Case Reports in Cardiology / 2016 / Article / Tab 1

Case Report

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 yearAge/sexCV manifestationsLVEF (%)TreatmentOutcome

Cushner et al. [4]196353/MDyspnea, orthopnea, LV enlargement, pulmonary edema, and right pleural effusionN/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]199847/FEdema, dyspnea, tachypnea, lung crepitations, cardiomegaly, and pulmonary congestionN/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]200036/MDyspnea, fatigue, dizziness, malaise, and tachycardia25%(1) Corticosteroid therapy
(2) No treatment for CHF
(i) At 7 weeks, LVEF improved to 55%
Wolff et al. [7]200742/FHypotension, tachycardia, respiratory failure, bilateral pulmonary edema, and cardiogenic shock30%(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]201321/MNausea, weakness, progressive dyspnea, asystolic cardiac arrest, pericardial effusion, severe biventricular failure, and cardiogenic shockN/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.201630/MOrthopnea, dyspnea, elevated jugular venous pressure, elevated BNP, dilated LV, severe systolic dysfunction, and bilateral pleural effusions15(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.

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