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Titolo:
Severe non-infectious circulatory shock related to hypopituitarism
Autore:
Hazouard, E; Piquemal, R; Dequin, PF; Tayoro, J; Valat, C; Legras, A;
Indirizzi:
CHU Bretonneau, Serv Reanimat Med, F-37044 Tours 1, France CHU BretonneauTours France 1 Serv Reanimat Med, F-37044 Tours 1, France CHU Bretonneau, Clin Med A2, F-37044 Tours, France CHU Bretonneau Tours France F-37044 , Clin Med A2, F-37044 Tours, France CHU Bretonneau, Nucl Med Lab, F-37044 Tours 1, France CHU Bretonneau Tours France 1 eau, Nucl Med Lab, F-37044 Tours 1, France
Titolo Testata:
INTENSIVE CARE MEDICINE
fascicolo: 8, volume: 25, anno: 1999,
pagine: 865 - 868
SICI:
0342-4642(199908)25:8<865:SNCSRT>2.0.ZU;2-D
Fonte:
ISI
Lingua:
ENG
Soggetto:
ACUTE ADRENAL INSUFFICIENCY; PITUITARY-FUNCTION; CRITICAL ILLNESS; SURGICAL STRESS; HORMONE; PREDICTION; SYSTEM;
Keywords:
hypopituitarism; intensive care; septic shock; adrenocorticotropic insufficiency; oxygen consumption; hemodynamics;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
20
Recensione:
Indirizzi per estratti:
Indirizzo: Hazouard, E CHU Bretonneau, Serv Reanimat Med, 2 Blvd Tonnelle, F-37044 Tours 1, France CHU Bretonneau 2 Blvd Tonnelle Tours France 1 Tours 1, France
Citazione:
E. Hazouard et al., "Severe non-infectious circulatory shock related to hypopituitarism", INTEN CAR M, 25(8), 1999, pp. 865-868

Abstract

The authors report a case of refractory non-infectious circulatory shock with catecholamine and massive fluid loading-resistant features related to hypopituitarism. A 76-year-old man was admitted for shock after suffering from gastroenteritis for 3 days. He was pale and had sparse axillary and pubic hair and small testes. Right catheterization showed shock with low preload pressure and a low oxygen extraction ratio relevant for septic shock. Ultrasound tomography revealed a distended gallbladder due to a stone without peritoneal effusion. A noninflammatory hydrops of the gallbladder was removed surgically. No microorganism was isolated. Cerebral computed tomography (CT) scan showed a pituitary mass. In the post-surgical period the shock became uncontrollable. Cortisol replacement therapy was instituted and clinical and hemodynamic improvement occurred after 2 h. Hormonal screening on admission before catecholamine administration showed a major decrease in all the hypothalamic-pituitary hormone concentrations. The patient died on day 15 with multiple organ failure. Hypopituitarism, probably owing to pituitary adenoma, was the only disease identified in this case. Hormone replacement therapy dramatically improved the clinical and hemodynamic status, although the role of an abdominal sepsis could not be eliminated. Arguments that pituitary hormone deficiency might increase the hemodynamic consequences ofadrenal deficiency are discussed.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 01/06/20 alle ore 02:34:11