Cardiogenic Shock Due to Nonischemic Cardiomyopathy Induced by Severe Anterior Hypopituitarism

ABSTRACT Objective: To review a case of life-threatening cardiogenic shock due to nonischemic cardiomyopathy associated with anterior hypopituitarism and to compare this case with previous reports in the literature. Methods: We describe the clinical presentation, biochemistry, imaging, treatment, and outcome of a patient with cardiogenic shock. We conducted an English language literature search of nonischemic cardiomyopathy associated with hypopituitarism secondary to Sheehan syndrome. Results: Cardiogenic shock due to nonischemic cardiomyopathy associated with anterior hypopituitarism is rare and has been attributed to thyroid-stimulating hormone, cortisol, and growth hormone (GH) deficiencies. A 40-year-old female with no previous cardiac history presented with cardiogenic shock due to nonischemic cardiomyopathy. An chocardiograph (ECG) revealed global hypokinesia with severely decreased left ventricular ejection fraction. She was treated with inotropes and an intra-aortic balloon pump. The patient volunteered a history of severe postpartum hemorrhage 20 years ago during childbirth with subsequent failure to lactate. Further workup confirmed central hypothyroidism, hypoadrenalism, hypogonadism, and GH deficiency, and magnetic resonance imaging (MRI) of her pituitary demonstrated an empty sella. She was treated with levothyroxine (LT4) and hydrocortisone replacement therapy. After 18 months, ECG revealed partial improvement of her low ejection fraction. Conclusion: We report an unusual case of persistent nonischemic cardiomyopathy and highlight the importance of considering hypopituitarism secondary to Sheehan syndrome as an etiology of cardiomyopathy in young female patients presenting with cardiogenic shock. The continued presence of persistent nonischemic cardiomyopathy is likely to be due to the effects of prolonged untreated anterior hypopituitarism. Instituting appropriate hormone replacement therapy may improve the overall cardiac function of these patients. Abbreviations: ECG echocardiograph GH growth hormone L4 levothyroxine MRI magnetic resonance imaging