Depletion of neurohypophyseal content of vasopressin in septic shock.
OBJECTIVE
To assess the mechanisms underlying the inappropriately low plasma vasopressin levels reported in septic shock.


METHODS
Prospective case series.


METHODS
A 26-bed general medical intensive care unit at a university hospital.


METHODS
Septic shock patients.


RESULTS
In three consecutive patients with septic shock, plasma vasopressin levels, circulating vasopressinase activity, baroreflex sensitivity, and neurohypophyseal vasopressin content were assessed. Plasma vasopressin concentration was unexpectedly within normal range in two patients (1.6 pg/mL and 1.8 pg/mL) and increased in one (16 pg/mL). In all cases, vasopressinase activity was undetectable, baroreflex sensitivity was decreased, and the high signal intensity of the posterior lobe of the pituitary gland on T1-weighted magnetic resonance images was absent. Magnetic resonance imaging and plasma vasopressin levels normalized after recovery from shock in the patient who survived.


CONCLUSIONS
These data suggest that in septic shock, inappropriately low plasma levels of vasopressin are at least partly related to a depletion of vasopressin stores in the neurohypophysis.
Sharshar
Tarek
T
Service de Réanimation Médicale, Hôpital Raymond Poincaré, Garches, France.
Carlier
Robert
R
Blanchard
Anne
A
Feydy
Antoine
A
Gray
Françoise
F
Paillard
Michel
M
Raphael
Jean-Claude
JC
Gajdos
Philippe
P
Annane
Djillaii
D
D000368:Aged; D017704:Baroreflex; D010122:Cystinyl Aminopeptidase / Q000097:blood; D005583:Fourier Analysis; D005738:Gas Gangrene / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010904:Pituitary Gland, Posterior / Q000378:metabolism* / Q000473:pathology; D011014:Pneumonia / Q000378:metabolism / Q000503:physiopathology; D011446:Prospective Studies; D012772:Shock, Septic / Q000378:metabolism* / Q000503:physiopathology; D018461:Soft Tissue Infections / Q000378:metabolism / Q000503:physiopathology; D018709:Statistics, Nonparametric; D014667:Vasopressins / Q000378:metabolism*
D014667:Vasopressins; D010122:Cystinyl Aminopeptidase