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Reversible cardiomyopathy in paediatric Addison's disease--a cautionary tale
L S Conwell1, L M Gray, R G Delbridge
1Department of Endocrinology and Diabetes Royal Children's Hospital, Brisbane, Queensland, Australia. louise_conwell@health.qld.gov.au
Journal of Pediatric Endocrinology & Metabolism : JPEM
|November 5, 2003
Summary
Addison's disease can cause reversible cardiomyopathy, a rare complication. Treatment required intensive cardiac and ventilatory support in a pediatric patient, highlighting a critical potential side effect.
Area of Science:
- Endocrinology
- Cardiology
- Pediatrics
Background:
- Addison's disease, or primary adrenal insufficiency, requires lifelong hormone replacement therapy.
- Cardiovascular complications are known in Addison's disease, but cardiomyopathy is rarely reported.
Observation:
- A 13-year-old girl presented with Addison's disease and developed acute cardiac failure post-treatment initiation.
- Initial clinical improvement was followed by severe cardiac decompensation requiring intensive care.
Findings:
- The patient required high-dose intravenous hydrocortisone, oral fludrocortisone, inotropic support, and mechanical ventilation for cardiovascular stability.
- Cardiomyopathy resolved within one week with continued glucocorticoid and mineralocorticoid replacement therapy.
Implications:
- Reversible cardiomyopathy is a rare, life-threatening complication of Addison's disease, particularly in pediatric cases.
- This case underscores the need for vigilant cardiac monitoring in patients with Addison's disease, especially during treatment initiation.
- This is the second reported pediatric case and the first requiring ventilatory support for this complication.