Why the study?
Stress cardiomyopathy secondary to adrenal crisis is a rare phenomenon relevant to early clinical detection.
Adrenal crisis is a rare but reversible cause of stress cardiomyopathy that can lead to sudden cardiac arrest and responds to hydrocortisone therapy.
Prompt recognition of hyperkalemic arrest in young adults warrants urgent adrenal workup; leaves open reversibility of associated LV dysfunction.
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.
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Harris et al. (2021) studied this question.
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