[Cardiovascular arrest in adrenal cortex insufficiency]

We describe the case of a 55 year old patient with acute adrenal insufficiency who suffered from abdominal pain, recurrent syncope and cardiac arrest. 32 hours after the successful cardio-pulmonal resuscitation, the patient developed a catecholamine resistant hyperdynamic shock. With the initiation of prednisolone therapy, because of suspected acute adrenal insufficiency, catecholamines became effective and led to a hemodynamic stabilisation and a general amelioration of the patient. Glucocorticoids have a permissive function for catecholamines and therefore are essential in these situations. After fluid replacement acute adrenal insufficiency may present as hyperdynamic shock which can be confounded with septic shock. Cardiac arrest however is an unusual complication of Addison's disease and the responsible pathological mechanism is unknown.