A Case of Adrenal Crisis-Induced Stress Cardiomyopathy

Abstract

We report a case of a 36-year-old male who presented to the emergency department with complaints of weakness. On presentation the patient was hypotensive, hyperkalemic, and hyponatremic. The patient experienced a sudden cardiac arrest in the computed tomography (CT) scanner moments after arrival. Electrocardiogram (EKG) demonstrated PR prolongation and widened QRS. Echocardiogram demonstrated a left ventricular ejection fraction of 26%-30% with evidence of severe hypokinesis of the mid antero-septal and inferior-septal segments of the left ventricle. CT of the chest, abdomen, and pelvis demonstrated hypoplastic/atrophic adrenal glands. Total cortisol level was undetectable by lab measurement. The patient was diagnosed with stress cardiomyopathy secondary to adrenal crisis. He was managed with hydrocortisone and eventually made a full clinical recovery and improvement in left ventricular ejection fraction. This article references the rarity of this phenomenon and its relevance to early clinical detection.