Sheehan Syndrome Leading to Acute Systolic and Diastolic Heart Failure: A Case Report

Abstract

Introduction Endocrinopathies involving the pituitary gland, thyroid gland, parathyroid glands, or adrenal glands cause reversible cardiomyopathies. Sheehan s syndrome, a rare post-partum cause of multiple simultaneous endocrinopathies, leading to cardiomyopathy is rare. We present a young woman with newly diagnosed Sheehan Syndrome, untreated for 6 years, leading to profound combined systolic and diastolic heart failure. Case Report A 28-year-old woman presented with history of hypothyroidism presented with weakness, cold intolerance, nausea, and vomiting. She was found to have hypotension, hypoglycemia, and hypothermia. Her AM cortisol and ACTH were low, concerning for a non-primary adrenal insufficiency. She noted that after her last pregnancy 6 years prior, she had amenorrhea, hair loss, fatigue, and facial swelling. She denied a history of post-partum hemorrhage or severe blood loss. But, an MRI of her brain showed she had flattening of her anterior pituitary, consistent with a partially empty sella. Records showed that she was first diagnosed combined systolic and diastolic heart failure (with an ejection fraction of 25%) of unknown origin 2 years prior. Another transthoracic echocardiogram was ordered, and revealed severe combined systolic and diastolic cardiomyopathy with an ejection fraction of 10%. Her heart failure was attributed to her panhypopituitarism. She was treated with hydrocortisone and levothyroxine for hormone replacement. She was treated with diuretics, digoxin, and an ACE inhibitor for her heart failure. Summary Panhypopituitarism leading to heart failure is rare. In panhypopituitarism, cardiac abnormalities have been attributed to growth hormone deficiency, hypothyroidism, and corticosteroid deficiency. In hypocortisolism, the pathophysiology is not completely understood and LV dysfunction rarely occurs. Hypothyroidism, most notably from the deficiency in T3, results in bradycardia, decreased myocardial contractility, and increased systemic peripheral resistance. Improvement of cardiac function has been noted with treatment of these deficiencies. Increased awareness that Sheehan s syndrome may lead to dilated cardiomyopathy can lead to increased diagnosis and treatment of this reversible cardiomyopathy.