Published online Jul 16, 2022. doi: 10.12998/wjcc.v10.i20.7029
Peer-review started: November 14, 2021
First decision: March 24, 2022
Revised: April 1, 2022
Accepted: May 22, 2022
Article in press: May 22, 2022
Published online: July 16, 2022
Shock is among the most common conditions that clinicians face in intensive care unit (ICU), of which hypovolemic shock is encountered most frequently; some patients instead suffer from neurogenic, cardiogenic, or infectious forms of shock. However, there are additional types of shock from unusual causes that are often undiagnosed. Here, we report the case of a patient who was initially misdiagnosed with hypovolemic shock, but exhibited persistent hypotension because of continuous fluid replacement and vasoactive drug administration, and was eventually diagnosed with hypopituitarism with crisis.
A 73-year-old Chinese man was admitted to the neurosurgery department following injury caused by a heavy object with symptoms of anemia and high fever. He was transferred to the ICU on the fourth day after hospitalization because of hypotension and unconsciousness. Blood analysis indicated that the patient was suffering from anemia and thrombocytopenia. Ultrasonography showed that there was no apparent abnormality in the cardiac structure but there was mild tricuspid regurgitation. Computed tomography revealed that there were signs of hemorrhage at the right basal ganglia; accordingly, hypovolemic shock, possibly septic shock, was initially considered. Even after routine treatment for shock, the hypotension remained severe. The patient was again thoroughly examined to investigate the underlying cause. The antishock therapy was supplemented with corticosteroids to counter potential hypopituitarism. The patient made a full recovery, and the blood pressure returned to normal.
A case of pituitary adenoma with multiple injuries was identified. Because of hypopituitarism, functionality of the corresponding endocrine system was restricted, with the most pronounced manifestation being unstable blood circulation requiring hormone replacement therapy. Such cases are relatively rare but may occur if multiple injuries are sustained. The present case represents a reference for the clinical treatment of patients with multiple injuries.
Core Tip: Here, we report that a patient was initially misdiagnosed with hypovolemic shock and later developed persistent hypotension due to continuous fluid replacement along with vasoactive drug administration. The patient was eventually diagnosed with hypopituitarism with a pituitary crisis, and the case was identified as pituitary adenoma with multiple lesions, which limited the corresponding endocrine system function. The most apparent manifestation was unstable blood circulation and hormone replacement therapy requirement. The presentation was relatively rare but could happen if multiple injuries persisted. This case can be a reference for the clinical treatment of patients with multiple injuries, and is different from a hypopituitary-pituitary crisis secondary to craniocerebral trauma. Hypopituitary-pituitary crisis in trauma patients is rarely reported in the literature.