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 coronari...Continue Reading
References
Feb 1, 1991·Chest·A FrustaciM A Russo
Oct 15, 1995·Circulation·M WhiteJ Lindenfeld
Oct 1, 1995·American Heart Journal·I U Scott, D D Gutterman
Apr 1, 1995·Japanese Circulation Journal·K IgaT Konishi
Feb 1, 1993·Cardiovascular Research·H MoriH Okino
Oct 1, 1993·Mayo Clinic Proceedings·E E Benarroch
Apr 3, 1999·Stroke; a Journal of Cerebral Circulation·S A MayerL M Klebanoff
Jul 14, 2001·Journal of the American College of Cardiology·K TsuchihashiUNKNOWN Angina Pectoris-Myocardial Infarction Investigations in Japan
Apr 11, 2003·The American Journal of Cardiology·Lydia CassorlaNorman H Silverman
Aug 19, 2003·Heart·W J R DesmetJ A Y Dens
Feb 3, 2005·Circulation·Scott W SharkeyBarry J Maron
Nov 16, 2005·Circulation·Nader M BankiJonathan G Zaroff
Apr 7, 2006·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·H GraweH P Kühl
May 25, 2006·European Heart Journal·Monica GianniEva Lonn
Nov 3, 2006·International Journal of Cardiology·Birger WolffDierk Werner
Jun 19, 2007·Chest·Volkhard KurowskiPeter W Radke
Aug 1, 2007·Endocrine Journal·Satoru SakiharaToshihiro Suda
Dec 21, 2007·Nature Clinical Practice. Cardiovascular Medicine·Alexander R LyonSian E Harding
Aug 9, 2008·Journal of General Internal Medicine·Brett A SealoveValentin Fuster
Feb 17, 2009·International Journal of Cardiology·Sujeeth Reddy PunnamVishal Gupta
Mar 3, 2009·Internal Medicine·Chizuko UkitaToshiji Iwasaka
Oct 15, 2010·Journal of Clinical Neurology·Hyun-Ji ChoJeeyoung Oh
Jul 23, 2011·Epilepsia·Claudia StöllbergerJosef Finsterer
Citations
Jun 16, 2016·Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine·Nicholas G KounisGeorge Hahalis
Jul 9, 2016·Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine·Sahajal DhooriaDigambar Behera
Jul 3, 2018·Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine·Ramavath Devendra NaikSanjeev Sinha
Mar 23, 2018·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Bulent GorenekUNKNOWN ESC Scientific Document Group
Oct 30, 2018·Journal of the American Heart Association·Sonali GuptaJoseph Mattana
Oct 30, 2020·European Endocrinology·Sanjay KalraSandeep Chaudhary