Case Report - Hypotension in Acromegaly: a clinical conundrum

Abstract Introduction Hypotension in Acromegaly would commonly nudge a clinician to look for either acute adrenal crises or apoplexy. Both conditions if left untreated may turn fatal. Most cases of apoplexy are associated with pituitary macroadenoma. Due to the large size of tumor at initial detection, clinical or subclinical apoplexy is not uncommon in acromegaly. The classical presentation includes sudden onset headache associated with visual disturbances. The risk factors include hypertension, elderly age, use of anticoagulants and dopamine agonists. Secondary adrenal insufficiency is common in large pituitary tumors and may persist or even develop after surgery.Case Presentation A 55 year female of Acromegaly with pituitary macroadenoma went into sudden unexplained hypotension and shock which led us to sequentially rule out apoplexy, secondary adrenal insufficiency and cardiac causes amongst others. The plausible end culprit for the cause of hypotension was a conundrum which we discuss in this report.Conclusion This case highlights the importance of being aware of first dose hypotension with drugs which in this case was risperidone.