Abstract:

Objective To investigate the clinical features, diagnostic approach, and causes of missed diagnosis in an elderly patient with hypoglycemic coma as the initial manifestation of hypopituitarism, and to provide reference for early recognition and intervention. Methods A case of an elderly woman with panhypopituitarism and pituitary crisis caused by primary empty sella was reported. Her clinical data and diagnostic and treatment process were reviewed, and the relevant literature was summarized. Results The patient initially presented with fatigue and hypoglycemic coma. Admission laboratory tests showed markedly reduced levels of multiple pituitary hormones and target gland hormones. Brain magnetic resonance imaging revealed empty sella. She was diagnosed with panhypopituitarism due to primary empty sella and pituitary crisis (hypoglycemic type plus hyponatremic type). After treatment with glucocorticoid and low-dose thyroid hormone replacement, along with symptomatic and supportive therapy to correct hypoglycemia and hyponatremia, the patient regained consciousness, symptoms improved, serum sodium and blood glucose returned to normal, and she was discharged for follow-up. Conclusion Hypopituitarism in elderly patients lacks specific clinical manifestations and is easily missed when presenting with atypical symptoms such as hypoglycemic coma and electrolyte disturbances. In elderly patients with unexplained hypoglycemia, hyponatremia, or hypothyroidism, pituitary function should be promptly evaluated and brain imaging performed. Early diagnosis and standardized hormone replacement therapy can effectively prevent progression to pituitary crisis and reduce mortality.

Key words: hypopituitarism, elderly, hypoglycemic coma, empty sella turcica, pituitary crisis