Severe non-infectious circulatory shock related to hypopituitarism

The authors report a case of refractory non-infectious circulatory shock wi th catecholamine and massive fluid loading-resistant features related to hy popituitarism. A 76-year-old man was admitted for shock after suffering fro m gastroenteritis for 3 days. He was pale and had sparse axillary and pubic hair and small testes. Right catheterization showed shock with low preload pressure and a low oxygen extraction ratio relevant for septic shock. Ultr asound tomography revealed a distended gallbladder due to a stone without p eritoneal effusion. A noninflammatory hydrops of the gallbladder was remove d surgically. No microorganism was isolated. Cerebral computed tomography ( CT) scan showed a pituitary mass. In the post-surgical period the shock bec ame uncontrollable. Cortisol replacement therapy was instituted and clinica l and hemodynamic improvement occurred after 2 h. Hormonal screening on adm ission before catecholamine administration showed a major decrease in all t he hypothalamic-pituitary hormone concentrations. The patient died on day 1 5 with multiple organ failure. Hypopituitarism, probably owing to pituitary adenoma, was the only disease identified in this case. Hormone replacement therapy dramatically improved the clinical and hemodynamic status, althoug h the role of an abdominal sepsis could not be eliminated. Arguments that p ituitary hormone deficiency might increase the hemodynamic consequences of adrenal deficiency are discussed.