Tako-tsubo following transphenoidal pituitary surgery

Zac-Varghese, S., Mendoza, N.



A 61 year old lady was admitted for an elective transphenoidal pituitary surgery (TSPS) to remove a pituitary non-functioning adenoma causing bitemporal hemianopia. She was referred as a private patient having come from a country with significant political upheaval and a healthcare system in crisis. She was seen pre-operatively and was well. Her past medical history included Familial Mediterranean Fever and inflammatory bowel syndrome. She was a non-smoker and did not drink any alcohol


The TSPS was uneventful and the pituitary tumour easily identified and removed. The operation lasted approximately one hour during which time her observations were stable. Six hours following the operation she complained of chest pain. This was central and crushing in nature.



The medical team were called an ECG revealed new left bundle branch block (LBBB). Aspirin, beta blockers and a statin were started and an angiogram was arranged. A laboratory measured troponin was 400 and this rose to 1958 at 12 hours. The angiogram did not reveal any atheromatous lesions or occlusion and a diagnosis of Tako-tsubo was suspected. ECHO and cardiac MRI were carried out. The ECHO revealed anterior wall, anterior and distal septal hypokinesia and mild to moderately reduced LV systolic function. There was good posterior wall function.



In view of these findings, a diagnosis of Tako-tsubo was made. Further questioning revealed that in addition to the stress caused by the operation and the political situation at home, she also had some family problems and the cumulative effect of these physical and emotional stressors most likely led to the post-operative events.