Pituitary and adrenal disease in acute medicine

The foundation doctor may need to deal with pituitary or adrenal pathology in the acute setting as part of a medical emergency or because an incidental lesion within the gland has been found on imaging. Pituitary apoplexy refers to a vascular event within a pituitary tumour, and the clinical features include acute onset headache, reduced consciousness, visual disturbance and diplopia. A high index of suspicion is required to make the diagnosis and appropriate imaging is needed. Acute adrenal insufficiency presents with hypoglycaemia, hypotension, hyponatraemia, hyperkalaemia and dehydration. Intravenous hydrocortisone should be given empirically if the clinical features are suggestive, as the condition may be fatal if untreated. A systematic approach is required to determine the clinical significance of incidentally found pituitary and adrenal lesions, which includes determining the size of the lesion and biochemical assessment to exclude endocrine hypersecretion.