Cardiogenic Shock Due to Nonischemic Cardiomyopathy Induced by Severe Anterior Hypopituitarism

Kissell, Nicolas; Mudd, James O.; Gelow, Jill M.; Chong, Lindsay E.; Yuen, Kevin C.J.

doi:10.4158/ep14207.cr

Cited by 6 publications

(6 citation statements)

References 23 publications

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“…At 9 months after discharge, echocardiography showed completely normalized cardiac function without growth hormone replacement ( 11 ). Similarly, Kissell et al ( 12 ) reported on a 40-year-old patient with cardiogenic shock due to non-ischemic cardiomyopathy induced by severe anterior hypopituitarism initially treated with levothyroxine and hydocortisone replacement therapy, who had 20 years of history of undiagnosed Sheehan syndrome. Eighteen months later, echocardiography revealed that LVEF was partially reversed ( 12 ).…”

Section: Discussionmentioning

confidence: 92%

“…Similarly, Kissell et al ( 12 ) reported on a 40-year-old patient with cardiogenic shock due to non-ischemic cardiomyopathy induced by severe anterior hypopituitarism initially treated with levothyroxine and hydocortisone replacement therapy, who had 20 years of history of undiagnosed Sheehan syndrome. Eighteen months later, echocardiography revealed that LVEF was partially reversed ( 12 ). One hypothesis is that GH deficiency is involved in pathogenic mechanisms of cardiomyopathy, although there is a possibility of complete recovery of cardiac function without growth hormone replacement ( 10 , 11 ).…”

Section: Discussionmentioning

confidence: 92%

“…The definite reason why the patient's hormone-induced cardiac dysfunction was not completely resolved remains elusive. One explanation that long-standing hormone deficiencies drive the irreversible change of myocardial damage appears to not be dependable ( 11 , 12 ). Bao and Fisher ( 11 ) reported on a 35-year-old woman with long-standing hypopituitarism for 15 years and heart failure for at least 10 years with severely compromised cardiac function.…”

Section: Discussionmentioning

confidence: 99%

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Refractory hypotension induced by Sheehan syndrome with pituitary crisis: A case report

Liu

Chen

et al. 2017

Experimental and Therapeutic Medicine

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The present study reported on an unusual case of refractory hypotension induced by Sheehan syndrome with pituitary crisis and explored the causes and treatment of hypotension in hypopiptuitarism. Refractory hypotension is a rare and severe complication of longstanding hypopituitarism induced by Sheehan syndrome with pituitary crisis. A 48-year-old Chinese woman with pituitary crisis due to Sheehan syndrome developed refractory hypotension and received longstanding vasopressor blood pressure support and hormone replacement therapy. Besides normalized blood pressure, echocardiography over 3 months revealed partial reversibility of her cardiac function with hormone replacement therapy. Consistent numerous studies reviewed, hormone replacement therapy may improve cardiac function in patients with cardiomyopathy linked to Sheehan syndrome. A retrospective study of 77 cases with hypopituitarism encountered at Qilu Hospital of Shandong University (Jinan, China) was also performed and the incidence rate of hypotension was analyzed, revealing that the present case was the first of refractory hypotension induced by Sheehan syndrome with pituitary crisis at this institution in 16 years.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Refractory hypotension induced by Sheehan syndrome with pituitary crisis: A case report

Liu

Chen

et al. 2017

Experimental and Therapeutic Medicine

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“…Panhypopituitarism may present with heart failure,[ 2 6 7 8 ] cardiac tamponade,[ 3 4 ] Takotsubo cardiomyopathy,[ 9 ] arrhythmias,[ 5 19 ] and cardiogenic shock. [ 6 20 21 ] The prior diminished pituitary reserve could have persisted after a stressful AMI. Third, AMI leading to cardiogenic shock caused acute hypotension which, in turn, led to vasoconstriction, vasospasm in arteries supplying pituitary, and thus acute pituitary infarction.…”

Section: Discussionmentioning

confidence: 99%

Panhypopituitarism in Acute Myocardial Infarction

Ghosh

Chatterjee

Roy

et al. 2021

Annals of African Medicine

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While hypopituitarism is known to be associated with increased cardiovascular morbidity and mortality, panhypopituitarism as a complication of myocardial infarction (MI) is very rare. Here, we report a case of rapidly developing empty sella syndrome with florid manifestations of panhypopituitarism after MI (due to critical stenosis in the left anterior descending artery) complicated by cardiogenic shock in a 65-year-old man. The patient was initially stabilized with conservative management of non-ST-elevated MI and cardiogenic shock, but after initial improvement, he again deteriorated with refractory shock (not adequately responding to vasopressors), seizures, hypoglycemia, hyponatremia, hyperkalemia, and metabolic acidosis. After ruling out recurrent cardiogenic shock or other causes of refractory hypotension, panhypopituitarism was diagnosed with the help of hormonal assays and imaging. With no prior evidence of hypopituitarism, we suspect that panhypopituitarism developed due to acute pituitary apoplexy secondary to initial cardiogenic shock. The patient was successfully survived by the emergency endocrine management followed by secondary coronary angioplasty.

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“…The exact mechanisms of hypopituitarism-related cardiogenic shock are not clear but likely related to the combined effects of multiple endocrine insufficiencies. In literature, the most common presentations are postpartum cardiomyopathy induced by anterior pituitary failure, where heart failure has developed insidiously underneath undiagnosed Sheehan’s syndrome [16,17]. While initial presentations are impressive, each respective patient saw complete if not considerable improvement of cardiac function following proper hormone replacement therapy using a combination of corticosteroid and levothyroxine.…”

Section: Discussionmentioning

confidence: 99%

Cardiogenic Shock Requiring Extracorporeal Membrane Oxygenation Support in a Patient with Panhypopituitarism: A Case Report

Huang

Kreitler

Tilton

et al. 2019

Cureus

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We present a 58-year-old female with a past history of a pituitary adenoma resected two years prior to admission who developed polymorphic ventricular tachycardia and cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO). We noted that the patient had stopped taking all of her medications six months prior to presentation. An extensive workup revealed acute panhypopituitarism with secondary hypothyroidism, secondary adrenal insufficiency, and central diabetes insipidus. She was immediately initiated on thyroid and adrenal hormone replacement therapy as well as fluid replacement. Within five days of her medical treatment, the patient’s cardiac function improved and she was successfully weaned from VA-ECMO and subsequently discharged home with appropriate hormone replacement therapy.

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Cardiogenic Shock Due to Nonischemic Cardiomyopathy Induced by Severe Anterior Hypopituitarism

Cited by 6 publications

References 23 publications

Refractory hypotension induced by Sheehan syndrome with pituitary crisis: A case report

Refractory hypotension induced by Sheehan syndrome with pituitary crisis: A case report

Panhypopituitarism in Acute Myocardial Infarction

Cardiogenic Shock Requiring Extracorporeal Membrane Oxygenation Support in a Patient with Panhypopituitarism: A Case Report

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