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Objective To observe the effect of low-dose corticosteroid treatments with different courses on surgical postoperative patients with septic shock, and investigate the withdrawal time. Methods 89 patients diagnosed with septic shock in ICU from Oct 2010 to Feb 2013 were enrolled in this study. Patients were divided into groups A, B and C (control group) randomly. All patients were received ACTH stimulation tests within 2 hours after admitting in ICU, and then group A was treated with hydrocortisone 50 mg Q6 h for 7 days, group B was treated with hydrocortisone 50 mg Q6 h for 5 days, and the control group was treated with saline. The adrenocorticotropic hormone (ACTH), cortisol (Cort) and interleukin-6 (lL-6) levels in serum were measured and compared before and after treatment. The incidence of relative adrenal insufficiency (RAl) in surgical postoperative patients with septic shock and the treatment effects of different courses were observed. Results The incidence of RAI in surgical postoperative patients with septic shock was 61.80%. Compared with control group, the mortalities of groups A and B had no differences in day-7 and day-28 (P > 0.05), while shock reverse times shorted (P< 0.05). There were no differences of complications among the three groups. Before treatment, the IL-6 level in RAI patients was significantly higher than that in non-RAI patients (< 0.01). The IL-6 level in serum of death patients was higher than that of survival patients in groups A and B after treatment (< 0.05). The effect of corticosteroid treatment was not related to ACTH stimulation test. Conclusion The incidence of RAI in patients with postoperative septic shock is high. The low-dose corticosteroid (hydrocortisone 200 mg/d, 5 d or 7 d) therapy can shorten shock-reverse-time in patients with septic shock. Continuously monitor for IL-6 levels in serum can be used as a marker to guide the corticosteroid therapy. [ABSTRACT FROM AUTHOR]