Special commentaryRelative adrenal insufficiencyLoriaux, Donald L; Fleseriu, MariaAuthor Information Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA Correspondence to Donald L. Loriaux, MD, PhD, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA Tel: +1 503 494 8459; fax: +1 503 494 6990; e-mail: firstname.lastname@example.org Current Opinion in Endocrinology, Diabetes and Obesity: October 2009 - Volume 16 - Issue 5 - p 392-400 doi: 10.1097/MED.0b013e3283307d53 Buy Metrics Abstract Purpose of review This article will review the clinical presentation, diagnosis, and treatment of acute adrenal insufficiency and explore the concept of ‘relative adrenal insufficiency’ in the critically ill. Recent findings Current dogma suggests that as many as 70% of patients in intensive care units with the clinical syndromes of sepsis or cardiogenic shock have ‘relative adrenal insufficiency’. This article will explore how this concept came into being and why the concept has no clinical utility. Summary This article will provide an approach to critically ill patients that will identify adrenal insufficiency when it is part of the pathophysiology of a given patient and, at the same time, prevent the unnecessary treatment of critically ill patients with high doses of glucocorticoids for ‘stress’ when adrenal insufficiency is not a factor in the illness. © 2009 Lippincott Williams & Wilkins, Inc.