Alves Rosa, Alegria Sofia, Luiz Henrique Vara, Judas Tiago
Department of Internal Medicine, Hospital Garcia de Orta, Almada, Portugal.
Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal.
Eur J Case Rep Intern Med. 2020 Feb 24;7(4):001478. doi: 10.12890/2020_001478. eCollection 2020.
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.
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.
心包积液的临床表现范围广泛，从影像学检查中的偶然发现到诸如心包填塞这种潜在致命的紧急情况，心包填塞是最严重的表现形式。作者报告了一例因呼吸急促住院的中年男性病例。初步检查显示大量心包积液伴血流动力学障碍。进一步检查发现全垂体功能减退。肢端肥大症的表型提示垂体腺瘤继发的肢端肥大症，可能已发展为垂体卒中。开始进行激素替代治疗后临床症状改善。在3年的随访中，没有心包积液复发的证据。全垂体功能减退是一种相对罕见的病症，但可导致危及生命的并发症，如肾上腺危象、昏迷和黏液性水肿相关性心力衰竭。心包积液是继发性甲状腺功能减退极其罕见的一种表现。
认识心包填塞的临床表现。认识心包积液的非典型病因，如严重的全垂体功能减退。激素替代治疗对治疗全垂体功能减退有效。
