Lovelock Joshua D, Coslet Sandra, Johnson Marie, Rich Stuart, Gomberg-Maitland Mardi
Department of Cardiology, University of Chicago Hospitals, 5841 S. Maryland Avenue, Chicago, IL 60637, USA.
J Cardiovasc Med (Hagerstown). 2007 Sep;8(9):754-7. doi: 10.2459/JCM.0b013e328011c256.
Relative adrenal insufficiency in critically ill patients is an important syndrome in septic shock. The insufficient stress response of the hypothalamic-pituitary-adrenal axis in acute illness contributes to hemodynamic instability. Treatment of this state in septic shock improves patient outcomes. In this report, we describe the case of a patient with severe diastolic dysfunction who presented in cardiogenic shock associated with relative adrenal insufficiency and had a complete recovery with corticosteroid replacement. Alteration of the hypothalamic-pituitary-adrenal axis may be more prevalent than suspected in end-stage heart failure, and the diagnosis and treatment of this syndrome may ultimately improve outcomes in a subgroup of heart failure patients.
危重症患者的相对性肾上腺功能不全是脓毒症休克中的一种重要综合征。急性疾病时下丘脑 - 垂体 - 肾上腺轴应激反应不足会导致血流动力学不稳定。在脓毒症休克中治疗这种状态可改善患者预后。在本报告中，我们描述了一例严重舒张功能障碍患者，该患者出现与相对性肾上腺功能不全相关的心源性休克，经皮质类固醇替代治疗后完全康复。下丘脑 - 垂体 - 肾上腺轴的改变在终末期心力衰竭中可能比预期更为普遍，对该综合征的诊断和治疗最终可能改善一部分心力衰竭患者的预后。
