Atypical and rare cardiac revelation about Sheehan's syndrome: A report of three cases

• Published in: Annales de cardiologie et d'angeiologie Vol. 66; no. 4; p. 239
• Main Authors: Bouznad, N, Mghari, G El, Hattaoui, M El, Ansari, N El
• Format: Journal Article
• Language: French
• Published: France 01.09.2017
• Subjects: Adult; Female; Heart Diseases - etiology; Humans; Hypopituitarism - complications; Hypopituitarism - diagnosis; Middle Aged; Thyroid stimulating insufficiency; Syndrome de Sheehan; Arrêt cardiorespiratoire; Replacement therapy; Cardio respiratory arrest; Insuffisance thyréotrope; Opothérapie substitutive; Sheehan's syndrome; Tamponade; Tamponnade
• ISSN: 1768-3181
• DOI: 10.1016/j.ancard.2016.12.007

Sheehan syndrome is a potentially serious complication in the postpartum period corresponding to ischemic necrosis of the anterior pituitary related to postpartum haemorrhage. We report three original observations showing an unusual mode of revelation of this syndrome. The first observation is that of a 46-year-old patient admitted initially to resuscitation for a recovered cardiorespiratory arrest, severe hypoglycemia and profound hyponatremia. The second is that of a 45-year-old patient, admitted for recurrent cardiac tamponade after pericardial and pleural puncture and pericardial drainage; clinical survey found signs of slight panhypopituitarism. The latest case is that of a patient of 44 years, admitted to pericardial effusion average abundance revealed by dyspnea and tachypnea with hypotension. The interrogation of all patients revealed the concept of an old hemorrhagic syndrome, absence of lactation and secondary amenorrhea thereafter. Laboratory tests showed insufficient thyroid-stimulating, low cortisol, a hypogonadism hypogonadism. The pituitary magnetic resonance imaging showed an empty sella in the three cases. Patients were placed under replacement therapy with L-thyroxine and hydrocortisone with good clinical, biological and echocardiographic evolution. The three cases illustrate a rare heart atypical presentation for Sheehan's syndrome and underline the importance of early diagnosis and suitable replacement therapy of this syndrome to avoid this complication that can be life threatening.