{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T05:40:13Z","timestamp":1756359613979,"version":"3.44.0"},"reference-count":20,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,12,19]]},"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2020-234983","type":"journal-article","created":{"date-parts":[[2021,1,25]],"date-time":"2021-01-25T11:32:55Z","timestamp":1611574375000},"page":"e234983","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Takotsubo cardiomyopathy associated with adrenal insufficiency in the context of long-term steroid use mimicking acute coronary syndrome"],"prefix":"10.1136","volume":"14","author":[{"given":"Timothy","family":"Bagnall","sequence":"first","affiliation":[{"name":"Cardiology Department, Kingston Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying Ran","family":"Tow","sequence":"additional","affiliation":[{"name":"Accident and Emergency Department, North Middlesex University Hospital, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Bunce","sequence":"additional","affiliation":[{"name":"Cardiology Department, St George's Hospital, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zoe","family":"Astroulakis","sequence":"additional","affiliation":[{"name":"Cardiology Department, St George's Hospital, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,1,25]]},"reference":[{"key":"2025082722025504000_14.1.e234983.1","first-page":"203","article-title":"[Myocardial stunning due to simultaneous multivessel coronary spasms: a review of 5 cases]","volume":"21","author":"Dote","year":"1991","journal-title":"J Cardiol"},{"key":"2025082722025504000_14.1.e234983.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2007.07.002"},{"key":"2025082722025504000_14.1.e234983.3","unstructured":"Carita P , Fazio G , Novo G . 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