Reversible Heart Failure as a Result of Newly Diagnosed Primary Adrenal Insufficiency
ABSTRACT: Objective: We report a case of primary adrenal insufficiency which presented with a rare finding of fulminant cardiogenic shock that improved with hydrocortisone administration. The presentation, clinical manifestations, laboratory results, radiologic findings, and management of a patient...
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doaj-87b9c4380440436a91fd227916a405562021-04-30T07:25:12ZengElsevierAACE Clinical Case Reports2376-06052016-01-0124e321e324Reversible Heart Failure as a Result of Newly Diagnosed Primary Adrenal InsufficiencyKristen A. Hyland, MD0Daniel S. Altman, MD1Jennifer M. Perkins, MD2Department of Medicine, Wilmington VA Medical Center, Wilmington, Delaware; Address correspondence to Dr. Kristen Hyland, Endocrinology, Diabetes and Metabolism Physician, Department of Medicine, Wilmington VA Medical Center, 1601 Kirkwood Highway, Wilmington, DE 19805. E-mail:Department of Medicine, Thomas Jefferson University Hospital, Thomas Jefferson University, Philadelphia, PennsylvaniaDepartment of Medicine, Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Duke University, Durham, North Carolina.ABSTRACT: Objective: We report a case of primary adrenal insufficiency which presented with a rare finding of fulminant cardiogenic shock that improved with hydrocortisone administration. The presentation, clinical manifestations, laboratory results, radiologic findings, and management of a patient that developed cardiogenic shock as the result of an Addisonian crisis are described. Pertinent literature, physiology, and management are discussed.Methods: A 21-year-old male with a 1-year history of nausea and dizziness presented with a 3-day history of malaise, sore throat, fever, and weakness. The patient was hypotensive and was admitted to a local hospital for possible septic shock with low ejection fraction (EF). The patient subsequently developed a rapidly progressive cardiogenic shock requiring intubation and placement of biventricular assist devices.Results: The patient was diagnosed with adrenal insufficiency after mental status change and persistent cardiogenic shock. Stress-dose steroids were initiated and rapid improvement followed. EF returned to normal after 5 days and the ventricular assist devices were removed.Conclusion: In this case, primary adrenal insufficiency presented with reversible fulminate biventricular heart failure and other end organ dysfunction that was resolved with support and stress-dose steroids. This was an unusual presentation of adrenal insufficiency, which led to a delayed diagnosis. This case illustrates the importance of considering adrenal insufficiency in unexplained heart failure.Abbreviations: EF = ejection fraction; IV = intravenous; PCP = primary care providerhttp://www.sciencedirect.com/science/article/pii/S2376060520305666 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Kristen A. Hyland, MD Daniel S. Altman, MD Jennifer M. Perkins, MD |
spellingShingle |
Kristen A. Hyland, MD Daniel S. Altman, MD Jennifer M. Perkins, MD Reversible Heart Failure as a Result of Newly Diagnosed Primary Adrenal Insufficiency AACE Clinical Case Reports |
author_facet |
Kristen A. Hyland, MD Daniel S. Altman, MD Jennifer M. Perkins, MD |
author_sort |
Kristen A. Hyland, MD |
title |
Reversible Heart Failure as a Result of Newly Diagnosed Primary Adrenal Insufficiency |
title_short |
Reversible Heart Failure as a Result of Newly Diagnosed Primary Adrenal Insufficiency |
title_full |
Reversible Heart Failure as a Result of Newly Diagnosed Primary Adrenal Insufficiency |
title_fullStr |
Reversible Heart Failure as a Result of Newly Diagnosed Primary Adrenal Insufficiency |
title_full_unstemmed |
Reversible Heart Failure as a Result of Newly Diagnosed Primary Adrenal Insufficiency |
title_sort |
reversible heart failure as a result of newly diagnosed primary adrenal insufficiency |
publisher |
Elsevier |
series |
AACE Clinical Case Reports |
issn |
2376-0605 |
publishDate |
2016-01-01 |
description |
ABSTRACT: Objective: We report a case of primary adrenal insufficiency which presented with a rare finding of fulminant cardiogenic shock that improved with hydrocortisone administration. The presentation, clinical manifestations, laboratory results, radiologic findings, and management of a patient that developed cardiogenic shock as the result of an Addisonian crisis are described. Pertinent literature, physiology, and management are discussed.Methods: A 21-year-old male with a 1-year history of nausea and dizziness presented with a 3-day history of malaise, sore throat, fever, and weakness. The patient was hypotensive and was admitted to a local hospital for possible septic shock with low ejection fraction (EF). The patient subsequently developed a rapidly progressive cardiogenic shock requiring intubation and placement of biventricular assist devices.Results: The patient was diagnosed with adrenal insufficiency after mental status change and persistent cardiogenic shock. Stress-dose steroids were initiated and rapid improvement followed. EF returned to normal after 5 days and the ventricular assist devices were removed.Conclusion: In this case, primary adrenal insufficiency presented with reversible fulminate biventricular heart failure and other end organ dysfunction that was resolved with support and stress-dose steroids. This was an unusual presentation of adrenal insufficiency, which led to a delayed diagnosis. This case illustrates the importance of considering adrenal insufficiency in unexplained heart failure.Abbreviations: EF = ejection fraction; IV = intravenous; PCP = primary care provider |
url |
http://www.sciencedirect.com/science/article/pii/S2376060520305666 |
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