Corticosuprarenal insufficiency and acute myocardial infarction – clinical and therapeutic particularities

Introduction: T he most important effects of adrenal cortical hormones are increased blood pressure, hyperglycemia by stimulating gluconeogenesis as well as anti-inflammatory and immunosuppressive activity. Corticotherapy used in the treatment of Addison’s di-sease is associated with high cardiovascular risk, and acute coronary syndrome reflects the response to seve-re endothelial injury that stimulates the hypothalamic-pituitary-adrenal axis and modulates neurovascular and hormonal response.
Case presentation: We present the case of a 71 year old patient diagnosed with Addison\’s disease at 41 years under treatment with Prednisone 5 mg/day (the last endocrinology check-up being 10 years ago) that is brought by the ambulance for dehydration syndrome and syncope state at home. Patient complex evaluati-on objectifies hyperglycemia, leukocytosis, thrombo-cytosis, dyselectrolytemia, acidosis, nitrate retention. Hospitalize electrocardiogram was normal. The deve-lopment of hemodynamic instability required the esta-blishment of positive inotropic agents support, hydro-electrolytic and acid-base rebalance, and subsequently the patient was directed for monitoring at the Endocri-nology Clinic. During hospitalization, the patient chest pain reappears and electrocardiographic appearance of acute and inferior myocardial infarction, which is why it is transferred to the coronary intensive care unit. The positive diagnosis of acute myocardial infarction was supported by clinical and electrocardiographic criteria. Thrombolytic therapy was performed with subsequent favorable evolution.
Conclusions: Coronary atherosclerosis is the most common cause of acute myocardial infarction and inflammation is the pathophysiological link in athe-rosclerotic plaque initiation, progression, and rup-ture. Adrenocorticotropic and cortisol play a role in atherogenesis by modulating the function of vascular endothelium. For patients with myocardial ischemia secondary to Addison\’s disease it is necessary to op-timize corticotherapy and initiate anti-ischemic treat-ment with careful interdisciplinary monitoring for sub-sequent cardiovascular complications.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)