A 41-year-old white woman with a history of autoimmune
Hashimoto thyroiditis diagnosed 3 years earlier and acute
adrenal insufficiency diagnosed 3 weeks earlier presented with new onset of
heart failure New York Heart Association class IV, which had started shortly after initiation of
hormone replacement therapy with
hydrocortisone 20 mg/day and
fludrocortisone 0.3 mg/day. Nine days before admission she had collapsed because of
dizziness and had a
cerebral concussion and
open fracture of her nasal bone, however, no further investigations were carried out at that time. A physical examination revealed leg
edema,
tachycardia,
tachypnea, bilateral basal crepitations, and blood pressure 110/70 mmHg. An electrocardiogram showed
sinus tachycardia, low voltage, negative T-waves in V5 and V6 and a corrected QT interval of 590 ms. Echocardiography revealed a reduced left ventricular systolic function with an ejection fraction of 30 %, and septal, apical, and anterior wall akinesia. Cardiac magnetic resonance imaging showed relative enhancement of
gadolinium, indicating
hyperemia and capillary leakage, and no myocardial
scars. Because of the improvement in her cardiac function, lack of cardiovascular risk factors, and lack of signs for
ischemia on magnetic resonance imaging, no coronary angiography was carried out. The results of sellar and renal magnetic resonance imaging were normal. Her
troponin T was slightly elevated.
Bisoprolol and
ramipril were started. Her
fludrocortisone dose was reduced to 0.05 mg/day. Her electrocardiogram and systolic function, documented by echocardiography and magnetic resonance imaging, normalized within 6 months.
CONCLUSIONS: