Journal of Yeungnam Medical Science

Yeungnam University College of Medicine, Yeungnam University Institute Medical Science (영남대 의대 학술지 편집위원회)
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A patient with stress induced cardiomyopathy that occurred after cessation of hormone replacement therapy for panhypopituitarism

범뇌하수체저하증의 호르몬 대체요법 중단 후 발생한 스트레스 심근병증

  • Nam, Seoung Wan (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Lee, Jun-Won (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Sim, Jeong Han (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Pack, Hyun Sung (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Im, Changjo (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Lim, Jung Soo (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Ahn, Sung Gyun (Department of Internal Medicine, Yonsei University Wonju College of Medicine)
  • 남승완 (연세대학교 원주의과대학 내과학교실) ;
  • 이준원 (연세대학교 원주의과대학 내과학교실) ;
  • 심정한 (연세대학교 원주의과대학 내과학교실) ;
  • 백현성 (연세대학교 원주의과대학 내과학교실) ;
  • 임창조 (연세대학교 원주의과대학 내과학교실) ;
  • 임정수 (연세대학교 원주의과대학 내과학교실) ;
  • 안성균 (연세대학교 원주의과대학 내과학교실)
  • Received : 2015.03.05
  • Accepted : 2015.06.01
  • Published : 2016.11.18
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Abstract

Stress induced cardiomyopathy (SC) is characterized by transient left ventricular (LV) dysfunction in the absence of coronary artery disease. We report on a patient with panhypopituitarism who developed SC resulting from withdrawal of hormonal replacement therapy (HRT). A 52-year-old male visited our hospital for progressively worsening dyspnea. The patient had discontinued HRT 7 days ago, which had been administered for 18 months after transsphenoidal adenomectomy for pituitary macroadenoma. Initial electrocardiogram showed marked sinus bradycardia. Transthoracic echocardiography showed apical ballooning with an LV ejection fraction of 25%. No significant obstructive lesions were observed on coronary angiography. With a clinical diagnosis of SC associated with panhypopituitarism, HRT was restarted, including glucocorticoid and thyroxine, along with standard heart failure management. His LV function had normalized at 2-month follow-up. He remains asymptomatic and administration of beta-blocker and angiotensin converting enzyme inhibitor were discontinued He currently only requires HRT.

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References

  1. Yun MH, Choi S, Park JY, Kim CH, Beom JW, Park G, et al. Coincident takotsubo cardiomyopathy and coronary artery disease. Korean J Med 2012;83:791-5. Korean. https://doi.org/10.3904/kjm.2012.83.6.791
  2. Tsuchihashi K, Ueshima K, Uchida T, Oh-mura N, Kimura K, Owa M, et al. Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina Pectoris-Myocardial Infarction Investigations in Japan. J Am Coll Cardiol 2001;38:11-8. https://doi.org/10.1016/S0735-1097(01)01316-X
  3. Wittstein IS, Thiemann DR, Lima JA, Baughman KL, Schulman SP, Gerstenblith G, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med 2005;352:539-48. https://doi.org/10.1056/NEJMoa043046
  4. Ueyama T, Kasamatsu K, Hano T, Yamamoto K, Tsuruo Y, Nishio I. Emotional stress induces transient left ventricular hypocontraction in the rat via activation of cardiac adrenoceptors: a possible animal model of 'tako-tsubo' cardiomyopathy. Circ J 2002;66:712-3. https://doi.org/10.1253/circj.66.712
  5. Gianni M, Dentali F, Grandi AM, Sumner G, Hiralal R, Lonn E. Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur Heart J 2006;27:1523-9. https://doi.org/10.1093/eurheartj/ehl032
  6. De Giorgi A, Fabbian F, Tiseo R, Parisi C, Misurati E, Molino C, et al. Takotsubo cardiomyopathy and endocrine disorders: a mini-review of case reports. Am J Emerg Med 2014;32:1413-7. https://doi.org/10.1016/j.ajem.2014.07.030
  7. Oelkers W. Hyponatremia and inappropriate secretion of vasopressin (antidiuretic hormone) in patients with hypopituitarism. N Engl J Med 1989;321:492-6. https://doi.org/10.1056/NEJM198908243210802
  8. Ginsburg KS, Bers DM. Isoproterenol does not enhance Ca-dependent Na/Ca exchange current in intact rabbit ventricular myocytes. J Mol Cell Cardiol 2005;39:972-81. https://doi.org/10.1016/j.yjmcc.2005.09.005
  9. Saini HK, Tripathi ON, Zhang S, Elimban V, Dhalla NS. Involvement of $Na^+/Ca^{2+}$ exchanger in catecholamine-induced increase in intracellular calcium in cardiomyocytes. Am J Physiol Heart Circ Physiol 2006;290:H373-80. https://doi.org/10.1152/ajpheart.00613.2005
  10. Falola M, Fonbah W, McGwin G Jr. Takotsubo cardiomyopathy versus ST-elevation myocardial infarction in a large case-control study: proposing a new mechanism. Int J Cardiol 2013;167:1079-81. https://doi.org/10.1016/j.ijcard.2012.10.059
  11. 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. https://doi.org/10.1507/endocrj.K07-012
  12. Rao MK, Xu A, Narayanan N. Glucocorticoid modulation of protein phosphorylation and sarcoplasmic reticulum function in rat myocardium. Am J Physiol Heart Circ Physiol 2001;281:H325-33. https://doi.org/10.1152/ajpheart.2001.281.1.H325
  13. Machida K, Ishibashi R, Hara T, Ohtsuka A, Hayashi K. Effects of corticosterone on $Ca^{2+}$ uptake and myofibrillar disassembly in primary muscle cell culture. Biosci Biotechnol Biochem 2003;67:244-9. https://doi.org/10.1271/bbb.67.244
  14. Penefsky ZJ, McCann FV. Electrical properties of developing rat heart. Effects of dexamethasone. J Dev Physiol 1989;12:27-33.
  15. Narayanan N, Khandelwal RL. Microsomal phosphorylase in rat heart: depletion following adrenalectomy and restoration by in vivo administration of dexamethasone. Endocrinology 1985;117:1544-9. https://doi.org/10.1210/endo-117-4-1544
  16. Kern KB, Hilwig RW, Rhee KH, Berg RA. Myocardial dysfunction after resuscitation from cardiac arrest: an example of global myocardial stunning. J Am Coll Cardiol 1996;28:232-40. https://doi.org/10.1016/0735-1097(96)00130-1
  17. Laurent I, Monchi M, Chiche JD, Joly LM, Spaulding C, Bourgeois B, et al. Reversible myocardial dysfunction in survivors of out-of-hospital cardiac arrest. J Am Coll Cardiol 2002;40:2110-6. https://doi.org/10.1016/S0735-1097(02)02594-9
  18. Lee JW, Kim JY. Stress-induced cardiomyopathy: the role of echocardiography. J Cardiovasc Ultrasound 2011;19:7-12. https://doi.org/10.4250/jcu.2011.19.1.7