Reversible Cardiomyopathy Induced by Adrenal Insufficiency: A Case Report

TL;DR

A 56-year-old woman with adrenal insufficiency developed reversible cardiomyopathy, which improved significantly after hormone therapy.

Contribution

This case report demonstrates that adrenal insufficiency can cause reversible cardiomyopathy, emphasizing the need for early endocrine evaluation.

Findings

The patient showed biventricular dysfunction and reduced ejection fraction on admission.

Cardiac function improved markedly after hydrocortisone therapy, with recovery of systolic function and reduced valvular regurgitation.

Early endocrine evaluation and treatment led to complete functional recovery and normalization of ejection fraction.

Abstract

Adrenal insufficiency, though rare, can cause serious cardiovascular complications such as reversible cardiomyopathy. We present the case of a 56-year-old woman admitted to the intensive care unit with bradycardia, hypotension, and hypoglycemia, followed by hemodynamic instability and subsequent development of supraventricular tachycardia requiring stabilization. Endocrine assessment performed after stabilization demonstrated panhypopituitarism with radiological evidence of an empty sella, central hypothyroidism, and biochemical findings consistent with central adrenal insufficiency, confirmed by low morning cortisol with low adrenocorticotropic hormone levels. On admission, echocardiography showed biventricular dysfunction with a reduced ejection fraction and severe tricuspid regurgitation. Following initiation of intravenous hydrocortisone and supportive therapy, repeat echocardiography at one month demonstrated significant improvement, with recovery of systolic function and marked reduction in valvular regurgitation, consistent with reversible cardiomyopathy. This case highlights the importance of adrenal insufficiency as a potential cause of unexplained cardiomyopathy. The patient’s cardiac function improved markedly following appropriate endocrine therapy, with normalization of ejection fraction and resolution of valvular abnormalities. These findings underscore the value of early endocrine evaluation and timely management in preventing irreversible cardiac damage and achieving complete functional recovery.

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