Takotsubo cardiomyopathy and pituitary apoplexy: a case report

Yang, Chun; Han, Xiu; Du, Yuan; Ma, Aiqun

doi:10.1186/s12872-020-01521-1

Cited by 4 publications

(5 citation statements)

References 20 publications

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“…( Table 1 ) Headache was severe, often described as the most painful headache episode an individual has ever experienced, and graded, for example, as high as 9 on a scale from 0 to 10, with 10 being the most severe in one study [ 31 ]. For practical purposes we point out that headache was absent in some cases; thus, an index of suspicion should be provided by other endocrine and non-endocrine clinical elements [ 43 , 86 , 196 , 197 , 198 , 199 , 200 , 201 , 202 , 203 , 204 , 205 , 206 , 207 , 208 , 209 , 210 , 211 , 212 , 213 , 214 , 215 , 216 ]. For instance, Enatsu et al reported a 65-year-old woman admitted for a nonfunctioning pituitary adenoma-associated PA who presented third cranial nerve palsy and sudden decrease in visual acuity unaccompanied by headache [ 196 ].…”

Section: Pitnet Complicated With Pamentioning

confidence: 99%

“…One case of gigantism (+5 SD) was reported on a 9-year-old boy with lactosomatotroph PitNET [ 32 ]. Hypopituitarism included elements of hypogonadism [ 127 , 128 , 129 , 131 , 135 ] like disturbances of menstrual cycle in women of reproductive age [ 171 , 172 ], etc., but, also, with a more severe potential, hypotension [ 29 , 48 , 83 , 199 , 210 , 213 ].…”

Section: Pitnet Complicated With Pamentioning

confidence: 99%

“…For instance, we mention rivaroxaban, enoxaparin, dabigatran etexilate, warfarin, heparin, apixaban, and aspirin. Other vascular and clotting triggers include Takotsubo cardiomyopathy [ 213 ], heparin-induced thrombocytopenia [ 35 ], thrombocytopenia of other causes [ 97 , 208 ], and polycythemia [ 108 ]. Medical treatments in point are further on (at the statistical level of rare case reports): androgen deprivation therapy for prostate cancer [ 52 , 88 , 99 , 157 , 168 ], systemic chemotherapy like bleomycin, etoposide, cisplatin [ 184 ], doxorubicin, cyclophosphamide [ 207 ], and thyroxine therapy [ 61 ].…”

Section: Pitnet Complicated With Pamentioning

confidence: 99%

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Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

et al. 2023

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Various complications of pituitary neuroendocrine tumors (PitNET) are reported, and an intratumor hemorrhage or infarct underlying pituitary apoplexy (PA) represents an uncommon, yet potentially life-threatening, feature, and thus early recognition and prompt intervention are important. Our purpose is to overview PA from clinical presentation to management and outcome. This is a narrative review of the English-language, PubMed-based original articles from 2012 to 2022 concerning PA, with the exception of pregnancy- and COVID-19-associated PA, and non-spontaneous PA (prior specific therapy for PitNET). We identified 194 original papers including 1452 patients with PA (926 males, 525 females, and one transgender male; a male-to-female ratio of 1.76; mean age at PA diagnostic of 50.52 years, the youngest being 9, the oldest being 85). Clinical presentation included severe headache in the majority of cases (but some exceptions are registered, as well); neuro-ophthalmic panel with nausea and vomiting, meningism, and cerebral ischemia; respectively, decreased visual acuity to complete blindness in two cases; visual field defects: hemianopia, cranial nerve palsies manifesting as diplopia in the majority, followed by ptosis and ophthalmoplegia (most frequent cranial nerve affected was the oculomotor nerve, and, rarely, abducens and trochlear); proptosis (N = 2 cases). Risk factors are high blood pressure followed by diabetes mellitus as the main elements. Qualitative analysis also pointed out infections, trauma, hematologic conditions (thrombocytopenia, polycythemia), Takotsubo cardiomyopathy, and T3 thyrotoxicosis. Iatrogenic elements may be classified into three main categories: medication, diagnostic tests and techniques, and surgical procedures. The first group is dominated by anticoagulant and antiplatelet drugs; additionally, at a low level of statistical evidence, we mention androgen deprivation therapy for prostate cancer, chemotherapy, thyroxine therapy, oral contraceptives, and phosphodiesterase 5 inhibitors. The second category includes a dexamethasone suppression test, clomiphene use, combined endocrine stimulation tests, and a regadenoson myocardial perfusion scan. The third category involves major surgery, laparoscopic surgery, coronary artery bypass surgery, mitral valvuloplasty, endonasal surgery, and lumbar fusion surgery in a prone position. PA in PitNETs still represents a challenging condition requiring a multidisciplinary team from first presentation to short- and long-term management. Controversies involve the specific panel of risk factors and adequate protocols with concern to neurosurgical decisions and their timing versus conservative approach. The present decade-based analysis, to our knowledge the largest so far on published cases, confirms a lack of unanimous approach and criteria of intervention, a large panel of circumstantial events, and potential triggers with different levels of statistical significance, in addition to a heterogeneous clinical picture (if any, as seen in subacute PA) and a spectrum of evolution that varies from spontaneous remission and control of PitNET-associated hormonal excess to exitus. Awareness is mandatory. A total of 25 cohorts have been published so far with more than 10 PA cases/studies, whereas the largest cohorts enrolled around 100 patients. Further studies are necessary.

