Abstract

A large proportion of patients presenting on the acute medical take are frail and elderly and a significant proportion of these will have symptoms such as confusion, reduced mobility and electrolyte disturbances. These symptoms are typically attributed either to the iatrogenic effects of prescribed medications, disturbances in fluid balance and possible infective causes. We describe the case of a gentleman who presented with delirium, reduced mobility and hyponatraemia who was subsequently found to have pituitary failure secondary to pituitary apoplexy.

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References

1. Rajasekaran S, Vanderpump M, Baldeweg S, et al. 2011. UK guidelines for the management of pituitary apoplexy. ClinEndocrinol 74 (1): 9–20.
2. British Geriatrics Society. The Prevention, Diagnosis and Management of Delirium in Older People. 2006. http://www. bgs.org.uk/Publications/Clinical%20Guidelines/clinical_1-2_ fulldelirium.htm (accessed 25 Jan 2012)
3. Sanders AB. 2002. Missed delirium in older emergency department patients: a quality-of-care problem. Ann Emerg Med 39: 338–41.
4. Chanson P, Lepeintre, J F, Ducreux D. Management of pituitary apoplexy. Expert OpinPharmacother 2004; 5(6): 1287–98.
5. http://bestpractice.bmj.com/best-practice/monograph/1124/ emergencies.html (accessed March 8, 2012).
6. Ayuk J, McGregor EJ, Mitchell RD, et al. Acute management of pituitary apoplexy - surgery or conservative management? ClinEndocrinol (Oxf) 2004; 61(6): 747–52.
7. Verrees M, Arafah BM, Selman WR. Pituitary tumour apoplexy: characteristics, treatment, and outcomes. Neurosurgical Focus 2004. http://www.medscape.com/viewarticle/474903_6 (accessed 3 August 2009).
8. Cooper MS, Stewart PM. 2005. Diagnosis and treatment of ACTH deficiency. Rev EndocrMetabDisord 6 (1): 47–54.