Acute coronary syndrome with ST segment elevation in a patient with Addison disease: Case report and brief review of physiopathological mechanisms: A case study

Abstract

The adrenal gland serve important roles in the modulation of the immune response, the adjustment of blood pressure, the stress reaction via glucocorticoids and the hydroelectrolytic balance via mineralocorticoids. Primary adrenal insufficiency, known as Addison disease, is characterized by a decrease in glucocorticoid secretion (cortisol) and, more rarely, by a hyposecretion of mineralocorticoids (aldosterone). The production of cortisol, which is a hormone that helps the body respond to stress, is regulated in the brain, the hypothalamus and the pituitary gland. The hypothalamus stimulates the pituitary gland to produce adrenocorticotropic hormone, which stimulates cortisol production from the adrenal gland. If left untreated, Addison disease has a high mortality rate. Corticotherapy used in the treatment of Addison disease is associated with a certain cardiovascular risk. The proatherogenic effect of corticoids is based on the chronic inflammatory response of the vascular wall to a series of events. The aim of the current case report was to review the pathophysiological mechanisms and interactions that may lead to the onset of acute coronary syndrome with ST elevation in a patient with Addison disease.

Coronary artery disease in a patient with Addison’s disease: a case report and literature review

“…et al [ 24 ] F 41 II -APS ↓ ↓ Shortness of breath Tachycardia, inverted T wave in V5, V6, prolongation of cQT ↑ Not complete Dyskinetic apical lateral and inferior walls of LV, EF 30% Takotsubo cardiomyopathy Maranduca. et al [ 17 ] F 71 Possible adrenal tuberculosis ↑ ↓ Chest pain q wave in I, aVL, V5, V6, ST elevation in V2–V5 (–) Not complete LV apical and inferior wall akinesis EF 50% STEMI Otsuka. et al [ 25 ] M 60 Adrenalectomy ↑ ↓ Palpitation, fatigue, chest pain ST elevation, ventricular tachycardia (–) No significant visible stenosis, diffuse spasm of LAD after ergometrine administration (–) Coronary spasms …”

“…Therefore, it is necessary to check whether the patient has Addison’s disease or other systemic diseases when the patient suddenly has an aggravation of cardiovascular disease. In our literature review, only 1 out of 11 patients with Addison's disease who had cardiovascular symptoms underwent stent implantation (due to myocardial infarction) [ 17 ], while the rest were able to control their cardiovascular symptoms with hormone replacement and optimized CAD medication.…”