suspected when patients with such illnesses have refractory hypotension that fails to respond to conventional therapies. Patients with CIRCI may benefit from corticosteroids, but the evidence is conflicting, and routine cortisol measurement or ACTH stimulation testing in patients admitted to the intensive care unit is not recommended.