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Takotsubo Cardiomyopathy Secondary to Adrenal Insufficiency: A Case Report and Literature Review. Case Rep Cardiol 2020; 2020:6876951. [PMID: 32566318 PMCID: PMC7298333 DOI: 10.1155/2020/6876951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 03/22/2020] [Accepted: 03/28/2020] [Indexed: 01/01/2023] Open
Abstract
We report a case of a middle-aged female who presented with altered mental status, hypotension, and hypoglycemia and was diagnosed with secondary adrenal insufficiency. She was also found to have elevated troponin I on initial evaluation with diffuse T wave inversions on electrocardiogram. Transthoracic echocardiogram revealed ejection fraction of 38% with apical akinesia. Subsequent left heart catheterization revealed clean coronary arteries. She was diagnosed with typical Takotsubo cardiomyopathy secondary to adrenal insufficiency. She was managed with IV hydrocortisone with resolution of symptoms. This article adds to the select few cases in the literature of the association of Takotsubo cardiomyopathy resulting from secondary adrenal insufficiency.
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Alkhateeb M, Alsakkal M, Alfauri MN, Alasmar D. Reversible dilated cardiomyopathy as a complication of adrenal cortex insufficiency: a case report. J Med Case Rep 2018; 12:345. [PMID: 30458836 PMCID: PMC6247618 DOI: 10.1186/s13256-018-1899-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular manifestations associated with Addison's disease are previously documented. We described a case of an 11-year-old girl who developed dilated cardiomyopathy as a complication to Addison's disease. Glucocorticoid replacement therapy resulted in near-complete recovery of cardiac function. It is the first reported case of reversible cardiomyopathy as a complication of primary adrenal insufficiency in Syria. CASE PRESENTATION An 11-year-old Caucasian girl with no significant past medical history presented with abdominal pain, vomiting after meals, and a low-grade fever. A physical examination and laboratory evaluation suggested primary adrenal insufficiency. An echocardiogram showed changes consistent with dilated cardiomyopathy. Causes of primary adrenal insufficiency other than autoimmune were excluded. CONCLUSIONS Dilated cardiomyopathy is a rare complication of primary adrenal insufficiency. Proper treatment of adrenal insufficiency with glucocorticoid replacement therapy resulted in restoration of normal cardiac function.
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Hyland KA, Altman DS, Perkins JM. Reversible Heart Failure as a Result of Newly Diagnosed Primary Adrenal Insufficiency. AACE Clin Case Rep 2016. [DOI: 10.4158/ep15835.cr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Minette MS, Hoyer AW, Pham PP, DeBoer MD, Reller MD, Boston BA. Cardiac function in congenital adrenal hyperplasia: a pattern of reversible cardiomyopathy. J Pediatr 2013; 162:1193-8, 1198.e1. [PMID: 23337094 DOI: 10.1016/j.jpeds.2012.11.086] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 10/10/2012] [Accepted: 11/29/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate cardiac function in infants with congenital adrenal hyperplasia (CAH) before and after corticosteroid replacement therapy. STUDY DESIGN This prospective, case-control study included 9 infants with CAH. Cardiac function was assessed by echocardiography at presentation and after corticosteroid replacement therapy. Six term infants underwent 2 echocardiograms each and served as the control group. Data on fractional shortening (FS), rate-corrected velocity of circumferential fiber shortening (Vcf), wall stress, tissue Doppler indices, myocardial performance index, left ventricular mass, and Vcf/wall stress were obtained. RESULTS The infants with CAH exhibited myocardial dysfunction at baseline and lower systolic blood pressure (SBP) compared with the control group. FS, a measure of systolic contractility, differed significantly from before to after corticosteroid treatment (mean, 32.3%±4.7% pretreatment, 39.9%±5.0% posttreatment). Vcf, a preload-independent measure of cardiac contractility, also differed significantly before and after treatment (mean, 1.23±0.16 circumferences/second pretreatment, 1.45±0.22 circumferences/second posttreatment). SBP was also lower (mean, 84±9.3 mmHg) and improved with treatment (mean, 95±4.8 mmHg). The control group demonstrated no statistically significant changes in FS, Vcf, or SBP. There was a change in left ventricular mass in the control group between the 2 studies. CONCLUSION Newborns with CAH have evidence for cardiac dysfunction at baseline that reverses with corticosteroid replacement therapy. These data suggest that corticosteroids play a direct role in modulating cardiac function in the newborn.
