background Sepsis is one of the serious complications during perioperative stage, which often occurred after severe trauma and heavy surgeries. It is a heavy public health problem all over the world, due to the mortality of sepsis and septic shock reaching up to 50%, and the high cost of treatment. Objective To compensate the impaired adrenal function more precisely, via supplementing right amount exogenous glucocorticoid timely, aiming to improve prognosis and reduce mortality. Content This article reviews the changes of the adrenal cortex function in sepsis patients, and the mechanism of sepsis with adrenal insufficiency Trend Considering that sepsis with adrenal insufficiency maybe results from a variety of mechanisms, so we need more in-depth researches the mechanisms to prevent its occurrence and improve the treatments, aiming to improve the prognosis and reduce mortality.