Heart failure with low ejection fraction as a presentation of severe primary adrenal insufficiency

Abstract

Addison’s disease or primary adrenal insufficiency is a condition where there is decreased
production of glucocorticoid and mineralocorticoid from adrenal cortex and it’s prevalance is
around 100- 140 cases per millions in western societies. It has wide range of clinical features and is
a serious condition. If diagnosed and treated in time, patient’s condition can improve significantly.
Here we present 37 years old female who presented with wide range of vague clinical features
and was in shock and on investigation, her serum sodium was low and potassium level was high.
With usual treatment of shock, patient condition didn’t improve. So, echocardiography was done
which showed global Left Ventricular wall hypokinesia with left ventrical ejection fraction of 25-
30%. She was also taking treatment for hypothyroidism. Endocrinology consultation was done
for her hypothyroidism, hyponatremia and possible adrenal crisis. Serum Cortisol was sent which
was found low. With treatment with glucocorticoids and mineralcorticoids, patient improved
significantly. She recovered from shock, her serum sodium and potassium became normal and
after one month, left ventricular ejection fraction improved to 50%. So, with timely diagnosis and
proper treatment, Addison’s disease can be treated easily.