Supplemental glucocorticoid therapy is a topic widely debated in the medical field. Patients present with various signs, symptoms and etiologies making diagnosis of the condition elusive. There is wide inter-patient variability in cortisol response during stress so defining normal response concentrations of cortisol is difficult. Deficiency of cortisol in acutely ill patients increases the potential of morbidity and mortality. Despite the conflicting evidence, if cortisol deficiency is identified, supplemental treatment with glucocorticoids is advocated. One aspect agreed on by all is the need for continued investigations in the requirement of supplemental glucocorticoids.