Thank you to PGY3 Dan Kaplan for presenting a a patient with uncontrolled type 1 diabetes, found to have evidence of hypopituitarism and eventually diagnosed with pituatary abscess secondary candida glabrata.
Causes of hypopituitarism
- Pituatary masses (macroadenomas, apoplexy, craniopharyngioma, meningioma etc)
- Infiltrative diseases (sarcoidosis, tuberculosis, hemochromatosis)
- Sheehan’s syndrome, immunologic (hypophysitis, Ipilimumab)
- Infection/abscess are rare
Acute hypopituitarism presents with symptoms of ACTH/cortisol deficiency: nausea, vomiting, hypotension (loss of peripheral vascular tone), hyponatremia (due to inappropriate secretion of ADH).
*Remember secondary adrenal insufficiency does not lead to salt wasting, hyperkalemia and volume contraction because it does not cause aldosterone deficiency.
*If adrenal insufficiency is started, do not delay initiation of stress dose steroids but draw hormone levels prior to administration.
While pitutary infection and abscess are rare, they need to be considered in a patient with uncontrolled diabetes (such as this patient, who had an A1c of 16.5%!!). An important infection to evaluate for in such patients is Mucormycosis, and rapid imaging and consultation of surgical services are necessary.