Cushing’s leads to heart attack and heart failure in woman, 61

Heart condition seen to improve in rare case after treatment with Korlym

Margarida Maia, PhD avatar

by Margarida Maia, PhD |

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A woman seated on an examining table takes an oral medication as a doctor hands her a glass of water.

For a woman in her 60s in China, Cushing’s syndrome led to a myocardial infarction or heart attack, and to heart failure, according to a report on the rare case.

The patient’s Cushing’s was secondary to an adrenocortical adenoma — a benign, or non-cancerous, tumor that formed in the outer layer of the adrenal glands — that responded well to treatment with Korlym (mifepristone), an oral therapy approved for lowering high blood sugar levels.

As a result of that successful treatment, her heart condition also improved.

The researchers noted that this was a “unique” clinical presentation, because “non-atherosclerotic myocardial infarction [a heart attack occurring due to a reason other than fat plaque buildup inside blood vessels] is rarely reported in Cushing’s syndrome patients.”

Her case was described in the report, “Cushing’s syndrome presenting as non-atherosclerotic myocardial infarction and heart failure,” published in the journal ESC Heart Failure.

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Cushing’s occurs when there is too much of the steroid hormone cortisol in the body. Sometimes this happens due to a tumor that forms in the adrenal glands located on top of the kidneys. The tumor can cause the adrenal glands to produce excessive amounts of cortisol.

Common symptoms include an excess buildup of fat around the abdomen and at the back of the neck, weight gain or obesity, and a round, swollen face. People with Cushing’s also can experience excess growth of body hair and mental health problems.

When it remains untreated for a long time, Cushing’s can lead to other health problems, ranging from high blood pressure, or hypertension, to high blood sugar. Although less common, it also can lead to blood clots, heart attack, and heart failure.

Now, a team of researchers in China described the case of a 61-year-old woman who was admitted to the hospital with chest pain. She had a history of chronic obstructive pulmonary disease, commonly called COPD, which is a lung disorder that makes it hard to breathe.

An electrocardiogram — a test used to assess the heart’s electrical activity — revealed an ST elevation, or an abnormal pattern that usually indicates total blockage of a coronary artery, which is a major blood vessel supplying the heart. The test also showed damage to the heart muscle.

Blood tests revealed the presence of high levels of certain proteins that are released into the bloodstream upon injury to the heart muscle. Despite this, a test called coronary angiography showed no blockages or narrowing in the heart’s blood vessels.

An echocardiography was then done. This test uses sound waves to generate a picture of the heart, allowing doctors to examine its structure and function. It showed an enlarged left atrium, which is the heart’s top chamber, and left ventricle — the bottom chamber — that could not pump blood well enough.

Based on these results, the woman was treated with a combination of medications for ST elevation myocardial infarction and heart failure.

“However, the patient’s condition was not improved despite optimized medication,” the researchers wrote.

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Instead, the woman returned to the hospital because of chest discomfort and swelling. She now also had new symptoms, among them a puffy face, excess buildup of fat around the abdomen, and high blood sugar levels.

A CT scan revealed the presence of a tumor on the right adrenal gland, and an MRI scan of the heart showed an enlarged heart with reduced function, along with signs of scarring, known as fibrosis, and fat buildup.

Additional blood tests revealed the patient had low potassium and high cortisol levels. After an overnight low-dose dexamethasone suppression test, her cortisol levels remained higher than normal, leading doctors to make a diagnosis of Cushing’s.

Dexamethasone is a corticosteroid that turns off the production of cortisol in healthy people. However, in people with Cushing’s, cortisol levels do not drop in response to a low dose of dexamethasone, as was seen in this case.

The woman was started on Korlym, and her “condition and cardiac [heart] function improved,” the researchers wrote. Ten months later, she underwent surgery to remove the adrenocortical adenoma.

This case indicates that early diagnosis and effective treatment of Cushing’s syndrome may be crucial in preventing irreversible cardiac dysfunction secondary to cardiovascular [heart and blood vessel] events and heart failure.

About 1.5 years later, “the patient showed marked improvement in [the] face and body shape, with no complaints of chest distress or oedema [swelling],” the team noted.

“This case indicates that early diagnosis and effective treatment of Cushing’s syndrome may be crucial in preventing irreversible cardiac dysfunction secondary to cardiovascular [heart and blood vessel] events and heart failure,” the researchers wrote.