Panhypopituitarism in an Elderly Patient: A Case Report of Pituitary Macroadenoma Presenting With Sepsis-Like Symptoms

TL;DR

An elderly woman with sepsis-like symptoms was diagnosed with a pituitary tumor causing hormone deficiencies and improved with hormone replacement therapy.

Contribution

Highlights the importance of considering pituitary disease in elderly patients with sepsis-like symptoms.

Findings

An 85-year-old woman with sepsis-like symptoms was found to have panhypopituitarism due to a pituitary macroadenoma.

Hormone replacement therapy with hydrocortisone and levothyroxine led to rapid clinical improvement.

Ophthalmologic evaluation showed preserved vision, supporting non-surgical management.

Abstract

Panhypopituitarism is uncommon but clinically significant, most often caused by pituitary macroadenomas. Its presentation can be subtle and nonspecific, which may lead to misdiagnosis, particularly in elderly patients. We report the case of an 85-year-old woman admitted with fever, abdominal pain, hypotension, and acute confusion, initially managed as sepsis. Laboratory tests revealed hyponatremia and multiple anterior pituitary hormone deficiencies. Magnetic Resonance Imaging (MRI) confirmed a pituitary macroadenoma with suprasellar extension. The patient showed rapid clinical improvement after initiation of hydrocortisone and levothyroxine replacement. Ophthalmologic evaluation demonstrated preserved visual function, supporting conservative management. This case underscores the importance of considering endocrine causes, especially adrenal insufficiency due to pituitary disease, in elderly patients presenting with sepsis-like symptoms. Early recognition and timely hormone replacement can be life-saving.

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