Pituitary apoplexy

Case contributed by Assoc Prof Frank Gaillard

Presentation

Patient presented with acute headache.

CT

Vague hyperdensity is seen in the pituitary fossa, more so on the right. 

MRI

The pituitary is enlarged with remodeling of the pituitary fossa. Heterogeneous with high T1 and low T2 signal, particularly on the right. Findings are in keeping with pituitary apoplexy.

Case Discussion

Pituitary apoplexy is an acute clinical syndrome caused by either hemorrhage or infarction of the pituitary gland. Although variable, it typically comprises of headache, visual deficits, ophthalmoplegia, and altered mental status. An existing pituitary macroadenoma is usually present (60-90%) but it can occur with healthy glands in few isolated cases.

The patient had the diagnosis confirmed histologically after transsphenoidal resection. 

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