Introduction: Severe endocrine disorders such as hypothyroidism and adrenal insufficiency can present with nonspecific signs and become life-threatening if not promptly treated. In patients with panhypopituitarism, interruption or omission of hormone replacement therapy can trigger acute multi-organ failure. We report a clinical case where endocrine decompensation led to shock with electromechanical dissociation secondary to cardiac tamponade.
Case presentation: A 34-year-old man with medical history of familial hypercholesterolemia and panhypopituitarism secondary to a craniopharyngioma previously resected presented to the emergency department in shock with electromechanical dissociation. On arrival, he exhibited hyponatremia, hypotension, and normal heart rate, consistent with severe hypothyroidism. The patient reported missing his adrenal insufficiency medication the day before admission and was uncertain about the previous day’s intake.
Urgent median sternotomy was performed to drain cardiac tamponade, evacuating 500 ml of clear fluid consistent with pericarditis. During hospitalisation, the endocrinology team assessed the patient and deemed myxedema coma and adrenal crisis as the most probable diagnoses.
Pharmacological treatment: Management included emergency surgery for tamponade relief and intensive hormone replacement therapy with corticosteroids and levothyroxine. At discharge, doses of levothyroxine and fludrocortisone were increased to optimise endocrine control.
Discussion: This case highlights the critical importance of treatment adherence and endocrine monitoring in panhypopituitarism patients. Untreated severe hypothyroidism and adrenal insufficiency due to missed medication contributed to the acute decompensation. Rapid hormonal correction was essential for clinical recovery.
Conclusion: Endocrine decompensation in panhypopituitarism can lead to life-threatening conditions such as myxoedema coma and shock. Early intervention, individualised pharmacological adjustment, and multidisciplinary collaboration among endocrinology, cardiology, and intensive care teams are crucial for patient recovery. Patient education and close follow-up are key to preventing future endocrine crises with potential fatal outcomes.