The ADRENAL trial evaluated whether hydrocortisone could reduce mortality in adults with septic shock who were receiving mechanical ventilation. Nearly 3,800 patients were randomised to continuous hydrocortisone or placebo, with treatment continued for up to seven days or until ICU discharge. The trial found no significant difference in 90-day mortality between the two groups. Despite the absence of a mortality benefit, hydrocortisone accelerated resolution of shock and reduced the duration of mechanical ventilation and ICU stay in several analyses. These findings are clinically relevant because corticosteroid therapy in septic shock is often judged on more than survival alone. Faster haemodynamic recovery may reduce dependence on vasopressors and support earlier liberation from life support, but treatment also carries potential harms such as hyperglycaemia and neuromuscular complications. ADRENAL therefore supports a nuanced approach: corticosteroids can change the trajectory of shock even when they do not demonstrably change long-term survival. The trial is also useful when interpreting apparently conflicting corticosteroid evidence, because different dosing regimens and combinations can produce different results. For bedside decision-making, the key is to use steroids selectively in patients with ongoing vasopressor-dependent shock rather than viewing them as a universal mortality-reducing intervention.