title: Young adult patient with headache, fever and blurred vision.
abstract: BACKGROUND
  This case highlights the fact that acute pituitary apoplexy may be misdiagnosed due to being confused with other entities exhibiting similar symptoms, such as meningitis or subarachnoid hemorrhage.
  
  
  METHODS
  A patient in his late 30s presented with sudden and severe frontal headache, fever, blurred vision, nausea, confusion, as well as oculomotor palsy (CN III) with partial ptosis of the left eyelid, dilated left pupil and left eye globe deviation inferiorly and laterally. The final diagnosis was acute pituitary apoplexy complicating a pituitary macroadenoma. In this setting, headache is usually present due to stretching and irritation of the dura mater, and fever due to meningeal irritation or upward expansion leading to hypothalamic dysfunction. Decreased visual acuity and defects in visual fields are caused by upward expansion, which compresses the optic chiasm. Ophthalmoplegia can also be observed due to lateral expansion with invasion of the cavernous sinus.
  
  
  CONCLUSIONS
  Medical professionals involved in emergency care should be aware of this clinical entity and collaborate with endocrinologists using a multidisciplinary team approach for prompt diagnosis and optimal treatment of such patients.
authors.affiliation: Department of Endocrinology and Diabetes, Hellenic Red Cross Hospital, 1 Athanasaki Str., 11526, Athens, Greece.
authors.forename: Stavroula A
authors.initials: SA
authors.lastname: Paschou
authors.affiliation: Department of Endocrinology and Diabetes, Hellenic Red Cross Hospital, 1 Athanasaki Str., 11526, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tzioras
authors.affiliation: Department of Endocrinology and Diabetes, Hellenic Red Cross Hospital, 1 Athanasaki Str., 11526, Athens, Greece.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Trianti
authors.affiliation: Department of Radiology, Hellenic Red Cross Hospital, Athens, Greece.
authors.forename: Stavroula
authors.initials: S
authors.lastname: Lyra
authors.affiliation: Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Vasileios-Arsenios
authors.initials: VA
authors.lastname: Lioutas
authors.affiliation: Department of Neurosurgery, "G. Gennimatas" General Hospital, Athens, Greece.
authors.forename: Andreas
authors.initials: A
authors.lastname: Seretis
authors.affiliation: Department of Endocrinology and Diabetes, Hellenic Red Cross Hospital, 1 Athanasaki Str., 11526, Athens, Greece. mahi_vr@hotmail.com.
authors.forename: Andromachi
authors.initials: A
authors.lastname: Vryonidou
mesh_terms: D000328:Adult; D005334:Fever / Q000209:etiology; D006261:Headache / Q000209:etiology; D006801:Humans; D008297:Male; D010899:Pituitary Apoplexy / Q000150:complications / Q000175:diagnosis*; D010911:Pituitary Neoplasms / Q000150:complications / Q000175:diagnosis*; D014786:Vision Disorders / Q000209:etiology