Cardiopulmonary Arrest Due to Idiopathic Unilateral Adrenal Hemorrhage

A 52-year-old Japanese man was admitted to hospital because of cardiopulmonary arrest (CPA [ventricular fibrillation]). There was no family history and he did not have a history of smoking and drinking. After venoarterial extracorporeal membrane oxygenation was initiated, he recovered from CPA with a normal ECG (Figure A); however, the ECG monitor revealed ventricular tachycardia (VT) (Figure B). Echocardiography showed diffuse severe hypokinesis; coronary angiography showed normal coronary arteries; computed tomography (CT) revealed an enlarged right adrenal gland (RAG) with high density (Figure C). At 2 weeks after admission, the RAG was more enlarged (Figure D). ¹²³I-metaiodobenzylguanidine scintigraphy revealed no accumulation in the RAG, but normal accumulation in the left adrenal gland (Figure E) and low accumulation in the heart (Figure F), suggesting a hypercatecholaminergic condition. As there was no significant increase of serum and urine levels of catecholamines (plasma free metanephrine, 20 pg/mL [<130)]; normetanephrine, 20 pg/mL [<506]; urine vanillylmandelic acid 2.9 μg/mLCr [1.2–4.9]), he was diagnosed with CPA due to VT caused by idiopathic adrenal hemorrhage (i.e., catecholamine surge). His condition gradually improved, and underwent cardioverter defibrillator implantation. CT showed ameliorated enlargement of the RAG with low density (Figure G), ECG and echocardiography were normal, and he was discharged 3 months after admission. Approximately 6 months after CPA, CT showed that the RAG was nearly normal in size with calcification (Figure H). For 3 years, he has not had a recurrence of VT or CPA.

Figure.

ECG (A) and ECG monitor (B) on admission. Abdominal computed tomography (CT) on admission (C) and over time (D, 2 weeks; G, 3 months; H, 6 months later). ¹²³I-metaiodobenzylguanidine scintigraphy: (E) adrenal gland; (F) heart. NTproBNP, N-terminal pro-brain natriuretic peptide.

Conflicts of Interest

The authors declare there are no conflicts of interest.

Funding / IRB Information

None.

Disclosures

K.M. is a member of Circulation Journal’s Editorial Team.