Cardiogenic Shock Due to Non-Ischemic Cardiomyopathy Induced by Severe Anterior Hypopituitarism.

Objective: To review a case of life-threatening cardiogenic shock due to non-ischemic cardiomyopathy associated with anterior hypopituitarism, and to compare this case with previous reported cases in the literature.Methods: We report the clinical presentation, biochemistry, imaging, treatment, and outcome of a patient with cardiogenic shock. We conducted an English language literature search of non-ischemic cardiomyopathy associated with hypopituitarism secondary to Sheehan syndrome.Results: Cardiogenic shock due to non-ischemic cardiomyopathy associated with anterior hypopituitarism is rare, and has been attributed to TSH, cortisol and GH deficiencies. A 40-year-old woman with no previous cardiac history, presented with cardiogenic shock due to non-ischemic cardiomyopathy. Echocardiography revealed global hypokinesia with severely decreased left ventricular ejection fraction. She was treated with inotropes and an intra-aortic balloon pump. 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 MRI of her pituitary demonstrated an empty sella. She was treated with levothyroxine and hydrocortisone replacement therapy. After 18 months, echocardiography revealed partial, but not complete reversal, of her ejection fraction.Conclusion: We report an unusual case of persistent non-ischemic cardiomyopathy, and highlight the importance of considering hypopituitarism secondary to Sheehan syndrome as an etiology of cardiomyopathy in young women presenting with cardiogenic shock. The continued presence of persistent non-ischemic 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.