Chest Pain in the Setting of Altered Mental Status

Pediatric Emergency Care
Yuen Lie TjoengKimball Prentiss

Abstract

We report on a young adult female presenting with altered mental status and chest pain. Timely review of her electronic medical record revealed a history of panhypopituitarism with poor medication adherence, although this was unknown at the time of her initial evaluation.The patient required hormone replacement and significant fluid resuscitation, followed by definitive treatment with a pericardiocentesis. She was discharged home on hospital day 4, with normalization of her diminished left ventricular ejection fraction at her 1-month follow-up.Although panhypopituitarism and cardiac tamponade are rare diagnoses, we highlight the management of severe hypothyroidism, the importance of early administration of hydrocortisone for panhypopituitarism, and the need for aggressive volume expansion to maintain preload in cardiac tamponade.

References

Feb 15, 2005·The Journal of Emergency Medicine·Laura Pimentel, Karen N Hansen
Nov 28, 2006·Endocrinology and Metabolism Clinics of North America·Leonard Wartofsky
Oct 10, 2007·Circulation·Irwin Klein, Sara Danzi
Mar 12, 2008·Circulation·Jaume Sagristà-SauledaG Permanyer-Miralda
Sep 24, 2011·Journal of Thyroid Research·Vivek MathewSubhankar Chowdhury
Mar 27, 2012·The Medical Clinics of North America·Joanna Klubo-Gwiezdzinska, Leonard Wartofsky
Sep 8, 2012·European Journal of Endocrinology·Bernadette Biondi

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