Circulatory collapse in a 30-year-old amenorrheic woman

Abstract

A 30-year-old woman presented to the emergency services of the hospital with drowsiness, poor appetite, constipation, postural giddiness and amenorrhea since the birth of her last child four years ago which was associated with post-partum haemorrhage. Examination revealed a blood pressure of 70/40 mmHg, pulse rate 100 beats/min, temperature 36.4C, puffy face, myxoedema, dry skin, delayed relaxation of ankle reflexes, normal jugular pulse and poorly localisable apex beat. The investigations on admission revealed serum Na+ 137 mmol/l, K+ 3.8 mmol/l, triiodothyronine 0.09 nmoUl (normal range 1.2-2.4 nmolIl), thyroxine 1.29 nmol/l (51-155 nmol/l), thyroid-stimulating hormone 1.4 mU/l (0-6 mU/l), luteinising hormone 2.0 IU/1, follicle-stimulating hormone 3.2 IU/l and oestradiol 70 nmol/l. Serum prolactin and cortisol were less than the 2.5 ,ug/l and 15 nmol/l, respectively. Computed tomography (CT) of the pituitary fossa demonstrated an empty sella. The cardiac echocardiogram and chest X-ray are shown in figures 1 and 2, respectively. * sinus bradycardia * congestive heart failure * conduction abnormalities (atrial, ventricular and intraventricular) * septal hypertrophy * coronary atherosclerosis * pericardial effusion * cardiac tamponade Box