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Typical and reverse Takotsubo syndromes as initial manifestations of consecutive Addisonian crises in a 38-year-old patient: the heart has its reasons!
  1. Melissa Tso1 and
  2. Shravan Nosib2
  1. 1Department of Medicine, Royal University Hospital, Saskatoon, Saskatchewan, Canada
  2. 2Division of Cardiology, Royal University Hospital, Saskatoon, Saskatchewan, Canada
  1. Correspondence to Dr Shravan Nosib; shravan.nosib{at}


We report an interesting case of a 38-year-old woman presenting with reverse Takotsubo syndrome (TTS) secondary to an Addisonian crisis, her second such episode. A few years prior, she had presented with typical TTS in the setting of Addisonian crisis; diagnostic work-up revealing Auto-Immune Polyglandular Syndrome Type II (APS II). We believe this to be the first case report of typical and variant phenotypes of TTS in a patient with APS II. The pathogenic link between these two conditions is explored. In patients presenting with Addisonian crises and refractory shock, the possibility of concurrent TTS should be considered. TTS muddies the diagnostic waters and poses therapeutic challenges as outlined.

  • cardiovascular medicine
  • heart failure
  • interventional cardiology
  • clinical diagnostic tests
  • adrenal disorders

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  • Contributors On behalf of my coauthor and myself, I have the honour to submit the above case report for potential publication in your esteemed journal. MT was responsible for the main write up of the case as she was closely involved in the care of the patient. SN reviewed the manuscript and made appropriate corrections. I was the attending physician responsible for the care of the patient during her admission and follow-up.

  • 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.