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

We present a case of a middle-aged woman with a prolonged history of diarrhea, vomiting, and abdominal pain. Upon admission to the ICU, she exhibited hypotension and hypoglycemia. Based on presenting gastrointestinal complaints, she was initially treated for acute gastroenteritis; however, continuous refractory hypotension led to an echocardiographic assessment. A left ventricular ejection fraction (LVEF) of 30-35% with apical akinesis and distinct apical ballooning was visualized on a transthoracic echocardiogram, suggestive of takotsubo cardiomyopathy. An increasing inotropic demand raised concerns regarding alternative etiologies. Further evaluation revealed decreased adrenocorticotropic hormone and cortisol levels, leading to a diagnosis of secondary adrenal insufficiency. Treatment with fludrocortisone significantly improved her adrenal insufficiency and her cardiomyopathy. This case highlights secondary adrenal insufficiency as a rare but potential cause of takotsubo cardiomyopathy in Pakistan, with the use of fludrocortisone as a treatment option in a carefully selected patient.