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A case of isolated sinus bradycardia as an unusual presentation of adrenal insufficiency

INTRODUCTION: Sinus bradycardia is a common entity encountered in clinical practice. The differential diagnosis is quite broad; it can be an incidental finding in otherwise healthy adults or the first clue to a lethal pathology. CASE PRESENTATION: This case highlights a patient who presented with sy...

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Autores principales: Reyes, Jonathan Vincent M., Majeed, Hafsa, Song, David, Ahmad, Saad, Bray, Ashley, Almas, Talal, Alshamlan, Abdulaziz, Lieber, Joseph J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8379430/
https://www.ncbi.nlm.nih.gov/pubmed/34457259
http://dx.doi.org/10.1016/j.amsu.2021.102727
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author Reyes, Jonathan Vincent M.
Majeed, Hafsa
Song, David
Ahmad, Saad
Bray, Ashley
Almas, Talal
Alshamlan, Abdulaziz
Lieber, Joseph J.
author_facet Reyes, Jonathan Vincent M.
Majeed, Hafsa
Song, David
Ahmad, Saad
Bray, Ashley
Almas, Talal
Alshamlan, Abdulaziz
Lieber, Joseph J.
author_sort Reyes, Jonathan Vincent M.
collection PubMed
description INTRODUCTION: Sinus bradycardia is a common entity encountered in clinical practice. The differential diagnosis is quite broad; it can be an incidental finding in otherwise healthy adults or the first clue to a lethal pathology. CASE PRESENTATION: This case highlights a patient who presented with symptomatic sinus bradycardia, which resulted in syncope requiring admission for permanent pacemaker implantation and later found to have an underlying adrenal insufficiency (AI). Patient's underlying hyponatremia was corrected but bradycardia persisted and after the initiation of steroids, bradycardia resolved. Therefore, the likely culprit for bradycardia was AI. DISCUSSION: Multiple disease processes that manifest with sinus bradycardia are commonly due to the increased vagal tone or the presence of intrinsic conduction disorders. Sinus bradycardia is a common clinical finding with a broad differential including intrinsic and extrinsic causes of sinus node dysfunction or AV block. CONCLUSION: It is imperative for clinicians to be aware of rare etiologies for underlying symptomatic bradycardia. While extremely effective at preventing symptomatic bradycardia, avoiding a pacemaker by correcting the underlying etiology of symptomatic bradycardia may improve quality of life and avoid an unnecessary procedure.
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spelling pubmed-83794302021-08-26 A case of isolated sinus bradycardia as an unusual presentation of adrenal insufficiency Reyes, Jonathan Vincent M. Majeed, Hafsa Song, David Ahmad, Saad Bray, Ashley Almas, Talal Alshamlan, Abdulaziz Lieber, Joseph J. Ann Med Surg (Lond) Case Report INTRODUCTION: Sinus bradycardia is a common entity encountered in clinical practice. The differential diagnosis is quite broad; it can be an incidental finding in otherwise healthy adults or the first clue to a lethal pathology. CASE PRESENTATION: This case highlights a patient who presented with symptomatic sinus bradycardia, which resulted in syncope requiring admission for permanent pacemaker implantation and later found to have an underlying adrenal insufficiency (AI). Patient's underlying hyponatremia was corrected but bradycardia persisted and after the initiation of steroids, bradycardia resolved. Therefore, the likely culprit for bradycardia was AI. DISCUSSION: Multiple disease processes that manifest with sinus bradycardia are commonly due to the increased vagal tone or the presence of intrinsic conduction disorders. Sinus bradycardia is a common clinical finding with a broad differential including intrinsic and extrinsic causes of sinus node dysfunction or AV block. CONCLUSION: It is imperative for clinicians to be aware of rare etiologies for underlying symptomatic bradycardia. While extremely effective at preventing symptomatic bradycardia, avoiding a pacemaker by correcting the underlying etiology of symptomatic bradycardia may improve quality of life and avoid an unnecessary procedure. Elsevier 2021-08-16 /pmc/articles/PMC8379430/ /pubmed/34457259 http://dx.doi.org/10.1016/j.amsu.2021.102727 Text en © 2021 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Reyes, Jonathan Vincent M.
Majeed, Hafsa
Song, David
Ahmad, Saad
Bray, Ashley
Almas, Talal
Alshamlan, Abdulaziz
Lieber, Joseph J.
A case of isolated sinus bradycardia as an unusual presentation of adrenal insufficiency
title A case of isolated sinus bradycardia as an unusual presentation of adrenal insufficiency
title_full A case of isolated sinus bradycardia as an unusual presentation of adrenal insufficiency
title_fullStr A case of isolated sinus bradycardia as an unusual presentation of adrenal insufficiency
title_full_unstemmed A case of isolated sinus bradycardia as an unusual presentation of adrenal insufficiency
title_short A case of isolated sinus bradycardia as an unusual presentation of adrenal insufficiency
title_sort case of isolated sinus bradycardia as an unusual presentation of adrenal insufficiency
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8379430/
https://www.ncbi.nlm.nih.gov/pubmed/34457259
http://dx.doi.org/10.1016/j.amsu.2021.102727
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