Hypercortisolism in septic shock is not suppressible by dexamethasone infusion.
OBJECTIVE
To explore the feedback regulation of glucocorticoids on corticotropin secretion in patients with septic and nonseptic circulatory shock.


METHODS
Prospective study.


METHODS
An intensive care unit of a general hospital.


METHODS
Two groups of patients with septic shock (n = 11) or nonseptic shock (n = 7). A control group (n = 20) was also studied.


METHODS
Intravenous dexamethasone (1 mg/hr for 4 hrs) suppression test.


METHODS
Plasma concentrations of corticotropin-releasing factor, beta-lipotropin, and corticosteroid-binding globulin measured by radioimmunoassays, and plasma cortisol measured by radiocompetition assay; the ratio of cortisol to corticosteroid-binding globulin calculated as the free cortisol index.


RESULTS
In both groups of patients, the concentrations of plasma cortisol and beta-lipotropin, and the ratio of cortisol to corticosteroid-binding globulin, were higher than normal subjects (p < .001) and were not different between septic and nonseptic shock patients, whereas the plasma corticosteroid-binding globulin concentration was significantly (p < .001) lower in septic shock patients than in normal subjects (444 +/- 154 vs. 696 +/- 56 nmol/L [22.0 +/- 7.6 vs. 34.5 +/- 2.8 mg/L]), but not significantly lower in nonseptic shock patients (607 +/- 157 nmol/L [30.0 +/- 7.8 mg/L]). In contrast to the complete suppressive effect of dexamethasone infusion on cortisol and beta-lipotropin concentrations in normal subjects, dexamethasone did not suppress cortisol or lipotropin in either septic or nonseptic shock patients.


CONCLUSIONS
During circulatory shock, hypercortisolism is associated with high concentrations of lipotropin, and is not suppressible by intravenous dexamethasone infusion.
Perrot
D
D
Département d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Lyon, France.
Bonneton
A
A
Dechaud
H
H
Motin
J
J
Pugeat
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003346:Corticotropin-Releasing Hormone / Q000097:blood; D003907:Dexamethasone / Q000008:administration & dosage* / Q000494:pharmacology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012769:Shock / Q000097:blood; D012772:Shock, Septic / Q000097:blood*; D014156:Transcortin / Q000032:analysis; D008083:beta-Lipotropin / Q000097:blood
D003907:Dexamethasone; D014156:Transcortin; D003346:Corticotropin-Releasing Hormone; D008083:beta-Lipotropin; D006854:Hydrocortisone