Regression of cardiac abnormalities after replacement therapy in Addison'sdisease

Objective: To evaluate by echocardiography the cardiac structure and functi on in patients with primary adrenocortical insufficiency. Design and Methods: Two-dimensionally guided M-mode echocardiograms and spe ctral Doppler studies were performed in seven consecutive patients with new ly diagnosed autoimmune primary adrenal failure before and 4-8 months after an adequate regimen of steroid substitution. Echocardiographic parameters were also studied in ten healthy controls. Results: In the cases with untreated Addison's disease, both left ventricul ar end-systolic and end-diastolic dimensions were significantly reduced in comparison with those in controls (P < 0.01). Four patients had echocardiog raphic signs of mitral valve prolapse (MVP) at the anterior leaflet, with n o evidence of mitral regurgitation by Doppler echocardiography. Systolic cl icks characteristic of MVP were present on auscultation in two of these cas es. Left ventricular chamber size normalized, i.e. significantly increased (P < 0.01), and both echocardiographic and physical signs of MVP resolved a fter steroid substitution in all patients. All other echocardiographic indi ces were normal before and after treatment, Conclusions: Patients with untreated Addison's disease have cardiac abnorma lities which regress after steroid substitution. A valvular-ventricular dis proportion due to the hypovolemic state could explain these findings.