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Yan H, Qi Q, Zhang K, He B, Chu G, Wang G, Wen H, Zhao Y, Liu H, Zhao L, Chen Y. Adrenal crisis and acute exacerbation of interstitial lung disease after thymoma needle biopsy: a case report and literature review. Transl Lung Cancer Res 2021; 10:3292-3302. [PMID: 34430365 PMCID: PMC8350080 DOI: 10.21037/tlcr-21-195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/20/2021] [Indexed: 11/30/2022]
Abstract
Thymoma is the most common paraneoplastic syndrome–associated tumor. It is related to a variety of autoimmune diseases including myasthenia gravis, systemic lupus erythematosus, and hypogammaglobulinemia. Only a few reports of thymoma associated with Addison’s disease have been reported to date. Herein, we report a novel case of thymoma complicated with autoimmune Addison’s disease and interstitial lung disease. The patient developed adrenal crisis with persistent hypotensive shock and heart block after needle biopsy. Acute exacerbation of the interstitial lung disease was also observed, accompanied by severe respiratory failure. After treatment with glucocorticoids, somatostatin, and temporary pacemaker implantation, the patient’s condition improved, and the thymoma had shrunk in size. Finally, he underwent transsternal extended thymectomy and lymph node dissection. Hydrocortisone was given intravenously before surgery, on the operation day and after the surgery. The operation was uneventful, and no hypotension or fever occurred. Cortisol and ACTH were still obviously abnormal at 1 month post-surgery. The clinical manifestations of Addison’s disease and interstitial lung disease are hidden and can be easily overlooked. However, in the postoperative period, Addison’s disease can lead to adrenal crisis developing, which can progress to life-threatening shock, arrhythmia, and acute respiratory failure. Therefore, clinicians should be aware of this phenomenon and consider a regimen combining proactive glucocorticoid replacement therapy with somatostatin to preserve the life of such patients.
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Affiliation(s)
- Hengyi Yan
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qi Qi
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Kai Zhang
- Department of Gastroenterology, Endoscopic Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bing He
- The First Endocrinology Department, Shengjing Hospital of China Medical University, Shenyang, China
| | - Guoming Chu
- Department of Clinical Genetics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Guan Wang
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Hua Wen
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yanyan Zhao
- Department of Clinical Genetics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hongxu Liu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Li Zhao
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yu Chen
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
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Takotsubo Cardiomyopathy Secondary to Adrenal Insufficiency: A Case Report and Literature Review. Case Rep Cardiol 2020; 2020:6876951. [PMID: 32566318 PMCID: PMC7298333 DOI: 10.1155/2020/6876951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 03/22/2020] [Accepted: 03/28/2020] [Indexed: 01/01/2023] Open
Abstract
We report a case of a middle-aged female who presented with altered mental status, hypotension, and hypoglycemia and was diagnosed with secondary adrenal insufficiency. She was also found to have elevated troponin I on initial evaluation with diffuse T wave inversions on electrocardiogram. Transthoracic echocardiogram revealed ejection fraction of 38% with apical akinesia. Subsequent left heart catheterization revealed clean coronary arteries. She was diagnosed with typical Takotsubo cardiomyopathy secondary to adrenal insufficiency. She was managed with IV hydrocortisone with resolution of symptoms. This article adds to the select few cases in the literature of the association of Takotsubo cardiomyopathy resulting from secondary adrenal insufficiency.
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3
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Verhoestraete P, Carpentier M, Donck J, Vandekerckhove H. Dilated cardiomyopathy and rhabdomyolysis caused by hypopituitarism: a challenging diagnosis. Acta Cardiol 2019; 75:593-597. [PMID: 31536463 DOI: 10.1080/00015385.2019.1665848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | | | - Jan Donck
- Department of Nephrology, AZ Sint-Lucas Ghent, Ghent, Belgium
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4
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Huang D, Kreitler K, Tilton S, Cavarocchi NC, Hirose H. Cardiogenic Shock Requiring Extracorporeal Membrane Oxygenation Support in a Patient with Panhypopituitarism: A Case Report. Cureus 2019; 11:e4995. [PMID: 31497426 PMCID: PMC6726413 DOI: 10.7759/cureus.4995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We present a 58-year-old female with a past history of a pituitary adenoma resected two years prior to admission who developed polymorphic ventricular tachycardia and cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO). We noted that the patient had stopped taking all of her medications six months prior to presentation. An extensive workup revealed acute panhypopituitarism with secondary hypothyroidism, secondary adrenal insufficiency, and central diabetes insipidus. She was immediately initiated on thyroid and adrenal hormone replacement therapy as well as fluid replacement. Within five days of her medical treatment, the patient's cardiac function improved and she was successfully weaned from VA-ECMO and subsequently discharged home with appropriate hormone replacement therapy.
