Official websites use. Share sensitive information only on official, secure websites. To investigate the relationship between adrenal gland function and pressor response to noradrenaline in septic shock.
Basal cortisol level, noradrenaline—mean arterial pressure dose-response curve and cortisol response to intravenous corticotrophin bolus were obtained in nine patients fulfilling usual criteria for septic shock and in six normal volunteers. In patients with septic shock, dose-response curve to noradrenaline was determined a second time 60 min after a 50 mg intravenous hydrocortisone bolus. Five patients had impaired adrenal function reserve.
In septic shock, impaired adrenal function reserve may partly be accounted for by the depressed pressor sensitivity to noradrenaline. The latter may be substantially improved by physiological doses of hydrocortisone. Keywords: noradrenaline, dose-response curve, septic shock, adrenal function, hydrocortisone. Septic shock is a clinical syndrome which associates sepsis with hypotension. This form of shock usually results in a dramatic fall in systemic vascular resistance and generalized blood flow maldistribution.
After aggressive volume loading, the typical haemodynamic pattern consists in low vascular resistance and normal or elevated cardiac output [ 1 ]. If multiple organ failure probably involves complex inflammatory processes [ 3 ], the mechanism of vascular refractoriness to pressor agents remains unclear. Sepsis may induce myocardial dysfunction [ 4 ] but blood vessels contractility is also altered and this involves multiple factors [ 5 , 6 ].
Firstly, enhanced nitric oxide release by the inducible form of nitric oxide synthase may account, at least partly, for by the vasodilation and resistance to vasoconstrictors [ 7 — 9 ].
