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INNOSC Theranostics and
Pharmacological Sciences The Takotsubo syndrome: A gender disparity

of males developed the disease due to emotional stress, Finally, the impact of catecholamine excess on the
whereas 34.3% of females and 50.8% of males developed different ballooning patterns that are characteristic of
TTS through physical stress. This is very similar to the TTS has not been fully explained, although there is
Japanese reports. These reports suggest that women now substantial evidence that sympathetic activation
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tend to respond more to emotional stressors, while men plays a central role in TTS. Thus far, several rational
respond primarily to physical stressors. recommendations have been put forth. For instance, it has
As previously mentioned, TTS is mainly explained by been proposed that myocardial damage could result from
stress responses, even though the pathophysiology of TTS a catecholamine surge. Various mechanisms that lead to
is poorly understood. The sexes’ varying reactions to stress increased cardiac work can be mentioned in this context,
could be the cause of this. Remarkably, postmenopausal including microvascular coronary vasoconstriction and
women make up the majority of patients. The effects of damage mediated by adrenoreceptors. 48
estrogen concentration may be more significant than 4. Discussion
previously believed in relation to their susceptibility to
emotional stress as a trigger for TTS, which calls for more 4.1. Role of sex steroids in modulation of behavioral
research. Women are thought to have stronger immune and psychological aspects
responses to both self-antigens and foreign invaders. In Stress is recognized to have an impact on the endocrine,
addition, autoimmune diseases are more common in behavioral, and molecular responses of stress systems.
women than in men. The distinct role that men and women The implications of rats’ sex differences for stress response
attribute to sex hormones plays an important part in immune have been reported, indicating that stress had a distinct
cell activity. 43,44 Through the use of experimental rat models, sexual dimorphic effect on the behavioral, endocrine,
the Cidlowski group demonstrated that there is a gender and molecular response of the stress systems in the rats’
difference in the prevalence of numerous major diseases hypothalamus. Remarkably, this effect is also observed in
that have an inflammatory component. Interestingly, the human data on stress and depression. Interesting findings
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sex-specific variations in prevalence may be related to presented by Dumas et al.’s research demonstrate how age
a relationship between inflammatory diseases and the 50
sexually dimorphic effects of GC. These findings suggest and estrogen status affect older women’s stress, indicating
that while a lack of GC receptors (GR) may contribute to that estradiol plays a significant role in regulating the
certain diseases in women, GR’s anti-inflammatory effects emotional response to stressful situations.
seem to be more potent in men. This has been observed Another fascinating study from the field of psychology
in vivo in the liver in a systemic inflammatory sepsis model. revealed that older women have altered negative feedback
45
This suggests that in homeostatic female mice, a primary of the HPA axis using the Dex-CRH test. After comparing
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mechanism guarantees a quicker reaction to inflammatory the behavioral stress responses of premenopausal and
stimuli, which in turn leads to a stronger expression of the postmenopausal women with the effects of estrogen, they
most prevalent proinflammatory genes. were able to draw the following conclusion: premenopausal
Apart from emotional stress, postmenopausal and postmenopausal women differ significantly in how
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women may also be significantly triggered by behavioral they respond to psychological stress. The higher risk of
stress reactions, psychological stress, and changes in cardiovascular disease in women who have gone through
estrogen concentration. Research has demonstrated that menopause may be partially explained by this lack of
premenopausal and postmenopausal women react to adaptation. It seems that estrogen reduces the reaction
psychological stress in quite different ways. Crucially, brought on by stress. The TTS framework discussed in
it seems that estrogen reduces the impact of reactions the present review may heighten this circumstance, which
instigated by stress. This indicates that an imbalance in the shows a clear androgen/estrogen imbalance and a strong
levels of androgen and estrogen in TTS could exacerbate inflammatory background.
the stress response. Furthermore, the dexamethasone/ 4.2. Possible female sex steroid-mediated
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corticotropin-releasing hormone (Dex-CRH) test shows modulation of functional cerebral asymmetry
that older women have altered HPA axis negative feedback,
as demonstrated by studies on hormonal and psychological Studies on the gender-specific differences in sympathovagal
reactions to psychosocial stress and Dex-CRH in young, regulation and functional cerebral asymmetry imply that
healthy controls and postmenopausal women in good the female pattern of dominance is characterized by the
health. Furthermore, the available evidence indicates that left hemisphere, which is believed to have parasympathetic
46
supplementing with estradiol seems to alter human HPA predominance, whereas the male pattern indicates dominance
feedback sensitivity. 47 of the right hemisphere, which is believed to have sympathetic

Volume 7 Issue 4 (2024) 4 doi: 10.36922/itps.3142