Isolated ACTH deficiency presenting with severe myocardial dysfunction

Abstract

We present a case of isolated adrenocorticotropic hormone (ACTH) deficiency complicated by acute adrenal crisis and severe myocardial dysfunction. A 54-year-old woman developed consciousness disturbance, hypoglycemia, hyponatremia, and rhabdomyolysis. Initial echocardiographic examinations on the sixth hospital day revealed marked right-sided atrial and ventricular dilatation and severe tricuspid regurgitation. A computed tomography scan for pulmonary embolism was negative. On the 14th hospital day, she became dyspneic and hypotensive. Repeated echocardiographic examinations demonstrated diffuse and severe hypokinesis of the left ventricle. The previous right-sided chamber dilatation became less apparent. Congestive heart failure and severe hypotension were refractory to catecholamines, while she was eventually diagnosed as having acute adrenal crisis due to isolated ACTH deficiency. Hydrocortisone replacement therapy was started, and echocardiographic examinations revealed that the left ventricular dysfunction completely returned to normal in the following eight days. Severe myocardial dysfunction is an uncommon but serious complication of acute adrenal insufficiency. The present case was unique in that diffuse left ventricular dysfunction was preceded by right ventricular dysfunction.

A case of congestive heart failure caused by secondary hypocortisolism

“…Additionally, LV dysfunction rarely occurs with adrenocortical insufficiency. Previous reports have indicated that severe myocardial dysfunction is an uncommon but serious complication of adrenal insufficiency . In such cases, electrocardiographic and echocardiographic abnormalities normalized after steroid replacement therapy.…”

“…In addition to these common causes, there are other rare causes of left‐sided congestive heart failure. There are a few reports of left ventricular (LV) dysfunction caused by isolated adrenocorticotrophic hormone (ACTH) deficiency . Isolated adrenocorticotrophic hormone deficiency is a rare cause of secondary adrenocortical insufficiency and is difficult to diagnose .…”

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

“…Moreover, the glucocorticoids deficit reduces the expression of adrenergic receptors and adrenalin synthesis and affects the cardiovascular reactivity to catecholamines. These mechanisms could explain the severe myocardial dysfunction associated to adrenal insufficiency ( 15 ). However, we could not identify animal studies explaining mechanisms associated with the occurrence of acute coronary syndrome in adrenal insufficiency.…”

Reversible dilated cardiomyopathy as a complication of adrenal cortex insufficiency: a case report

“…Adrenal insufficiency has also been associated with transient left ventricular apical ballooning known as Takotsubo cardiomyopathy. This type occurs exclusively in adult patients [ 11 ].…”