Sheehan’s syndrome presenting as cardiac tamponade

• Published in: BMJ case reports Vol. 2018; p. bcr-2017-223129
• Main Authors: Mittal, Ankit, Ray, Animesh, Talupula, Ram Manohar, Sood, Rita
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 03.02.2018; BMJ Publishing Group
• Series: Case Report
• Subjects: Bradycardia - etiology; Brain - diagnostic imaging; Cardiac Tamponade - diagnostic imaging; Cardiac Tamponade - etiology; Cardiac Tamponade - therapy; Case reports; Diagnosis, Differential; Echocardiography; Female; Gangrene; Heart - diagnostic imaging; Hormone replacement therapy; Humans; Hydrocortisone - administration & dosage; Hypopituitarism - blood; Hypopituitarism - complications; Hypopituitarism - diagnosis; Hypopituitarism - drug therapy; Hypothyroidism; Magnetic Resonance Imaging; Middle Aged; Patients; Pericardial Effusion - diagnostic imaging; Pericardial Effusion - etiology; Pericardial Effusion - therapy; Pericardiocentesis; Pituitary Hormones - blood; Radiography; Stains & staining; Syndrome; Thyroid gland; Thyroxine - administration & dosage; Tuberculosis; Unusual Association of Diseases/Symptoms; Womens health; pericardial disease; pituitary disorders
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2017-223129

A 50-year-old woman presented with progressive dyspnoea and oedema with rapid deterioration over the last few days. Clinical examination revealed hypotension with cold clammy skin, raised jugular venous pressure and muffled heart sounds and was diagnosed to have cardiac tamponade, later confirmed on two-dimensional echocardiography. However, patient had bradycardia, and the other striking examination findings were coarse facies with pallor, madarosis, absent axillary and pubic hair and breast atrophy. Her blood sugar level was also low. Detailed history revealed an episode of postpartum haemorrhage with lactation failure and early menopause. Pericardiocentesis was done with a pig-tail catheter. Hormone profile and MRI brain confirmed the diagnosis of Sheehan’s syndrome. Patient improved on treatment with thyroxine and hydrocortisone supplementation and was discharged with education about stress dosing.