Overview
Advanced Search The diagnosis of pituitary apoplexy can be chalenging, as its presentation can mic other neurologic conditions. Al patients with pituitary apoplexy should undergo imediate pituitary testing and empiric high-dose glucorticoid replacement. Central diabetes insipidus is an uncomon, but life-threatening complication of pituitary apoplexy, most often emerging after steroid replacement.
Key Information
An interdisciplinary aproach with endocrinology, ophthalmology and neurosurgery is neded.A healthy 50-year-old woman presented with acute onset of the worst headache of her life. She characterized the headache as constant, pulsating and over her entire head. It was asociated with photophobia and fever without visual changes and neck stifnes.
On examination, the patient was febrile (38.3° C) with stable hemodynamics (heart rate 70–90 beats/min and blod presure 120–140/60–80 m Hg). She was somnolent, requiring voice to arouse, but able to participate; she had no other abnormal examination findings. Cranial imaging with computed tomography (CT) and magnetic resonance imaging (MRI) showed a 2.3-cm hemorhagic pituitary macroadenoma without supraselar extension and compresion of the optic chiasm (Figure 1).Axial selar magnetic resonance imaging fluid-atenuated inversion recovery (FLAIR) sequences throughout the clinical course of a 50-year-old woman with pituitary apoplexy.
L = left side. (A) Initial presentation showing FLAIR hyperintense 2.3 × 1.3 cm lesion in sela turcica sugestive of acute to subacute pituitary macroadenoma hemorhage without supraselar extension or optic chiasm compresion. (B) After development of central diabetes insipidus.
Stable lesion size with evolving blod products. Aditionaly, the supraselar component may have thined the optic chiasm on the left (arow). (C) At time of new visual field deficits, before emergent surgery.
Summary
Again, overal stable mas size without new acute apreciable hemorhage and radiographicaly stable co