Takotsubo Cardiomyopathy during Acute Adrenal Crisis due to Isolated Adrenocorticotropin Deficiency

Ukita, Chizuko; Miyazaki, Hiroshi; Toyoda, Nagaoki; Kosaki, Atsushi; Nishikawa, Mitsushige; Iwasaka, Toshiji

doi:10.2169/internalmedicine.48.1662

Cited by 23 publications

(12 citation statements)

References 27 publications

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“…Similar to these six cases, intensive stress induced by adrenal insufficiency caused reversible cardiomyopathy in our patient, although the detailed mechanism of left ventricular dysfunction in Takotsubo cardiomyopathy remains unknown [10–17]. According to the report by Ukita et al [8], they listed all cases of Takotsubo cardiomyopathy with isolated ACTH deficiency [5–7]. Comparing those cases, we found that all cases including ours were female patients although we could not figure out the meanings of the sex difference.…”

Section: Discussionsupporting

confidence: 75%

Isolated Adrenocorticotropin Deficiency Associated with Delirium and Takotsubo Cardiomyopathy

Murakami

Matsushita

Arai

et al. 2012

Case Reports in Endocrinology

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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.

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Section: Discussionsupporting

confidence: 75%

Isolated Adrenocorticotropin Deficiency Associated with Delirium and Takotsubo Cardiomyopathy

Murakami

Matsushita

Arai

et al. 2012

Case Reports in Endocrinology

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“…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.…”

Section: Discussionmentioning

confidence: 75%

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

et al. 2015

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A 73-year-old woman was admitted due to weight loss and generalized malaise. The basal levels of all the anterior pituitary hormones, except for prolactin, were reduced. However, they were all elevated in response to exogenous hypothalamic hormones. After starting hydrocortisone replacement, the patient had polyuria of >5,000 mL/day. T1-weighted MRI depicted a low signal of an oval mass in the sella turcica and an isointense signal of another mass at the pituitary stalk. These findings indicate a hypothalamic type of hypopituitarism and masked central diabetes insipidus which possibly derived from the atypical occupation of Rathke's cleft cyst at the pituitary stalk.

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“… 2 , 3 Wide varieties of presenting symptoms were reported, including depressive disorder, 4 lower extremities’ motion abnormality, 5 and stress-induced cardiomyopathy. 6 , 7 Compared with primary adrenocortical insufficiency, which has clinical presentations, skin pigmentation, and electrolyte abnormalities including hyponatremia and hyperkalemia, the symptoms and physical findings of secondary adrenocortical insufficiency are nonspecific and difficult to diagnose. Hypercalcemia was reported in 5.5% of primary adrenocortical insufficiency.…”

Section: Discussionmentioning

confidence: 99%

A case of isolated adrenocorticotropic hormone deficiency: a rare but possible cause of hypercalcemia

Harano¹,

Kitano²,

Akiyama³

et al. 2015

IMCRJ

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A 52-year-old woman presented with an 8-month history of epigastric pain, nausea, and weight loss. One year before, she was diagnosed with breast cancer. During the postoperative chemotherapy, she developed epigastric pain and nausea. As a result, she gradually lost 12 kg of her body weight. We performed upper gastrointestinal endoscopy, which revealed mild erosive gastritis. After the treatment with a proton pump inhibitor, her symptoms persisted. Before the admission, mild hypercalcemia was pointed out. Fluid replacement didn’t improve hypercalcemia. We assessed adrenocortical function, which showed that her serum cortisol and adrenocorticotropic hormone were decreased. Through loading tests, we established diagnosis of isolated adrenocorticotropic hormone deficiency. She was treated with hydrocortisone. Soon after the treatment, her serum calcium level returned to normal and her symptoms improved. In a case of hypercalcemia unresponsive to fluid replacement, we recommend ruling out adrenal insufficiency after excluding more common diseases which induce hypercalcemia.

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Takotsubo Cardiomyopathy during Acute Adrenal Crisis due to Isolated Adrenocorticotropin Deficiency

Abstract: We report a 69-year-old

Cited by 23 publications

References 27 publications

Isolated Adrenocorticotropin Deficiency Associated with Delirium and Takotsubo Cardiomyopathy

Isolated Adrenocorticotropin Deficiency Associated with Delirium and Takotsubo Cardiomyopathy

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

A case of isolated adrenocorticotropic hormone deficiency: a rare but possible cause of hypercalcemia

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