Abstract
Objective
Acute adrenocortical insufficiency is an unusual cause of isolated shock. The purpose of this study is to describe the cardiovascular changes in 6 patients with acute adrenal insufficiency presenting with hemodynamic instability.
Design
Retrospective and prospective study
Setting
Medical intensive care unit in a university hospital.
Patients
6 patients studied by right cardiac catheterization.
Measurements and results
Results before glucocorticoid treatment show two possible hemodynamic states: 1) myocardial depression with hypovolemia in 3 patients, and 2) hyperdynamic shock with high cardiac output and diminished systemic arterial resistance in 3 other patients. The 3 patients presenting hyperdynamic shock were all given intravenous fluid therapy of over 20 ml/kg before the first hemodynamic measurement. For 2 other patients with low cardiac index and high systemic arterial resistance studied prospectively, 20 ml/kg intravenous fluid therapy transformed the hemodynamic state to hyperdynamic shock. The cardiovascular effect of glucocorticoid treatment studied in 4 patients was resulted in an improvement in the left ventricular systolic work index.
Conclusions
Diagnosis of acute adrenocortical insufficiency must be considered if clinical manifestations are present suggesting septic shock without any obvious infectious cause in patients having undergone considerable intravenous fluid therapy as an initial course of treatment.
References
Brown FK, Remington JW (1955) Arteriolar responsiveness in adrenal crisis in the dog. Am J Physiol 82:279–284
Lefer AM, Verrier RL, Carson WW (1968) Cardiac performance in experimental adrenal insufficiency in cats. Circ Res 22: 817–827
Lefer AM (1975) Corticosteroids and circulatory functions. In: Greep RO, Astwood EB (eds) Handbook of physiology: the adrenal gland. The American Physiological Society. Washington DC pp 191–206
Reidenberg MM, Ohler EA, Sevy RW, Harakal C (1963) Hemodynamic changes in adrenalectomized dogs. Endocrinology 72:918–923
Webb WR, Degerli IU, Hardy JD, Unal M (1965) Cardiovascular responses in adrenal insufficiency. Surgery 58:273–282
Case Records of the Massachusetts General Hospital (Case 15/1985) (1985) N Engl J Med 312:976–983
Dorin RI, Kearns PJ (1988) High output circulatory failure in acute adrenal insufficiency. Crit Care Med 16:296–297
Ernest D, Fisher MM (1991) Heparin-induced thrombocytopaenia complicated by bilateral adrenal haemorrhage. Intensive Care Med 17:238–240
Melby MJ, Bergman X, Ramos T, Reinhold R, Mackey W (1988) Acute adrenal insufficiency mimicking septic shock. A case report. Pharmacotherapy 8:69–71
Claussen MS, Landercasper J, Cogbill TH (1992) Acute adrenal insufficiency presenting as shock after trauma and surgery: three cases and review of the literature. J Trauma 32:94–100
Lawton JM, Bay G (1992) Acute adrenal insufficiency. Hemodynamic and echographic characteristics. Wis Med J 91:214–216
Burke CW (1985) Adrenocortical insufficiency. Clin Endocrinol Metab 14:947–976
Guyton A (1976) Circulatory shock and physiology of its treatment. In: Textbook of medical physiology. Saunders, Philadelphia, pp 357–360
Verrier RL, Rovetto MJ, Lefer AM (1969) Blood volume and myocardial function in adrenal insufficiency. Am J Physiol 217: 1559–1564
Rovetto MJ, Murphy RA, Lefer AM (1970) Cardiac impairement in adrenal insufficiency: reduced ATPase activity of myocardial contractile tractile proteins. Circ Res 26:419–428
Xarli VP, Steele AA, Davis PJ, Buescher ES, Rios CN, Garcia-Bunuel R (1978) Adrenal hemorrhage in the adult. Medicine 57:211–221
Steer M, Fromm D (1980) Recognition of adrenal insufficiency in the postoperative patients. Am J Surg 139:443–446
Jacobson SA, Blute RD, Green DF, MacPhedran P, Weiss RM, Lytton B (1986) Acute adrenal insufficiency as a complication of urological surgery. J Urol 135:337–340
Alford WC, Meador CK, Mihalevich J, Burros GR, Glassford DM, Stoney SW, Thomas CS (1979) Acute adrenal insufficiency following cardiac surgical procedures. J Thorac Cardiovasc Surg 78:489–493
Wemeau JL, Cappoen JP, Vennin Ph, Ego F, Lefebvre J, Linquette M (1982) The treatment of acute adrenocortical insufficiency by small dose of hydrocortisone infused by automatic pump. Therapie 37:83–87
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Bouachour, G., Tirot, P., Varache, N. et al. Hemodynamic changes in acute adrenal insufficiency. Intensive Care Med 20, 138–141 (1994). https://doi.org/10.1007/BF01707669
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DOI: https://doi.org/10.1007/BF01707669