Hyperreninemic hypoaldosteronism: a possible etiological factor of septic shock-induced acute renal failure

Cheyron, Damien du; Lesage, Anne; Daubin, Cédric; Ramakers, Michel; Charbonneau, P.

doi:10.1007/s00134-003-1986-6

Cited by 72 publications

(48 citation statements)

References 33 publications

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“…Our findings provide in vivo evidence that increases in aldosterone and cortisol secretion result from independent mechanisms. This is consistent with previous studies involving critically ill patients with (17) or wi thout (18) sepsis. Therefore, patients with septic shock may exhibit insufficient glucocorticoid production without concomitant deficiency of mineralocorticoid synthesis, and vice versa.…”

Section: Discussionsupporting

confidence: 93%

Aldosterone secretion in patients with septic shock: a prospective study

Moraes

Friedman

Viana

et al. 2013

Arq Bras Endocrinol Metab

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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. Subjects and 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-pituitaryadrenal axis. These results suggest that activation of the adrenal gland in critically ill patients occurs by multiple mechanisms. Arq Bras Endocrinol Metab. 2013;57(8):636-41 Keywords Aldosterone; hydrocortisone; adrenal insufficiency; septic shock RESUMO Objetivo: Avaliar os níveis séricos dos principais fatores que regulam a ativação da zona glomerulosa e a produção de aldosterona em pacientes com choque séptico, assim como sua resposta ao teste de cortrosina em alta dose (250 µg). Sujeitos e métodos: Em 27 portadores de choque séptico, foram aferidos níveis basais de aldosterona, cortisol, ACTH, renina, sódio, potássio e lactato, bem como realizado teste de cortrosina. Resultados: Renina se correlacionou com níveis basais de aldosterona e sua variação após teste de cortrosina. Cortisol basal e sua variação não se correlacionaram com ACTH. Apenas três pacientes apresentaram disfunção concomitante da secreção de aldosterona e cortisol. Conclusões: Ativação das zonas fasciculada e glomerulosa são independentes. Secreção de aldosterona é dependente da integridade do sistema renina-angiotensina-aldosterona, enquanto secreção de cortisol não parece predominantemente dependente do eixo hipotálamo-hipófise-adrenal. Esses resultados sugerem que a ativação da adrenal em pacientes críticos ocorre por múltiplos mecanismos. Arq Bras Endocrinol Metab. 2013;57(8):636-41 Descritores Aldosterona; hidrocortisona; insuficiência adrenal; choque séptico

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Section: Discussionsupporting

confidence: 93%

Aldosterone secretion in patients with septic shock: a prospective study

Moraes

Friedman

Viana

et al. 2013

Arq Bras Endocrinol Metab

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“…Our results confirm previous observations of a lack of association between sepsis and DHEA and S-DHEA deficiency [23]. Previous observations of sepsis which showed dissociation between aldosterone levels and renin activity [24,25] are not in contradiction with our findings of intact zona glomerulosa. In fact, these findings together suggest that aldosterone regulation is shifted from renin to ACTH and/or cytokine command.…”

Section: Discussionsupporting

confidence: 64%

Human and experimental septic shock are characterized by depletion of lipid droplets in the adrenals

et al. 2010

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“…Despite the high angiotensin II plasma levels, pronounced hypotension, associated with a reduced vasopressor effect of angiotensin II, has been reported [17]. Moreover, RAS activation contributes to oxidative stress and endothelial dysfunction [24], which has been associated with development of kidney [33] and pulmonary [25,26] injury and with the severity of organ dysfunction [19].…”

Section: Angiotensin II Receptorsmentioning

confidence: 99%