Sheehan’s syndrome presenting as cardiac tamponade

Abstract

A 50-year-old woman presented with progressive dyspnoea and oedema with rapid deterioration over the last few days. Clinical examination revealed hypotension with cold clammy skin, raised jugular venous pressure and muffled heart sounds and was diagnosed to have cardiac tamponade, later confirmed on two-dimensional echocardiography. However, patient had bradycardia, and the other striking examination findings were coarse facies with pallor, madarosis, absent axillary and pubic hair and breast atrophy. Her blood sugar level was also low. Detailed history revealed an episode of postpartum haemorrhage with lactation failure and early menopause. Pericardiocentesis was done with a pig-tail catheter. Hormone profile and MRI brain confirmed the diagnosis of Sheehan's syndrome. Patient improved on treatment with thyroxine and hydrocortisone supplementation and was discharged with education about stress dosing.

Sheehan’s syndrome presenting as massive pericardial effusion, ventricular tachycardia and diabetes insipidus

“…Cardiac tamponade is uncommon in hypothyroidism because of the slow and progressive fluid accumulation and rarer in secondary hypothyroidism because of associated hypovolaemia secondary to hypocortisolaemia. Only a few cases of tamponade secondary to massive pericardial effusion have been described in the literature in patients with SS 8–10…”

Panhypopituitarism in acute myocardial infarction

“…First, there was panhypopituitarism presenting as AMI. Panhypopituitarism may present with heart failure,[ 2 6 7 8 ] cardiac tamponade,[ 3 4 ] Takotsubo cardiomyopathy,[ 9 ] arrhythmias,[ 5 19 ] and cardiogenic shock. [ 6 20 21 ] The prior diminished pituitary reserve could have persisted after a stressful AMI.…”

“…The intricate relationship of the pituitary and heart is well-known. While hypopituitarism makes the patients prone to cardiovascular (CV) diseases and may present with predominant CV manifestations,[ 1 2 3 4 5 6 7 8 9 10 ] several CV disorders are associated with perturbations of single or multiple hypothalamic–pituitary–end-organ axes either as a physiologic response[ 11 12 13 14 ] or pathological consequences. [ 15 16 ] We present a case of acute myocardial infarction (AMI) followed by left ventricular failure (LVF) and cardiogenic shock unresponsive to vasopressor therapy and complicated by panhypopituitarism and empty sella (ES).…”