SUN-091 - Pituitary Apoplexy Presenting as Flu-Like Illness: Diagnostic Challenges in the Absence of Visual Field Deficits

Background:

Pituitary apoplexy is a rare endocrine emergency resulting from acute hemorrhage or infarction of the pituitary gland, complicating 2-12% of pituitary adenomas. While classically presenting with sudden severe headache and visual disturbances, nonspecific symptoms may delay diagnosis, particularly when visual field deficits are absent.

Case Presentation:

A 70-year-old male with a history of left bundle branch block, hyperlipidemia, and benign prostatic hyperplasia presented with one week of flu-like symptoms, fatigue, dizziness, and weakness. Initial laboratory evaluation revealed hyponatremia of 125 with urine Na of 35. Further endocrine workup demonstrated low thyroid-stimulating hormone 0.08, low free thyroxine, and low morning cortisol, consistent with panhypopituitarism. On detailed history, the patient reported a sudden severe headache at symptom onset accompanied by projectile vomiting, as well as transient visual changes prior to admission. Physical examination revealed no visual field deficits. Noncontrast CT of the brain showed a prominent Sella turcica, and subsequent MRI confirmed a pituitary adenoma complicated by pituitary apoplexy. The patient was transferred to a tertiary care center with neurological ICU and underwent urgent transsphenoidal resection. He was discharged on physiologic hydrocortisone replacement (20 mg morning, 10 mg evening) and levothyroxine 112 mcg daily with good clinical recovery.

Conclusion:

This case illustrates the diagnostic challenge of pituitary apoplexy when classic visual field deficits are absent, and initial presentation mimics common viral illness. The key to diagnosis was detailed history-taking that elicited the sudden severe headache, projectile vomiting, and transient visual changes—features that were initially overshadowed by nonspecific flu-like symptoms. Early recognition through careful history and prompt imaging with noncontrast CT followed by MRI are critical for timely diagnosis and intervention, which can prevent life-threatening complications and long-term endocrine morbidity.

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