Pericardial Effusion as an Initial Presentation of Panhypopi
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Panhypopituitarism is a relatively rare entity & the most common cause is pituitary tumoural lesions (macroadenomas, cysts, metastases). The main cardiovascular manifestations are sinus bradycardia, left ventricular dysfunction, decompensated heart failure, dilated cardiomyopathy, conduction anomalies (prolonged QT, ventricular arrhythmias), mitral valve prolapse and pericardial effusion.

Panhypopituitarism can lead to life-threatening complications such as adrenal crisis, coma and myxoedema-associated cardiac failure.

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.

An electrocardiogram showed low-voltage QRS complexes and a chest x-ray presented an increased cardiac silhouette and bilateral pleural effusion. Thoraco-abdomino-pelvic CT revealed the presence of a large pericardial effusion (approximately 25 mm in diameter) associated with bilateral pleural effusion. Transthoracic echocardiography confirmed massive pericardial effusion, with abundant fibrin and haemodynamic compromise, impaired right ventricular filling, but with good biventricular function.

Pericardiocentesis was performed with drainage of serohaematic pericardial fluid and thoracentesis with fibrinous citrus-yellow fluid. In the context of the aetiological study of hyponatraemia, panhypopituitarism was diagnosed: secondary hypothyroidism, secondary hypocortisolism, hypogonadotropic hypogonadism, hypoprolactinaemia and decreased insulin-like growth factor 1.