Reversible Cardiomyopathy Accompanied by Secondary Adrenal Insufficiency

Ikegami, Yasuyuki; Fukuda, Taeko; Jo, Rie; Momiyama, Yukihiko

doi:10.1161/circheartfailure.115.002919

Cited by 7 publications

(6 citation statements)

References 3 publications

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“…Notably, cardiovascular manifestations of adrenal insufficiency, including dilated cardiomyopathy, arrhythmias, and Takotsubo cardiomyopathy, were rarely reported in primary and secondary adrenal insufficiency ( 4 , 9 , 10 ). The underlying mechanisms may involve downregulation of adrenergic receptors, membrane calcium transporter dysfunction, decreased phosphorylase activity, increased catecholamine levels, and disturbances in electrolyte levels ( 11 , 12 ).…”

Section: Discussionmentioning

confidence: 99%

“…It is reported that more than 30% of patients receiving corticosteroids may develop tertiary adrenal insufficiency ( 2 ). Primary and secondary adrenal insufficiency are considered quite rare causes of dilated cardiomyopathy ( 3 , 4 ). However, to the best of our knowledge, no case of cardiomyopathy associated with tertiary adrenal insufficiency has been reported in the literature.…”

Section: Introductionmentioning

confidence: 99%

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Cardiomyopathy Associated With Tertiary Adrenal Insufficiency Manifesting as Refractory Heart Failure, Shock, and Sudden Cardiac Death: A Case Report

Wang

Luo

Feng

2021

Front. Cardiovasc. Med.

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Dilated cardiomyopathy is an etiologically heterogeneous disorder. Early diagnosis and prompt treatment of the underlying disease are of great significance. Primary and secondary adrenal insufficiency are considered quite rare causes of dilated cardiomyopathy. However, to the best of our knowledge, no case of cardiomyopathy associated with tertiary adrenal insufficiency has been reported. Herein, we described a 68-year-old woman with a 15-year history of seasonal dermatitis presented with frequent heart failure and shock. At first, she was diagnosed with idiopathic dilated cardiomyopathy, but standard heart failure and antishock treatment failed. Given her long-term use of dexamethasone for treating seasonal dermatitis, and clinical manifestations consistent with adrenal insufficiency, we tested her basal plasma cortisol, simultaneous corticotropin, and other pituitary hormones, confirming that she had tertiary adrenal insufficiency. Additionally, abdominal enhanced computed tomography revealed atrophic bilateral adrenal glands, indicating long-standing and severe adrenal insufficiency. Then hydrocortisone replacement therapy was initiated, and she recovered rapidly. During the next 2 years of follow-up, she never experienced any episodes of heart failure and shock. Unfortunately, she refused the implantation of defibrillator with cardiac resynchronization therapy (CRT-D) and died of sudden cardiac death 2 years later. Although we could not exclude the coincidence of idiopathic dilated cardiomyopathy with tertiary adrenal insufficiency with 100% certainty, her unique clinical course strongly indicated that her cardiomyopathy resulted from tertiary adrenal insufficiency. This case demonstrates that patients on corticosteroids are at risk for tertiary adrenal insufficiency, which may result in refractory cardiomyopathy and even sudden cardiac death.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cardiomyopathy Associated With Tertiary Adrenal Insufficiency Manifesting as Refractory Heart Failure, Shock, and Sudden Cardiac Death: A Case Report

Wang

Luo

Feng

2021

Front. Cardiovasc. Med.

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“…Adrenal insufficiency can precipitate heart failure [53,54] and even necessitate VA ECMO support in severe cases [51,55]. It is unknown to what extent (relative) adrenal insufficiency plays a role in ECMO weaning failure.…”

Section: Endocrine Effectsmentioning

confidence: 99%

The ABCDE approach to difficult weaning from venoarterial extracorporeal membrane oxygenation

2022

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Venoarterial extracorporeal membrane oxygenation (VA ECMO) has been increasingly applied in patients with cardiogenic shock in recent years. Nevertheless, many patients cannot be successfully weaned from VA ECMO support and 1-year mortality remains high. A systematic approach could help to optimize clinical management in favor of weaning by identifying important factors in individual patients. Here, we provide an overview of pivotal factors that potentially prevent successful weaning of VA ECMO. We present this through a rigorous approach following the relatable acronym ABCDE, in order to facilitate widespread use in daily practice.

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“…Outros casos descritos na literatura expõem a reversibilidade da miocardiopatia dilatada quando associada à síndrome de Sheehan; porém, a maioria deles associando reposição hormonal e terapia direcionada à ICC com fração de ejeção reduzida. 7,[9][10][11][12] Doshi et al, 3 abordaram o caso clínico de uma paciente de 42 anos com uma apresentação de emergência de choque cardiogênico secundário a pan-hipopituitarismo devido à síndrome de Sheehan. Amenorreica há 14 anos (data da última gestação), a paciente foi tratada com glicocorticoide, levotiroxina e 48 horas de uso de inotrópico.…”

Section: Relato De Casounclassified

Reversibilidade da Cardiomiopatia Dilatada na Síndrome de Sheehan: Um Relato de Caso

Dourado¹,

Costa²,

Carvalho³

et al. 2021

Arquivos Brasileiros De Cardiologia

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Reversible Cardiomyopathy Accompanied by Secondary Adrenal Insufficiency

Cited by 7 publications

References 3 publications

Cardiomyopathy Associated With Tertiary Adrenal Insufficiency Manifesting as Refractory Heart Failure, Shock, and Sudden Cardiac Death: A Case Report

Cardiomyopathy Associated With Tertiary Adrenal Insufficiency Manifesting as Refractory Heart Failure, Shock, and Sudden Cardiac Death: A Case Report

The ABCDE approach to difficult weaning from venoarterial extracorporeal membrane oxygenation

Reversibilidade da Cardiomiopatia Dilatada na Síndrome de Sheehan: Um Relato de Caso

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