Ahmed Mustafa, Maliyakkal Abdul Majeed
Medicine, Hamad Medical Corporation, Doha, QAT.
Clinical Medicine, QU Health, Qatar University, Doha, QAT.
Cureus. 2022 May 16;14(5):e25061. doi: 10.7759/cureus.25061. eCollection 2022 May.
Adrenal insufficiency is a rare disorder that results from etiological factors affecting either the hypothalamic-pituitary axis or the adrenal gland itself. Studies have associated an inherently increased risk of cardiovascular events with this condition. It is treated with exogenous steroid supplementation. However, in recent years, there have been an increasing number of reports regarding the potential of steroid therapy to precipitate acute cardiac events. However, this risk is generally assumed to be dose-dependent and could be absent in patients receiving low-dose glucocorticoid treatment. We present a case of a 71-year-old woman who was admitted to our institution with bilateral lower limb swelling. Blood investigation revealed hypoalbuminemia and hyponatremia. Upon further evaluation she was diagnosed to have adrenal insufficiency and was started on hydrocortisone replacement therapy; however, the patient developed non-ST-segment elevation myocardial infarction (NSTEMI) and acute pulmonary edema a few days after starting steroid replacement therapy. Here, we discuss the possible association between hydrocortisone use and the development of acute cardiac events.
肾上腺功能不全是一种罕见的疾病，由影响下丘脑 - 垂体轴或肾上腺本身的病因引起。研究表明，这种疾病本身会增加心血管事件的风险。它通过外源性类固醇补充进行治疗。然而，近年来，关于类固醇疗法引发急性心脏事件的可能性的报道越来越多。然而，一般认为这种风险是剂量依赖性的，在接受低剂量糖皮质激素治疗的患者中可能不存在。我们报告一例71岁女性患者，因双侧下肢肿胀入住我院。血液检查显示低白蛋白血症和低钠血症。进一步评估后，她被诊断为肾上腺功能不全，并开始接受氢化可的松替代治疗；然而，患者在开始类固醇替代治疗几天后发生了非ST段抬高型心肌梗死（NSTEMI）和急性肺水肿。在此，我们讨论使用氢化可的松与急性心脏事件发生之间的可能关联。
