A 53-year-old woman with a history of chronic daily headache studied, one month before admission, by magnetic resonance imaging (MRI) of the brain showed the presence of a sudden hypophyseal macroadenoma of 18 mm. She was admitted to the hospital with a few minutes of postural slack
Physical examination is normal in the emergency room, but hypotension of 70/40 mmHg, sinus bradycardia at 34 bpm, and various electrocardiographic abnormalities such as low voltages, prolonged QTc interval of 450 msec, prolonged QT interval of 50 msec).
During cardiac monitoring, the patient also presents self-limitedhas of torsade de point polymorphic ventricular tachycardia, which does not produce symptoms or is treated hemodynamically; therefore, she is admitted with magnesium sulfate transient ICU.
In the directed anamnesis, she did not refer to previous syncopes or dyspnea, chest pain and tensions up to daily, but highlighted a chronic clinical picture of three months of evolution, consisting of intense diuresis, sad mood, hypoxia, frequent nausea without vomiting.
He also narrates, in the days prior to admission, a sudden episode of severe frontal headache accompanied by blurred vision and vomiting, without other focal neurological symptoms, which had been interpreted as a migraine crisis.
In the initial laboratory tests, hypernatremia with sodium 147 mmol/L35, secondary hypothyroidism with FTór4 insufficiency/dL (0.93-1.70), T44 pg/4.270 μg/dL (10.8mL), secondary TSHp-19.70), and thyrotropin (10.36±1.26).
Complete hormonal study shows a decrease in all pituitary hormones with luteinizing hormone or LH < 0.1 mIU/mL (7.7-58.5), follicle stimulating hormone or FSH 0.3 mIU/mL GH (25.8-168).
Vasopressin or ADH levels below 1 pg/ mL (1.2-7.6), hypernatremia and low urinary osmolarity of 198 mmol/Kg (300-1,300) reinforce the suspicion of diabetes.
The basal values obtained allow diagnosing the existence of panhypopituitarism without the need for stimulation tests.
Cranial MRI showed no abnormalities in the pituitary gland or a previous adenoma. A retinal detachment showed a fluid-signalling image that seemed to have a wall, a real contrast enhancement.
The case was evaluated by Neurosurgery, which ruled out surgical treatment.
In a new directed anamnesis, the patient does not highlight previous symptoms of hyperfunction such as hormonal responsiveness, hirsutism, arterial hirsutism or menstrual alterations (currently with gynecological growth and nillig).
Normalized sinus electrocardiogram was initiated with intravenous electrocardiogram with a dose of 100 mg every 8 h (at discharge 20 mg every 12 h orally) and oral levothyroxine at a dose of 125 mcg daily, with an asymptomatic heart rhythm.
