Critical Illness Related Corticosteroid Insufficiency (CIRCI)

  • Akhil Khosla
  • Amy M. AhasicEmail author


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.


Adrenal insufficiency Critical illness-related corticosteroid insufficiency (CIRCI) Relative adrenal insufficiency Steroid replacement ACTH stimulation testing, refractory shock 


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Section of Pulmonary, Critical Care and Sleep MedicineYale University School of MedicineNew HavenUSA
  2. 2.Section of Pulmonary, Critical Care and Sleep MedicineNorwalk Hospital, Nuvance HealthNorwalkUSA

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