Pituitary apoplexy

Pituitary apoplexy is an uncommon complication of pituitary adenomas. The syndrome is manifest by an abrupt onset of signs and symptoms associated with infarction or hemorrhage into a preexisting pituitary adenoma. The lesion swells and expands, leading to compression of local suprasellar and parasellar structures. The incidence of pituitary apoplexy ranges from 1 to 20% in surgically verified pituitary adenomas, with a slight male predominance. Most frequently, pituitary apoplexy occurs in previously undiagnosed pituitary adenomas. The diagnosis may often be confused with aneurysmal sub-arachnoid hemorrhage or meningitis. When pituitary apoplexy is misdiagnosed and left untreated, the neurological sequelae can be devastating, resulting in permanent blindness, coma, or death. Glucocorticoid administration and transsphenoidal decompression remain the mainstay of treatment in this acute event.