Primary takotsubo syndrome with recurrent prolactinoma

Both peripartum cardiomyopathy (PPCM) and takotsubo syndrome (TTS) are diagnoses of exclusion and are thus considered a heterogeneous disease group. TTS is generally triggered by psychogenic or physical stress. Recently, the anti-angiogenic factor cleaved prolactin has been noted as a cause of PPCM, but the precise mechanisms of these diseases remain unexplained. An 87-year-old female with a past surgical history, including transsphenoidal endoscopic surgery to remove a pituitary prolactinoma, recently underwent surgery to repair a left-sided femoral neck fracture and developed dyspnea followed by back pain; shortly after, she became embarrassed by fecal incontinence. Her initial electrocardiogram showed T wave inversions with QT prolongation leading to sustained ventricular tachycardia. No obstructive coronary artery disease was found on emergent coronary angiography, and the left ventriculography findings were consistent with TTS. After acute-phase treatment, she was diagnosed with recurrent prolactinoma based on her head magnetic resonance imaging findings. This patient's high levels of prolactin may have played a role in the pathogenesis of TTS.

Peripartum cardiomyopathy and takotsubo syndrome (TTS) are diagnosed by exclusion, and their precise mechanisms remain unknown. We present a case of TTS associated with a prolactinoma.