title: Aldosterone secretion in patients with septic shock: a prospective study.
abstract: OBJECTIVE
  To assess serum levels of the main factors that regulate the activation of the zona glomerulosa and aldosterone production in patients with septic shock, as well as their response to a high-dose (250 µg) adrenocorticotropic hormone (ACTH) stimulation test.
  
  
  METHODS
  In 27 patients with septic shock, baseline levels of aldosterone, cortisol, ACTH, renin, sodium, potassium, and lactate were measured, followed by a cortrosyn test.
  
  
  RESULTS
  Renin correlated with baseline aldosterone and its variation after cortrosyn stimulation. Baseline cortisol and its variation did not correlate with ACTH. Only three patients had concomitant dysfunction of aldosterone and cortisol secretion.
  
  
  CONCLUSIONS
  Activation of the zona glomerulosa and zona fasciculata are independent. Aldosterone secretion is dependent on the integrity of the renin-angiotensin-aldosterone system, whereas cortisol secretion does not appear to depend predominantly on the hypothalamic-pituitary-adrenal axis. These results suggest that activation of the adrenal gland in critically ill patients occurs by multiple mechanisms.
authors.forename: Rafael Barberena
authors.initials: RB
authors.lastname: Moraes
authors.forename: Gilberto
authors.initials: G
authors.lastname: Friedman
authors.forename: Marina Verçoza
authors.initials: MV
authors.lastname: Viana
authors.forename: Tiago
authors.initials: T
authors.lastname: Tonietto
authors.forename: Henrique
authors.initials: H
authors.lastname: Saltz
authors.forename: Mauro Antônio
authors.initials: MA
authors.lastname: Czepielewski
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood*; D003366:Cosyntropin / Q000008:administration & dosage / Q000378:metabolism; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007030:Hypothalamo-Hypophyseal System; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System; D011446:Prospective Studies; D012083:Renin / Q000097:blood*; D012084:Renin-Angiotensin System; D012772:Shock, Septic / Q000378:metabolism* / Q000401:mortality / Q000503:physiopathology; D015383:Zona Fasciculata; D015384:Zona Glomerulosa / Q000378:metabolism*
chemical_list: D003366:Cosyntropin; D000450:Aldosterone; D000324:Adrenocorticotropic Hormone; D012083:Renin; D006854:Hydrocortisone