Introduction: Presentation of pituitary tumours can be variable.If is a functioning pituitary tumour the clinical manifestation will be that of excessive hormone secreted, and if is a non functioning pituitary tumour, the presentation will be that of target endocrine organ insufficiency.
Bradycardia/complete heart block may be a non specific presentation of non functioning pituitary tumours.
Cases: We present 2 cases presenting with non functining pituitary tumours and bradycardia.
1.54 years old man was admitted with left sided painless eye ptosis.He denied headaches.His ECG showed bradycardia 2:1 block.
He had CT head which revealed bulky pituitary followed by MRI which showed pituitary macroadenoma measuring 1.9 cm but no optic chiasma compression.His blood test revealed hypopitutarism as evidenced by secondary hypothyroidism FT4 8.9, FT3 3.4, normal TSH, secondary hypogonadism with low testosterone level of 7.9 and inappropriate normal LH 1.8 and FSH8.1.
His past medical history include hypertension, hypereosinophilic syndrome and gastritis.
2.85 years old man presented with collapsed with loss of consciousness. There was no evidence of head injury or seizures. He had no focal neurology.He complained of 4 months history of memory loss and general lethargy. He denied having headaches or visual disturbance. His past medical history included chronic back pain and hiatus hernia. On admission he was found hypotensive BP 108/60), bradycardic. Blood test revealed mild hyponatraemia, 9 am cortisol was 93, prolactin 533, testosterone 0.6, LH 0.4, FSH 2.4, TSH 1.13 and FT4 10. ECG revealed junctional bradycardia MRI scan of his brain revealed a large pituitary tumour (1.2×2.2×1.5)cm compressing the optic chiasm.
Discussion: Various central nervous diseases including pituitary tumours may be associated with arryhythmias including bradycardia. Secondary hypothyroidism may contribute to bradycardia and correcting the hypothyroidism with levothyroxine is important before consideration of permanent pace maker.
Conclusion: Pituitary tumours presenting with bradycardia is not uncommon as demonstrated by the above cases. Bradycardia may be due to secondary hypothyroidism or the effect on the autonomic nervous system.