Abstract
A 30-year-old man presenting with dyspnea and chest pain about 15 hours earlier, was referred to our hospital. On arrival, his systolic blood pressure was about 86 mmHg, and heart rate was 130 min−1. He had developed hypopituitarism since 14 years old after the resection of a craniopharyngioma. Echocardiogram demonstrated pulmonary hypertension, and computed tomogram with contrast media showed massive pulmonary thromboembolism. Pulmonary arterial pressure was about 65 mmHg. He was treated with intravenous anticoagulant therapy and recombinant tissue plasminogen activator. Thereafter, the patient's pulmonary arterial pressure decreased to 45∼50 mmHg and the heart rate declined to 70∼80 min−1, while dyspnea and chest pain disappeared. Oral anticoagulant was started, and on hospital day 4, he was moved to the general ward. The patient was discharged on hospital day 39. Patients with hypopituitarism continuously treated with hormone replacement therapy are thought to easily develop an unstable coagulative state leading to repetitive thromboembolism considered in panhypopituitarism.
