Background: Cardiac failure is an infrequently reported complication of Addisons disease which is unique in its reversibility. We report a rare case of heart failure as the initial presentation of Addisons disease.
Case Summary: A 39-year-old gentleman presented with classical features of heart failure and hypotension. His Echocardiogram showed moderately impaired left ventricular function. Addisons disease was suspected due to hyponatremia, hyperkalaemia and low cortisol levels; A short synacten test confirmed this and he was started on dual therapy hydrocortisone and fludrocortisone. His left ventricular function returned to normal in 5 days. He was followed up with hydrocortisone day curve.
Discussion: Heart failure is a rare but acknowledged complication of Addisons disease. In majority of the cases, the cardiac dysfunction secondary to Addisons disease is reversible with dual therapy of glucocorticoids and mineralocorticoids. Expeditious recognition and initiation of pharmacotherapy is crucial for the reversibility and resolution of symptoms.