Yeungnam Univ J Med.  2016 Dec;33(2):125-129. 10.12701/yujm.2016.33.2.125.

A patient with stress induced cardiomyopathy that occurred after cessation of hormone replacement therapy for panhypopituitarism

• Nam SW
• Lee JW
• Sim JH
• Pack HS
• Im C
• Lim JS
• Ahn SG

• KMID: 2366124
• DOI: http://doi.org/10.12701/yujm.2016.33.2.125

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.

Keyword

Takotsubo cardiomyopathy; Stress cardiomyopathy; Hypopituitarism

MeSH Terms

Bradycardia
Cardiomyopathies*
Coronary Angiography
Coronary Artery Disease
Diagnosis
Dyspnea
Echocardiography
Electrocardiography
Follow-Up Studies
Heart Failure
Hormone Replacement Therapy*
Humans
Hypopituitarism
Male
Middle Aged
Peptidyl-Dipeptidase A
Takotsubo Cardiomyopathy
Thyroxine
Peptidyl-Dipeptidase A
Thyroxine