[Steroid replacement therapy for shocks after cardiac surgery].

A 63-year-old woman who underwent surgery for valve replacement had shocks 2 times. First, 1 postoperative day (POD), she had dyspnea, high grade fever and tacycardia. Then, she was intubated again, and needed intraaortic ballon pumping (IABP) support. Second, 32 POD, she had dyspnea, loss of consciousness and metabolic acidosis. Then she was intubated and needed continuous hemodiafiltration (CHDF). In both cases, causes were unknown, but she recovered from shocks after steroid therapy. Relative adrenal insufficiency during septic shock has been well known, and it was reported that steroid therapy reduce the risk of death. Also in cardiac surgery, relative adrenal insufficiency and euthyroid sick syndrome due to stress may occur. In a case of shock requiring large amount of catecholamine after cardiac surgery and the reason of the shock is unknown, specimens of adrenocorticotropic hormone (ACTH), cortisol, thyroid-stimulating hormone (TSH), free T3 and free T4 should be taken following by administration of 100 mg hydrocortisone intravenously.