Wall David, Nieding Kristina, Scheuba Christian, Haug Alexander, Schmook Maria, Kiefer Florian W
Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Clinical Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Clinical Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria.
BMJ Case Rep. 2025 Mar 19;18(3):e261704. doi: 10.1136/bcr-2024-261704.
We report a case of a woman in her mid-30s who developed severe cardiac shock hours after giving birth to her second child with the need for extracorporeal haemodynamic support. Initially, postpartum cardiomyopathy was suspected, and high-urgency heart transplantation was considered. However, the endocrine work-up and imaging revealed pheochromocytoma as the cause for acute heart failure that was completely reversible. Notably, the patient also developed Sheehan's syndrome with pituitary necrosis and sustained hypopituitarism, most likely as a consequence of the haemodynamic failure during pheochromocytoma crisis. While pheochromocytoma crisis is already an extremely rare peripartum complication, the current case is-to the best of our knowledge-the first report of pheochromocytoma associated with Sheehan's syndrome. This case also highlights the clinical conundrum that pheochromocytomas can be easily overlooked in pregnancy due to non-specific symptoms and confusion with pregnancy-related hypertension or hypertension-associated other diseases. Appropriate case detection is important, especially in pregnant women with early onset of hypertension.
我们报告了一例35岁左右的女性病例，她在生下第二个孩子数小时后出现严重的心源性休克，需要体外血液动力学支持。最初，怀疑是产后心肌病，并考虑进行紧急心脏移植。然而，内分泌检查和影像学检查显示嗜铬细胞瘤是急性心力衰竭的病因，且完全可逆。值得注意的是，患者还出现了席汉综合征，伴有垂体坏死和持续性垂体功能减退，很可能是嗜铬细胞瘤危象期间血液动力学衰竭的结果。虽然嗜铬细胞瘤危象已经是一种极其罕见的围产期并发症，但就我们所知，本病例是第一例与席汉综合征相关的嗜铬细胞瘤报告。该病例还凸显了一个临床难题，即由于非特异性症状以及与妊娠相关高血压或高血压相关其他疾病的混淆，嗜铬细胞瘤在妊娠期间很容易被忽视。适当的病例检测很重要，尤其是对于早期出现高血压的孕妇。
