Reversible Heart Failure as a Result of Newly Diagnosed Primary Adrenal Insufficiency

Abstract

Objective: We report a case of primary adrenal insufficiency which presented with a rare finding of fulminant cardiogenic shock that improved with hydrocortisone administration. The presentation, clinical manifestations, laboratory results, radiologic findings, and management of a patient that developed cardiogenic shock as the result of an Addisonian crisis are described. Pertinent literature, physiology, and management are discussed. Methods: A 21-year-old male with a 1-year history of nausea and dizziness presented with a 3-day history of malaise, sore throat, fever, and weakness. The patient was hypotensive and was admitted to a local hospital for possible septic shock with low ejection fraction (EF). The patient subsequently developed a rapidly progressive cardiogenic shock requiring intubation and placement of biventricular assist devices. Results: The patient was diagnosed with adrenal insufficiency after mental status change and persistent cardiogenic shock. Stress-dose steroids were initiated and rapid improvement followed. EF returned to normal after 5 days and the ventricular assist devices were removed. Conclusion: In this case, primary adrenal insufficiency presented with reversible fulminate biventricular heart failure and other end organ dysfunction that was resolved with support and stress-dose steroids. This was an unusual presentation of adrenal insufficiency, which led to a delayed diagnosis. This case illustrates the importance of considering adrenal insufficiency in unexplained heart failure. Abbreviations: EF = ejection fraction; IV = intravenous; PCP = primary care provider