A rare cause of polyserositis: Delayed diagnosis of Sheehan’s syndrome

Polyserositis is a challenging differential diagnosis. We present a case of severe serositis in a 51-year-old Caucasian woman complicated by pericardial, peritoneal and pleural exudates in the setting of panhypopituitarism and no other obvious etiology. The patient had obtundation, pretibial edema, anemia, hyponatremia, and high levels of CA 125. Low levels of TSH, free T3 and free T4 suggested central hypothyroidism. Decreased levels of morning cortisol, growth hormone, and gonadotropins indicated panhypopituitarism. The patient reported cessation of menses after her last delivery approximately 20 years ago. To our knowledge, this is the first reported case of panhypopituitarism presenting with polyserositis.

PDF

___

AOzkaya S, Butun SE, Findik S, et al. A very rare cause of pleuritic chest pain: bilateral pleuritis as a first sign of familial mediterranean Fever. Case Rep Pulmonol. 2013;2013:315751.

Maharaj S, Chang S. Consideration of C-reactive protein and polyserositis in systemic lupus erythematosus presenting with cardiac symptoms. Am J Emerg Med. 2015;33:115-6.

Novak S, Anic F, Luke-Vrbanić TS. Extremely high serum ferritin levels as a main diagnostic tool of adult-onset Still’s disease. Rheumatol Int. 2012;32:1091-4.

Tawfik P, Gertner E, McEvoy CE. Severe polyserositis induced by the 13-valent pneumococcal conjugate vaccine: a case report. J Med Case Rep 2017;11:142.

Guillet E, Mas C, Bauvin I, et al. Extrarespiratory manifestations of Mycoplasma pneumoniae: a case report. Arch Pediatr. 2014;21:381-3.

Shetty G. Polyserositis: A rare presentation. Oman Med J. 2012;27:336.

Brajkovic AV, Zlopasa O, Brida V, et al. Resolution of polyserositis after removal of appendix mucinous cystadenoma. Tohoku J Exp Med. 2015;235:25-8.

Gottehrer A, Roa J, Stanford GG, et al. Hypothyroidism and pleural effusions. Chest. 1990;98:1130-2.

Lin CT, Liu CJ, Lin TK, et al. Myxedema associated with cardiac tamponade. Jpn Heart J. 2003;44:447-50.

Ates I, Kaplan M, Yilmaz N. Newly diagnosed primary hypothyroidism applicant with massive pericardial effusion and acute renal failure. Endocr Regul. 2016;50:24-6.

Hataya Y, Akamizu T, Kanamoto N, et al. A case of subclinical hypothyroidism developing marked pleural effusions and peripheral edema with elevated vascular endothelial growth factor. Endocr J. 2007;54:577-84.

Miljic D, Doknic M, Stojanovic M, et al. Impact of etiology, age and gender on onset and severity of hyponatremia in patients with hypopituitarism: retrospective analysis in a specialised endocrine unit. Endocrine. 2017;58:3129.

Fatma M, Mouna E, Nabila R, et al. Sheehan’s syndrome with pancytopenia: a case report and review of the literature. J Med Case Rep. 20113;5:490

Sahin F, Yildiz P. Serum CA-125: biomarker of pulmonary tuberculosis activity and evaluation of response to treatment. Clin Invest Med. 2012;35:E223-8.

Kimura R, Imaeda K, Mizuno T, et al. Severe ascites with hypothyroidism and elevated CA125 concentration: a case report. Endocr J. 2007;54:751-5.