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Affiliation(s)
- Mary S Minette
- Division of Pediatric Cardiology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA.
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Shimizu M, Monguchi T, Takano T, Miwa Y. Isolated ACTH deficiency presenting with severe myocardial dysfunction. J Cardiol Cases 2011; 4:e26-e30. [PMID: 30546710 PMCID: PMC6265152 DOI: 10.1016/j.jccase.2011.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 04/21/2011] [Accepted: 05/06/2011] [Indexed: 10/18/2022] Open
Abstract
We present a case of isolated adrenocorticotropic hormone (ACTH) deficiency complicated by acute adrenal crisis and severe myocardial dysfunction. A 54-year-old woman developed consciousness disturbance, hypoglycemia, hyponatremia, and rhabdomyolysis. Initial echocardiographic examinations on the sixth hospital day revealed marked right-sided atrial and ventricular dilatation and severe tricuspid regurgitation. A computed tomography scan for pulmonary embolism was negative. On the 14th hospital day, she became dyspneic and hypotensive. Repeated echocardiographic examinations demonstrated diffuse and severe hypokinesis of the left ventricle. The previous right-sided chamber dilatation became less apparent. Congestive heart failure and severe hypotension were refractory to catecholamines, while she was eventually diagnosed as having acute adrenal crisis due to isolated ACTH deficiency. Hydrocortisone replacement therapy was started, and echocardiographic examinations revealed that the left ventricular dysfunction completely returned to normal in the following eight days. Severe myocardial dysfunction is an uncommon but serious complication of acute adrenal insufficiency. The present case was unique in that diffuse left ventricular dysfunction was preceded by right ventricular dysfunction.
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Affiliation(s)
- Masatoshi Shimizu
- Department of Cardiology, National Hospital Organization Kobe Medical Center, Kobe, Japan
| | - Tomoko Monguchi
- Department of Internal Medicine, National Hospital Organization Kobe Medical Center, Kobe, Japan
| | - Takatsugu Takano
- Department of Cardiology, National Hospital Organization Kobe Medical Center, Kobe, Japan
| | - Yoichi Miwa
- Department of Internal Medicine, National Hospital Organization Kobe Medical Center, Kobe, Japan
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Deegan RJ, Furman WR. Cardiovascular Manifestations of Endocrine Dysfunction. J Cardiothorac Vasc Anesth 2011; 25:705-20. [DOI: 10.1053/j.jvca.2010.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Indexed: 01/27/2023]
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Ukita C, Miyazaki H, Toyoda N, Kosaki A, Nishikawa M, Iwasaka T. Takotsubo cardiomyopathy during acute adrenal crisis due to isolated adrenocorticotropin deficiency. Intern Med 2009; 48:347-52. [PMID: 19252360 DOI: 10.2169/internalmedicine.48.1662] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
We report a 69-year-old woman who had isolated adrenocorticotropic hormone (ACTH) deficiency. Subsequently, she had Takotsubo cardiomyopathy during acute adrenal crisis. Replacement therapy with hydrocortisone sufficiently improved her cardiomyopathy. We conclude that her myocardial dysfunction was closely related to adrenal insufficiency and suggest that in certain circumstances, adrenal crisis may cause Takotsubo cardiomyopathy.
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Affiliation(s)
- Chizuko Ukita
- The Second Department of Internal Medicine, Kansai Medical University, Osaka.
