Endocrine Abstracts

We present this case of 29-year old lady who presented 3 weeks post-partum with new onset dilated cardiomyopathy.

Case report: This lady was complaining of fatigue, dizziness and weight loss since 2019. She went to Turkey and felt that ‘tan never went away’. She had her thyroid function done by GP in January, 2020, which showed sub-clinical hypothyroidism with positive TPO. She was started on Levothyroxine which she never tolerated. She lost 25 kg of weight in 2 years. She became pregnant in June 2020 and had hyperemesis which continued till end of pregnancy. Baby’s growth stopped at end of term. She had uneventful delivery in Feb, 2021. She had an episode of black-out 3 weeks post-partum and presented to hospital. On admission, she was noted to have pigmentation on neck, shoulders and face. Her electrolytes showed hyponatremia and hyperkalaemia. She had short synacthen test which showed cortisol < 30 at 0 and 30 minutes. Her ACTH was >2000. Her adrenal anti-bodies were positive. She was started on hydrocortisone replacement. As she had collapse and positive D- dimer, CTPA was done which showed pulmonary edema. She had ECG which showed global T-wave inversion. Her trop was elevated at 231 and BNP at 11,486. She had ECHO cardiogram which confirmed reduced ejection fraction of 38% and left ventricular hypokinesia. She was started on low dose beta blockers and ACEi. She had cardiac MRI 72 hours later which showed mildly dilated LV and normal ejection fraction. The changes were not suggestive of post-partum cardiomyopathy. A follow up cardiac MRI scan in 3 months showed complete resolution of changes. Her BNP returned to normal.

Conclusion: This case reflects a rare complication of Addison’s disease with resolution of cardiomyopathy after hormonal replacement therapy.