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Review
. 2023 Jan 29;23(1):54.
doi: 10.1186/s12872-023-03079-0.

Coronary artery disease in a patient with Addison's disease: a case report and literature review

Ruohan Zhao #  1 , Suxin Luo #  2 , Shuzhen Wang  1 , Yi Wen  3 , Feng Xiong  4
Affiliations
Review

Coronary artery disease in a patient with Addison's disease: a case report and literature review

Ruohan Zhao et al. BMC Cardiovasc Disord. .

Abstract

Background: Addison's disease which is due to dysfunction of the adrenal gland, with abnormal secretion of glucocorticoids and mineralocorticoids, is rare. By inducing inflammation and disorders of water and electrolyte metabolism, Addison's disease may accelerate progression of co-existed cardiovascular diseases. Addison's disease combined with cardiovascular disease is infrequent, only 10 cases in the literature.

Case presentation: We reported a 51-year-old male patient with unstable angina pectoris and hypotension. Changes on coronary angiography within 2 years suggested rapid progression of coronary artery disease in a patient with low cardiovascular risk. An additional clue of skin hyperpigmentation, fatigue and further examination confirmed the diagnosis of Addison's disease caused by adrenal tuberculosis. After hormone replacement treatment, the frequency and severity of the angina pectoris were alleviated significantly, as were hypotension, hyperpigmentation and fatigue.

Conclusions: The combination of Addison's disease and coronary artery disease in one patient is rare. Addison's disease can induce inflammation and disorders of water and electrolyte metabolism, which may further accelerate the course of coronary artery disease. Meanwhile, the hypotension in Addison's disease may affect the coronary blood flow, which may result in an increased susceptibility to unstable angina in the presence of coronary stenosis. So, we should analyze comprehensively if the coronary artery disease progress rapidly.

Keywords: Addison’s disease; Adrenal tuberculosis; Case report; Coronary artery disease; Unstable angina.

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Conflict of interest statement

The author’s decalared that they have no competing interests.

Figures

Fig. 1
Fig. 1
A two years ago, coronary artery CTA showed the right coronary was almost normal. B two years later, coronary angiography showed 80% stenosis (red arrow) of the proximal right coronary artery
Fig. 2
Fig. 2
Skin and mucosal pigmentation changes in patients with Addison’s disease. A Diffuse dark-brown changes in facial skin; B Dark-brown spots of different sizes visible on the lips and tongue; C Diffuse dark-brown changes on the back of the hands; D After 2 months of treatment, the pigmentation on the back of the handss was partially reversed
Fig. 3
Fig. 3
Enhanced CT findings of the chest and abdomen in Addison patients. A, B Visible irregular thickening of the bilateral adrenal glands with a few punctate calcifications (red arrows); C Multiple small nodules, cords, and calcifications in the upper lobes of the lungs (red arrow); D Multiple calcifications in the left hilar and mediastinum lymph nodes (red arrow)
Fig. 4
Fig. 4
Patient’s follow-up images. A, B Pulmonary tuberculosis and adrenal tuberculosis are stable. (red arrow showed the calcification in the upper lobes of right lungs and lymph node); C Calcification of adrenal tuberculosis increased (red arrow). D A stenosis of 60% in the proximal segment of right coronary artery (red arrow); E A stenosis of 40–50% in the distal segment of anterior descending branch, a stenosis of 20–30% in the middle segment of circumflex artery (red arrow)
Fig. 5
Fig. 5
Time line table of the patient
See this image and copyright information in PMC

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