A rare cause of hypoactive delirium. (19th October 2014)

• Record Type: Journal Article
• Authors: Kosari, S A; Amiruddin, A; Shorakae, S; Kane, R
• Is Part Of: BMJ case reports. Volume 2014
• Publication Date: 2014-10-19
• Subjects: Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2014-205382
• Languages: English
• ISSNs: 1757-790X

Abstract

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.