Pituitary apoplexy

Case contributed by Ammar Haouimi
Diagnosis almost certain

Presentation

Sudden onset of severe headaches.

Patient Data

Age: 50 years
Gender: Male
mri
This study is a stack
Axial
T1
This study is a stack
Coronal
T2
This study is a stack
Axial
Gradient Echo
This study is a stack
Sagittal
T1 fat sat
This study is a stack
Sagittal
T1 C+
This study is a stack
Coronal
T1 C+
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Info

Sellar mass with suprasellar extension, elevating the optic chiasma. It displays a high signal centrally on T1 and T2 and a low signal on GE, not attenuated on T1 fat sat sequence (hemorrhagic infarct). The postcontrast sequences demonstrate peripheral enhancement.

Case Discussion

The clinical context and the MRI features in a patient known for pituitary macroadenoma are highly suggestive of pituitary apoplexy.

Pituitary apoplexy is an acute clinical condition caused by either hemorrhagic or non-hemorrhagic necrosis of the pituitary gland.

An existing pituitary macroadenoma is present in 60-90% but has been reported in healthy pituitary glands in a few isolated cases.

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