Subacute Haemorrhagic Pituitary Apoplexy Leading to Secondary Adrenal Insufficiency: A Case Report

Pituitary apoplexy is an acute and potentially life-threatening complication of pituitary adenomas caused by haemorrhage or infarction within the gland. Clinical presentation may be non-specific, creating diagnostic difficulty and increasing the risk of delayed recognition, particularly when symptoms evolve subacutely. We report a case of a 52-year-old postmenopausal female with type 2 diabetes who presented with a six-week history of progressive fatigue, weakness, headache, nausea, weight loss, and unexpectedly improved glycaemic control. Initial community blood testing demonstrated an undetectable serum cortisol level, prompting urgent hospital admission. Further evaluation revealed panhypopituitarism, and magnetic resonance imaging demonstrated a haemorrhagic pituitary macroadenoma with suprasellar extension and optic chiasmal compression. The patient was treated promptly with intravenous hydrocortisone, followed by oral glucocorticoid replacement and levothyroxine, resulting in rapid clinical improvement. This case highlights the diagnostic challenge of pituitary apoplexy presenting with subacute constitutional symptoms and underscores the importance of early recognition and timely multidisciplinary management to prevent life-threatening complications.