Takotsubo Cardiomyopathy in a Patient With Presumptive Autoimmune Polyendocrine Syndrome II

Takotsubo cardiomyopathy (TCM) is an increasingly described form of transient cardiomyopathy in which patients develop a distinct left ventricular apical ballooning typically following a significant emotional or physical stress. The etiology of this syndrome is not clear, but it is likely that direct catecholamine toxicity to the susceptible myocardium plays a role. The syndrome is most common in women and has been described in association with a variety of forms of physiologic or emotional stress. In general, the prognosis is favorable and complete recovery is common. The authors report the case of a young woman with presumed autoimmune polyendocrine syndrome II (APS II) who developed TCM after presenting with adrenal insufficiency. APS II is an endocrine disorder in which Addison’s disease can occur with autoimmune thyroid disease, type 1 diabetes mellitus, premature ovarian failure, vitamin B12 deficiency, vitiligo, and other manifestations. Hormonal preconditioning and psychological stress may trigger TCM.