MON-LB066 Older Self Neglect as an Unusual Presentation in Panhypopituitarism

Panhypopituitarism can emerge from pituitary adenoma, infection, infiltration, or congenital causes.(1) Clinical presentation vary with symptoms associated with thyroid, adrenal and gonadal insufficiency.(2) Headache or visual impairments can occur secondary to pituitary mass. A 74-year-old white veteran male was brought to the emergency department exhibiting a delirium. His neighbor reported a year of progressive decline, weight loss, social withdrawal, memory dysfunction, changes in behavior and personality. The patient denies visual disturbance or headaches. Screening with 3D-CAM (Confusion Assessment Method) indicative of delirium. On admission, he was afebrile, pulse at 55/min and BP of 105/66 mmHg. The mini nutritional assessment was 7 (i.e., malnourished) and 17/30 points on Montreal Cognitive Assessment (MoCA<26 for cognitive impairment). His neurological examination showed no focal deficit. A laboratory profile revealed hyponatremia (130 mEq/L; NR 136 - 145 mEq/L) and hyperkalemia (5.4 mEq/L; NR 3.5 - 5.1 mEq/L). Leucocytes were documented in urine indicating urinary tract infection. He was hospitalized and prescribed antimicrobial therapy and fluids. On day three, agitation and behavioral disturbance emerged and prompted the primary team to order CT scan of the head that showed a suprasellar mass, suggestive of pituitary adenoma. Further studies detected a low morning cortisol (3.8 ug/dl; NR 6-30 ug/dl ) with normal ACTH (17.33 pg/mL NR 7.2 - 63.3), low free T4 (0.6 ng/dl; NR 0.71 - 1.85 ng/dl) with normal TSH (2.00 uIU/mL, NR 0.45 - 4.70 uIU/mL), but no evidence of diabetes insipidus. Endocrinology team was consulted and treatment was initiated with glucocorticoid and levothyroxine replacement. On day 12, the patient was reevaluated and was found alert and oriented to person, time and place. He scored 25/30 on MOCA. A recommendation for brain biopsy was refused by the patient. The relationship between personality changes and panhypopituitarism is yet to be understood. This case illustrates the need to keep a high index of suspicion for endocrine and metabolic disorders in older adults with atypical presentation of delirium and self-neglect.References1. Fernandez-Rodriguez E, Bernabeu I, Andujar-Plata P, Casanueva FF (2012) Subclinical hypopituitarism. Best Pract Res Clin Endocrinol Metab 26: 461-469.2. Toogood AA, Stewart PM (2008) Hypopituitarism: clinical features, diagnosis, and management. Endocrinol Metab Clin North Am 37: 235-261. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.