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Affiliation(s)
- Denis Huang
- Surgery, Thomas Jefferson University, Philadelphia, USA
| | - Kristin Kreitler
- Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Scott Tilton
- Surgery, Critical Care, Penn Presbyterian Medical Center, Philadelphia, USA
| | | | - Hitoshi Hirose
- Cardiothoracic Surgery, Thomas Jefferson University, Philadelphia, USA
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5
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Gupta S, Goyal P, Idrees S, Aggarwal S, Bajaj D, Mattana J. Association of Endocrine Conditions With Takotsubo Cardiomyopathy: A Comprehensive Review. J Am Heart Assoc 2018; 7:e009003. [PMID: 30371307 PMCID: PMC6404898 DOI: 10.1161/jaha.118.009003] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Sonali Gupta
- Department of MedicineSt. Vincent's Medical CenterBridgeportCT
- The Frank H. Netter MD School of Medicine at Quinnipiac UniversityNorth HavenCT
| | - Pradeep Goyal
- The Frank H. Netter MD School of Medicine at Quinnipiac UniversityNorth HavenCT
- Department of RadiologySt. Vincent's Medical CenterBridgeportCT
| | - Sana Idrees
- Department of MedicineSt. Vincent's Medical CenterBridgeportCT
- The Frank H. Netter MD School of Medicine at Quinnipiac UniversityNorth HavenCT
| | - Sourabh Aggarwal
- Cardiology DivisionDepartment of MedicineUniversity of Nebraska Medical CenterOmahaNE
| | - Divyansh Bajaj
- Department of MedicineSt. Vincent's Medical CenterBridgeportCT
- The Frank H. Netter MD School of Medicine at Quinnipiac UniversityNorth HavenCT
| | - Joseph Mattana
- Department of MedicineSt. Vincent's Medical CenterBridgeportCT
- The Frank H. Netter MD School of Medicine at Quinnipiac UniversityNorth HavenCT
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6
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Manthri S, Bandaru S, Ibrahim A, Mamillapalli CK. Acute Pericarditis as a Presentation of Adrenal Insufficiency. Cureus 2018; 10:e2474. [PMID: 29904615 PMCID: PMC5999392 DOI: 10.7759/cureus.2474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Acute pericarditis as a presenting sign of adrenal insufficiency is rarely reported. We present a rare case that highlights pericarditis as a clinical presentation of secondary adrenal insufficiency later complicated by cardiac tamponade. A 44-year-old lady who presented to the hospital with a one-day history of pleuritic chest pain and shortness of breath. In the emergency room, she had a blood pressure of 70/35 mmHg. Laboratory evaluation revealed white blood cell count of 16.08 k/cumm with neutrophilia, normal renal function and elevated troponin (0.321 ng/mL, normal 0.000-0.028). An electrocardiogram (EKG) showed sinus tachycardia, low voltage, PR suppression and ST changes consistent with acute pericarditis. Echocardiogram showed small pericardial effusion without tamponade physiology. Infectious workup was negative; she was thought to have acute adrenal insufficiency likely secondary to viral pericarditis. We treated the patient with high dose nonsteroidal anti-inflammatory drugs (NSAIDS) and hydrocortisone. Three weeks later, she presented to emergency room with complaints of persistent nausea, vomiting, chills, weakness. Her blood pressure was 49/23 mmHg. Random serum cortisol level was <1.2 mcg/dl (normal A.M. specimens 3.7-19.4 mcg/dl). Echocardiogram showed loculated pericardial fluid adjacent to the right ventricle with echocardiographic evidence of tamponade. Emergent pericardiocentesis yielded 250 ml of straw color fluid. Blood pressure improved after the procedure. The patient was initially started on IV stress dose steroids, but following clinical stabilization, hydrocortisone was switched to a physiological dose of 15 mg in am and 10 mg in pm. Although the mechanism of pericarditis in adrenal failure is unknown, this clinical presentation may help early diagnosis of adrenal failure and pericarditis. Early recognition and prompt treatment of this rare presentation are critical to prevent morbidity and mortality.
