Pericardial Effusion as an Initial Presentation of Panhypopituitarism

Authors

• Rosa Alves Department of Internal Medicine, Hospital Garcia de Orta, Almada, Portugal
• Sofia Alegria Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
• Henrique Vara Luiz Department of Endocrinology, Hospital Garcia de Orta, Almada, Portugal
• Tiago Judas Department of Internal Medicine, Hospital Garcia de Orta, Almada, Portugal

rosa.alves@hgo.min-saude.pt

Keywords

Abstract

Pericardial effusion has a broad spectrum of clinical presentation, ranging from an incidental finding on imaging to a potentially fatal emergency such as pericardial tamponade, the most severe presentation. The authors present a case of a middle-aged male hospitalized due to shortness of breath. Initial work-up was positive for massive pericardial effusion with haemodynamic compromise. Additional study revealed panhypopituitarism. The acromegalic phenotype was suggestive of acromegaly secondary to pituitary adenoma, which had probably evolved to apoplexy. Hormone replacement was started with clinical improvement. At the 3-year follow-up, there was no evidence of recurrence of pericardial effusion. Panhypopituitarism is a relatively rare entity, but can lead to life-threatening complications such as adrenal crisis, coma and myxoedema-associated cardiac failure. Pericardial effusion is an extremely rare manifestation of secondary hypothyroidism.