Endocrine Abstracts

Introduction: Pituitary apoplexy is defined as a clinical syndrome resulting from sudden hemorrhage or infarction of the pituitary gland, mostly within a pituitary micro/macroadenoma. One of the rare diseases that has been reported following pituitary apoplexy is Takotsubo cardiomyopathy (TC). TC, also known as stress cardiomyopathy, is a transient left ventricular dysfunction in the absence of coronary artery disease that is usually associated with psychological and physiological stressors. The purpose of this study was to systematically review the papers describing patients with TC and pituitary apoplexy.

Methods: This study is a systematic review that followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Web of Science, Scopus, ScienceDirect, and Google Scholar were searched up to 2022 using the following keywords: “pituitary apoplexy”, “pituitary hemorrhage”, “pituitary infarction”, “Takotsubo cardiomyopathy”, “Takotsubo syndrome”, “stress cardiomyopathy”, and “broken heart syndrome”. English studies reporting TC in patients with pituitary apoplexy were included without any age, gender, and nationality restrictions.

Results: A total of 6 studies describing 6 cases, including 2 (33%) males and 4 (67%) females, were included. The age range of the patients was from 62 to 85 years with an average of 74 years. In past medical history, atrial fibrillation, complete heart block, hypertension, mild cognitive impairment, diabetes insipidus, nausea, and vomiting were reported. The most common signs and symptoms included altered level of consciousness (6 patients, 100%), headache (5 patients, 83%), nausea/vomiting (4 patients, 67%), hypotension, tachycardia, fever (each one: 3 patients, 50%), and neuro-ophthalmic diseases (2 patients, 33%). The electrocardiogram revealed T wave inversion in limb and/or precordial leads in all patients. Echocardiography showed left ventricular ballooning, apex akinesia, and left ventricular ejection fraction reduction with the lowest level of 20%. In laboratory data, ACTH/cortisol insufficiency (6 patients, 100%), abnormal thyroid function test (5 patients, 83%), low testosterone (3 patients, 50%), and elevated troponin were reported. All patients had pituitary adenoma, of which 4 (67%) were treated conservatively and 2 (33%) with transsphenoidal surgery.

Conclusions: It seems that TC can be a rare complication of pituitary apoplexy. The exact mechanism is not understood, but it may be related to endocrinological abnormalities including ACTH, cortisol, and thyroid hormones insufficiency. So, in case of suspicion of TC associated with pituitary apoplexy, it is recommended to perform more appropriate paraclinical measures such as troponin test, electrocardiography, and echocardiography to prevent misdiagnosis and mismanagement.