Untreated Addison's Disease Complicated by Pulmonary Congestion due to Left Ventricular Failure
Authors: GILBERT B. CUSHNER
Journal: Annals of Internal Medicine (1963)

Case Studies1 February 1963Untreated Addison's Disease Complicated by Pulmonary Congestion due to Left Ventricular FailureGILBERT B. CUSHNER, M.D., SANFORD F. ZAHLER, M.D., A. GORMAN HILLS, M.D.GILBERT B. CUSHNER, M.D.Search for more papers by this author, SANFORD F. ZAHLER, M.D.Search for more papers by this author, A. GORMAN HILLS, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-58-2-341 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAlthough dyspnea on mild exertion is sometimes present, signs of frank heart failure—pulmonary edema, venous distention, hepatomegaly, peripheral edema—are rarely seen in untreated patients with Addison's disease (1, 2); indeed, only one report observing this association has been found in the literature (3). A patient with severe, untreated panhypoadrenocorticism and associated heart disease due to rheumatic fever and coronary atherosclerosis has recently been observed in whom the dominant clinical features were cardiomegaly and pulmonary edema. The case demonstrates that pulmonary congestion due to left ventricular failure can complicate severe untreated Addison's disease and affords an "experiment of nature" which bears...References1. SOFFERDORFMANGABRILOVE LJRIJL: The Human Adrenal Gland, Lea & Febiger, Philadelphia, 1961, p. 295. Google Scholar2. PASCHKISRAKOFFCANTAROW KEAEA: Clinical Endocrinology, 2d Ed., Paul B. Hoeber, Inc., Medical Division of Harper and Brothers, New York, 1958, p. 329. Google Scholar3. MAJNAR R: Chronic cardiac decompensation with adrenocortical insufficiency. Orv. Hetil. 99: 386, 1958. MedlineGoogle Scholar4. TAKASULASKERSHALHOUB TWRJ: Mechanisms of hyponatremia in chronic congestive heart failure. Ann. Intern. Med. 55: 368, 1961. LinkGoogle Scholar5. SOMERVILLELEVINETHORN WMDGW: The electrocardiogram in Addison's disease. Medicine 30: 43, 1951. CrossrefMedlineGoogle Scholar6. THORNDORRANCEDAY GWSSE: Addison's disease: evaluation of synthetic desoxycorticosterone acetate therapy in 158 patients. Ann. Intern. Med. 16: 1053, 1942. LinkGoogle Scholar7. SORKIN SZ: Addison's disease. Medicine 28: 371, 1949. CrossrefMedlineGoogle Scholar8. MCGAVACK TH: Changes in heart volume in Addison's disease and their significance. Amer. Heart J. 21: 1, 1941. CrossrefGoogle Scholar9. CLEGHORN RA: Recognition and treatment of Addison's disease. Canad. Med. Ass. J. 44: 581, 1941. MedlineGoogle Scholar10. HILLSCHALMERSWEBSTERROSENTHAL AGTMGDO: Adrenal cortical regulation of the distribution of water and electrolytes in the human body. J. Clin. Invest. 32: 1236, 1953. CrossrefMedlineGoogle Scholar11. JARVISJENKINSSOSMANTHORN JLDMCGW: Roentgenologic observations in Addison's disease. Radiology 62: 16, 1954. CrossrefMedlineGoogle Scholar12. WILLSONRYNEARSONDRY DMEMTJ: Cardiac failure following treatment of Addison's disease with desoxycorticosterone acetate. Proc. Mayo Clin. 16: 168, 1941. Google Scholar13. SOFFERENGELOPPENHEIMER LJFLBS: Treatment of Addison's disease with desoxycorticosterone acetate (by intramuscular injections and subcutaneous implantation of pellets). JAMA 115: 1860, 1960. CrossrefGoogle Scholar14. LARAGH JH: Mechanisms of edema formation and principles of management. Amer. J. Med. 21: 423, 1956. CrossrefMedlineGoogle Scholar15. DAVIS JO: Mechanisms of salt and water retention in congestive heart failure. Amer. J. Med. 29: 486, 1960. CrossrefMedlineGoogle Scholar16. MERRILL AJ: Edema and increased renal blood flow in patients with chronic congestive heart failure: evidence of forward failure as the primary cause of edema. J. Clin. Invest. 