敗血症を契機に発症した急性副腎不全の１例

Abstract

A 24-year-old healthy man was admitted with hemorrhagic shock due to amputation of the bilateral lower limbs. After the first operation on limbs, hyponatremia with sodium wasting and circulatory instability developed on hospital day 2; endocrinological examination showed hypoaldosteronism and subsequently positive left femoral open-wound culturing followed by a persistent septic state. The absolute low value of cortisol and weak response to the rapid ACTH test helped us to diagnose absolute adrenal insufficiency (AI). Refractory hyperdynamic shock was promptly reversed by treatment with intravenous hydrocortisone and we debrided and surgically closed the left femoral openwound that was the source of sepsis. Several authors have shown that serum cortisol concentration is usually high and absolute AI is rare in sepsis. Due to the lack of specific signs and symptoms in AI, it is difficult to distinguish it from septic shock. Our experience shows the utility of endocrinological examination, including rapid ACTH and CRH tests in the diagnosis of sepsis-induced AI and their results show that AI in septic patients appears to be related to both primary and secondary failure.