Hypophysitis: A Rare Cause of Impaired Consciousness in a Middle-Aged Woman

Hypophysitis occurs predominantly in women, usually during pregnancy or postpartum period. Hypophysitis involving the anterior pituitary often presents with adrenal insufficiency.

We describe a 43-year-old woman who presented with recurrent episodes of alteration of sensorium due to hyponatremia. She had a 3-month history of amenorrhea and on evaluation had evidence of pan-hypopituitarism. The magnetic resonance images of the brain showed mild pituitary enlargement and thickened pituitary stalk with homogenous contrast enhancement indicating hypophysitis. She was treated with oral steroids and thyroxine supplements. She remained asymptomatic at 15-month follow-up on low-dose oral steroids and thyroxine supplements.

Hypopituitarism due to hypophysitis resulted in recurrent episodes of hyponatremia in our patient.

Our case highlights the importance of a systematic search for the etiology for hyponatremic encephalopathy.