25: 389, 1946. CrossrefGoogle Scholar17. LADUE JS: Cardiac failure and function tests, in Pathologic Physiology, Mechanisms of Disease, 3d Ed., ed. by Sodeman, W. A., W. B. Saunders Company, Philadelphia, 1961, p. 570. Google Scholar18. REILLYFRENCHLAUSCOTTWHITE WARMFYKGWE: Whole blood volume determined by radio-chromiumtagged red cells. Circulation 9: 571, 1954. CrossrefMedlineGoogle Scholar19. LARAGH JH: Aldosterone in fluid and electrolyte disorders: hyper- and hypoaldosteronism. J. Chron. Dis. 11: 292, 1960. CrossrefMedlineGoogle Scholar20. WOLFFKOCZOREKBUCHBORN HPKRE: Hyperaldosteronism in heart disease. Lancet 2: 63, 1957. CrossrefGoogle Scholar21. DAVISHOWELLHYATT JODSRE: Sodium excretion in adrenalectomized dogs with chronic cardiac failure produced by pulmonary artery constriction. Amer. J. Physiol. 183: 263, 1955. CrossrefMedlineGoogle Scholar22. HUDSONCHOBANIANRELMAN JBAVAS: Hypoaldosteronism, a clinical study of a patient with an isolated adrenal mineralocorticoid deficiency resulting in hyperkalemia and Stokes-Adams attacks. New Engl. J. Med. 257: 529, 1957. CrossrefMedlineGoogle Scholar23. HILLNICKERSONCHENAULTMCNEILSTARNESGAUTNEY SRJFSBJHWRMC: Studies in man on hypo- and hyperaldosteronism. Arch. Intern. Med. 104: 982, 1959. CrossrefMedlineGoogle Scholar24. LAMBREWCARVERPETERSONHORWITH CTSTREM: Hypoaldosteronism as a cause of hyperkalemia and syncopal attacks in a patient with complete heart block. Amer. J. Med. 31: 81, 1961. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: GILBERT B. CUSHNER, M.D.; SANFORD F. ZAHLER, M.D.; A. GORMAN HILLS, M.D.Affiliations: Miami, FloridaFrom the Section of Endocrinology and Metabolism and the Section of Cardiology, Department of Medicine, University of Miami School of Medicine, Jackson Memorial Hospital, Miami 36, Florida.Dr. Cushner was a trainee, 1961-1962, under training grant 2A-5061, National Institute of Arthritis and Metabolic Diseases, National Institutes of Health.Requests for reprints should be addressed to A. Gorman Hills, M.D., Department of Medicine, University of Miami School of Medicine, Jackson Memorial Hospital, Miami 36, Florida. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byCardiac dysfunction in active pulmonary tuberculosis: Mysterious facts of TB’s pandoraCase report: Hypoadrenocorticism crisis complicated by non-cardiogenic pulmonary edema in a dogCase of Junctional Rhythm in the Setting of Acute Adrenal InsufficiencyVentricular systolic dysfunction in dogs diagnosed with hypoadrenocorticismReversible Biventricular Heart Failure Due to Primary Adrenal InsufficiencyReversible Stress Induced Cardiomyopathy in Adrenal InsufficiencyAddison’s Disease and Dilated Cardiomyopathy: A Case Report and Review of the LiteratureAcquired long QT interval in a recurrent septic female patient with polymorphic ventricular tachycardia due to primary acute adrenal insufficiencyThe Role of the Adrenal Cortex in the Pathogenesis of a Spontaneous, Hereditary Congestive Heart FailureCase of adrenocortical insufficiency and congestive heart failure 1 February 1963Volume 58, Issue 2Page: 341-346KeywordsCardiovascular therapyEdemaEndocrinologyHospital medicineHypoglycemiaHypotensionMetabolic disordersPulmonary diseasesRheumatic feverStable coronary artery disease ePublished: 1 December 2008 Issue Published: 1 February 1963 PDF downloadLoading ...