HEMODYNAMIC-CHANGES IN ACUTE ADRENAL INSUFFICIENCY

Objective: Acute adrenocortical insufficiency is an unusual cause of i solated shock. The purpose of this study is to describe the cardiovasc ular changes in 6 patients with acute adrenal insufficiency presenting with hemodynamic instability. Design: Retrospective and prospective s tudy. Setting: Medical intensive care unit in a university hospital. P atients. 6 patients studied by right cardiac catheterization. Measurem ents and results: Results before glucocorticoid treatment show two pos sible hemodynamic states: 1) myocardial depression with hypovolemia in 3 patients, and 2) hyperdynamic shock with high cardiac output and di minished systemic arterial resistance in 3 other patients. The 3 patie nts presenting hyperdynamic shock were all given intravenous fluid the rapy of over 20 ml/kg before the first hemodynamic measurement. For 2 other patients with low cardiac index and high systemic arterial resis tance studied prospectively, 20 ml/kg intravenous fluid therapy transf ormed 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. Conclus ions: Diagnosis of acute adrenocortical insufficiency must be consider ed if clinical manifestations are present suggesting septic shock with out any obvious infectious cause in patients having undergone consider able intravenous fluid therapy as an initial course of treatment.