A case of Takotsubo cardiomyopathy in a patient with Iatrogenic thyrotoxicosis

Kwon, Se Ah; Yang, Jae Hyuk; Kim, Min Kyu; Park, Seon Wook; Kim, Seong Hwan; Park, Kyong Hwa; Park, Woo Jung

doi:10.1016/j.ijcard.2009.06.040

Cited by 13 publications

(3 citation statements)

References 9 publications

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“…It has also been postulated that hyperthyroidism predisposes to Takotsubo cardiomyopathy by acting synergistically with adrenergic hormones in states of catecholamine excess (8). Indeed, when we investigated previous case reports regarding the association of Takotsubo cardiomyopathy and thyrotoxicosis, several cases of Takotsubo cardiomyopathy were found to be complicated with thyrotoxicosis ( Table 2) (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). All cases were shown to present typical signs of Takotsubo cardiomyopathy (23).…”

Section: Discussionmentioning

confidence: 95%

Congestive Heart Failure Secondary to a TSH-Secreting Pituitary Adenoma Aggravated by Takotsubo Cardiomyopathy in an Elderly Patient

Sakuma

Koide

Yoshida

et al. 2018

AACE Clinical Case Reports

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Objective:To review a case of congestive heart failure (CHF) due to a thyroid-stimulating hormone (TSH)secreting pituitary adenoma (TSH-oma) concomitant with Takotsubo cardiomyopathy in an elderly patient.Methods: We describe the clinical course, laboratory data, imaging studies, and management of the patient and provide a brief literature review regarding Takotsubo cardiomyopathy associated with hyperthyroidism.Results: A 76-year-old woman was admitted to our hospital for CHF treatment. Chest X-ray and electrocardiogram (ECG) showed cardiomegaly and broad T-wave inversion, respectively. Furthermore, left ventricular angiogram and subsequent coronary angiogram showed mild hypokinesis of the apex, without signs of obstructive coronary disease. Pulmonary hypertension was determined through right-heart catheterization. Accordingly, we clinically diagnosed this patient with Takotsubo cardiomyopathy complicated with pulmonary hypertension. Administration of β-blockers and angiotensin-receptor blockers markedly improved the abnormal ECG findings and wall motion due to Takotsubo cardiomyopathy. However, the cardiomegaly and pulmonary hypertension remained. We then detected hyperthyroidism with inappropriate TSH secretion. Brain magnetic resonance imaging revealed a pituitary macroadenoma, suggesting hyperthyroidism due to TSH-oma. Octreotide administration immediately led to the normalization of thyroid hormone secretion, which in turn improved the hyperthyroidism, cardiac enlargement, and pulmonary hypertension. Transsphenoidal surgery was safely performed. Pathologic investigation confirmed the diagnosis of TSH-oma.Conclusion: We report a rare case of Takotsubo cardiomyopathy complicated with hyperthyroidism due to TSH-oma in an elderly patient. Clinically, CHF is an important sign of hyperthyroidism in the elderly. Octreotide administration could be useful for the peri-operative management of elderly patients with TSH-omas and cardiovascular complications. (AACE Clinical Case Rep. 2018;4:e115-e123) Abbreviations: CHF = congestive heart failure; ECG = electrocardiogram; LAR = long-acting release; SITSH = syndrome of inappropriate thyroid-stimulating hormone secretion; TRH = thyrotropin-releasing hormone; TSH = thyroidstimulating hormone; TSH-oma = thyroid-stimulating hormone-secreting pituitary adenoma; TR-PG = tricuspid regurgitation pressure gradient e116 Heart Failure Due to TSH-oma, AACE Clinical Case Rep. 2018;4(No. 2)

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Section: Discussionmentioning

confidence: 95%

Congestive Heart Failure Secondary to a TSH-Secreting Pituitary Adenoma Aggravated by Takotsubo Cardiomyopathy in an Elderly Patient

Sakuma

Koide

Yoshida

et al. 2018

AACE Clinical Case Reports

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“…Numerous case reports and case series have been published describing several variants of the condition 17–22. A number of case reports have now been published of patients developing Takotsubo cardiomyopathy as a result of drug administration during diagnostic tests such as dobutamine stress echo,23–26 anaesthesia administration,27 epinephrine administration28–30 and with iatrogenic thyrotoxicosis 31. Case reports have also described patients who developed ABS following administration of β-2 agonists for acute asthma exacerbation 32–38.…”

Section: Discussionmentioning

confidence: 99%

Takotsubo cardiomyopathy with use of salbutamol nebulisation and aminophylline infusion in a patient with acute asthma exacerbation

Hasan¹,

Tai

2016

BMJ Case Reports

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Takotsubo cardiomyopathy, apical ballooning syndrome or stress-induced cardiomyopathy is characterised by transient left ventricular dysfunction, mimicking myocardial infarction in the absence of obstructive coronary artery disease or acute plaque rupture on coronary angiography. The exact mechanism of myocardial dysfunction in Takotsubo cardiomyopathy is unknown; however, due to its association with physical and emotional stress, it is postulated that catecholamines play a central role in its pathogenesis. We present a case of a patient who was admitted with acute asthma exacerbation and was treated with β-2 agonist nebulisation and intravenous aminophylline. During her hospital stay she developed Takotsubo cardiomyopathy.

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“…However, it is hypothesized exogenous thyroid administration could have directly influenced myocardial oxygen supply and demand, and lead to a critical imbalance. Other possible mechanisms were embolism with later recanalization, small vessel disease of the heart [4]. There are few cases of Takotsubo cardiomyopathy related to hyperthyroidism [2,3].…”

mentioning

confidence: 99%

A case of asymptomatic patient with hyperthyroidism documented the onset of Takotsubo cardiomyopathy by holter monitoring

Katoh

Tokunaga

Kobayashi

et al. 2011

International Journal of Cardiology

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A case of Takotsubo cardiomyopathy in a patient with Iatrogenic thyrotoxicosis

Cited by 13 publications

References 9 publications

Congestive Heart Failure Secondary to a TSH-Secreting Pituitary Adenoma Aggravated by Takotsubo Cardiomyopathy in an Elderly Patient

Congestive Heart Failure Secondary to a TSH-Secreting Pituitary Adenoma Aggravated by Takotsubo Cardiomyopathy in an Elderly Patient

Takotsubo cardiomyopathy with use of salbutamol nebulisation and aminophylline infusion in a patient with acute asthma exacerbation

A case of asymptomatic patient with hyperthyroidism documented the onset of Takotsubo cardiomyopathy by holter monitoring

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