Acute presentation of a pituitary adenoma

John, a 68-year-old Caucasian man, is a new patient to your practice and has recently moved into the area. He presents to you complaining of a one-month history of nonspecific symptoms including lethargy, reduced appetite and low libido. Four weeks ago, he experienced a severe headache affecting his frontal region, which was associated with vomiting. This headache episode lasted three days and was not associated with any antecedent trauma or localising neurological deficit. He did not seek medical attention at the time and attributed his symptoms to the recent stress of moving. More recently, he has experienced occasional postural dizziness, particularly on standing quickly and on rising each morning.

Picture credit: © Mehau Kulyk/SPL