Introduction: Acute cardiac insufficiency induced by stress (Takotsubo cardiomyopathy (TTC)) is a reversible cardiomyopathy induced by severe emotional stress or severe clinical conditions. It is characterised by transient left ventricular systolic dysfunction and electrocardiographic changes. This cardiomyopathy has been described in some severe neurological conditions and in patients with pheochromocytoma. To date, some cases of this cardiomyopathy have been described in patients with hyponatremia due to isolated secondary adrenal insufficiency or in a patient with both hypothyroidism and adrenal insufficiency. TTC has been known to be more prevalent in women (the role of sex and hormones is not yet well defined).
Case report: We present a case of a 43-year-old woman with hypopituitarism, probably due to autoimmune hypophysitis with secondary hypothyroidism, secondary adrenal insufficiency, and hypogonadism as well as with primary hypothyroidism due to Hashimotos thyroiditis. The patient was treated for primary hypothyroidism, but her general condition suggested adrenal insufficiency. On admission, her plasma cortisol was 0 μg/dl, so she was treated immediately with hydrocortisone. As a routine examination, echocardiography was performed revealing ampulla cardiomyopathy. Electrocardiography showed T wave inversion in almost all leads. Two weeks after treatment with hydrocortisone and thyroxine, an echocardiographic examination showed recovered left ventricular wall motion and improvement in the ejection fraction and electrocardiography was normal. This is, to our knowledge, the first report of TTC due to hypothyroidism and adrenal insufficiency with no hyponatremia, no evident hypoglycemia and no evident catecholamine overproduction.
Conclusions: Adrenocortical failure is considered to be one of the triggering factors for ampulla cardiomyopathy. All patients with severe adrenal insufficiency should be screened for cardiomyopathy and first-line treatment in these cases consists of proper steroid substitution and careful monitoring of cardiac function.
16 - 20 May 2015
European Society of Endocrinology