| Repairing a broken heart with hormone replacement therapy: Case report of cardiogenic shock due to undiagnosed pituitary insufficiency. | |
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MedLine Citation:
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PMID: 22138080 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Objectives: To indicate cardiogenic shock as a very rare but serious clinical consequence of untreated panhypopituitarism secondary to Sheehan's syndrome; to emphasize the importance of eliciting a detailed endocrine and obstetric history in women presenting with idiopathic heart failure; to indicate the diagnostic shortcomings of screening for thyroid dysfunction solely with TSH determinations; and to report the reversibility of severe heart failure induced by long-term pituitary insufficiency.Methods: Described is a case report of a 35 year old woman who presented with severe congestive heart failure, hypotension and confusion. Her two-dimensional echocardiogram revealed marked systolic and diastolic dysfunction. In screening for possible endocrine causes of heart failure, a normal TSH level of 0.72 (0.35-5.5 mcIU/ml) was unremarkable; but a profoundly low free T4 level of 0.12 (0.9-1.8 ng/dl) led clinicians to pursue a workup of central hypothyroidism.Results: Endocrine testing confirmed panhypopituitarism and adrenal insufficiency. Brain MRI noted empty sella syndrome. Further questioning of the patient revealed a history of extensive postpartum bleeding 15 years earlier, failure to lactate, and secondary amenorrhea; all consistent with undiagnosed Sheehan's syndrome. In the hospital, the patient was treated with intravenous corticosteroids and levothyroxine. Her mental status and symptomatic heart failure improved dramatically. Following nine months of oral levothyroxine and glucocorticoid therapy, the patient has remained asymptomatic and repeat echocardiography indicated completely normalized cardiac function.Conclusions: Severe heart failure and cardiogenic shock can be a very rare (but fortunately reversible) complication of longstanding panhypopituitarism resulting from undiagnosed Sheehan's syndrome. |
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Authors:
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Shunzhong S Bao; Simon J Fisher |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-12-2 |
Journal Detail:
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Title: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists Volume: - ISSN: 1934-2403 ISO Abbreviation: - Publication Date: 2011 Dec |
Date Detail:
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Created Date: 2011-12-5 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9607439 Medline TA: Endocr Pract Country: - |
Other Details:
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Languages: ENG Pagination: 1-13 Citation Subset: - |
Affiliation:
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Division of Endocrinology, Metabolism & Lipid Research, Department of Medicine, Washington University, St. Louis, MO, 660 S. Euclid Ave, St. Louis, MO 63011. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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