Acute coronary syndrome with ST segment elevation in a patient with Addison disease: Case report and brief review of physiopathological mechanisms: A case study

Maranduca,Minela Aida; Statescu,Cristian; Sascau,Radu Andy; Dima,Nicoleta; Hurjui,Loredana Liliana; Serban,Dragomir Nicolae; Serban,Ionela Lacramioara

doi:10.3892/etm.2020.8855

Acute coronary syndrome with ST segment elevation in a patient with Addison disease: Case report and brief review of physiopathological mechanisms: A case study

Authors:
- Minela Aida Maranduca
- Cristian Statescu
- Radu Andy Sascau
- Nicoleta Dima
- Loredana Liliana Hurjui
- Dragomir Nicolae Serban
- Ionela Lacramioara Serban
View Affiliations

Affiliations: Department of Physiology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania, Department of Internal Medicine, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
Published online on: June 10, 2020 https://doi.org/10.3892/etm.2020.8855
Pages: 1230-1236
Copyright: © Maranduca et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The adrenal gland serve important roles in the modulation of the immune response, the adjustment of blood pressure, the stress reaction via glucocorticoids and the hydroelectrolytic balance via mineralocorticoids. Primary adrenal insufficiency, known as Addison disease, is characterized by a decrease in glucocorticoid secretion (cortisol) and, more rarely, by a hyposecretion of mineralocorticoids (aldosterone). The production of cortisol, which is a hormone that helps the body respond to stress, is regulated in the brain, the hypothalamus and the pituitary gland. The hypothalamus stimulates the pituitary gland to produce adrenocorticotropic hormone, which stimulates cortisol production from the adrenal gland. If left untreated, Addison disease has a high mortality rate. Corticotherapy used in the treatment of Addison disease is associated with a certain cardiovascular risk. The proatherogenic effect of corticoids is based on the chronic inflammatory response of the vascular wall to a series of events. The aim of the current case report was to review the pathophysiological mechanisms and interactions that may lead to the onset of acute coronary syndrome with ST elevation in a patient with Addison disease.

View Figures

View References

1	Erichsen MM, Løvås K, Skinningsrud B, Wolff AB, Undlien DE, Svartberg J, Fougner KJ, Berg TJ, Bollerslev J, Mella B, et al: Clinical, immunological, and genetic features of autoimmune primary adrenal insufficiency: Observation from a Norwegian registry. J Clin Endocrinol Metab. 94:4882–4890. 2009.PubMed/NCBI View Article : Google Scholar
2	Kemp S, Berger J and Aubourg P: X-linked adrenoleukodystrophy: Clinical, metabolic, genetic and pathophysiological aspects. Biochim Biophys Acta. 1822:1465–1474. 2012.PubMed/NCBI View Article : Google Scholar
3	Rao RH, Vagnucci AH and Amico JA: Bilateral massive adrenal hemorrhage: early recognition and treatment. Ann Intern Med. 110:227–235. 1989.PubMed/NCBI View Article : Google Scholar
4	Rao RH: Bilateral massive adrenal hemorrhage. Med Clin North Am. 79:107–129. 1995.PubMed/NCBI View Article : Google Scholar
5	Bhatia E, Jain SK, Gupta RK and Pandey R: Tuberculous addison's disease: Lack of normalization of adrenocortical function after anti-tuberculous chemotherapy. Clin Endocrinol (Oxf). 48:355–359. 1998.PubMed/NCBI View Article : Google Scholar
6	Walker BF, Gunthel CJ, Bryan JA, Watts NB and Clark RV: Disseminated cryptococcos is in an apparently normal host presenting as primary adrenal insufficiency: Diagnosis by fine needle aspiration. Am J Med. 86:715–717. 1989.PubMed/NCBI View Article : Google Scholar
7	Elias AN and Gwinup G: Effects of some clinically encountered drugs on steroid synthesis and degradation. Metabolism. 29:582–595. 1980.PubMed/NCBI View Article : Google Scholar
8	Nicolaides NC, Chrousos, Charmandari E. In: De Groot LJ, Chrousos G, Dungan K, Grossman A, Hershman JM, Koch C, Korbonits M, McLachlan R, New M, Purnell J, Rebar R, Singer F, Vinik A, editors. Adrenal Insuffiency Endotext [Internet]. South Dartmouth (MA): MD http://Text.comsimpleText.com, Inc.; 2000-2013.
9	Norasyikin AW, Norlela S, Rozita M, Masliza M, Shamsul AS and Nor Azmi K: Adrenal insufficiency in acute coronary syndrome. Singapore Med J. 50:962–966. 2009.PubMed/NCBI
10	Sger HB and Nahrendorf M: Inflammation: A trigger for acute coronary syndrome. Q J Nucl Med Mol Imaging. 60:185–193. 2016.PubMed/NCBI
11	Tabas I and Bornfeldt KE: Macrophage phenotype and function in different stages of atherosclerosis. Circ Res. 118:653–667. 2016.PubMed/NCBI View Article : Google Scholar
12	Coll RC, Robertson AA, Chae JJ, Higgins SC, Munoz-Planillo R, Inserra MC, Vetter I, Dungan LS, Monks BG, Stutz A, et al: A small-molecule inhibitor of the NLRP3 inflammasome for the treatment of inflammatory diseases. Nat Med. 21:248–255. 2015.PubMed/NCBI View Article : Google Scholar
13	Varol C, Mildner A and Jung S: Macrophages: Development and tissue specialization. Annu Rev Immunol. 33:643–675. 2015.PubMed/NCBI View Article : Google Scholar
14	Fantidis P: The role of the stress-related anti-inflammatory hormones ACTH and cortisol in atherosclerosis. Curr Vasc Pharmacol. 8:517–525. 2010.PubMed/NCBI View Article : Google Scholar
15	Shimizu M, Monguchi T, Takano T and Miwa Y: Isolated ACTH deficiency presenting with severe myocardial dysfunction. J Cardiol Cases. 4:e26–e30. 2011.PubMed/NCBI View Article : Google Scholar
16	Shokr M, Rashed A, Lata K and Kondur A: Dexamethasone associated ST elevation myocardial infarction four days after an unremarkable coronary angiogram-another reason for cautious use of steroids: A case report and review of the literature. Case Rep Cardiol. 2016(4970858)2016.PubMed/NCBI View Article : Google Scholar
17	Walker BR: Glucocorticoids and cardiovascular disease. Eur J Endocrinol. 157:545–559. 2007.PubMed/NCBI View Article : Google Scholar
18	Rogers KM, Bonar CA, Estrella JL and Yang S: Inhibitory effect of glucocorticoid on coronary artery endothelial function. Am J Physiol Heart Circ Physiol. 283:H1922–H1928. 2002.PubMed/NCBI View Article : Google Scholar
19	Jun SS, Chen Z, Pace MC and Shaul PW: Glucocorticoids downregulate cyclooxygenase-1 gene expression and prostacyclin synthesis in fetal pulmonary artery endothelium. Circ Res. 84:193–200. 1999.PubMed/NCBI View Article : Google Scholar
20	Yildirim U, Gulel O, Soylu K, Yuksel S and Sahin M: Steroid-induced recurrent myocardial ischemia. Rev Port Cardiol. 33:473.e1–4. 2014.PubMed/NCBI View Article : Google Scholar