Optical Coherence Tomography (OCT) Imaging of Coronary Plaque Rupture Resulting in Acute Coronary Syndrome in a Patient with Addisons’ Crisis

Acute coronary syndrome (ACS) in a patient with acute adrenal insufficiency (AAI) is rare and presents a diagnostic challenge to the treating physician due to its uncharacteristic presentation. AAI is an uncommon but serious condition presenting with vomiting, low blood pressure and weakness. The outcome of AAI depends on early treatment with corticosteroids. Long-term use of corticosteroids is an independent risk factor for cardiovascular disease. Corticosteroids induce a chronic inflammatory response of the vasculature, leading to atheroma formation and progression. ACS is a major cause of hospital admission and death in patients with long-term use of steroids. The most common cause of ACS is atherothrombosis. Optical coherence tomography (OCT) is an intravascular imaging modality that provides a detailed picture of atheromatous plaque morphology due to its high resolution. We hereby present a case of ACS resulting from a plaque rupture in a patient with AAI and the utility of intravascular imaging in the assessment of the underlying mechanism of ACS.