Discussion
The pathogenic mechanisms behind TTS and TGA remain unsolved, but a
catecholamine surge may be part of the underlying
pathophysiology.[1][15] Based on several pathophysiologic
findings, it has been suggested that TGA might be a “cerebral
Takotsubo”.[16]
The presented patient suffered from two comorbidities which are known to
be associated with TTS as well as TGA, migraine and hypothyroidism.
Migraine has been identified as a risk factor for TTS as well as
TGA.[1][15][17] Hypothyroidism is more frequent in patients
with TTS as well as TGA than in the general
population.[17][18][19] The pathomechanism of hypothyroidism
as well as migraine in these disorders, however, is unclear.
The coincidence of TGA and TTS associated with a long-lasting stressor
has, to our knowledge, only described in one case.[12] (Table) Of
note, similar to our patient, the reported female suffered from
hypothyroidism.
The comedication of our patient may possibly have contributed to the
development of TTS. TTS has been reported after ingestion of a weight
management supplement containing caffeine and amphetamine-like
stimulants.[20] In a further case, TTS occurred after a combined
drug intoxication containing acetaminophen.[21]
We conclude that TTS and TGA can occur simultaneously even after
long-standing stressors. Probably, hypothyroidism and migraine make the
patient more susceptible to TTS and TGA.