Glucocorticoid administration is not recommended in patients with heart failure because
of its related sodium and fluid retention. However, previous experimental and clinical
studies have demonstrated that glucocorticoids can also induce a diuretic effect and
improve renal function in patients with acute decompensated heart failure (ADHF) with
refractory diuretic resistance. We report the case of a 65-year-old man with a known
diagnosis of aortic stenosis, systolic ventricular dysfunction, and chronic obstructive
pulmonary disease who was admitted for ADHF. After 3 days, during which resistance
to conventional therapy was observed, intravenous methylprednisolone (60 mg/d) was
added to ongoing medical treatment. Three days after the onset of glucocorticoid therapy,
daily urine volume progressively increased (up to 5.8 L/d ). Concurrently, signs and
symptoms of congestion improved, the weight and brain natriuretic peptide plasma levels
decreased (−7 kg and −46%, respectively) and glomerular filtration rate increased
(+26%). Bioimpedance vector analysis showed a net reduction of fluid content (from
88.4% to 73.6% of hydration at discharge). In conclusion, this case report suggests
that in a patient with ADHF and congestion resistant to diuretic therapy, glucocorticoid
administration is safe and associated with improvement in congestion, neurohormonal
status, and renal function. These data support the possible usefulness of glucocorticoids
in this setting.
To read this article in full you will need to make a payment
Subscribe to The American Journal of Emergency Medicine
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Whole-body bioelectrical impedance analysis in patients with chronic heart failure: reproducibility of the method and effects of body side.Ital Heart J. 2001; 2: 594-598
- New method for monitoring body fluid variation by bioimpedance analysis: The RXc graph.Kidney Int. 1994; 46: 534-539
- Clinical and hemodynamic effects of cortisone in patients with rheumatic heart disease and congestive heart failure.Am Heart J. 1958; 55: 851-866
- The use of prednisone in congestive heart failure.Am J Med Sci. 1957; 234: 281-286
- Corticosteroids in heart disease.Br Med J. 1966; 2: 721-724
- Corticotropin (ACTH) in heart disease: its paradoxical effect on sodium excretion in resistant congestive failure.Circulation. 1955; 11: 702-710
- Diuretic effect of steroid therapy in obstinate heart failure.Br Med J. 1959; 1: 876-883
- Prednisone adding to usual care treatment for refractory decompensated congestive heart failure.Int Heart J. 2008; 49: 587-595
- Potent diuretic effects of prednisone in heart failure patients with refractory diuretic resistance.Can J Cardiol. 2007; 23: 865-868
- Potent potentiating diuretic effects of prednisone in congestive heart failure.J Cardiovasc Pharmacol. 2006; 48: 173-176
- The effects of cortisone and hydrocortisone on water diuresis and renal function in man.J Clin Invest. 1957; 36: 767-779
- Metabolic studies with a new series of 1, 4-diene steroids. II. Effects in normal subjects of prednisone, prednisolone, and 9 alpha-fluoroprednisolone.J Clin Invest. 1959; 38: 691-701
- Mechanism of the glucocorticoid-induced increase in glomerular filtration rate.Am J Physiol. 1978; 234: F166-F1670
- Glucocorticoid-induced renal vasodilatation is mediated by a direct renal action involving nitric oxide.Am J Physiol. 1997; 273: R1972-R1979
- Inhibition of prostaglandin and nitric oxide synthesis prevents cortisol-induced renal vasodilatation in sheep.Am J Physiol. 1999; 276: R1125-R1131
- Differential regional hemodynamic effects of corticotropin in conscious sheep.Hypertension. 1994; 24: 49-55
- Permissive action of glucocorticoid substitution therapy on the effects of atrial natriuretic peptide (hANP) in patients with adrenocortical insufficiency.Exp Clin Endocrinol. 1990; 95: 315-321
- Effect of glucocorticoids on the binding of atrial natriuretic peptide to endothelial cells.Eur J Pharmacol. 1990; 178: 105-159
- Potentiation of atrial natriuretic peptide-stimulated cyclic guanosine monophosphate formation by glucocorticoids in cultured rat renal cells.Br J Pharmacol. 1989; 96: 795-800
- Gluco- and mineralocorticoids may regulate the natriuretic effect and the synthesis and release of atrial natriuretic factor by the rat atria in vivo.Biochem Biophys Res Commun. 1985; 131: 806-814
- Changes in brain natriuretic peptide levels and bioelectrical impedance measurements after treatment with high-dose furosemide and hypertonic saline solution versus high-dose furosemide alone in refractory congestive heart failure: a double-blind study.J Am Coll Cardiol. 2005; 45: 1997-2003
Article Info
Publication History
Published online: March 16, 2011
Accepted:
January 17,
2011
Received:
January 16,
2011
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
