We describe 2 patients with hypopituitarism who presented with a presenting history suggesting subarachnoid hemorrhage (SAH) in the absence of pituitary hemhorrage. In both patients diagnosis was delayed, in one case by over 5 years. The presence of hyponatraemisa at each presentation in baoth patients was consistent (and considered part of the syndrome of SAH. Investigation of hyponatraemia in both patients led to the dianosis of hypopituitarism. History, physical examination and confirmatory laboratory and radiological investigations are shown with discussion of literature.
Sudden thunderclap headache warrants exclusion of subarachnoid haemorrhage. The presence of hyponatraemis heralded an alternate cause for symptoms. In one patient the presence of hypopituitarism was apparent when other history was considered. This presentation of hypopituitarism is unreported but warrants consideration when thunderclap headache is associated with hyponatraemis and SAH is not demonstrated.