Takotsubo cardiomyopathy and pituitary apoplexy: a case report

Chun Yang,Ai-Qun Ma,Xiu Han,Yuan Du

doi:10.1186/s12872-020-01521-1

Chun Yang, Ai-Qun Ma + Show 2 more

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https://doi.org/10.1186/s12872-020-01521-1

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Abstract

BackgroundTakotsubo cardiomyopathy (TTC) has been widely recognized in recent decades and is triggered by either physical or psychological stressors.Case presentationA 70-year-old woman presented to the Emergency Department due to confusion, hypotension, fever, chills, and cough. She had a one-year history of diabetes insipidus. Pituitary function examination at admission revealed decreased thyroid, sex and adrenal hormones. Pituitary MRI displayed findings suggestive of nonhemorrhagic pituitary apoplexy. Electrocardiogram (ECG) revealed T-wave inversion and extended QT interval. Transthoracic echocardiogram (TTE) showed left ventricular apical dysplasia and ballooning, accompanied by reduced left ventricular ejection fraction. Coronary angiography (CAG) revealed no obvious coronary arterial stenosis. The left ventriculogram demonstrated an octopus clathrate appearance. Most ECG and TTE changes recovered 10 days later.ConclusionsTo the best of our knowledge, this is the first report of newly diagnosed TTC associated with pituitary apoplexy.

Highlights

BackgroundTakotsubo cardiomyopathy (TTC) was first described in Japanese in 1990 by Sato [1] because of the resemblance between Takotsubo (name of a Japanese octopus trap) and the left ventricular appearance during systole of the patients [2]
Takotsubo cardiomyopathy (TTC) has been widely recognized in recent decades and is triggered by either physical or psychological stressors.Case presentation: A 70-year-old woman presented to the Emergency Department due to confusion, hypotension, fever, chills, and cough
To the best of our knowledge, this is the first report of newly diagnosed TTC associated with pituitary apoplexy

Summary

Background

Takotsubo cardiomyopathy (TTC) was first described in Japanese in 1990 by Sato [1] because of the resemblance between Takotsubo (name of a Japanese octopus trap) and the left ventricular appearance during systole of the patients [2]. Case presentation A 70-year-old female patient with a one-year history of diabetes insipidus was transferred to the Emergency Department of our hospital due to confusion and hypotension (minimum of 70/44 mmHg, maintained by dopamine) She had fever (maximum of 39.3 °C), chills, and cough with a small amount of white phlegm that lasted for 2 days. The patient fainted 6 months ago and fell, and the head computed tomography (CT) at that time demonstrated left frontal and occipital fractures accompanied by frontotemporal lobe cerebral contusion, subarachnoid and subdural haemorrhage (Fig. 1 a), and incidental pituitary micro adenoma (Fig. 1 b) She had menopause at 48 years old. Emergency bedside TTE showed left ventricular ballooning, apical dyskinesia, and abnormal diastolic function (LVEF being 36% by Simpson’s method) (Fig. 4 a b c), which was considered Takotsubo cardiomyopathy. TTE showed recovered LV apical ballooning and normal wall motion at 10 days after treatment (Fig. 4 d). At 2 months after treatment, there were no left ventricular apical ballooning or wall motion abnormalities, with LVEF at 63% by Simpson’s method (Figs. 4e and f)

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