Abstract
Introduction: Takotsubo Cardiomyopathy (TTC), defined by transient myocardial dysfunction with patterns of regional hyperkinesis, commonly arises after an emotional or physical stressor and hypokinesis. Here, we report a TTC case in the setting of pituitary apoplexy. Case: An 82-year-old Male with a history of hypertension, hyperlipidemia, pituitary adenoma, and complete heart block (status post permanent pacemaker) was admitted to the ED after one week of malaise, nausea, and vomiting. The day prior, he developed a severe frontal pressure headache and intermittent blurry vision. He had no chest pain and initially stable vitals, but later became lethargic and febrile to 101.6F with nonsustained ventricular tachyarrhythmias. EKG showed deep T-wave inversions in V2-V4 concerning for pathologic central nervous system T-waves (Fig. 1A). An echocardiogram revealed reduced left ventricular ejection fraction (LVEF) of 20% and akinesis of all mid-myocardial apical segments (Fig. 1B-D). Labs included flat troponin trend, lactate 5 mmol/L, and electrolyte derangements of magnesium 1.5 mEq/L, phosphorous 1.0 mEq/L, and potassium 3.2 mEq/L. In the cardiac care unit, his pacemaker settings were increased from 60 to 80 bpm due to QT prolongation and torsades de pointes on telemetry (Fig. 1E). Given his history of pituitary adenoma, an MRI Sella was performed and was notable for pituitary apoplexy and interval gland enlargement (Fig. 1F). Further labs revealed low cortisol, TSH, and testosterone. Stress dose steroids and levothyroxine were initiated and he underwent transphenoidal resection. Following these interventions, he was afebrile and no longer experienced his chief complaints. Repeat EKG and echocardiogram showed T-wave resolution in V2-V4 (Fig. 1G) and LVEF 50-55%, respectively. Conclusion: Neuroendocrine disorders should be considered as possible stressors in TTC. Early recognition and treatment can ensure favorable outcomes with pituitary apoplexy.
Published Version
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