Catecholamine dependency in a polytrauma patient: relative adrenal insufficiency?

A 65-year-old polytrauma patient was admitted post-operatively to the inten sive care unit. His situation deteriorated with hemodynamic instability and continuous high fever. An infectious focus could not be found and repeated cultures remained negative.: Empirical administration of antibiotics and c hanging of lines did not have any effect on the clinical picture. It was im possible to lower the dose of catecholamines because of repeated occurrence of hypotension, despite optimal hydration state and filling pressures. On the 15th day of admission intravenous hydrocortisone was started on suspici on of relative adrenal insufficiency, This action resulted in rapid hemodyn amic recovery, disappearance of fever and enabled rapid tapering of the dos e of noradrenaline, Incidence of relative adrenal insufficiency and diagnos tic strategies are discussed in the population of critically intensive care patients.