Takotsubo Endocrinopathy

Kalra, Sanjay; Lakhani, Om J; Chaudhary, Sandeep

doi:10.17925/ee.2020.16.2.97

Cited by 6 publications

(5 citation statements)

References 26 publications

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“… 6 Furthermore, recent studies have shown that endocrine disorders, such as hyperthyroidism, pheochromocytoma, and primary aldosteronism, are associated with TCM onset. 7 The patient had been taking yokukansan, a licorice‐containing (1.5 g/day) Kampo drug, for over 10 years. According to the Japanese Adverse Drug Reports Database, yokukansan is associated with a low incidence of side effects.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have shown that TCM precipitated by either physical or unidentified triggers has poorer short‐ and long‐term cardiovascular outcomes than TCM precipitated by emotional triggers 6 . Furthermore, recent studies have shown that endocrine disorders, such as hyperthyroidism, pheochromocytoma, and primary aldosteronism, are associated with TCM onset 7 . The patient had been taking yokukansan, a licorice‐containing (1.5 g/day) Kampo drug, for over 10 years.…”

Section: Discussionmentioning

confidence: 99%

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Torsade de pointes in an older patient with Takotsubo cardiomyopathy caused by licorice‐induced pseudoaldosteronism: A case report

Yoshida

Yamamoto

Inoue

et al. 2022

Clinical Case Reports

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Takotsubo cardiomyopathy (TCM) is an acute reversible ventricular dysfunction that often causes QT interval prolongation, which can lead to a fatal arrhythmia. 1 Glycyrrhiza uralensis (licorice in English; kanzo in Japanese) is one of the components of Kampo drugs, which are often used for the treatment of various diseases in older patients (Figure 1A-1C). Long-term use of licorice can initiate pseudoaldosteronism, mainly manifesting as severe hypokalemia leading to QT interval prolongation. 2 Yokukansan (TJ-54), which consists of seven dried herbs, including licorice, is reportedly effective for dementia, insomnia, and schizophrenia (Figure 1D). 3,4 Moreover, polypharmacy, an unresolved issue in the aging population, is associated with drug side effects, including fatal arrhythmia due to QT interval prolongation. 5 We herein report a cautionary case of licorice-induced pseudoaldosteronism that precipitated the onset of TCM and subsequent fatal arrhythmia in an octogenarian patient on polypharmacy. | CASE REPORTAn 84-year-old woman with a history of old cerebral infarction and Alzheimer-type dementia was brought to our emergency department because of anorexia and body weakness that persisted for 1 week, progressively worsening dyspnea at rest, and subsequent somnolence. The patient had a history of long-term use of several medications for her comorbidities: aspirin (100 mg/day) for old

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Torsade de pointes in an older patient with Takotsubo cardiomyopathy caused by licorice‐induced pseudoaldosteronism: A case report

Yoshida

Yamamoto

Inoue

et al. 2022

Clinical Case Reports

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“…Catecholamine-driven cardiac impairment may arise from direct cardiotoxicity via myocardial catecholamine-receptor signalling, microvascular ischemia, and transient coronary artery vasospasm [ 5 ]. It has been suggested that all patients with suspected Takotsubo cardiomyopathy should be evaluated for underlying endocrine drivers, such as pheochromocytoma and thyrotoxicosis [ 6 ]. Our patient in the second case likely developed acute Takotsubo cardiomyopathy related to pheochromocytoma, with the inflammatory change around the upper pole of the right kidney more likely to represent non-specific changes related to her acute crisis.…”

Section: Discussionmentioning

confidence: 99%

Acute Pulmonary Edema as a Cardiovascular Manifestation of Pheochromocytoma

Ng¹,

Yu²,

Rajkanna³

2023

Cureus

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Pheochromocytoma most commonly presents with the triad of paroxysms of headache, palpitations, and diaphoresis. Pheochromocytoma crisis, caused by a supra-physiological surge of catecholamine release, is an endocrine emergency that can present with various clinical manifestations. Acute pulmonary edema is one of the manifestations of pheochromocytoma crisis and can be either cardiogenic or non-cardiogenic. Here, we report cases of acute pulmonary edema of each type, related to pheochromocytoma crisis, which were presented to our district general hospital in 2020.

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“…Despite the predominance of postmenopausal women, no study has provided evidence on the association between sex hormone levels and Takotsubo cardiomyopathy. 4 The pathophysiology of Takotsubo cardiomyopathy is complex, with multiple mechanisms theorised to be involved. The neuroendocrine axis is proposed to be involved, with catecholamine-mediated myocardial damage due to either direct toxicity and/or microvascular dysfunction as well as sensitisation of the myocardial tissue to sympathetic hormones by thyroid hormones exacerbating the catecholaminergic-mediated myocardial tissue damage through synergism.…”

Section: Case Reportmentioning

confidence: 99%

Takotsubo cardiomyopathy in the setting of thyroid storm

et al. 2022

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A woman in her 50s with a background of chronic obstructive pulmonary disease secondary to smoking presented with intermittent chest tightness, dyspnoea and vomiting for 4 days. A presumed diagnosis of acute coronary syndrome (ACS) was made based on dynamic ischaemic ECG changes and elevation in high-sensitivity cardiac troponin T levels. She underwent emergent coronary angiography which demonstrated mild coronary artery disease with left ventriculography suggestive of mid-wall variant Takotsubo cardiomyopathy. Thyroid function tests performed to investigate sinus tachycardia were consistent with hyperthyroidism, and her thyroid-stimulating hormone receptor antibody was elevated. A diagnosis of thyroid storm was made in the setting of a newly diagnosed Graves’ disease and the patient was subsequently commenced on guideline-based therapy. This case demonstrates that Takotsubo cardiomyopathy, a mimic of ACS, is a possible complication of thyroid storm and therefore hyperthyroidism should be considered in the list of differentials in patients presenting with Takotsubo cardiomyopathy.

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Takotsubo Endocrinopathy

Cited by 6 publications

References 26 publications

Torsade de pointes in an older patient with Takotsubo cardiomyopathy caused by licorice‐induced pseudoaldosteronism: A case report

Torsade de pointes in an older patient with Takotsubo cardiomyopathy caused by licorice‐induced pseudoaldosteronism: A case report

Acute Pulmonary Edema as a Cardiovascular Manifestation of Pheochromocytoma

Takotsubo cardiomyopathy in the setting of thyroid storm

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