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Affiliation(s)
- Sukesh Manthri
- Department of Geriatrics, Saint Louis University School of Medicine
| | - Sindhura Bandaru
- Department of Internal Medicine, Southern Illinois University School of Medicine
| | - Abdisamad Ibrahim
- Department of Internal Medicine, Southern Illinois University School of Medicine
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7
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De Giorgi A, Fabbian F, Tiseo R, Parisi C, Misurati E, Molino C, Pala M, Salmi R, Volpi R, Manfredini R. Takotsubo cardiomyopathy and endocrine disorders: a mini-review of case reports. Am J Emerg Med 2014; 32:1413-7. [PMID: 25261397 DOI: 10.1016/j.ajem.2014.07.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 07/17/2014] [Accepted: 07/26/2014] [Indexed: 01/20/2023] Open
Affiliation(s)
- Alfredo De Giorgi
- Clinica Medica, Department of Medicine, Azienda Ospedaliera-Universitaria (AOU), Ferrara, Italy.
| | - Fabio Fabbian
- Clinica Medica, Department of Medicine, AOU, Ferrara, Italy.
| | - Ruana Tiseo
- Clinica Medica, Department of Medicine, AOU, Ferrara, Italy.
| | - Claudia Parisi
- Clinica Medica, Department of Medicine, AOU, Ferrara, Italy.
| | - Elisa Misurati
- Clinica Medica, Department of Medicine, AOU, Ferrara, Italy.
| | | | - Marco Pala
- Clinica Medica, Department of Medicine, AOU, Ferrara, Italy.
| | - Raffaella Salmi
- Second Internal Medicine, Department of Medicine, AOU, Ferrara, Italy.
| | - Riccardo Volpi
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
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8
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Fernández Simón I, Alcántara Carmona S, Fernández Muñoz R, Martínez Álvarez L, Rodríguez C, Lipperheide Vallhonrat I. Shock cardiogénico por panhipopituitarismo. Med Intensiva 2014; 38:329-30. [DOI: 10.1016/j.medin.2013.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 04/11/2013] [Accepted: 04/21/2013] [Indexed: 10/26/2022]
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9
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Moore PK, Marzec LN, Krantz MJ. Signs of stress: deep symmetric T-wave inversions. Am J Med 2013; 126:682-4. [PMID: 23764264 DOI: 10.1016/j.amjmed.2013.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 03/08/2013] [Accepted: 03/08/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Peter K Moore
- Department of Medicine, Cardiology Division, Denver Health Medical Center, Denver, CO 80204, USA
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10
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Minette MS, Hoyer AW, Pham PP, DeBoer MD, Reller MD, Boston BA. Cardiac function in congenital adrenal hyperplasia: a pattern of reversible cardiomyopathy. J Pediatr 2013; 162:1193-8, 1198.e1. [PMID: 23337094 DOI: 10.1016/j.jpeds.2012.11.086] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 10/10/2012] [Accepted: 11/29/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate cardiac function in infants with congenital adrenal hyperplasia (CAH) before and after corticosteroid replacement therapy. STUDY DESIGN This prospective, case-control study included 9 infants with CAH. Cardiac function was assessed by echocardiography at presentation and after corticosteroid replacement therapy. Six term infants underwent 2 echocardiograms each and served as the control group. Data on fractional shortening (FS), rate-corrected velocity of circumferential fiber shortening (Vcf), wall stress, tissue Doppler indices, myocardial performance index, left ventricular mass, and Vcf/wall stress were obtained. RESULTS The infants with CAH exhibited myocardial dysfunction at baseline and lower systolic blood pressure (SBP) compared with the control group. FS, a measure of systolic contractility, differed significantly from before to after corticosteroid treatment (mean, 32.3%±4.7% pretreatment, 39.9%±5.0% posttreatment). Vcf, a preload-independent measure of cardiac contractility, also differed significantly before and after treatment (mean, 1.23±0.16 circumferences/second pretreatment, 1.45±0.22 circumferences/second posttreatment). SBP was also lower (mean, 84±9.3 mmHg) and improved with treatment (mean, 95±4.8 mmHg). The control group demonstrated no statistically significant changes in FS, Vcf, or SBP. There was a change in left ventricular mass in the control group between the 2 studies. CONCLUSION Newborns with CAH have evidence for cardiac dysfunction at baseline that reverses with corticosteroid replacement therapy. These data suggest that corticosteroids play a direct role in modulating cardiac function in the newborn.
