title: A rare cause of hypoactive delirium.
abstract: A 90-year-old man was transferred to a geriatric evaluation and management (GEM) unit for management of hypoactive delirium following a pneumonia and acute myocardial infarction complicated by septic shock. He was found to have central hypothyroidism and hypoadrenalism leading to the diagnosis of hypopituitarism. Cerebral imaging confirmed this was secondary to a pituitary haemorrhage. This case illustrates the complexity of assessment of delirium and its aetiologies. Hypoactive forms of delirium in particular can be difficult to detect and therefore remain undiagnosed. While this patient's delirium was likely multifactorial, his hypopituitary state explained much of his hypoactivity. His drowsiness, bradycardia, hypotension and electrolyte imbalance provided clinical clues to the diagnosis.
authors.affiliation: Department of Geriatrics, Eastern Health, Burwood East, Victoria, Australia.
authors.forename: S A
authors.initials: SA
authors.lastname: Kosari
authors.affiliation: Eastern Health, Burwood East, Victoria, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Amiruddin
authors.affiliation: Monash Medical Centre, Clayton, Victoria, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Shorakae
authors.affiliation: Department of Geriatrics, Eastern Health, Burwood East, Victoria, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Kane
mesh_terms: D000309:Adrenal Insufficiency / Q000188:drug therapy / Q000209:etiology; D000369:Aged, 80 and over; D003693:Delirium / Q000209:etiology*; D020249:Hormone Replacement Therapy; D006801:Humans; D007018:Hypopituitarism / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D007037:Hypothyroidism / Q000188:drug therapy / Q000209:etiology; D008297:Male; D010907:Pituitary Hormones / Q000627:therapeutic use; D013963:Thyroid Hormones / Q000627:therapeutic use
chemical_list: D010907:Pituitary Hormones; D013963:Thyroid Hormones