RT Journal Article
SR Electronic
T1 Getting to the heart of hypopituitarism
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 140
OP 142
DO 10.7861/clinmedicine.17-2-140
VO 17
IS 2
A1 Julie Martin-Grace
A1 Mohamed Ahmed
A1 Niall Mulvihill
A1 Eoin R Feeney
A1 Rachel K Crowley
YR 2017
UL http://www.rcpjournals.org/content/17/2/140.abstract
AB A 53-year-old woman was diagnosed with hypopituitarism following an acute presentation with cardiac tamponade and hyponatraemia, having recently been investigated for a pericardial effusion. Secondary hypothyroidism is a rare cause of pericardial effusion and tamponade, but an important differential to consider. Management requires appropriate hormone replacement and, critically, a low threshold for commencing stress dose steroids. Clinical signs classically associated with cardiac tamponade are frequently absent in cases of tamponade due to primary and secondary hypothyroidism, and the relatively volume deplete state of secondary hypoadrenalism in hypopituitarism may further mask an evolving tamponade, as the rise in right atrial pressure is less marked even in the presence of large effusion. Our case demonstrates the importance of a high index of suspicion for cardiac tamponade in this patient cohort, even in the absence of clinical signs, and for measuring both thyroid-stimulating hormone and thyroxine levels when evaluating a pericardial effusion.