PMID- 33644667
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220420
IS  - 2514-2119 (Electronic)
IS  - 2514-2119 (Linking)
VI  - 5
IP  - 2
DP  - 2021 Feb
TI  - Venoarterial extracorporeal membrane oxygenation as bridge to effective treatment 
      in a 19-year-old woman with acute adrenal crisis: a case report.
PG  - ytab031
LID - 10.1093/ehjcr/ytab031 [doi]
LID - ytab031
AB  - BACKGROUND: Adrenal crisis is an acute life-threatening exacerbation of the 
      Addison's disease or primary adrenal insufficiency (PAI) and is associated with a 
      high mortality rate. It can be the first manifestation of adrenal insufficiency 
      and is caused by a critical lack of glucocorticoids. CASE SUMMARY: Here, we 
      report the case of a 19-year-old woman presenting to the emergency room with 
      unspecific symptoms, i.e. lethargy, fatigue, arthralgia, dyspnoea, and 
      hypotension. The patient's examination showed major pericardial effusion 
      resulting in cardiac tamponade requiring immediate pericardiocentesis. In the 
      further course, acute right heart failure and progressive cardiogenic shock 
      occurred. Due to recurrent bradycardia and finally asystole, the patient had to 
      be resuscitated for 15 min in total until return of spontaneous circulation. 
      However, non-invasive haemodynamic stabilization of the patient was not 
      successful. Hence, venoarterial extracorporeal membrane oxygenation (VA-ECMO) was 
      used as salvage intervention to provide temporary circulatory support. We 
      diagnosed an Addison crisis as first manifestation of her previously unknown 
      Addison's disease. An appropriate substitution therapy with hydrocortisone and 
      fludrocortisone was immediately initiated and the patient's condition rapidly 
      improved. After a total in-hospital stay of 4 weeks, she recovered completely and 
      could be discharged from hospital. DISCUSSION: An Addison crisis requires rapid 
      diagnosis and immediate treatment to end a life-threatening condition caused by 
      critical glucocorticoid deficiency. In patients with non-specific symptoms, such 
      as fatigue, hypotension, weight loss, and hyponatraemia, adrenocortical 
      insufficiency should be considered as differential diagnosis. If patients suffer 
      from an Addison crisis, clinical suspicion requires immediate substitution of 
      hydrocortisone as this is essential for patient's survival. Venoarterial 
      extracorporeal membrane oxygenation therapy can serve as a bridge to diagnosis 
      and effective treatment in patients requiring temporary cardiopulmonary support, 
      especially as salvage intervention for patients in cardiogenic shock. To our 
      knowledge, this is the first case of a young patient with acute Addison crisis 
      and cardiogenic shock, who was successfully salvaged by VA-ECMO support.
CI  - (c) The Author(s) 2021. Published by Oxford University Press on behalf of the 
      European Society of Cardiology.
FAU - Lusebrink, Enzo
AU  - Lusebrink E
AD  - Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der 
      Universitat Munchen, Marchioninistrasse 15, 81377 Munich, Germany.
AD  - DZHK (German Center for Cardiovascular Research), partner site Munich Heart 
      Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, 
      Marchioninistrasse 15, 81377 Munich, Germany.
FAU - Krieg, Kathrin
AU  - Krieg K
AUID- ORCID: 0000-0002-7958-0460
AD  - Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der 
      Universitat Munchen, Marchioninistrasse 15, 81377 Munich, Germany.
AD  - DZHK (German Center for Cardiovascular Research), partner site Munich Heart 
      Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, 
      Marchioninistrasse 15, 81377 Munich, Germany.
FAU - Massberg, Steffen
AU  - Massberg S
AUID- ORCID: 0000-0001-7387-3986
AD  - Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der 
      Universitat Munchen, Marchioninistrasse 15, 81377 Munich, Germany.
AD  - DZHK (German Center for Cardiovascular Research), partner site Munich Heart 
      Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, 
      Marchioninistrasse 15, 81377 Munich, Germany.
FAU - Orban, Martin
AU  - Orban M
AUID- ORCID: 0000-0001-9830-1941
AD  - Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der 
      Universitat Munchen, Marchioninistrasse 15, 81377 Munich, Germany.
AD  - DZHK (German Center for Cardiovascular Research), partner site Munich Heart 
      Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, 
      Marchioninistrasse 15, 81377 Munich, Germany.
LA  - eng
PT  - Case Reports
DEP - 20210220
PL  - England
TA  - Eur Heart J Case Rep
JT  - European heart journal. Case reports
JID - 101730741
PMC - PMC7896809
OTO - NOTNLM
OT  - Addison crisis
OT  - Addison's diseases
OT  - Case report
OT  - Venoarterial extracorporeal membrane oxygenation
EDAT- 2021/03/02 06:00
MHDA- 2021/03/02 06:01
PMCR- 2021/02/20
CRDT- 2021/03/01 05:41
PHST- 2020/08/12 00:00 [received]
PHST- 2020/09/28 00:00 [revised]
PHST- 2021/01/09 00:00 [accepted]
PHST- 2021/03/01 05:41 [entrez]
PHST- 2021/03/02 06:00 [pubmed]
PHST- 2021/03/02 06:01 [medline]
PHST- 2021/02/20 00:00 [pmc-release]
AID - ytab031 [pii]
AID - 10.1093/ehjcr/ytab031 [doi]
PST - epublish
SO  - Eur Heart J Case Rep. 2021 Feb 20;5(2):ytab031. doi: 10.1093/ehjcr/ytab031. 
      eCollection 2021 Feb.