• Chia-Chen Hsu, Hong-Da Lin, Chung-Yen Huang, and Yi-Lun Chiang.
• Division of Endocrinology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
• Medicine (Baltimore). 2022 Jun 3; 101 (22): e29274e29274.

RationalePituitary apoplexy occurs in about 8% of those with nonfunctioning pituitary adenoma. Subsequent hormone deficiency, especially corticotropic deficiency, is the most common finding. We describe the unusual manifestations of adrenal insufficiency that are usually overlooked in such cases, with the aim of raising awareness of this disease.Patient ConcernsA 53-year-old male with a history of hyponatremia came to our hospital with intermittent fever and generalized pruritic skin rash. He also reported general weakness, abdominal pain, poor appetite, and severe retroorbital headache.DiagnosesLaboratory data revealed hypereosinophilia, hypotonic hyponatremia, and hypopituitarism, including secondary adrenal insufficiency. Sellar magnetic resonance imaging revealed a pituitary macroadenoma, 2 cm in height, with mild displacement of the optic chiasm. Pathologic report and immunohistochemical stains of surgical specimen showed pituitary gonadotropic adenoma with apoplexy.InterventionsTranssphenoidal removal of the pituitary adenoma was performed. The patient received intravenous hydrocortisone then oral form cortisone acetate regularly.OutcomesHis symptoms and laboratory data recovered after the operation and medical treatment.LessonsThis case highlights that eosinophilia, pruritic skin rash and fever can be manifestations of adrenal insufficiency, and that they may initially be regarded as cellulitis.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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