Complete anterior pituitary failure and postpartum cardiomyopathy

To present a case of presumed autoimmune hypophysitis that occurred concurrently with severe postpartum cardiomyopathy and pneumonitis.

We describe the clinical, laboratory, and imaging findings in a young postpartum woman who presented with decompensated heart failure.

Two weeks after childbirth, a 37-year-old previously healthy woman required urgent pericardiocentesis and inotropic support because of new-onset left ventricular systolic dysfunction, pericardial effusions, and hypotension. Analysis of pericardial fluid was negative for malignant cells and culture, and no cardiac tamponade or thrombus was evident. Results of a rheumatologic serology survey were negative, as was an assessment for antithyroid antibodies. Chest radiography revealed bilateral pleural effusions. Magnetic resonance imaging of the pituitary showed a homogeneously enlarged gland, consistent with the postpartum state, but no discrete pituitary lesions. Laboratory results included low levels of thyrotropin, free triiodothyronine, free thyroxine, and cortisol and a high erythrocyte sedimentation rate. The patient's symptoms responded to prednisone therapy (60 mg/day) as well as an angiotensin-converting enzyme inhibitor and a b -adrenergic blocking agent. Follow-up magnetic resonance images showed an atrophic pituitary with an empty sella turcica.

To our knowledge, this is the first reported case of concomitant presumed autoimmune hypophysitis, complete anterior pituitary failure, postpartum cardiomyopathy, and pneumonitis.