A potential diagnostic protocol for critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients

Critical illness-related corticosteroid insufficiency (CIRCI) is described as impairment of the hypothalamic-pituitary-adrenal axis during critical illness. As a functional and likely transient deficiency acquired during critical illness, CIRCI refers to an insufficiently activated corticosteroid relative to the degree of stress. The 2008 guidelines recommend adrenocorticotropic hormone stimulation test or a random plasma cortisol could establish the diagnosis of CIRCI, but the most recent 2017 guidelines make no recommendation regarding which one is better for the diagnosis of CIRCI. Thus, certain supplements are needed. Herein, we attempted to provide our own opinions and introduce a potential protocol that might be helpful to improve the diagnosis of CIRCI.