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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Br&#225;s DR&#46; et al&#46; describe the case of a young woman who presents with a clinical picture compatible with Takotsubo syndrome five months after delivery&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This case is of particular interest because it is rare and highlights the likely influence of sex hormones&#44; especially estrogen levels&#44; on the occurrence of this cardiomyopathy&#46; As this mechanism is still under investigation&#44; it makes the case even more relevant&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">As the authors point out&#44; despite the higher incidence of Takotsubo syndrome in postmenopausal women&#44; cases have been reported in premenopausal women&#44; especially in the immediate postpartum period&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> but not only&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> thus suggesting that this cardiomyopathy occurs not only at menopause&#44; but at other stages of reproductive life when estrogen levels are reduced&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The role of sex hormones in the development of Takotsubo cardiomyopathy has been a subject of interest and research&#44; and it has been suggested that reduced levels of estrogen in menopause predispose women to Takotsubo syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The young woman reported in this clinical case was taking progesterone contraceptive pill and was breastfeeding&#44; consequently presenting low levels of estrogen&#44; which may have predisposed her to the development of this syndrome in the presence of a trigger &#40;discussion&#47;epileptic seizure&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Estrogen receptors are widely expressed in the cardiovascular system and in the central nervous system&#46; Clinical analysis of autonomic nervous system function in patients with Takotsubo cardiomyopathy revealed a transient increase in sympathetic nervous system activity and a decrease in vagal activity&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Research has been carried out in rats&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> in which estrogen supplementation diminished the effects of catecholamines on the heart and attenuated stress-induced hypothalamic-sympathoadrenal discharge&#46; It was found that in these rats estrogen supplementation increases the levels of cardioprotective substances such as atrial natriuretic peptide and the heat shock protein &#40;HSP&#41;704&#46; This work suggest that the reduction of estrogen levels may lead to a predisposition to the development of this cardiomyopathy&#44; either by direct action on the heart and indirect action on the nervous system&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">However&#44; conflicting results are observed in humans&#46; In humans&#44; there are no studies demonstrating that hormone replacement therapy in postmenopausal women prevents the occurrence of Takotsubo syndrome&#44; and a Swiss registry showed that during Takotsubo syndrome in postmenopausal women estrogen levels are elevated&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">These results reinforce the need for more research in this area with randomized studies that allow us to better understand the influence of sex hormones&#44; specifically estrogen&#44; on the predisposition of women to Takotsubo syndrome throughout their reproductive life&#46; The case presented by the authors has drawn attention to this problem&#44; fueling interest in research in this area&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare</p></span></span>"
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What is the role of estrogen in predisposition to Takotsubo syndrome throughout a woman's reproductive life?
Qual o papel dos estrogénios na predisposição à síndrome de Takotsubo ao longo da vida reprodutiva feminina?
Ana Rita Almeida
Hospital Garcia de Orta, Almada, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Br&#225;s DR&#46; et al&#46; describe the case of a young woman who presents with a clinical picture compatible with Takotsubo syndrome five months after delivery&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This case is of particular interest because it is rare and highlights the likely influence of sex hormones&#44; especially estrogen levels&#44; on the occurrence of this cardiomyopathy&#46; As this mechanism is still under investigation&#44; it makes the case even more relevant&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">As the authors point out&#44; despite the higher incidence of Takotsubo syndrome in postmenopausal women&#44; cases have been reported in premenopausal women&#44; especially in the immediate postpartum period&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> but not only&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> thus suggesting that this cardiomyopathy occurs not only at menopause&#44; but at other stages of reproductive life when estrogen levels are reduced&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The role of sex hormones in the development of Takotsubo cardiomyopathy has been a subject of interest and research&#44; and it has been suggested that reduced levels of estrogen in menopause predispose women to Takotsubo syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The young woman reported in this clinical case was taking progesterone contraceptive pill and was breastfeeding&#44; consequently presenting low levels of estrogen&#44; which may have predisposed her to the development of this syndrome in the presence of a trigger &#40;discussion&#47;epileptic seizure&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Estrogen receptors are widely expressed in the cardiovascular system and in the central nervous system&#46; Clinical analysis of autonomic nervous system function in patients with Takotsubo cardiomyopathy revealed a transient increase in sympathetic nervous system activity and a decrease in vagal activity&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Research has been carried out in rats&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> in which estrogen supplementation diminished the effects of catecholamines on the heart and attenuated stress-induced hypothalamic-sympathoadrenal discharge&#46; It was found that in these rats estrogen supplementation increases the levels of cardioprotective substances such as atrial natriuretic peptide and the heat shock protein &#40;HSP&#41;704&#46; This work suggest that the reduction of estrogen levels may lead to a predisposition to the development of this cardiomyopathy&#44; either by direct action on the heart and indirect action on the nervous system&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">However&#44; conflicting results are observed in humans&#46; In humans&#44; there are no studies demonstrating that hormone replacement therapy in postmenopausal women prevents the occurrence of Takotsubo syndrome&#44; and a Swiss registry showed that during Takotsubo syndrome in postmenopausal women estrogen levels are elevated&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">These results reinforce the need for more research in this area with randomized studies that allow us to better understand the influence of sex hormones&#44; specifically estrogen&#44; on the predisposition of women to Takotsubo syndrome throughout their reproductive life&#46; The case presented by the authors has drawn attention to this problem&#44; fueling interest in research in this area&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare</p></span></span>"
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