Pericardial Effusion as an Initial Presentation of Panhypopituitarism

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.

Learning points: To recognize the clinical presentation of cardiac tamponade.To recognize atypical causes of pericardial effusion, such as severe panhypopituitarism.Hormonal replacement is efficient in treating panhypopituitarism.

Keywords: Pericardial effusion; panhypopituitarism; pericardiocentesis.

Figure 1

(A) Chest x-ray at diagnosis showing an increased cardiac silhouette and bilateral pleural effusion. (B) Chest x-ray after pericardiocentesis, with a pigtail catheter placed in the pericardial space

Figure 2

Thoraco-abdomino-pelvic computed tomography revealed the presence of a large pericardial effusion (approximately 25 mm in diameter) associated with bilateral pleural effusion (A: normal window, B: pulmonary window)

Figure 3

Transthoracic echocardiography: massive pericardial effusion (*) and pleural effusion (†)

Figure 4

Magnetic resonance imaging: a partially empty sella with increased dimensions, and persistence of the posterior pituitary gland