Aneja and Carcillo’s review of adrenal insufficiency and the rationale for steroid use in sepsis is both concise and timely.¹ Although they acknowledge that further studies are needed in paediatrics before recommending a 7 day course of hydrocortisone in catecholamine resistant septic shock, they suggest that the logic for this therapy is “compelling”, recommending a bolus of hydrocortisone followed by an infusion of up to 50 mg/kg/day in states of sepsis-induced relative adrenal insufficiency.

This compelling logic is incorporated within their statement that, among children with septic shock, survivors exhibit dramatically increased plasma levels of cortisol compared to non-survivors (Aneja and Carcillo, …