Regression of cardiac abnormalities after replacement therapy in Addison's disease

Abstract

Objective: To evaluate by echocardiography the cardiac structure and function in patients with primary adrenocortical insufficiency. Design and Methods: Two-dimensionally guided M-mode echocardiograms and spectral Doppler studies were performed in seven consecutive patients with newly diagnosed autoimmune primary adrenal failure before and 4-8 months after an adequate regimen of steroid substitution. Echocardiographic parameters were also studied in ten healthy controls. Results: In the cases with untreated Addison's disease, both left ventricular end-systolic and enddiastolic dimensions were significantly reduced in comparison with those in controls (P < 0.01). Four patients had echocardiographic signs of mitral valve prolapse (MVP) at the anterior leaflet, with no evidence of mitral regurgitation by Doppler echocardiography. Systolic clicks characteristic of MVP were present on auscultation in two of these cases. Left ventricular chamber size normalized, i.e. significantly increased (P < 0.01), and both echocardiographic and physical signs of MVP resolved after steroid substitution in all patients. All other echocardiographic indices were normal before and after treatment. Conclusions: Patients with untreated Addison's disease have cardiac abnormalities which regress after steroid substitution. A valvular-ventricular disproportion due to the hypovolemic state could explain these findings.

Essential role of stress hormone signaling in cardiomyocytes for the prevention of heart disease

“…In addition, patients with Addison disease, a lifethreatening disorder characterized by decreased production of glucocorticoids, present with weak hearts (20). Although heart failure secondary to Addison disease has been described (21), cardiac hypertrophy has not been reported, perhaps reflecting the diagnosis and effective treatment of individuals before cardiac abnormalities become severe (22). Alternatively, because Addison disease operates at a systemic level and is also accompanied by insufficient mineralocorticoid signaling, the resulting heart pathology in these patients may differ from the cardiac abnormalities detected in the cardioGRKO mice, where glucocorticoid signaling is deficient only in cardiomyocytes.…”

Dehydroepiandrosterone substitution in female adrenal failure: no impact on endothelial function and cardiovascular parameters despite normalization of androgen status

“…Fallo et al . described reduced left ventricular dimensions in untreated patients with Addison's disease, which normalized after substitution 26 and Allolio et al . found impaired left diastolic relaxation after 48 h of withdrawal of glucocorticoid therapy 27 .…”

“…However, it was quite surprising to find that all included patients had concentric remodelling of the left ventricle, despite the young age of participants and the absence of hypertension or other concomitant disease. Fallo et al described reduced left ventricular dimensions in untreated patients with Addison's disease, which normalized after substitution 26 and Allolio et al found impaired left diastolic relaxation after 48 h of withdrawal of glucocorticoid therapy. 27 Aldosterone has trophic effects on the myocardium, but its role in the nonfailing heart seems modest.…”

Cardiac dysfunction in cirrhosis – does adrenal function play a role? A hypothesis

“…Four patients also had echocardiographic signs of mitral valve prolapse (MVP) without evidence of mitral regurgitation. After corticosteroid replacement, LV chamber size normalized and MVP resolved . Hypovolemia did not provide an adequate explanation for these findings, as baseline blood pressure and heart rate were normal.…”