Isolated ACTH deficiency presenting with severe myocardial dysfunction.

Area of Science:

• Endocrinology
• Cardiology
• Internal Medicine

Background:

• Isolated adrenocorticotropic hormone (ACTH) deficiency is a rare endocrine disorder.
• Acute adrenal crisis can present with diverse and severe systemic manifestations.

Observation:

• A 54-year-old woman presented with altered consciousness, hypoglycemia, hyponatremia, and rhabdomyolysis.
• Initial echocardiography showed right heart dilatation and tricuspid regurgitation, evolving to severe left ventricular hypokinesis and heart failure.
• The patient's condition was refractory to catecholamines but improved dramatically with hydrocortisone replacement therapy.

Findings:

• The patient was diagnosed with acute adrenal crisis secondary to isolated ACTH deficiency.
• Left ventricular dysfunction resolved completely within eight days of initiating hydrocortisone treatment.
• This case highlights severe myocardial dysfunction as a rare complication of acute adrenal insufficiency.

Implications:

• Early recognition and treatment of adrenal insufficiency are crucial in patients with unexplained cardiac dysfunction.
• This case underscores the potential for reversible myocardial impairment in acute adrenal crisis.
• The unique progression from right to left ventricular dysfunction offers insights into the pathophysiology of adrenal-induced cardiomyopathy.