Hormonal therapies in septic shock

Endocrine dysfunction is common in severe sepsis and is associated with increased morbidity and mortality risk. Clinical detection of this heterogenous disorder is limited, and the accuracy of laboratory diagnosis is complicated by the limitations in hormonal assays and the variable definitions used in its diagnosis. This article reviews the common hormone therapies that have been evaluated in the critically ill patient with sepsis, namely corticosteroids, vasopressin and insulin. There are numerous adult clinical trials in this area, some of which have revealed conflicting results. Pediatric data is much more limited. We present current recommendations for hormone therapy in adults and children, but caution that further study is needed to better understand the dynamic and complex endocrine responses during septic shock, and to develop improved methods for diagnosis and monitoring of patient response, so that we can determine not only which therapies to use, but how, in what combinations, and in which patients.