Pituitary apoplexy: sudden manifestation of a silent macroadenoma
Keywords:
pituitary apoplexy, pituitary neoplasms, headache, hypopituitarism
Abstract
Pituitary apoplexy is a rare neuroendocrine emergency, usually caused by hemorrhage or ischemia in a previously existing pituitary adenoma. This report presents the case of a 69-year-old male patient who, after being diagnosed with a silent pituitary macroadenoma without symptoms at onset, suddenly presented with a pituitary apoplexy. The clinical picture included severe headache, visual disturbance, and hormonal deficit. Despite the absence of relevant clinical manifestations before the event, the diagnosis was confirmed by neuroimaging studies and hormonal evaluation. The therapeutic approach, which included surgical intervention, enabled partial recovery of visual and hormonal function. This case highlights the importance of surveillance of patients with pituitary macroadenomas, even when they are clinically silent, as they can present acute and severe complications such as pituitary apoplexy.
References
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12. Capatina C, Inder W, Karavitaki N, Wass JAH. Management of endocrine disease: pituitary tumour apoplexy. Eur J Endocrinol [Internet]. 2015 [cited 2025 May 19];172(5): R179–90. Available from: https://pubmed.ncbi.nlm.nih.gov/25452466 Subscription required
2. Briet C, Salenave S, Chanson P. Pituitary apoplexy. Endocrinol Metab Clin North Am [Internet]. 2015 [cited 2025 May 19] ;44(1):199–209. Available from: https://pubmed.ncbi.nlm.nih.gov/25732655 Subscription required
3. Wildemberg LE, Glezer A, Bronstein MD, Gadelha MR. Apoplexy in nonfunctioning pituitary adenomas. Pituitary [Internet]. 2018 [cited 2025 May 19];21(2):138–44. Available from: https://pubmed.ncbi.nlm.nih.gov/29383476 Subscription required
4. Pyrgelis ES, Mavridis I, Meliou M. Presenting symptoms of pituitary apoplexy. J Neurol Surg A Cent Eur Neurosurg [Internet]. 2018 [cited 2025 May 19];79(1):52–9. Available from: https://pubmed.ncbi.nlm.nih.gov/28437813 Subscription required
5. Arbunea-Ghenoiu S, Ciubotaru GV, Dumitraşcu A, Alexandrescu A, Capatina C, Poiana C. Pituitary apoplexy: a retrospective study of 36 cases from a single center. Cureus [Internet]. 2022 [cited 2025 May 19];14(9): e29769. Available from: https://pubmed.ncbi.nlm.nih.gov/36340531
6. Iglesias P. Pituitary apoplexy: an updated review. J Clin Med [Internet]. 2024 [cited 2025 May 19];13(9):2508. Available from: https://pubmed.ncbi.nlm.nih.gov/38731037
7. Garcia-Feijoo P, Perez Lopez C, Paredes I, Cancela AA, Alvarez-Escola C, Calatayud M, et al. Exploring risk factors of severe pituitary apoplexy: insights from a multicenter study of 71 cases. Endocrine [Internet]. 2024 [cited 2025 May 19];86(1):333–41. Available from: https://pubmed.ncbi.nlm.nih.gov/38850439 Subscription required
8. Giritharan S, Gnanalingham K, Kearney T. Pituitary apoplexy—bespoke patient management allows good clinical outcome. Clin Endocrinol (Oxf) [Internet]. 2016 [cited 2025 May 19];85(3):415–22. Available from: https://pubmed.ncbi.nlm.nih.gov/27038242/#:~:text=Conclusion%3A%20In%20pituitary%20apoplexy%20patients,disease%20and%20surgical%20expertise%20available Subscription required
9. Serramito García R, Santín Amo JM, Román Pena P, Pita Buezas L, González Gómez L, García Allut A. Infarto cerebral tras apoplejía pituitaria: descripción de un caso y revisión de la literatura. Neurocirugía [Internet]. 2016 [cited 2025 May 19];27(6):310–4. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1130147316300161 Subscription required
10. Pineda-Centeno LM, Palacios-Rodríguez RA, Moncada-Habib T, Mondragon-Soto MG, Rodríguez-Hernández LA, et al. Pituitary apoplexy: description of medical and surgical treatment and clinical, visual, and endocrinological outcomes during the SARS-CoV-2 pandemic and over three years. Cureus [Internet]. 2024 [cited 2025 May 19];16(6): e63152. Available from: https://pubmed.ncbi.nlm.nih.gov/39055441
11. Lammert A, Walter MS, Giordano FA, Al Zhgloul M, Krämer BK, Nittka S, et al. Neuro-endocrine recovery after pituitary apoplexy: prolactin as a predictive factor. Exp Clin Endocrinol Diabetes [Internet]. 2020 [cited 2025 May 19];128(5):283–9. Available from: https://pubmed.ncbi.nlm.nih.gov/29966153 Subscription required
12. Capatina C, Inder W, Karavitaki N, Wass JAH. Management of endocrine disease: pituitary tumour apoplexy. Eur J Endocrinol [Internet]. 2015 [cited 2025 May 19];172(5): R179–90. Available from: https://pubmed.ncbi.nlm.nih.gov/25452466 Subscription required
