{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T12:16:50Z","timestamp":1756383410352,"version":"3.44.0"},"reference-count":9,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2015,2,26]]},"abstract":"<jats:p>Pituitary apoplexy, a syndrome caused by haemorrhage into the pituitary gland, typically manifests as sudden severe headache, visual symptoms and hypopituitarism, including adrenal insufficiency. We report a case of a 65-year-old man with adrenal insufficiency due to pituitary apoplexy presenting with anorexia following temporal headache and diagnosed through evaluation for hyponatraemia. MRI focusing on the pituitary gland helped to confirm the diagnosis. Our experience serves as a useful reminder of this atypical presentation of pituitary apoplexy, also known as \u2018subclinical pituitary apoplexy,\u2019 and underscores the importance of careful evaluation for hyponatraemia using serial urine osmolality, which is useful to distinguish hypovolaemic hyponatraemia from euvolaemic hyponatraemia. Clinicians should consider pituitary apoplexy as a differential diagnosis in cases of anorexia, loss of energy or hyponatraemia, following headache even when the patient is lacking classical symptoms such as severe headache or visual symptoms.<\/jats:p>","DOI":"10.1136\/bcr-2014-209120","type":"journal-article","created":{"date-parts":[[2015,4,9]],"date-time":"2015-04-09T11:30:58Z","timestamp":1428579058000},"page":"bcr2014209120","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Pituitary apoplexy presenting with anorexia and hyponatraemia"],"prefix":"10.1136","volume":"2015","author":[{"given":"Yosuke","family":"Sasaki","sequence":"first","affiliation":[{"name":"Department of General Medicine and Emergency Care, Toho University, School of Medicine, Ota-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenji","family":"Nakata","sequence":"additional","affiliation":[{"name":"Department of General Medicine and Emergency Care, Toho University, School of Medicine, Ota-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenichi","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Radiology, Toho University, School of Medicine, Ota-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuyo","family":"Ando","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Metabolism and Endocrinology, Toho University, School of Medicine, Ota-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2015,4,9]]},"reference":[{"key":"2025082804462965000_2015.apr09_1.bcr2014209120.1","unstructured":"Melmed S , Jameson J . Disorders of the anterior pituitary and hypothalamus. In: Longo DL , Fauci AS , Kapar DL , Hauser SL , Jameson, JL , Loscalzo J , eds. Harrison's principles of internal medicine. 18th edn. New York: McGraw-Hill, 2012: 2876\u2013903."},{"key":"2025082804462965000_2015.apr09_1.bcr2014209120.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2010.03913.x"},{"key":"2025082804462965000_2015.apr09_1.bcr2014209120.3","doi-asserted-by":"publisher","DOI":"10.4103\/2230-8210.141320"},{"key":"2025082804462965000_2015.apr09_1.bcr2014209120.4","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(14)70142-1"},{"key":"2025082804462965000_2015.apr09_1.bcr2014209120.5","doi-asserted-by":"crossref","first-page":"151","DOI":"10.52964\/AMJA.0564","article-title":"An unusual cause of confusion and hyponatraemia in an elderly patient","volume":"11","author":"Greer","year":"2012","journal-title":"Acute Med"},{"key":"2025082804462965000_2015.apr09_1.bcr2014209120.6","doi-asserted-by":"publisher","DOI":"10.3109\/09513590903184118"},{"key":"2025082804462965000_2015.apr09_1.bcr2014209120.7","doi-asserted-by":"publisher","DOI":"10.1186\/1752-1947-5-284"},{"key":"2025082804462965000_2015.apr09_1.bcr2014209120.8","first-page":"193","article-title":"Pituitary apoplexy presenting as Addisonian crisis after coronary artery bypass grafting","volume":"29","author":"Mattke","year":"2002","journal-title":"Tex Heart Inst J"},{"key":"2025082804462965000_2015.apr09_1.bcr2014209120.9","doi-asserted-by":"crossref","first-page":"W3","DOI":"10.1308\/147870809X400912","article-title":"Hyponatraemia after orthopaedic surgery\u2014a case of pituitary apoplexy","volume":"91","author":"Thomason","year":"2009","journal-title":"Ann R Coll Surg Engl"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2014-209120","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T11:46:38Z","timestamp":1756381598000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2014-209120"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,4,9]]},"references-count":9,"alternative-id":["10.1136\/bcr-2014-209120"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2014-209120","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2015,4,9]]}}}