Isolated Adrenocorticotropin Deficiency Associated with Delirium and Takotsubo Cardiomyopathy

Abstract

We report a 65-year-old woman with isolated adrenocorticotropic hormone (ACTH) deficiency. The patient was transported to the emergency outpatient department by ambulance complaining of malaise and nausea. Because her laboratory data revealed hyponatremia, we performed endocrinological examinations and diagnosed isolated ACTH deficiency. After admission, she went into a delirious state and suffered from takotsubo cardiomyopathy due to adrenal insufficiency. Replacement therapy with hydrocortisone sufficiently improved her delirium and cardiomyopathy. We conclude that her unstable mental state and myocardial dysfunction were closely related to adrenal insufficiency and suggest that adrenal crisis may cause delirium and Takotsubo cardiomyopathy.

Risk factors contributing to postoperative delirium in geriatric patients postorthopedic surgery

“…Sensitivity in blood pressure regulation is reduced in the elderly, which may lead to abnormally low blood pressure levels under anesthesia. Therefore, anesthesia can contribute to cerebral hypotension and transient cerebral hypoxia (McAiney et al ., ; Murakami et al ., ). Moreover, cerebral arteriosclerosis occurs among elderly patients, further compromising cerebral perfusion in the setting of intraoperative hypotension.…”

“…In recent years, improvements have been made in orthopedic surgical techniques and anesthesia, which have allowed increasing numbers of elderly individuals to benefit from orthopedic surgical treatment. While perioperative mortality and morbidity have been reduced, the number of orthopedic postoperative delirium cases has been increasing (McAiney et al ., ; Murakami et al ., ; Martinez‐Velilla et al ., ). Therefore, it has become increasingly necessary to determine the non‐obvious risk factors that produce postoperative delirium in orthopedic geriatric patients in order to better construct prevention and treatment strategies for these patients.…”

Hypothalamic Type of Hypopituitarism and Central Diabetes Insipidus Probably Linked to Rathke's Cleft Cyst

“…However, takotsubo cardiomyopathy is very rare in patients with hypopituitarism. In the literature, few takotsubo cardiomyopathy cases have so far presented with adrenal failure (24)(25)(26)(27)(28). Our patient suffered from takotsubo cardiomyopathy seven days after the hydrocortisone replacement therapy.…”

Somatic delusions, unusual presenting symptoms of isolated adrenocorticotropin deficiency

“…There were four previously reported cases of delirious patients with IAD, which were not mentioned in the article by Morigaki et al [3][4][5][6]. The four cases of delirium concurrent with IAD had gastrointestinal symptoms and hyponatremia when the presenting symptoms appeared [3].…”