An unusual case of pituitary apoplexy.
### Learning Point for Clinicians

Hypopituitarism secondary to pituitary metastasis may present as the initial manifestation of occult metastatic breast cancer. Clinicians should consider this possibility when evaluating patients with pituitary lesions. Hormone replacement therapy will improve quality of life, and urgent neurosurgical decompression may be indicated in cases complicated by pituitary apoplexy.

A 67-year-old female was admitted to our hospital with a history of lethargy and weight loss. Blood glucose on arrival was low (2.5 mmol/l). She had no medical history of note and was not on anti-diabetes treatment. Hormone profile showed panhypopituitarism: thyroid-stimulating hormone 0.17 mU/l (reference 0.4–4.0), FT4 7.7 pmol/l (reference 10.3–24.5), FT3 1.8 pmol/l (reference 2.67–7.03), follicle-stimulating hormone 1.8 IU/l (reference 16–157), luteinizing hormone <0.1 IU/l (reference 5.3–65.4), prolactin 193 mU/l (reference 102–496), insulin-like growth factor 1 4.3 nmol/l (reference 9.0–26.0) and adrenocorticotropic hormone (ACTH) 2.3 ng/l (reference 7.2–63.3). We demonstrated an inadequate cortisol response to synthetic ACTH: serum cortisol 68 nmol/l at baseline and 268 nmol/l at 30 min. Visual field perimetry was performed, but its interpretation was limited by poor visual acuity. Magnetic …