A normal response to Synachten test does not rule out corticosteroid effectiveness in weaning from catecholamine after septic shock.
Corticosteroids may improve haemodynamics and facilitate weaning from catecholamines in septic shock. According to some authors, such effects are only accomplished in the presence of absolute or relative adrenal insufficiency. Consequently, corticosteroids are usually given only to patients that present low blood cortisol values or show an inadequate response to cosyntropin (Synachten test). We report the case of a woman affected by septic shock secondary to pneumonia and dependent on norepinephrine infusion for 26 days, who was weaned from catecholamines with hydrocortisone, 100 mg/day i.v. She exhibited a normal response to Synachten, but corticosteroid therapy was continued because haemodynamics improved promptly. A pharmacological effect was hypothesized; the contemporary increase of platelet, decrease of white blood cells, and decrease of plasma fibrinogen supported this hypothesis.
Cavaliere
F
F
Institute of Anaesthesia and Critical Care, Catholic University of the Sacred Heart, Rome, Italy. f.cavaliere@rm.unicatt.it
Craba
A
A
Caputo
C
C
Gaspari
R
R
Conti
G
G
Proietti
R
R
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000324:Adrenocorticotropic Hormone; D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D002395:Catecholamines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006396:Hematemesis / Q000150:complications / Q000188:drug therapy; D006801:Humans; D009638:Norepinephrine / Q000008:administration & dosage / Q000627:therapeutic use; D011014:Pneumonia / Q000150:complications / Q000188:drug therapy; D012772:Shock, Septic / Q000188:drug therapy* / Q000503:physiopathology; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D002395:Catecholamines; D014662:Vasoconstrictor Agents; D000324:Adrenocorticotropic Hormone; D009638:Norepinephrine