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.