CASE REPORTS   

Gazzetta Medica Italiana Archivio per le Scienze Mediche 2014 March;173(3):149-54

Copyright © 2014 EDIZIONI MINERVA MEDICA

language: English

Pituitary apoplexy predisposing to Takotsubo cardiomyopathy

Holmberg V. ¹, Palojoki E. ², Koistinen H. ¹, Sane T. ¹, Matikainen N. ¹

¹ Department of Medicine Division of Endocrinology University of Helsinki, Helsinki, Finland; ² Division of Cardiology, Helsinki University Central Hospital University of Helsinki, Helsinki, Finland

Takotsubo cardiomyopathy is characterized by reversible left ventricular apical and / or midventricular hypokinesia with unknown etiology. The clinical presentation is similar to acute myocardial infarction in the absence of coronary artery disease. Various predisposing factors have been related to the Takotsubo cardiomyopathy such as acute neurological illnesses, endocrine diseases, pain and emotional stress. We present a patient who developed acute chest pain and classical signs of Takotsubo cardiomyopathy within 24 hours after typical symptoms and signs of histologically verified pituitary apoplexy. Cardiological evaluation revealed ST-segment elevation, apical akinesia and low ejection fraction with no evidence of coronary stenosis or thrombosis. During follow-up, the abnormalities in electrocardiogram and left ventricular function resolved completely. No other contributing factor for Takotsubo cardiomyopathy except for pituitary apoplexy was detected. To the best of our knowledge, this is the first case in the literature in which Takotsubo cardiomyopathy develops within 24 hours following the first symptoms of acute pituitary apoplexy. Therefore, pituitary apoplexy should be considered as a predisposing condition in Takotsubo patients presenting with nausea, headache and visual disturbances.