Suspected Adrenal Crisis-Associated Cardiogenic Shock Salvaged by VA-ECMO With Rapid Left Ventricular Recovery.

BACKGROUND

Primary adrenal insufficiency can precipitate circulatory collapse and may be complicated by reversible myocardial dysfunction requiring temporary mechanical circulatory support.

CASE SUMMARY: A 30-year-old woman with long-standing goiter and features suggestive of adrenal insufficiency presented with 5 days of nausea and vomiting that rapidly progressed to refractory shock with severe left ventricular systolic dysfunction (ejection fraction approximately 15%). Venoarterial extracorporeal membrane oxygenation was initiated for circulatory support, and an intra-aortic balloon pump was added as adjunct support. Serial echocardiography demonstrated apical akinesis with preserved basal contraction followed by rapid recovery to normal systolic function. Perfusion markers, including arterial lactate, normalized early and remained stable through device weaning and removal.

DISCUSSION: This case highlights bridge-to-recovery mechanical circulatory support in fulminant cardiogenic shock occurring in the setting of clinically suspected adrenal crisis; definitive adrenal axis confirmation was unavailable because corticosteroids were administered before transfer.

TAKE-HOME MESSAGES: Fulminant cardiogenic shock can occur in the setting of clinically suspected adrenal crisis with reversible stress-pattern myocardial dysfunction. Early venoarterial extracorporeal membrane oxygenation with adjunct support can provide an effective bridge to recovery when serial echocardiography and perfusion markers guide de-escalation.