Addison’s Disease and Dilated Cardiomyopathy: A Case Report and Review of the Literature

Table 1

Summary of adult case reports of Addison’s disease and dilated cardiomyopathy.

Case (reference)	Report year	Age/sex	CV manifestations	LVEF (%)	Treatment	Outcome
Cushner et al. [4]	1963	53/M	Dyspnea, orthopnea, LV enlargement, pulmonary edema, and right pleural effusion	N/A	(1) Meralluride, anticoagulation therapy, quinidine, digitalis; (2) ACTH, 20 units; (3) 9-alpha-Fluorohydrocortisone, 0.2 mg 3 times daily for 7 days prior to death	Day 20—decrease in pulmonary congestion Day 31—patient died
Bhattacharyya and Tymms [5]	1998	47/F	Edema, dyspnea, tachypnea, lung crepitations, cardiomegaly, and pulmonary congestion	N/A	(1) IV furosemide for 6 days; (2) Fludrocortisone dosage decreased by 50% (from 30 mg daily) and then stopped after 2 days	(i) CHF symptoms resolved; (ii) Addisonian crisis at 8 months, treated with hydrocortisone and; fludrocortisone; (iii) At 12 months, patient was doing well
Afzal and Khaja [6]	2000	36/M	Dyspnea, fatigue, dizziness, malaise, and tachycardia	25%	(1) Corticosteroid therapy; (2) No treatment for CHF	(i) At 7 weeks, LVEF improved to 55%
Wolff et al. [7]	2007	42/F	Hypotension, tachycardia, respiratory failure, bilateral pulmonary edema, and cardiogenic shock	30%	(1) IV hydrocortisone loading dose 100 mg and thereafter 10 mg/h; (2) Mechanical ventilation and continuous norepinephrine at 4.4 μg/kg min; (3) At discharge, oral hydrocortisone and fludrocortisone, standard	(i) At discharge, the LVEF improved to 52% with no evidence of wall-motion abnormalities
Krishnamoorthy et al. [8]	2013	21/M	Nausea, weakness, progressive dyspnea, asystolic cardiac arrest, pericardial effusion, severe biventricular failure, and cardiogenic shock	N/A	(1) TandemHeart implantation; (2) IV hydrocortisone loading dose 100 mg and thereafter 50 mg/8 h; (3) Weaned to physiologic dose of oral hydrocortisone by discharge; (4) 2 months after discharge, mineralocorticoid replacement for hypotension	(i) At 2 weeks after RVAD and LVAD removal, normal biventricular function; (ii) At 2 months, remained well
Mozolevska et al.	2016	30/M	Orthopnea, dyspnea, elevated jugular venous pressure, elevated BNP, dilated LV, severe systolic dysfunction, and bilateral pleural effusions	15	(1) IV furosemide, 40 mg oral at discharge; (2) Ramipril 5 mg; (3) Bisoprolol 10 mg; (4) Fludrocortisone dosage decreased by 50% (from 0.1 mg daily), prednisone unchanged at 5 mg daily	(i) LVEF improved to 44

LV, left ventricle; IV, intravenous; CHF, congestive heart failure; LVEF, left ventricular ejection fraction; ICU, intensive care unit; RVAD, right ventricular assist device; LVAD, left ventricular assist device; BNP, brain natriuretic peptide.