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Affiliation(s)
- Mary S Minette
- Division of Pediatric Cardiology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA.
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11
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Affiliation(s)
- Shrenik Doshi
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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12
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Isolated adrenocorticotropin deficiency associated with delirium and takotsubo cardiomyopathy. Case Rep Endocrinol 2012; 2012:580481. [PMID: 23243525 PMCID: PMC3518949 DOI: 10.1155/2012/580481] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 11/05/2012] [Indexed: 11/24/2022] Open
Abstract
We report a 65-year-old woman with isolated adrenocorticotropic hormone (ACTH) deficiency. The patient was transported to the emergency outpatient department by ambulance complaining of malaise and nausea. Because her laboratory data revealed hyponatremia, we performed endocrinological examinations and diagnosed isolated ACTH deficiency. After admission, she went into a delirious state and suffered from takotsubo cardiomyopathy due to adrenal insufficiency. Replacement therapy with hydrocortisone sufficiently improved her delirium and cardiomyopathy. We conclude that her unstable mental state and myocardial dysfunction were closely related to adrenal insufficiency and suggest that adrenal crisis may cause delirium and Takotsubo cardiomyopathy.
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13
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Theocharidou E, Krag A, Bendtsen F, Møller S, Burroughs AK. Cardiac dysfunction in cirrhosis - does adrenal function play a role? A hypothesis. Liver Int 2012; 32:1327-32. [PMID: 22292920 DOI: 10.1111/j.1478-3231.2011.02751.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 12/20/2011] [Indexed: 12/12/2022]
Abstract
Cirrhotic cardiomyopathy (CCM), a condition of unknown pathogenesis, is characterized by suboptimal ventricular contractile response to stress, diastolic dysfunction and QT interval prolongation. It is most often found in patients with advanced cirrhosis. It is clinically relevant during stressful conditions, such as sepsis, bleeding and surgery. CCM reverses after liver transplantation and potentially has a role in the pathogenesis of hepatorenal syndrome. In adrenal insufficiency (AI), cardiac dysfunction is a feature with low ejection fraction, decreased left ventricular chamber size and electrocardiographic abnormalities, including QT interval prolongation. With optimal diagnostic tests, AI is present in approximately 10% of patients with cirrhosis, particularly in those with advanced disease. Down-regulation and decreased number of beta-adrenergic receptors, and high catecholamine levels are common to both cardiac conditions. Thus, AI may play a role in CCM. Steroid replacement therapy reverses cardiac changes in AI, and may do so for CCM, with important therapeutic implications; this needs formal evaluation.
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Affiliation(s)
- Eleni Theocharidou
- The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital, Royal Free Hampstead NHS Trust and UCL, London, UK
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Shimizu M, Monguchi T, Takano T, Miwa Y. Isolated ACTH deficiency presenting with severe myocardial dysfunction. J Cardiol Cases 2011; 4:e26-e30. [PMID: 30546710 PMCID: PMC6265152 DOI: 10.1016/j.jccase.2011.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 04/21/2011] [Accepted: 05/06/2011] [Indexed: 10/18/2022] Open
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.
