Life-threatening stress-induced cardiomyopathy combined with acute adrenal crisis

Stress-induced cardiomyopathy, also known as Takotsubo cardiomyopathy and left ventricular apical ballooning syndrome, is characterized by transient systolic dysfunction of the apical and mid-segments of the left ventricle with the abscence of coronary occlusion, This disease typically occurs in postmenopausal women of an advanced age after emotional or physical stress. Although the prognosis is generally favorable, acute fatal complications have been reported in a small subset of patients. Some patients died with acute cardiac complications, on the other hand, other patients died with underlying critical illness which triggered stress-induced cardiomyopathy.

Early Identification and Diagnosis of Adrenal Crisis after Retroperitoneal Laparoscopic Unilateral Adrenalectomy

The occurrence of adrenal crisis after retroperitoneal laparoscopic unilateral adrenalectomy is usually concealed.If not timely diagnosis and treatment,it may cause shock,and even lead to death.It is very difficult to distinguish the clinical manifestations of adrenal crisis from nausea,vomiting,fatigue,gas separation from the lower diaphragm,abdominal pain,hypotension,hypertension,fever and hypothermia after operation.This makes it very difficult to identify and diagnose adrenal crisis early.This article mainly discusses the early recognition,diagnosis and treatment of adrenal crisis after unilateral adrenalectomy by retroperitoneoscope.

A Super-Aged Case with Marked Hyponatremia Reaching 98 mEq/L;Clinical Implications of Low Serum Sodium

A 79-year-old man, an in-patient at a long-term hospital suffers from Alzheimer dementia and thyroid hypofunction. Recently, he had also suffered from pneumonia followed by impaired consciousness and referred to our hospital for further examination. At the time of admission, the level of consciousness was JCS III-200 and other vital signs were normal. He had no edema on his limbs but had dry skin. According to chest CT, we detected pneumonia. Based on the laboratory data on admission, we detected low osmolality of 206 mOsm/kg of water and serum Na 98 mEq/L, beside urinary Na 54.1 mEq/L. We confirmed severe hyponatremia of hypersecretion type. Fluid replacement therapy was started mainly with Ringer’s solution which is similar to extracellular fluid. We diagnosed it as SIADH induced by adrenal crisis based on the significant lower serum Na value and low blood sugar. Consequently, the patient was administered Hydrocortisone and Fludrocortisone acetate. On the 14th day, serum Na level improved from 98 mEq/L to 140 mEq/L. After daily monitoring of serum Na and urinary Na, administration of fludrocortisone acetate was terminated. The patient was discharged on 25th day, since serum Na was stabilized with oral administration of hydrocortisone and oral salt supplement. This case report shows that adrenal crisis can be triggered by pneumonia. In cases of impaired consciousness, if hyponatremia and hypoglycemia are observed, we may have to suspect the possibility of adrenal crisis. Therefore, urinary biochemical examination is an important part of the laboratory tests.