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Takotsubo cardiomyopathy associated with adrenal insufficiency in the context of long-term steroid use mimicking acute coronary syndrome
  1. Timothy Bagnall1,
  2. Ying Ran Tow2,
  3. Nicholas Bunce3 and
  4. Zoe Astroulakis3
  1. 1Cardiology Department, Kingston Hospital NHS Foundation Trust, London, UK
  2. 2Accident and Emergency Department, North Middlesex University Hospital, London, UK
  3. 3Cardiology Department, St George's Hospital, London, UK
  1. Correspondence to Dr Timothy Bagnall; tbagnall{at}


Takotsubo cardiomyopathy (TCMP) is an important, though under-recognised, syndrome which mimics acute coronary syndrome (ACS) presenting with similar clinical, biochemical and ECG features. A 68-year-old man was referred as ACS for emergency coronary angiography; however, a history of lethargy, weight loss and electrolyte abnormalities prompted further investigations. Angiography was postponed, adrenal insufficiency confirmed and steroid replacement commenced. Echocardiography demonstrated reduced left ventricular (LV) function (45%) with regional wall motion abnormalities, although angiography confirmed unobstructed arteries. Steroid replacement induced a rapid improvement in symptoms and LV function. Few cases of TCMP associated with adrenal insufficiency have been reported. This appears to be the first case describing TCMP precipitated by new-onset secondary adrenal insufficiency following long-term steroid use in a male patient, and highlights the importance of considering TCMP in patients presenting with suspected ACS. Here, prompt recognition and treatment of a serious underlying disorder prevented a potentially life-threatening Addisonian crisis.

  • interventional cardiology
  • adrenal disorders
  • cardiovascular medicine

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  • Contributors TB, YT, NB and ZA involved with design of work and acquisition of information. TB and YT led on literature review. TB, ZA and YT involved with drafting article. ZA and NB took part in critical revision and TB, YT, NB and ZA all involved with final approval of version to be published. ZA identified and managed case as the consultant in charge and is the guarantor for the report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.