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Pituitary apoplexy presenting with anorexia and hyponatraemia
Yosuke Sasaki1, Kenji Nakata1, Kenichi Suzuki2
1Department of General Medicine and Emergency Care, Toho University, School of Medicine, Ota-ku, Tokyo, Japan.
BMJ Case Reports
|April 11, 2015
Summary
Pituitary apoplexy can present atypically with anorexia and hyponatraemia, even without severe headache or visual loss. Early diagnosis is crucial for managing adrenal insufficiency and other pituitary hormone deficiencies.
Area of Science:
- Endocrinology
- Neurology
Background:
- Pituitary apoplexy is a medical emergency characterized by hemorrhage into the pituitary gland.
- Typical symptoms include sudden severe headache, visual disturbances, and hypopituitarism, notably adrenal insufficiency.
Observation:
- A 65-year-old man presented with anorexia and temporal headache, later diagnosed with adrenal insufficiency due to pituitary apoplexy.
- Hyponatraemia was a key diagnostic indicator, prompting further investigation.
Findings:
- Magnetic Resonance Imaging (MRI) of the pituitary gland confirmed the diagnosis of pituitary apoplexy.
- The case highlights an atypical presentation, sometimes termed 'subclinical pituitary apoplexy'.
Implications:
- Clinicians should consider pituitary apoplexy in patients with anorexia, fatigue, or hyponatraemia following headache, even without classic symptoms.
- Serial urine osmolality is valuable for differentiating hypovolemic from euvolemic hyponatraemia in these cases.
- This underscores the importance of recognizing non-classical presentations for timely intervention and management of pituitary dysfunction.
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