Complete anterior pituitary failure and postpartum cardiomyopathy.

OBJECTIVE: To present a case of presumed autoimmune hypophysitis that occurred concurrently with severe postpartum cardiomyopathy and pneumonitis.

METHODS: We describe the clinical, laboratory, and imaging findings in a young postpartum woman who presented with decompensated heart failure.

RESULTS: Two weeks after childbirth, a 37-year-old previously healthy woman required urgent pericardiocentesis and inotropic support because of new-onset left ventricular systolic dysfunction, pericardial effusions, and hypotension. Analysis of pericardial fluid was negative for malignant cells and culture, and no cardiac tamponade or thrombus was evident. Results of a rheumatologic serology survey were negative, as was an assessment for antithyroid antibodies. Chest radiography revealed bilateral pleural effusions. Magnetic resonance imaging of the pituitary showed a homogeneously enlarged gland, consistent with the postpartum state, but no discrete pituitary lesions. Laboratory results included low levels of thyrotropin, free triiodothyronine, free thyroxine, and cortisol and a high erythrocyte sedimentation rate. The patient's symptoms responded to prednisone therapy (60 mg/day) as well as an angiotensin-converting enzyme inhibitor and a b -adrenergic blocking agent. Follow-up magnetic resonance images showed an atrophic pituitary with an empty sella turcica.

CONCLUSION: To our knowledge, this is the first reported case of concomitant presumed autoimmune hypophysitis, complete anterior pituitary failure, postpartum cardiomyopathy, and pneumonitis.