Estatísticas

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      "titulo" => "Takotsubo syndrome during breastfeeding&#58; Further insights into prolactin and its implications"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Our team is glad that this case report has raised interest in the role of estrogen in Takotsubo syndrome &#40;TTS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Even after many years of research&#44; the pathophysiology of Takotsubo syndrome cannot be explained by a unified hypothesis&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;3</span></a> This probably means that TTS is a complex entity in which multifactorial causes are constantly weighted &#40;from its biological background to environment&#47;triggers and underlying disease&#41;&#44; leading to the probability of suffering or not from this phenotype&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Sex disparity&#44; especially being female&#44; is a well-recognised predisposing factor for clinical probability of TTS<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> and it is the main contributing factor to the InterTAK Diagnostic score&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> However&#44; this relationship is not well established in pre-menopausal women&#46; The underlying mechanism is related to the cardioprotective action of estrogen&#44; a hormone that may be inhibited in some life stages of a premenopausal female &#8211; such as during peripartum period and lactation&#46; Solid evidence to ascertain this hypothesis in humans is still lacking&#44; and the available data remain animal-based&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#8211;8</span></a> Nonetheless&#44; we believe that these stages of a female&#39;s reproductive life may represent an important element in the &#8220;cocktail&#8221; of multifactorial causes leading to TTS&#46; After the journal&#39;s acceptance of our report&#44; in 2019&#44; another case of a lactating young woman that suffered from TTS &#40;in this case&#44; reverse TTS&#41; was published&#46; In this case&#44; the patient developed cardiogenic shock during hospital stay&#44; and was discharged with normal left ventricle ejection fraction&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We gladly report that our patient&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> a 22-year-old lactating woman&#44; whose TTS event reports back to 2017&#44; has been followed-up ever since and is free from cardiovascular symptoms&#44; with normal echocardiogram and no recurrences&#46; Neither strain&#47;strain rate nor diastolic stress testing has been performed&#46; Even though she is free from cardiovascular disease&#44; we have recommended a cardiology appointment and coordination with gynaecology&#47;obstetrics in the event of new pregnancies&#46; She has not had any more children since then&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The authors thank Yalta et al&#46; for the appropriate comment regarding our report&#46; Both discussed hypotheses for the physiopathology of this case&#44; besides the protection role of estrogens&#44; are relevant and they have one common link &#8211; the role of prolactin in inhibiting the gonadal axis and enabling a peripartum cardiomyopathy-like syndrome due to 16 kDa prolactin fragment&#46; Since there is no available biochemical&#47;molecular evidence in this case&#44; we can only hypothesize that this is a plausible explanation&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Since there is no solid evidence to sustain the recommendation to abstain from further breastfeeding or upfront anti-prolactin agents &#40;patient has normal left ventricle ejection fraction and no confirmed peripartum cardiomyopathy<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>&#41;&#44; we would refrain from giving this kind of advice to the patient&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The patient was discharged asymptomatic and with normal left ventricle ejection fraction&#46; We are not sure of the requirement for further workup regarding potential subclinical myocardial dysfunction based on the available information &#8211; nevertheless it could be interesting to interpret diastolic stress testing and myocardial strain in a clinical research setting&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Fortunately&#44; TTS in young women is a rare diagnosis&#44; which leads to a lack of high-grade evidence&#46; This is a setting in which case reports and case report series are of high value&#46; We hope that our publication keeps raising awareness of TTS during lactation&#44; and if possible&#44; we are able to conduct further research&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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