Hypopituitary coma

Question 1

Causes of coma from hypopituitarism

Answer 1

Usually gradual onset in person with known hypopituitarism
Other: pituitary infarction (Sheehan’s), SAH

Question 2

Symptoms and signs of hypopituitary coma

Answer 2

Hypothermia
Hypotension (refractory)
Septic signs (no fever)
Short stature, loss of axillary/public hair ± gonadal atrophy

Question 3

Investigations for suspected hypopituitary coma

Answer 3

Cortisol
TFTs
ACTH
Glucose

Pituitary fossa CT/MRI

Question 4

Management for hypopituitary coma

Answer 4

1st: Hydrocortisone
2nd: T3
3rd: prompt surgery (if cause is apoplexy)