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Affiliation(s)
- Masatoshi Shimizu
- Department of Cardiology, National Hospital Organization Kobe Medical Center, Kobe, Japan
| | - Tomoko Monguchi
- Department of Internal Medicine, National Hospital Organization Kobe Medical Center, Kobe, Japan
| | - Takatsugu Takano
- Department of Cardiology, National Hospital Organization Kobe Medical Center, Kobe, Japan
| | - Yoichi Miwa
- Department of Internal Medicine, National Hospital Organization Kobe Medical Center, Kobe, Japan
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15
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Nishizawa S, Nakamura T, Hamaoka T, Matsumuro A, Sawada T, Matsubara H. Lethal arrhythmia and corticosteroid insufficiency. Am J Emerg Med 2010; 27:1167.e1-3. [PMID: 19931775 DOI: 10.1016/j.ajem.2008.12.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Accepted: 12/02/2008] [Indexed: 10/20/2022] Open
Abstract
We describe a case of isolated adrenocorticotropic hormone deficiency that showed ventricular fibrillation associated with QT prolongation. A 72-year-old man was admitted because of consciousness disorder caused by severe hypoglycemia. On the second hospital day, QT intervals were unexpectedly prolonged and ventricular fibrillation occurred. Electrical defibrillation was performed and restored hemodynamically stable condition without neurologic deficits. He was diagnosed with endocrine tests as having isolated adrenocorticotropic hormone deficiency. QT prolongation was improved after hydrocortisone replacement therapy. We considered the QT prolongation was caused by corticosteroid insufficiency. We should be aware that corticosteroid insufficiency may provoke QT prolongation responsible for sudden cardiac death.
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Affiliation(s)
- Shinya Nishizawa
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
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Desai NR, Cheng S, Nohria A, Halperin F, Giugliano RP. Clinical problem-solving. When past is prologue. N Engl J Med 2009; 360:1016-22. [PMID: 19264691 DOI: 10.1056/nejmcps0805508] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Nihar R Desai
- Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
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17
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Ukita C, Miyazaki H, Toyoda N, Kosaki A, Nishikawa M, Iwasaka T. Takotsubo cardiomyopathy during acute adrenal crisis due to isolated adrenocorticotropin deficiency. Intern Med 2009; 48:347-52. [PMID: 19252360 DOI: 10.2169/internalmedicine.48.1662] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
We report a 69-year-old woman who had isolated adrenocorticotropic hormone (ACTH) deficiency. Subsequently, she had Takotsubo cardiomyopathy during acute adrenal crisis. Replacement therapy with hydrocortisone sufficiently improved her cardiomyopathy. We conclude that her myocardial dysfunction was closely related to adrenal insufficiency and suggest that in certain circumstances, adrenal crisis may cause Takotsubo cardiomyopathy.
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Affiliation(s)
- Chizuko Ukita
- The Second Department of Internal Medicine, Kansai Medical University, Osaka.
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18
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Coze S, Benyamine A, Serratrice J, Chlavignac V, Bernard F, Amri AB, Dubois N, Gariboldi V, Guidon C, Devolx BC, Weiller P. Un syndrome redoutable : l’insuffisance cardiaque gravissime de l’insuffisance surrénale aiguë. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sakihara S, Kageyama K, Nigawara T, Kidani Y, Suda T. Ampulla (Takotsubo) cardiomyopathy caused by secondary adrenal insufficiency in ACTH isolated deficiency. Endocr J 2007; 54:631-6. [PMID: 17664847 DOI: 10.1507/endocrj.k07-012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
We describe here a case of reversible ampulla (takotsubo) cardiomyopathy caused by secondary adrenal insufficiency in ACTH isolated deficiency. A 53-year-old woman was referred to our department for evaluation and treatment of unconsciousness. On admission, her plasma glucose level was 34 mg/dL, suggesting loss of consciousness due to hypoglycemia. Basal levels of ACTH, cortisol, and dehydroepiandrosterone sulfate in blood, and urinary free cortisol levels were all decreased. ACTH and cortisol levels were not adequately increased in response to CRH administration and the insulin tolerance test. Electrocardiography showed ST segment elevation and T wave inversion in leads V 1-6. The coronary arteries were free of organic stenosis, and a left ventriculogram revealed severe hypokinesis, particularly in the anterior and posterior walls. Based on a diagnosis of adrenocortical insufficiency caused by ACTH isolated deficiency, hydrocortisone was administered. Two weeks after treatment, ultrasound studies of the heart showed recovery of left ventricular wall motion. Activation of the sympathetic nervous system, adrenocortical failure, and hypoglycemic attack were considered to be triggering factors for the takotsubo cardiomyopathy. Careful monitoring of cardiac function and appropriate treatments for both cardiomyopathy and adrenocortical failure are required to recover cardiac dysfunction.
