Yoshino Yumiko, Harano Yoshihiro, Shibata Toshiro, Shiroko Junko
Department of Internal Medicine, Takayama Red Cross Hospital, Japan.
Department of Cardiovascular Medicine, Gifu Heart Center, Japan.
Intern Med. 2024 Dec 15;63(24):3333-3338. doi: 10.2169/internalmedicine.3491-24. Epub 2024 Apr 23.
Hypopituitarism is difficult to diagnose because of its non-specific symptoms, especially in the presence of comorbidities. A 77-year-old woman with worsening anorexia and exertional dyspnea was initially diagnosed with decompensated dry cold-type heart failure. Hormonal laboratory tests indicated secondary hypothyroidism as a part of the evaluation of heart failure. Furthermore, pituitary magnetic resonance imaging revealed thickening of the pituitary stalk and a loss of signal intensity in the posterior pituitary, thus suggesting lymphocytic hypophysitis. Oral hydrocortisone and levothyroxine improved the persistent anorexia. In this case, hypopituitarism occasionally presented as dry cold-type heart failure, thus making a prompt diagnosis challenging in the setting of concurrent heart failure.
垂体功能减退症因其症状不具特异性而难以诊断，尤其是在存在合并症的情况下。一名77岁女性，厌食和劳力性呼吸困难加重，最初被诊断为失代偿性干冷型心力衰竭。激素实验室检查显示继发性甲状腺功能减退，这是心力衰竭评估的一部分。此外，垂体磁共振成像显示垂体柄增粗和垂体后叶信号强度丧失，提示淋巴细胞性垂体炎。口服氢化可的松和左甲状腺素改善了持续存在的厌食症状。在这种情况下，垂体功能减退症偶尔表现为干冷型心力衰竭，因此在并发心力衰竭的情况下进行及时诊断具有挑战性。
