Urgencias endocrinas en la unidad de cuidados intensivos: síndrome poliglandular autoinmune con crisis adrenal y bloqueo cardíaco avanzado: reporte de un caso

Abstract

We present a case of a rare medical emergency with multiple risk factors and several causes, with high mortality when not diagnosed and treated in a timely manner. Knowing and linking to the description of this case can help the scientific community prepare for rare situations like this. This is a 48-year-old patient with a history of polyglandular autoimmune syndrome under treatment with corticosteroids, who consulted for asthenia, adynamia, weakness and polydipsia. Clinically, hypotension, hypoglycemia, hydroelectrolyte disturbances, acid-base imbalance, elevated thyroid stimulating hormone (TSH) with decreased free thyroxine (T4L) and low paratohormone (PTH) were identified. An adrenal crisis was diagosticated and was admitted to the ICU. During her stay in the intensive care unit (ICU), she presented with an advanced cardiac block that required a pacemaker implant with appropriate evolution. Adrenal crisis is a rare condition, diagnosis requires a high rate of suspicion even when the history of adrenal insufficiency is known. It is necessary to investigate thoroughly the history, background, clinical manifestations, adherence to corticosteroid therapy, perform a complete physical examination and request relevant paraclinical studies for a comprehensive evaluation. Recognize that cardiac block may be refractory to steroid therapy and require electrical support may be essential for patient survival.