title: Relative adrenal insufficiency in severe congestive heart failure with preserved systolic function: a case report.
abstract: Relative adrenal insufficiency in critically ill patients is an important syndrome in septic shock. The insufficient stress response of the hypothalamic-pituitary-adrenal axis in acute illness contributes to hemodynamic instability. Treatment of this state in septic shock improves patient outcomes. In this report, we describe the case of a patient with severe diastolic dysfunction who presented in cardiogenic shock associated with relative adrenal insufficiency and had a complete recovery with corticosteroid replacement. Alteration of the hypothalamic-pituitary-adrenal axis may be more prevalent than suspected in end-stage heart failure, and the diagnosis and treatment of this syndrome may ultimately improve outcomes in a subgroup of heart failure patients.
authors: Department of Cardiology, University of Chicago Hospitals, 5841 S. Maryland Avenue, Chicago, IL 60637, USA.
authors: Joshua D
authors: JD
authors: Lovelock
authors: Sandra
authors: S
authors: Coslet
authors: Marie
authors: M
authors: Johnson
authors: Stuart
authors: S
authors: Rich
authors: Mardi
authors: M
authors: Gomberg-Maitland
mesh_terms: D000309:Adrenal Insufficiency / Q000150:complications / Q000188:drug therapy*; D003971:Diastole; D005260:Female; D005938:Glucocorticoids / Q000494:pharmacology / Q000627:therapeutic use*; D006333:Heart Failure / Q000209:etiology*; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects / Q000503:physiopathology; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000187:drug effects / Q000503:physiopathology; D012770:Shock, Cardiogenic / Q000209:etiology*; D018497:Ventricular Dysfunction, Right / Q000150:complications*
chemical_list: D005938:Glucocorticoids