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Sakihara S, Kageyama K, Nigawara T, Kidani Y, Suda T. Ampulla (Takotsubo) cardiomyopathy caused by secondary adrenal insufficiency in ACTH isolated deficiency. Endocr J 2007; 54:631-6. [PMID: 17664847 DOI: 10.1507/endocrj.k07-012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
We describe here a case of reversible ampulla (takotsubo) cardiomyopathy caused by secondary adrenal insufficiency in ACTH isolated deficiency. A 53-year-old woman was referred to our department for evaluation and treatment of unconsciousness. On admission, her plasma glucose level was 34 mg/dL, suggesting loss of consciousness due to hypoglycemia. Basal levels of ACTH, cortisol, and dehydroepiandrosterone sulfate in blood, and urinary free cortisol levels were all decreased. ACTH and cortisol levels were not adequately increased in response to CRH administration and the insulin tolerance test. Electrocardiography showed ST segment elevation and T wave inversion in leads V 1-6. The coronary arteries were free of organic stenosis, and a left ventriculogram revealed severe hypokinesis, particularly in the anterior and posterior walls. Based on a diagnosis of adrenocortical insufficiency caused by ACTH isolated deficiency, hydrocortisone was administered. Two weeks after treatment, ultrasound studies of the heart showed recovery of left ventricular wall motion. Activation of the sympathetic nervous system, adrenocortical failure, and hypoglycemic attack were considered to be triggering factors for the takotsubo cardiomyopathy. Careful monitoring of cardiac function and appropriate treatments for both cardiomyopathy and adrenocortical failure are required to recover cardiac dysfunction.
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Affiliation(s)
- Satoru Sakihara
- Department of Endocrinology and Metabolism, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan
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Wiltshire EJ, Wilson R, Pringle KC. Addison's disease presenting with an acute abdomen and complicated by cardiomyopathy. J Paediatr Child Health 2004; 40:644-5. [PMID: 15469537 DOI: 10.1111/j.1440-1754.2004.00495.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Adrenal insufficiency typically presents with non-specific symptoms, followed by shock secondary to a salt-wasting crisis and/or the vascular effects of glucocorticoid deficiency if it progresses to acute adrenal insufficiency. Rhabdomyolysis and cardiac dysfunction are rarely reported, particularly in children. We report a child with adrenal insufficiency, presenting with acute abdominal signs, probably secondary to rhabdomyolysis, and complicated by reversible cardiomyopathy. Acute adrenal insufficiency should be considered with this presentation. The possibility of impaired cardiac function during its treatment should also be considered.
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Affiliation(s)
- E J Wiltshire
- Department of Paediatrics, Wellington School of Medicine and Health Sciences, Wellington, New Zealand.
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10
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Conwell LS, Gray LM, Delbridge RG, Thomsett MJ, Batch JA. Reversible cardiomyopathy in paediatric Addison's disease--a cautionary tale. J Pediatr Endocrinol Metab 2003; 16:1191-5. [PMID: 14594181 DOI: 10.1515/jpem.2003.16.8.1191] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 13 year-old girl with clinical features of Addison's disease developed acute cardiac failure after initiation of treatment and after initial clinical improvement. Large doses of i.v. hydrocortisone and oral fludrocortisone, in addition to inotropic and ventilatory support, were required to achieve cardiovascular stability. The cardiomyopathy improved over one week and her condition then remained stable on oral glucocorticoid and mineralocorticoid replacement therapy. Reversible cardiomyopathy is a rare and potentially life-threatening complication of Addison's disease. The second reported paediatric patient is presented, the only one reported to require ventilatory support.
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Affiliation(s)
- L S Conwell
- Department of Endocrinology and Diabetes Royal Children's Hospital, Brisbane, Queensland, Australia.
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Flores Antón B, Bonet Serra B, Adiego Burgos B, Martínez Orgado J, Martín Ancel A, Pérez-Lescure Picarzo J. [Congenital adrenal hyperplasia: an association with increased fetal nuchal translucency]. An Pediatr (Barc) 2003; 58:52-4. [PMID: 12628119 DOI: 10.1016/s1695-4033(03)77991-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
A neonate with increased nuchal translucency and congenital adrenal hyperplasia is described. The possible interferences in hormone assays when values are much higher than the average assay range are also discussed.
