July - September 2019, Volume 15, Issue 3

Benea SN, Lazar M, Hristea A, Hrisca RM, Niculae CM, Moroti RV

Central Hypothyroidism in Severe Sepsis

Acta Endo (Buc) 2019, 15 (3): 372-377
doi: 10.4183/aeb.2019.372

Objective. A partial or complete deficiency of hormone secretion by pituitary gland (hypopituitarism) is commonly seen after a pituitary apoplexy caused by an infarction of a pituitary adenoma or pituitary hyperplasia (as in Sheehan’s syndrome). Hypopituitarism may also follow surgery, when hypovolemia, anticoagulation, fat/ air/bone marrow microemboli can provoke a pituitary infarction/hemorrhage. Other causes of abrupt hypophyseal hypoperfusion, as hypovolemia during a septic shock, could also contribute. In the last mentioned situation, due to the complex endocrine-immune interrelation, sepsis could be masked and improperly managed. Case report. We report a case of a 72 years-old Caucasian woman, previously healthy, who underwent an orthopedic surgery for a femoral fracture. This event apparently triggered a central-origin hypothyroidism, misinterpreted as “post-surgical psychosis”, which, in turn, masked a symptomatology of a subsequent severe sepsis. The patient was admitted in the infectious diseases department with a severe gut-origin sepsis, needing surgery and long course antibiotics. The pituitary insufficiency was reversed. Conclusion. Pituitary apoplexy is an uncommon but potentially life-threatening disease, and could be precipitated by successive events – in our case an orthopedic surgery and a subsequent severe sepsis. It needs recognizing (has intrinsic severity and could mask other serious conditions), treat and monitor (could progress and/or reverse).

Keywords: surgery, sepsis, central hypothyroidism

Correspondence: Ruxandra Valentina Moroti MD, “Prof. Dr. Matei Bals” National Institute for Infectious Diseases, Adult IV, 1, Grozovici street, Bucharest, 021105, Romania, E-mail: ruxandra_moroti@yahoo.com