I see double: A case of Pituitary Apoplexy

Pituitary apoplexy is a rare but potentially life-threatening condition caused by either haemorrhage or infarction of the pituitary gland. It commonly occurs in non-functioning pituitary adenoma. Patients present with the clinical syndrome of headache, visual defects or ophthalmoplegia, altered consciousness and variable endocrine deficits. However, the condition may also be subclinical, like in our case, where the presenting feature was mild to moderate headache for a few months, misguiding the physician. Her prolactin level was high, and an MRI revealed evidence of haemorrhage within the pituitary gland. Her amenorrhoea persisted even after normalization of prolactin, which may be related to reduced LH and FSH after apoplexy. The case is reported because of its simplicity of presentation, which we should not ignore. J Assoc Clin Endocrinol Diabetol Bangladesh, July 2024;3(2): 67-70

A case of pituitary apoplexy which occurred in a patient with prolactinoma is reported. The signs and symptoms on presentation were headache, loss of vision, sixth-nerve palsy, subarachnoid haemorrhage and fever. Physicians are alerted to the necessity of prompt and accurate diagnosis in this condition to allow urgent decompression of the anterior visual pathways.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Pituitary apoplexy is usually the result of hemorrhagic infarction in pituitary adenoma. The clinical presentation of pituitary apoplexy varies widely and includes asymptomatic hemorrhage, classical pituitary apoplexy and even sudden death. Few cases of cerebral infarction associated with pituitary apoplexy have been reported in the literature. Pituitary apoplexy can cause narrowing of intracranial vessels by mechanical obstruction due to mass effect or by vasospasm resulting in cerebral ischemia. We report a case of pituitary apoplexy associated with cerebral infarction and the putative mechanisms.