Unexplained arterial thrombosis: approach to diagnosis and treatment

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Cardiac arrest secondary to Addison's disease

A 33-year-old man with a history of progressive weight loss, weakness, and darkened skin color collapsed in cardiorespiratory arrest. His down time, with CPR, was more than 60 minutes, with 20 minutes of documented asystole. He was resuscitated, with global neurological deficits that eventually cleared following aggressive rehabilitation therapy. The diagnosis of Addison's disease was suggested by clinical hyperpigmentation and a roentgenographic narrowed cardiac silhouette. Cardiac arrest is an unusual complication of adrenal insufficiency.     

Primary cardiac amyloidosis: an angiocardiographic clue to early diagnosis

Restrictive cardiomyopathy produced by primary cardiac amyloidosis may have a clinical syndrome identical to noncalcific constrictive pericarditis. We report two patients with amyloidosis and restrictive physiology who had enlarged papillary muscles shown on left ventricular angiocardiogram. Rapid volume expansion with normal saline failed to produce ventricular filling pressure equilibration as in occult constrictive pericarditis. The absence of diastolic pressure equilibration and enlarged papillary muscles may permit early diagnosis of cardiac amyloidosis.     

Clinical clues to the cause of Addison's disease

Tuberculosis and other potentially treatable diseases remain important causes of adrenal insufficiency. Knowledge of the cause of adrenal destruction, although often difficult to ascertain clinically, is necessary for appropriate management. Clinical data are reviewed in eight patients with Addison's disease who underwent computed tomographic scanning and in 31 additional patients with Addison's disease in whom autopsy was performed. Seven of eight patients (87 percent) with tuberculous Addison's disease of no greater than two years' duration had enlarged glands whereas patients with longer duration of disease had smaller or normal-sized glands. Adrenal enlargement was also found in five of six (87 percent) subjects with carcinomatous replacement of the adrenal glands. The adrenal glands were small or undetectable in each of 16 patients with idiopathic Addison's disease. Adrenal calcification was found in nine of 17 (53 percent) tuberculous patients and was not found in any of the 22 other patients. Duration of adrenal disease, adrenal size on computed tomographic scanning, and presence of adrenal calcification were useful clues to the cause of Addison's disease.