Interest in the role of the adrenal cortex in the recovery from an infection dates back nearly 100 yr. More than six decades of research on the role of corticosteroid supplementation as an adjunctive treatment for sepsis and septic shock failed to reveal conclusive results.

Recently two large-scale randomized controlled trials have added substantial new data to inform opinion regarding the role of corticosteroids in the treatment of septic shock.

In this article, we review the background, the current state of the evidence, and ongoing areas of uncertainty in this field and provide suggestions for clinical practice.

The new evidence provided by ADRENAL and APROCCHSS has given greater certainty to clinicians considering the use of corticosteroid treatment in patients with septic shock.

The results from the two recent randomized controlled trials are likely to reinforce the role of adjunctive corticosteroids and change the recommendation in future clinical practice guidelines.

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