Endocrine Abstracts

Pituitary apoplexy is a potentially life and vision threatening neuroendocrine emergency, which can often be misdiagnosed in the absence of the clinical hallmark of sudden onset headache and visual disturbance in a patient previously known to harbour a pituitary tumour. We report a 30 years old male patient with history of Vitiligo who presented to the emergency department with a 1-week history of vomiting, abdominal pain and lethargy along with postural hypotension and a very low serum sodium level of 104 mmol/l. Although the clinical scenario was highly suggestive of primary adrenal failure (Addison’s disease), thorough physical examination to rule out secondary adrenal failure (hypopituitarism) revealed bilateral small testis suggestive of longstanding hypogonadism. On direct questioning the patient admitted a history of a sudden onset severe bitemporal headache 10 days prior to presentation for which he failed to seek medical attention. A clinical diagnosis of pituitary apoplexy was made and the patient was promptly given intravenous hydrocortisone and fluids. His pituitary hormonal profile confirmed panhypopituitarism and MRI scan of the pituitary revealed a large pituitary mass with heterogeneous signal intensity, which is compressing the optic chiasm consistent with pituitary tumour apoplexy. The patient subsequently underwent early transphinoidal debulking with good postoperative outcome.

This case illustrates the importance of considering pituitary tumour apoplexy as a differential diagnosis in any patient presenting acutely with adrenal insufficiency/ hypopituitarism as delayed presentation and atypical features in patients who are not previously known to have pituitary tumour could lead to misdiagnosis. Early diagnosis of pituitary tumour apoplexy is crucial to preserve vision and ensure optimal outcome.