Patients with septic shock may have lack of endogenous steroid synthesis or insufficient corticosteroid activity. This forms the basis for exogenous steroid administration to patients with septic shock, though the timing, dose, and duration have varied among clinical studies over the last several decades. More recent evidence from large randomized clinical trials has overall supported use of hydrocortisone in those with septic shock, particularly when refractory or severe. The aim of this article is to guide clinical practice regarding steroid administration in septic shock from an evidence-based perspective.