Cardiac failure and multiple organ dysfunction syndrome in a patient with endocrine adenomatosis

• Published in: Acta anaesthesiologica Scandinavica Vol. 46; no. 9; pp. 1161 - 1164
• Main Authors: Dünser, M. W., Mayr, A. J., Gasser, R., Rieger, M., Friesenecker, B., Hasibeder, W. R.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Munksgaard International Publishers 01-10-2002; Blackwell
• Subjects: Adenoma - complications; Adenoma - diagnosis; Adrenal Gland Neoplasms - complications; Adrenal Gland Neoplasms - diagnosis; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; cardiac failure; Cardiac Output, Low - complications; Emergency and intensive care: endocrinopathies; Endocrinopathies; General aspects. Associated endocrine diseases. Endocrine paraneoplasic syndromes; glucocorticoids; Humans; hydrocortisone; Intensive care medicine; Male; Medical sciences; Middle Aged; multiple endocrine adenomatosis; Multiple Endocrine Neoplasia - complications; Multiple Endocrine Neoplasia - diagnosis; multiple organ dysfunction syndrome; Multiple Organ Failure - etiology; Pheochromocytoma - complications; Pheochromocytoma - diagnosis; pituitary coma; Pituitary Neoplasms - complications; Pituitary Neoplasms - diagnosis; Endocrinopathy; Coma; Human; Heart failure; Dexamethasone; Pheochromocytoma; Multiple organ failure; Cardiovascular disease; Adenoma; Catecholamine; Hydrocortisone; Glucocorticoid; Secretory tumor; Case study; Resistance; Chemotherapy; Adenomatosis; Treatment; Heart disease; Pituitary diseases; Adrenal gland diseases; Complication; Pituitary gland; Benign neoplasm
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1034/j.1399-6576.2002.460918.x

In this case report, we present the successful therapy of severe cardiac failure in pituitary adrenal insufficiency. A previously healthy 56‐year‐old‐man in pituitary coma due to an atypical variant of multiple endocrine adenomatosis (pituitary adenoma and pheochromocytoma) suffered from cardiac failure resistant to catecholamine and standard hydrocortisone therapy. After two bolus injections of dexamethasone (2 × 24 mg) mean arterial pressure and cardiac function dramatically improved, probably due to restoration of permissive effects on catecholamine action and reversal of pathophysiological mechanisms of cardiac failure. We conclude that in patients with severe cardiovascular failure in pituitary coma the administration of potent glucocorticoids may be more effective in reversing cardiovascular failure than standard dosages of hydrocortisone.