METHODS

Study Design: Case report.

Summary: 64 year old male presented to Emergency derpartment with sudden onset frontal and occipital headache associated with vomiting and photophobia.
Computed Tomography (CT) Head did not reveal intracranial pathology except for an incidental finding of enlarged pituitary gland with 15 mm diameter
A few days later ophthalmology assessment was requested . Patient complained of double vision. Visual acuity recorded was 6/12 and 6/9 in right and left eye respectively. Incidentally 2mm left sided ptosis was noted with pupil involvement. Anterior and posterior segment examination was unremarkable. There was no sign of papilledema. Colour vision was not affected.
Lumbar puncture was performed and cerebro spinal fluid (CSF) was negative for xanthochromia , CSF protein was high with low glucose, with negative screen for bacteria. C reactive protein was high so treatment was started suspecting viral encaphalitis.
Later on Magnetic resonance imaging (MRI) Head with contrast and MRI Pituitary with contrast revealed 16 x14 mm size of pituitary gland in craniocaudal and anterior posterior dimensions respectively. There was deviation of pituitary stalk towards right side. Pituitary macroadenoma diagnosis was made by radiology team as CT intracranial angiogram did not reveal any aneurym and neither did MR Angiogram.

RESULTS

Hormone assay showed Adrenocorticotropic hormone deficency( ACTH level