Endocrine Abstracts

A 52 year old gentleman was referred for an inpatient Endocrinology review. He was admitted after incidental finding of severe hyponatremia of 119. He felt unwell after having an episode of vomiting at home a few days ago and then had his bloods done at primary care. He denied any headache, dizziness, or visual disturbance. Further investigations were requested which revealed plasma osm 247, urine osm 350, and urine sodium 132. A diagnosis of SIADH was established and he was put on fluid restriction. His sodium level failed to improve over the following days and rather dropped to 114. CT TAP was organised which did not show any pathology. Short synacthen test showed suboptimal cortisol rise. Bloods showed normal prolactin, and low T4 with normal TSH. CT head was requested which showed an incidental finding of pituitary mass. MRI pituitary was organized which showed likely pituitary macroadenoma with internal haemorrhage. Impression of pituitary apoplexy was made and he was started on IV hydrocortisone was started. A detailed plan was made to discontinue fluid restriction, continue IV hydrocortisone, anterior pituitary profile, neurosurgery opinion, and ophthalmology referral for formal visual field testing. This case was discussed at pituitary MDT where the diagnosis of macroadenoma without apoplexy was established. He underwent trans-sphenoidal surgery to remove the tumour. I followed him up on the neurosurgery ward for Endocrinology input. He was commenced on hydrocortisone, levothyroxine replacement. A plan was made to discharge him with the follow up at Endocrine clinic.