Display options
Cite
Singh G, Manickam A, Sethuraman M, et al. Takotsubo cardiomyopathy in a patient with pituitary adenoma and secondary adrenal insufficiency. Indian J Crit Care Med. 2015;19(12):731-4doi: 10.4103/0972-5229.171410.
Singh, G., Manickam, A., Sethuraman, M., & Rathod, R. C. (2015). Takotsubo cardiomyopathy in a patient with pituitary adenoma and secondary adrenal insufficiency. Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 19(12), 731-4. https://doi.org/10.4103/0972-5229.171410
Singh, Georgene, et al. "Takotsubo cardiomyopathy in a patient with pituitary adenoma and secondary adrenal insufficiency." Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine vol. 19,12 (2015): 731-4. doi: https://doi.org/10.4103/0972-5229.171410
Singh G, Manickam A, Sethuraman M, Rathod RC. Takotsubo cardiomyopathy in a patient with pituitary adenoma and secondary adrenal insufficiency. Indian J Crit Care Med. 2015 Dec;19(12):731-4. doi: 10.4103/0972-5229.171410. PMID: 26816449; PMCID: PMC4711208.
Copy Download .nbib Format: NLM
Share it on

Indian J Crit Care Med. 2015 Dec;19(12):731-4. doi: 10.4103/0972-5229.171410.

Takotsubo cardiomyopathy in a patient with pituitary adenoma and secondary adrenal insufficiency.

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

Georgene Singh, Ari Manickam, Manikandan Sethuraman, Ramesh Chandra Rathod

Affiliations

  1. Department of Anaesthesiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
  2. Department of Anaesthesiology, Sri Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.

PMID: 26816449 PMCID: PMC4711208 DOI: 10.4103/0972-5229.171410

Abstract

We describe a case of Takotsubo cardiomyopathy in a case of pituitary macroadenoma in acute adrenal crisis. A 48-year-old man presented with acute onset altered sensorium, vomiting, and gasping. On admission, he was unresponsive and hemodynamically unstable. He was intubated and ventilated and resuscitated with fluids and inotropes. The biochemical evaluation revealed hyponatremia, hyperkalemia, and hypocortisolism. Hyponatremia was corrected with 3% hypertonic saline. Contrast enhanced computed tomography (CT) scan of the brain revealed a sellar-suprasellar mass with hypothalamic extension with no evidence of pituitary apoplexy. A diagnosis of invasive pituitary adenoma with the Addisonian crisis was made and steroid replacement was initiated. Despite volume resuscitation, he had persistent refractory hypotension, recurrent ventricular tachycardia, and metabolic acidosis. Electrocardiogram (ECG) showed ST elevation and T-wave inversion in lateral leads; cardiac-enzymes were increased suggestive of acute coronary syndrome. Transthoracic echocardiography showed severe regional wall motion abnormalities (RWMAs) involving left anterior descending territory and low ejection fraction (EF). Coronary angiogram revealed normal coronaries, apical ballooning, and severe left ventricular dysfunction, consistent with a diagnosis of Takotsubo's cardiomyopathy. Patient was managed with angiotensin-converting enzyme inhibitors and B-blockers. He improved over few days and recovered completely. At discharge, ECG changes and RWMA resolved and EF normalized to 56%. In patients with Addisonian Crisis with persistent hypotension refractory to optimal resuscitation, possibility of Takotsubo's cardiomyopathy should be considered. Early recognition of association of Takotsubos cardiomyopathy in neurological conditions, prompt resuscitation, and supportive care are essential to ensure favorable outcomes in this potentially lethal condition.

Keywords: Pituitary adenoma; secondary adrenal insufficiency; takotsubos cardiomyopathy

References

  1. Int J Cardiol. 2007 Mar 20;116(2):e71-3 - PubMed
  2. Epilepsia. 2011 Nov;52(11):e160-7 - PubMed
  3. Hellenic J Cardiol. 2009 Sep-Oct;50(5):436-8 - PubMed
  4. Int J Cardiol. 2010 Oct 8;144(2):e34-6 - PubMed
  5. Nat Clin Pract Cardiovasc Med. 2008 Jan;5(1):22-9 - PubMed
  6. Circulation. 2005 Feb 1;111(4):472-9 - PubMed
  7. Clin Res Cardiol. 2006 Mar;95(3):179-85 - PubMed
  8. Cardiovasc Res. 1993 Feb;27(2):192-8 - PubMed
  9. Jpn Circ J. 1995 Apr;59(4):236-40 - PubMed
  10. J Gen Intern Med. 2008 Nov;23(11):1904-8 - PubMed
  11. Chest. 1991 Feb;99(2):382-5 - PubMed
  12. Endocr J. 2007 Aug;54(4):631-6 - PubMed
  13. Intern Med. 2009;48(5):347-52 - PubMed
  14. Heart. 2003 Sep;89(9):1027-31 - PubMed
  15. Mayo Clin Proc. 1993 Oct;68(10):988-1001 - PubMed
  16. Circulation. 1995 Oct 15;92(8):2183-9 - PubMed
  17. J Clin Neurol. 2010 Sep;6(3):152-5 - PubMed
  18. J Am Coll Cardiol. 2001 Jul;38(1):11-8 - PubMed
  19. Eur Heart J. 2006 Jul;27(13):1523-9 - PubMed
  20. Am Heart J. 1995 Oct;130(4):909-11 - PubMed
  21. Can J Cardiol. 1999 Jul;15(7):811-4 - PubMed
  22. Stroke. 1999 Apr;30(4):780-6 - PubMed
  23. Circulation. 2005 Nov 22;112(21):3314-9 - PubMed
  24. Chest. 2007 Sep;132(3):809-16 - PubMed

Publication Types