Introduction: Cardiac pharmacology is vital when treating patients with complex endocrine and metabolic conditions. We present a challenging case of panhypopituitarism, severe hypothyroidism with prior myxedema coma, and chronic pericardial effusion, highlighting the need for careful cardiac drug management to prevent hemodynamic compromise.
Case: A 52-year-old man with panhypopituitarism, severe hypothyroidism, chronic alcohol use, and ex-smoker status was admitted for vomiting and systemic symptoms. He had a known chronic pericardial effusion previously drained and monitored. On admission, he showed signs of fluid overload (pericardial and bilateral pleural effusions, mild ascites, hepatic congestion).
Labs showed severe hyponatremia, mild hyperkalaemia, anaemia, and mild coagulopathy. Imaging confirmed stable moderate pericardial effusion without tamponade. He developed sepsis of unclear source, treated empirically with piperacillin- tazobactam.
Chronic meds included levothyroxine for hypothyroidism, hydrocortisone for adrenal insufficiency, pravastatin, vitamin D, furosemide, and spironolactone. Spironolactone was stopped due to hyperkalaemia risk and mild kidney injury; furosemide was adjusted to control fluid overload.
Discussion: This case shows the delicate balance in cardiac pharmacology when endocrine dysfunction coexists with fluid overload. Loop diuretics were used to manage right-sided congestion and prevent worsening effusions. Spironolactone, initially useful for fluid control, was stopped to avoid worsening hyperkalaemia and kidney injury, stressing the need for tight electrolyte monitoring.
Panhypopituitarism and hypothyroidism increased fluid retention, reduced cardiac contractility, and contributed to pericardial effusion. Maintaining euthyroid status with levothyroxine supported myocardial function and minimised effusion recurrence. Hydrocortisone was titrated to manage adrenal insufficiency safely and prevent hemodynamic collapse. Pravastatin contributed to cardiovascular risk reduction.
Conclusion: Patients with panhypopituitarism and severe hypothyroidism can develop cardiac complications like pericardial effusion and fluid overload. This case highlights the role of diuretics, cautious mineralocorticoid antagonist use, and strict electrolyte control in cardiac pharmacology. Multidisciplinary care with endocrinology and cardiology is key to optimise treatment, prevent decompensation, and tailor cardiac drugs safely in this fragile population.