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Section: Pitnet Complicated With Pamentioning

confidence: 99%

Section: Pitnet Complicated With Pamentioning

confidence: 99%

Section: Pitnet Complicated With Pamentioning

confidence: 99%

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Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

et al. 2023

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“…Diagnosing TS complications is of utmost importance in order to properly treat an individual patient. TTE is particularly useful in diagnosing TS in acute clinical scenarios which are not suggestive of a cardiac event [ 64 ], such as patients with neurological disease who also present dynamic electrocardiogram (ECG) changes and elevated troponin levels [ 65 , 66 , 67 , 68 ]. TTE has an important role in the perioperative and periprocedural care or in patients who become hemodynamically unstable in the Intensive Care Unit [ 48 , 69 , 70 , 71 , 72 , 73 , 74 ].…”

Section: Standard Echocardiographymentioning

confidence: 99%

An Extensive Review on Imaging Diagnosis Methods in Takotsubo Syndrome

Paraschiv,

Paduraru,

Balanescu

2023

Rev. Cardiovasc. Med.

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Takotsubo Syndrome (TS) is an acute, reversible cardiac dysfunction, with complex, not entirely understood pathophysiology and heterogeneous clinical picture. Imaging methods each have a crucial role in the diagnosis, in-hospital management, short term and long term follow up. Coronary angiography needs to be performed, especially in the setting of a suspected acute coronary syndrome, in order to rule out coronary artery disease. Echocardiography plays a central role both in the acute and the chronic phase. It is the first imaging investigation performed in patients with TS, valuable to diagnose systolic dysfunction, the wall motion pattern and early complications. Cardiac magnetic resonance tissue characterization provides an essential role in the differential diagnosis of TS with other non-ischemic causes of systolic dysfunction. This review focuses on the imaging methods and the important part they play in the complex management of the disease.

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“…Adrenal insufficiency should be considered in patients with PUO exhibiting specific and non specific signs and symptoms of adrenal dysfunction. It is worth noting that the patient had a history of Takotsubo cardiomyopathy, which has been associated with both empty sella syndrome and adrenal insufficiency in previous case reports [9][10][11][12]. Numerous publications have reported similar cases of secondary adrenal insufficiency associated with isolated ACTH deficiency and an empty sella [13,14].…”

mentioning

confidence: 94%

Pyrexia of Unknown Origin due to Secondary Adrenal Insufficiency: A Case Report

Bandyopadhyay,

Chandra,

Samanta

et al. 2024

JCDR

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Adrenal insufficiency is a critical condition that can often present with non specific symptoms, posing a diagnostic challenge in the context of co-existing conditions. Authors hereby, report a complex case of secondary adrenal insufficiency revealed through persistent fever and hyponatremia in a 73-year-old female with a multifaceted medical history, including hypertension, diabetes, and Takotsubo cardiomyopathy. Her symptoms of intermittent fever and diarrhoea were refractory to treatment, leading to hospital readmission. Initial laboratory investigations highlighted hyponatremia, low haemoglobin, elevated inflammatory markers, and low cortisol levels. Although a urinary tract infection with multidrug-resistant Klebsiella was identified and treated, her febrile state persisted. Extensive serological testing for a broad range of infectious diseases yielded negative results, excluding infectious etiologies as the cause of her fever. Imaging studies, including chest X-ray, Electrocardiogram (ECG), echocardiogram, Positron Emission Tomography (PET) scan, Computed Tomography (CT), and transesophageal echocardiography, failed to identify a source of infection or malignancy. Notably, a low random cortisol level coupled with an inappropriately low Adrenocorticotropic Hormone (ACTH) level prompted further endocrine evaluation. Magnetic Resonance Imaging (MRI) revealed an empty sella turcica, confirming secondary adrenal insufficiency. This diagnosis was substantiated by the patient’s positive response to steroid therapy, which led to clinical improvement and eventual discharge. The present case underlines the importance of considering adrenal insufficiency in patients presenting with unexplained hyponatremia and fever, particularly when other common aetiologies have been ruled out. It also illustrates the potential for critical endocrine disorders to mimic sepsis, underscoring the necessity of a comprehensive diagnostic approach in the face of complex presentations.

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Takotsubo cardiomyopathy and pituitary apoplexy: a case report

Cited by 4 publications

References 20 publications

Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

An Extensive Review on Imaging Diagnosis Methods in Takotsubo Syndrome

Pyrexia of Unknown Origin due to Secondary Adrenal Insufficiency: A Case Report

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