Adrenal Insufficiency – ABC CARDIOL

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Research Letter

A “Grasp Heart” Situation: Managing Heart Failure with Reduced Ejection Fraction in Primary Adrenal Insufficiency

Matheo Augusto Morandi Stumpf et al. Madson Queiroz Almeida

Primary adrenal insufficiency (PAI) is a well-established risk factor for ischemic heart disease, the most prevalent cause of heart failure. Treatment of patients with heart failure with reduced ejection fraction (HFrEF) and PAI is debatable. Here, we briefly discuss the evidence for treating both conditions.

Trials in this particular population are lacking in the literature. In 1983, a single prospective study showed a long-term follow-up of 22 patients with PAI. Seven patients developed HF during a mean follow-up of 30 years. Two of them did not receive mineralocorticoid replacement, while the remaining five had their fludrocortisone dose reduced (to a maximum of 0.1 mg/d). Three patients were advised to limit their sodium intake due to severe HF. HF was predominantly treated with digoxin and furosemide, the usual course of treatment at the time.

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A “Grasp Heart” Situation: Managing Heart Failure with Reduced Ejection Fraction in Primary Adrenal Insufficiency

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