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Affiliation(s)
- Satoru Sakihara
- Department of Endocrinology and Metabolism, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan
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Lavis VR, Picolos MK, Willerson JT. Endocrine Disorders and the Heart. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Ali RY, Haque B, Irish K, Hilwa S, Arjomand F. REVERSIBLE CARDIOMYOPATHY IN A 35-YEAR-OLD MALE WITH ADRENAL INSUFFICIENCY. Chest 2005. [DOI: 10.1378/chest.128.4_meetingabstracts.453s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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22
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Wang SY, Hsu SR, Su SL, Tu ST. Sheehan's syndrome presenting with early postpartum congestive heart failure. J Chin Med Assoc 2005; 68:386-91. [PMID: 16138719 DOI: 10.1016/s1726-4901(09)70181-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
We report the case of a young woman with Sheehan's syndrome who presented with ventricular arrhythmia and congestive heart failure. The patient was admitted because of postpartum hemorrhage and hypovolemic shock; a massive blood transfusion was required to restore blood volume. After initial stabilization, the patient developed acute respiratory distress and congestive heart failure accompanied by hemodynamic instability 2 weeks after delivery. Episodes of ventricular tachycardia of the torsade de pointes type and a prolonged QT interval were noted on baseline electrocardiogram. A low cortisol level was found incidentally, which led to the suspicion of hypopituitarism. The diagnosis was later supported by laboratory findings of multiple pituitary hormone deficiencies. After administration of corticosteroids and thyroxine, the patient's clinical condition improved dramatically. A pituitary magnetic resonance imaging scan 32 days after delivery revealed a diminished and flattened pituitary gland with prominent intrasellar cerebrospinal fluid loculation, which was compatible with the clinical diagnosis of empty sella with panhypopituitarism. The syndrome of acute anterior pituitary necrosis secondary to postpartum hemorrhage and shock was first described by Sheehan in 1939. Although the occurrence of Sheehan's syndrome is now rare, it should still be considered in any woman with a history of peripartum hemorrhage who develops manifestations of pituitary hormone deficiency. Appropriate hormone replacement therapy is essential and always results in dramatic clinical improvement.
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Affiliation(s)
- Shu-Yi Wang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
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Maffei P, Cajola S, Abrahamsohn C, Martini C. Rapidly reversible ECG abnormalities in chronic secondary adrenal insufficiency. Int J Cardiol 2002; 86:333-6. [PMID: 12419576 DOI: 10.1016/s0167-5273(02)00303-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Dünser MW, Mayr AJ, Gasser R, Rieger M, Friesenecker B, Hasibeder WR. Cardiac failure and multiple organ dysfunction syndrome in a patient with endocrine adenomatosis. Acta Anaesthesiol Scand 2002; 46:1161-4. [PMID: 12366515 DOI: 10.1034/j.1399-6576.2002.460918.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In this case report, we present the successful therapy of severe cardiac failure in pituitary adrenal insufficiency. A previously healthy 56-year-old-man in pituitary coma due to an atypical variant of multiple endocrine adenomatosis (pituitary adenoma and pheochromocytoma) suffered from cardiac failure resistant to catecholamine and standard hydrocortisone therapy. After two bolus injections of dexamethasone (2 x 24 mg) mean arterial pressure and cardiac function dramatically improved, probably due to restoration of permissive effects on catecholamine action and reversal of pathophysiological mechanisms of cardiac failure. We conclude that in patients with severe cardiovascular failure in pituitary coma the administration of potent glucocorticoids may be more effective in reversing cardiovascular failure than standard dosages of hydrocortisone.
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Affiliation(s)
- M W Dünser
- Division of General and Surgical Intensive Care Medicine, Department of Anesthesia and Critical Care Medicine, the Leopold Franzens University of Innsbruck, Innsbruck, Austria.
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