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Case Reports
. 2019 Jul-Sep;15(3):372-377.
doi: 10.4183/aeb.2019.372.

CENTRAL HYPOTHYROIDISM IN SEVERE SEPSIS

S N Benea  1   2 , M Lazar  1   2 , A Hristea  1   2 , R M Hrisca  3 , C M Niculae  1 , R V Moroti  1   2
Affiliations
Case Reports

CENTRAL HYPOTHYROIDISM IN SEVERE SEPSIS

S N Benea et al. Acta Endocrinol (Buchar). 2019 Jul-Sep.

Abstract

Objective: A partial or complete deficiency of hormone secretion by pituitary gland (hypopituitarism) is commonly seen after a pituitary apoplexy caused by an infarction of a pituitary adenoma or pituitary hyperplasia (as in Sheehan's syndrome). Hypopituitarism may also follow surgery, when hypovolemia, anticoagulation, fat/air/bone marrow microemboli can provoke a pituitary infarction/hemorrhage. Other causes of abrupt hypophyseal hypoperfusion, as hypovolemia during a septic shock, could also contribute. In the last mentioned situation, due to the complex endocrine-immune interrelation, sepsis could be masked and improperly managed.

Case report: We report a case of a 72 years-old Caucasian woman, previously healthy, who underwent an orthopedic surgery for a femoral fracture. This event apparently triggered a central-origin hypothyroidism, misinterpreted as "post-surgical psychosis", which, in turn, masked a symptomatology of a subsequent severe sepsis. The patient was admitted in the infectious diseases department with a severe gut-origin sepsis, needing surgery and long course antibiotics. The pituitary insufficiency was reversed.

Conclusion: Pituitary apoplexy is an uncommon but potentially life-threatening disease, and could be precipitated by successive events - in our case an orthopedic surgery and a subsequent severe sepsis. It needs recognizing (has intrinsic severity and could mask other serious conditions), treat and monitor (could progress and/or reverse).

Keywords: central hypothyroidism; sepsis; surgery.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1.
Figure 1.
Cranial CT scan with contrast: partial empty sella: (a) transverse section – overview; (b) detail of sella turcica with white arrows showing a pituitary rest in anterior part of sella and pituitary stalk.
Figure 2.
Figure 2.
Cranial CT scan with contrast: (a) sagittal section, (b), coronal section of sella turcica with pituitary stalk which extends to the bottom of sella (arrows).
Figure 3.
Figure 3.
The evolution after first admission (day zero = d0) in the ID (infectious diseases) clinic, three months after the orthopedic surgery; the values of T3 (circles), fT4 (triangles) and TSH (squares) were figured at the moments of day 9 (d9) when they were first checked, then after one week (d9+1w), three weeks (d9+3W), six weeks (d9+6w) and eight weeks (d9+8w), respectively – time is figured on the abscissa and the hormonal values on the ordinate.
See this image and copyright information in PMC

References

    1. Prabhakar VK, Shalet SM. Aetiology, diagnosis, and management of hypopituitarism in adult life. Postgrad Med J. 2006;82:259–266. - PMC - PubMed
    1. Bills DC, Meyer FB, Laws ER, Jr., Davis DH, Ebersold MJ, Scheithauer BW, Ilstrup DM, Abboud CF. A retrospective analysis of pituitary apoplexy. Neurosurgery. 1993;33(4):602–609. - PubMed
    1. Liu ZH, Tu PH, Pai PC, Chen NY, Lee ST, Chuang CC. Predisposing factors of pituitary hemorrhage. European Journal of Neurology. 2012;19(5):733–738. - PubMed
    1. Rajasekaran S, Vanderpump M, Baldeweg S, Drake W, Reddy N, Lanyon M, Markey A, Plant G, Powell M, Sinha S, Wass J. UK guidelines for the management of pituitary apoplexy. Pituitary Apoplexy Guidelines Development Group: May 2010. Clinical Endocrinology. 2011;74:9–20. - PubMed
    1. Khandelwal M, Chhabra A, Krishnan S. Pituitary apoplexy following bilateral total knee arthroplasty. J Postgrad Med. 2005;51:155–156. - PubMed

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