The glucocorticoid in acute decompensated heart failure: Dr Jekyll or Mr Hyde?

Glucocorticoid administration is not recommended inpatients with heart failure because of its related sodium andfluid retention. However, previous experimental andclinical studies have demonstrated that glucocorticoidscan also induce a diuretic effect and improve renalfunction in patients with acute decompensated heart failure(ADHF) with refractory diuretic resistance. We report thecase of a 65-year-old man with a known diagnosis ofaortic stenosis, systolic ventricular dysfunction, andchronic obstructive pulmonary disease who was admittedfor ADHF. After 3 days, during which resistance toconventional therapy was observed, intravenous methylprednisolone(60 mg/d) was added to ongoing medicaltreatment. Three days after the onset of glucocorticoidtherapy, daily urine volume progressively increased (up to5.8 L/d ). Concurrently, signs and symptoms of congestionimproved, the weight and brain natriuretic peptide plasmalevels decreased (−7 kg and −46%, respectively) andglomerular filtration rate increased (+26%). Bioimpedancevector analysis showed a net reduction of fluid content(from 88.4% to 73.6% of hydration at discharge). Inconclusion, this case report suggests that in a patient withADHF and congestion resistant to diuretic therapy,glucocorticoid administration is safe and associated withimprovement in congestion, neurohormonal status, andrenal function. These data support the possible usefulnessof glucocorticoids in this setting