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Pituitary Disorders/Neuroendocrinology

(12.05) Pleural Effusion as an Atypical Presentation of Panhypopituitarism

Friday, May 10, 2024
12:30 PM – 12:45 PM CDT
Location: ePoster Showcase, Empire Ballroom Foyer, Level 2
Introduction : Pleural effusion presents diverse clinical manifestations and requires various management approaches. Categorically, effusions are classified as exudative or transudative. Exudative effusions stem from heightened protein permeability in capillaries, often associated with pulmonary infections and inflammatory disorders. In contrast, transudative effusions are linked to altered hydrostatic or oncotic pressures, seen in conditions like congestive heart failure, nephrotic syndrome, and liver cirrhosis. Less common causes, such as pulmonary embolism, drug reactions, post-radiotherapy effects, esophageal rupture, and ovarian hyperstimulation syndrome, may lead to both exudative and transudative effusions. Although rare, pleural effusion can occur in severe hypothyroidism, necessitating thorough investigation to rule out other causes. Central hypothyroidism is less commonly associated with pleural effusion.

Case(s) Description : A case report involving a 28-year-old male with chronic sinusitis and asthma revealed progressive shortness of breath and worsening sinusitis symptoms. Initial investigations showed low sodium and potassium levels, and a CT Chest indicated a large left pleural effusion, mediastinal lymphadenopathy, and nodular densities in the right lung. Despite thoracentesis and pleural catheter placement, the pleural fluid was negative for infections and malignancy. A CT scan prompted by concerns about sinus infection revealed a sellar mass with cystic and calcified components. Subsequent MRI confirmed a partially cystic, partially calcified sellar mass affecting multiple structures. Hormonal assays indicated panhypopituitarism with significant central hypothyroidism and hypocortisolism. Treatment involved steroids, levothyroxine, and endoscopic endonasal resection.

Discussion :

This case report underscores an unusual presentation of panhypopituitarism, where pleural effusion is the initial manifestation. Panhypopituitarism is uncommon, with an incidence of 2.07–4.2 cases per 100,000 people/year and a prevalence of 37.5–45.5 cases per 100,000 people. Pituitary tumoral lesions, such as macroadenomas, cysts, and metastases, are the most common causes, followed by pituitary surgery or radiotherapy. The severity of hormone insufficiency and the specific pituitary hormones affected influence clinical manifestations, ranging from adrenal crisis to coma or heart failure. Pleural effusion related to hypothyroidism may be underestimated, and the impact of increased thyroid stimulating hormone on effusion pathophysiology involves glycosaminoglycan deposition, protein extravasation, poor lymphatic drainage, and sodium and water retention. Resolution of pleural effusion may occur with the return to a euthyroid state.