Adrenal Insufficiency in Septic Shock

Inclusion Criteria: * Patients who are 18 years of age or older * Patients who sign informed consent or are represented by a legally authorized representative to provide consent on behalf of the patient * Patients with septic shock meeting the ACCM/SCCM consensus conference definitions for septic shock Exclusion Criteria: * Patients with documented allergic or anaphylactic reactions to corticosteroids * Patients who have received steroid therapy within 6 months of presentation * Patients who have received steroids during their hospital admission, with the exception of a single dose of dexamethasone * Patients who have received etomidate in the preceding 12 hours * Patients who have had a prior adrenalectomy or a known history of adrenal disease (documented adrenal insufficiency or Cushing syndrome). * Documented Human Immunodeficiency Virus (HIV) infection * Pregnancy * Allergies to adrenocorticotropic hormone (ACTH) or corticosteroids * Administration of additional medications which may suppress the hypothalamic-pituitary axis: * Ketoconazole * Aminoglutethimide * Mitotane * Megestrol acetate * Suramin