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March 5, 2026CureusOpen Access

A Rare Case of Takotsubo Cardiomyopathy Responsive to Fludrocortisone in Secondary Adrenal Insufficiency

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Why the study?

Does fludrocortisone improve cardiac function in a patient with takotsubo cardiomyopathy secondary to adrenal insufficiency?

Population

A middle-aged woman with refractory hypotension, hypoglycemia, and takotsubo cardiomyopathy

Design

Case report

Key result

Fludrocortisone improved left ventricular ejection fraction from 30-35% to 45-50% in a middle-aged woman with secondary adrenal insufficiency and takotsubo cardiomyopathy.

Authors

WKWaqar KhalidM(Muhammad Umer Khan (14716756)MKMaheen Khoso

Discussion

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Overview

May warrant fludrocortisone in adrenal insufficiency-related takotsubo; hypothesis-generating pending prospective validation.

Key Points

  • This case report aims to illustrate the connection between secondary adrenal insufficiency and takotsubo cardiomyopathy.
  • Analyzed a middle-aged woman with gastrointestinal symptoms and hypotension
  • Conducted transthoracic echocardiogram to assess cardiac function
  • Evaluated hormone levels to confirm adrenal insufficiency
  • Administered fludrocortisone as treatment for adrenal insufficiency
  • Left ventricular ejection fraction was measured at 30-35%
  • Patient showed significant improvement in adrenal function after fludrocortisone treatment
  • Cardiomyopathy symptoms improved alongside adrenal insufficiency management

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

Does fludrocortisone improve cardiac function in a patient with takotsubo cardiomyopathy secondary to adrenal insufficiency?

P
Population
n=1 44-year-old woman with takotsubo cardiomyopathy secondary to adrenal insufficiency (due to chronic topical steroid use), presenting with refractory hypotension and hypoglycemia.
I
Intervention
Fludrocortisone (discharged on oral formulation) added to standard intensive care management.
O
Outcome
Improvement in left ventricular ejection fraction (LVEF) and de-escalation of vasopressors.surrogate

Main Result

Effect estimate: LVEF improved from 30-35% to 45-50%

Absolute Event Rate: 45% vs 30%

Secondary adrenal insufficiency is a rare cause of takotsubo cardiomyopathy that can be effectively managed with fludrocortisone to improve cardiac function and hemodynamic stability.

Limitations

  • Single patient case report limiting generalizability
  • No randomized control or comparator group
  • Coronary angiography was declined, so definitive exclusion of coronary artery disease was not performed

Cite This Study

Khalid et al. (2026) conducted a case report in Middle-aged woman (44 years) with secondary adrenal insufficiency and takotsubo cardiomyopathy due to chronic topical steroid use (n=1). Fludrocortisone was evaluated on Improvement in left ventricular ejection fraction (LVEF) (LVEF improved from 30-35% to 45-50%). Fludrocortisone improved left ventricular ejection fraction from 30-35% to 45-50% in a middle-aged woman with secondary adrenal insufficiency and takotsubo cardiomyopathy.

synapsesocial.com/papers/69a91dd2d6127c7a504c1066https://doi.org/10.7759/cureus.104591
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