Giovacchini Jacopo, Menale Silvia, Merilli Irene, Scheggi Valentina
Division of Cardiovascular and Perioperative Medicine, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
Division of General Cardiology, Department of Cardiothoracovascular Medicine, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
Egypt Heart J. 2024 Dec 12;76(1):157. doi: 10.1186/s43044-024-00590-3.
Hypopituitarism may trigger the development of acute pancreatitis (AP) through multiple mechanisms. AP may alter normal intracardiac conduction leading to an atrioventricular block. Due to the lack of similar cases, the correct timing and indication for pacemaker implantation in such a setting are unknown.
A 22-year-old woman with a history of sub-total excision of frontal astrocytoma with residual panhypopituitarism in replacement therapy was admitted to the emergency department with AP and peripancreatic necrosis, complicated by hypotension, sinus bradycardia with 2:1 atrioventricular block, and severe acute respiratory distress syndrome deserving intubation and mechanical ventilation. During the in-hospital course, the patient developed a systemic inflammatory response syndrome and acute kidney failure and was treated with intravenous dopamine, diuretics, and liquids. While she gradually recovered, advanced atrioventricular block persisted after the resolution of AP; therefore, a permanent pacemaker was implanted. During the follow-up, appropriate device interventions were detected.
No other cases of high-grade atrioventricular block in panhypopituitarism-induced AP have been reported in the literature. Our case suggests a pacemaker is necessary if the atrioventricular block does not recover with AP resolution. Further evidence is required to improve the management of rhythm disturbances in hypopituitarism patients who develop AP.
垂体功能减退可能通过多种机制引发急性胰腺炎（AP）。AP可能改变正常的心内传导，导致房室传导阻滞。由于缺乏类似病例，在这种情况下起搏器植入的正确时机和指征尚不清楚。
一名22岁女性，有额叶星形细胞瘤次全切除病史，残余垂体功能减退并接受替代治疗，因AP和胰腺周围坏死入住急诊科，并发低血压、2:1房室传导阻滞的窦性心动过缓，以及需要插管和机械通气的严重急性呼吸窘迫综合征。在住院期间，患者出现全身炎症反应综合征和急性肾衰竭，并接受了静脉注射多巴胺、利尿剂和补液治疗。虽然她逐渐康复，但AP消退后仍存在高度房室传导阻滞；因此，植入了永久性起搏器。在随访期间，检测到了适当的设备干预。
文献中未报道垂体功能减退所致AP合并高度房室传导阻滞的其他病例。我们的病例表明，如果房室传导阻滞在AP消退后未恢复，则有必要植入起搏器。需要进一步的证据来改善发生AP的垂体功能减退患者心律失常的管理。
