Unrecognizing panhypopitutarism due to hypothyreosis, anaemia and psyhosis

Panhypopitutarism is a decreased hormone activity of hypophysis. The aim of the study is to present the case of the patient with a previous diagnosed disease and regular therapy together with occurrence of a new symptomology resulting in pondering over another diseases. A female fifty-seven-year-old patient was admitted to the Clinic of Intensive Care Unit for Endocrinology, Diabetes and Metabolism Disorders. The patient was in a comatose state. According to heteroanaemnestic analysis, the patient had been feeling weakness, lack of appetite, sickness, stomach pain accompanied with vomiting and every-day headaches. The same patients has also been treated for psychiatric disorders for 15 years. She suffers from hypothyreosis and is inclined to anaemia. In 1994 she was admitted to hospital due to medicament poisoning. In the course of the last month she has been at general practitioner's due to her general bad health condition who eliminated the possibility of anaemia and acute disorders of thyroid gland and liver, according to the previous laboratory results. Gastritis was recorded through gstroscopic survey. Psychiatrist was asked to contribute with his advice. Due to low blood pressure attributed to high temperatures, the patient was provided with infusion. While being checked up, the patient was asthenic, in a certain comatose state, with reactions to any kind of external irritation, extremely pale with watery and yellowish mucous membrane without distinctive lateralization. Cor: the rhythmical heart action, clear tones, murmurs almost inaudible. Frequency 60/30 mm Hg. Other results insignificant, no signs of fresh bleeding. By ECG, it is registered chronic ischaemia in precordial arteries. Due to hyponatraemia, hypochloremia, hypoglycaemia, bradycardia, hypotension, weakness and prevailing paleness of the skin, the White Addison was presumed. On the ground of clinical picture, it was concluded that it was the case of panhypopitutarism of unknown cause. The patient was at the state of well-being because of substitutional therapy and indirect implications of cortisoic activity (GUK, Na, Cl, K, tension, frequency) were good. The conclusion was that even in patients with previous verified diagnoses, it is essential that we should think and act differentially and diagnostically.