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Affiliation(s)
- B Flores Antón
- Area de Pediatría y Neonatología. Fundación Hospital Alcorcón. Universidad Rey Juan Carlos. Madrid. España
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13
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Eto K, Koga T, Sakamoto A, Kawazoe N, Sadoshima S, Onoyama K. Adult reversible cardiomyopathy with pituitary adrenal insufficiency caused by empty sella--a case report. Angiology 2000; 51:319-23. [PMID: 10779002 DOI: 10.1177/000331970005100407] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors report a first case of reversible cardiomyopathy in an adult with adrenal insufficiency. A 62-year-old man was administered to hospital because of congestive heart failure. The electrocardiogram showed prolonged QT interval and negative T wave on the right precordial leads and frequent multifocal ventricular premature contractions. On the echocardiogram, the left ventricle was revealed to be diffusely hypokinetic with remarkable enlargement. 201Thallium single photon emission computed tomography (SPECT) revealed multiple flow defects in the left ventricular wall. He also had pituitary adrenal insufficiency secondary to an empty sella, which was diagnosed by hormonal studies and magnetic resonance images of the brain. After the replacement therapy with hydrocortisone, heart failure was sufficiently resolved. Abnormal flow defects in the myocardium on SPECT were also improved. To the authors' knowledge, adrenal insufficiency with cardiomyopathy has not been previously described in adult patients.
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Affiliation(s)
- K Eto
- The Division of Cardiology, Nippon Steel Yawata Memorial Hospital, Kitakyushu, Japan
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Vigneron P, Cabrol S, Tillous-Borde I, Tahraoui L, Bégué P, Costil J, Begeot M, Baudon JJ. [Myocardiopathy and isolated glucocorticoid deficit with ACTH resistance: a fortuitous association?]. Arch Pediatr 1999; 6:283-5. [PMID: 10191895 DOI: 10.1016/s0929-693x(99)80266-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED Hereditary syndrome of unresponsiveness to ACTH is a rare autosomal recessive disorder characterized by an isolated glucocorticoid deficiency which is exceptionally associated to regressive cardiomyopathy. CASE REPORT A male newborn had iterative episodes of hypoglycemia since the first hours of life. Acute bronchiolitis at the age of 14 days was associated with transitory dilated cardiomyopathy. Hypoglycemia was due to glucocorticoid deficiency secondary to ACTH insensitivity. Molecular biology showed a composite heterozygotism for the ACTH receptor gene. CONCLUSION Any congenital glucocorticoid deficiency should lead to search for cardiomyopathy.
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Affiliation(s)
- P Vigneron
- Laboratoire d'explorations fonctionnelles endocriniennes, hôpital Armand-Trousseau, Paris, France
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Kaji M, Tanaka Y, Kim SH, Kurosaki K, Kawasaki T, Saito A, Nakae J, Fujieda K. A Case of Congenital Lipoid Adrenal Hyperplasia Associated with Dilated Cardiomyopathy. Clin Pediatr Endocrinol 1998. [DOI: 10.1297/cpe.7.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Derish M, Eckert K, Chin C. Reversible cardiomyopathy in a child with Addison's disease. Intensive Care Med 1996; 22:460-3. [PMID: 8796402 DOI: 10.1007/bf01712167] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
An 11-year-old boy in acute adrenal crisis was subsequently diagnosed with Addison's disease and presumably had an unrecognized preceding chronic adrenal insufficiency. His adrenal insufficiency and hypovolemic shock were promptly diagnosed and treated in the emergency room. However, 24 h later, signs of congestive heart failure developed and an echocardiogram revealed cardiomyopathy. He responded to i.v. dopamine and his cardiomyopathy resolved over some days. Acute adrenal insufficiency and actual ventricular dysfunction had not been described in humans until last year; this is the second reported case of cardiomyopathy in a patient with acute adrenal insufficiency.
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Affiliation(s)
- M Derish
- Department of Pediatrics, Lucile Salter Packard Children's Hospital at Stanford, Palo Alto, CA 94304-0129, USA
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