Coronary Spastic Angina Induced by Adrenal Insufficiency

Otsuka, Yuki; Harada, Ko; Yasuda, Miho; Nakano, Yasuhiro; Hasegawa, Kou; Otsuka, Fumio

doi:10.2169/internalmedicine.4337-19

Cited by 3 publications

(5 citation statements)

References 25 publications

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“…Although the precise mechanism underlying the ST-T elevation in this case was unclear, hypothyroid is known to cause coronary endothelial dysfunction directly via an effect on the coronary vascular bed (20) or indirectly via low-grade inflammation (21) or by weakening the effect of the beta adrenergic hormone (22). GH deficiency is also known to reduce cardiac contractility (16,17). Both thyroid and growth hormones were reduced in this case.…”

Section: Discussionmentioning

confidence: 76%

“…Although the mechanism underlying the musculoskeletal pain caused by adrenal insufficiency was unclear (4), the reason for the chest pain might have been due to adrenal insufficiency. Furthermore, considering the anti-inflammatory effect of cortisol, a decreased cortisol level might have led to a reduction in the anti-inflammatory effect in the coronary arteries to coronary spasm (17). The presence of catecholamine-unresponsive shock and diuresis with sodium loss led us to conclude that hormone deficiency was the root cause.…”

Section: Discussionmentioning

confidence: 97%

“…This prompted us to suspect inferior myocardial infarction. Hypothyroidism is known to cause bradycardia, ST-T change, QT elongation, and impaired cardiac contractility (16,17). An abnormal ST-T segment in hypothyroidism can indicate either depression, inversion, or elevation (18).…”

Section: Discussionmentioning

confidence: 99%

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Panhypopituitarism Mimicking Acute Coronary Syndrome

et al. 2023

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A 59-year-old man suspected of having myocardial infarction with sinus bradycardia, a decreased blood pressure, and ST-change on an electrocardiogram was referred to our hospital's emergency department. Emergent coronary angiography revealed no significant findings. However, the patient experienced shock and required intensive care. Curiosity rose when his urination volume was not disturbed; we suspected hormonal abnormalities. A hormonal examination and imaging analysis revealed panhypopituitarism caused by a Rathke's cyst. Appropriate hormonal replacement therapy improved his symptoms and led to normalization of his electrocardiogram findings. Acute coronary syndrome (ACS) is a fatal disease; however, clinicians must not discount panhypopituitarism, as it may mimic ACS symptoms.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 97%

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Panhypopituitarism Mimicking Acute Coronary Syndrome

et al. 2023

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“…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 …”

Section: Discussionmentioning

confidence: 99%

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

Zhao

Luo

Wang

et al. 2023

BMC Cardiovasc Disord

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Background Addison’s disease which is due to dysfunction of the adrenal gland, with abnormal secretion of glucocorticoids and mineralocorticoids, is rare. By inducing inflammation and disorders of water and electrolyte metabolism, Addison’s disease may accelerate progression of co-existed cardiovascular diseases. Addison’s disease combined with cardiovascular disease is infrequent, only 10 cases in the literature. Case presentation We reported a 51-year-old male patient with unstable angina pectoris and hypotension. Changes on coronary angiography within 2 years suggested rapid progression of coronary artery disease in a patient with low cardiovascular risk. An additional clue of skin hyperpigmentation, fatigue and further examination confirmed the diagnosis of Addison’s disease caused by adrenal tuberculosis. After hormone replacement treatment, the frequency and severity of the angina pectoris were alleviated significantly, as were hypotension, hyperpigmentation and fatigue. Conclusions The combination of Addison’s disease and coronary artery disease in one patient is rare. Addison’s disease can induce inflammation and disorders of water and electrolyte metabolism, which may further accelerate the course of coronary artery disease. Meanwhile, the hypotension in Addison’s disease may affect the coronary blood flow, which may result in an increased susceptibility to unstable angina in the presence of coronary stenosis. So, we should analyze comprehensively if the coronary artery disease progress rapidly.

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“…It is intriguing that the risk of cardiovascular disease is increased not just by overtreatment [ 37 – 39 ] but also by transient adrenal insufficiency [ 40 ]. According to reports, the levels of inflammatory mediators, including interleukin-1, interleukin-6, and tumor necrosis factor, correlate with cortisol, and excessive levels of these mediators can be linked to a higher risk of cardiovascular events.…”

Section: Discussionmentioning

confidence: 99%

A 65-Year-Old Man with Bilateral Adrenal Hemorrhage Following Prophylaxis for Postoperative Deep Vein Thrombosis with Rivaroxaban

et al. 2023

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Patient: Male, 65-year-old Final Diagnosis: Adrenal insufficiency Symptoms: Severe sudden left lower quadrant (LLQ) abdominal pain of seven-hour duration associated with nausea and regurgitation Clinical Procedure: — Specialty: Endocrinology and Metabolic • General and Internal Medicine Objective: Unusual clinical course Background: Direct oral anticoagulant (DOAC) agents, such as rivaroxaban, treat and prevent venous thrombosis. Although adrenal hemorrhage due to DOACs has previously been reported, this is a rare condition that can present as an emergency. In this case report, we present a 65-year-old man who recently had bilateral knee arthroplasty and was started on rivaroxaban 10 mg daily for deep vein thrombosis (DVT) prophylaxis following the surgery. Case Report: Ten days after bilateral knee arthroplasty and starting rivaroxaban, the patient presented to the Emergency Department with severe, sudden abdominal pain. Abdominal computed tomography detected significantly enlarged bilateral adrenals, with ill-defined heterogeneous density extending to the upper part of perinephric and paranephric spaces, suggesting bilateral adrenal hemorrhage. A cosyntropin stimulation test was used to confirm the suspicion of adrenal insufficiency. Cortisol levels were 66 nmol/L before stimulation and 83 nmol/L 60 min after cosyntropin administration. Hydrocortisone was started intravenously at a dose of 50 mg every 8 h. After his symptoms improved, he was discharged on oral hydrocortisone at 10 mg in the morning and 5 mg in the evening. Seven weeks after discharge, follow-up abdominal ultrasonography showed that the bilateral adrenal hemorrhage had resolved. Conclusions: This case supports previous cases of adrenal hemorrhage as a rare but serious association with rivaroxaban and highlights the importance of rapid diagnosis using imaging and monitoring of patients for this possible adverse effect. Practitioners must remain vigilant when prescribing anticoagulation therapy, especially in patients who are at an increased risk for adrenal hemorrhage.

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Coronary Spastic Angina Induced by Adrenal Insufficiency

Cited by 3 publications

References 25 publications

Panhypopituitarism Mimicking Acute Coronary Syndrome

Panhypopituitarism Mimicking Acute Coronary Syndrome

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

A 65-Year-Old Man with Bilateral Adrenal Hemorrhage Following Prophylaxis for Postoperative Deep Vein Thrombosis with Rivaroxaban

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