Pituitary apoplexy


  • A 41 years old lady
  • No known medical illness
  • Presented with sudden onset of headache
  • Associated with blurring of vision.
  • Clinical examination shows bitemporal hemianopia
  • Blood investigations are unremarkable
MRI of brain in axial planes

MRI findings:

  • There is a lobulated lesion at the sellar extending to suprasellar region (red arrows) measuring about 18mm (W) x 15mm (AP) x 20mm (CC).
  • It is hyperintense on T1 and T2-weighted image and not suppressed on fat suppression sequence.
  • It causes compression and elevation of the optic chiasm (yellow arrow).
  • There is no communication with the adjacent intracerebral vessels. Both ICAs are displaced laterally with no significant compression or luminal narrowing seen.
  • There is minimal expansion of the sella. The normal pituitary is not seen.

HPE findings:

  • Macroscopy: specimen labelled as pituitary tumour, consist of a piece of brownish tissue measuring 3x2x2 mm.
  • Microscopy: section shows monomorphic proliferation of cells with uniform round nuclei, delicate stippled chromatin, inconspicuous nucleoli and moderate amount of cytoplasm. Mitosis and necrosis is not seen.
  • Interpretation: compatible with pituitary adenoma.

Diagnosis: Pituitary apoplexy


  • Pituitary apoplexy is an acute clinical syndrome typically comprises of headache, visual deficits, ophthalmoplegia, and altered mental status
  • It is caused by either hemorrhagic or non-hemorrhagic necrosis of the pituitary gland.
  • An existing pituitary adenoma is usually present (60-90%) but it can occur with healthy pituitary glands
  • Pituitary adenomas are very common pituitary tumour and are often not diagnosed.
  • MRI is the best imaging modality to demonstrate mass lesion in the sella and abnormal signal intensity suggestive of hemorrhage (T1-hyperintense) as demonstrated in this case.

Progress of patient:

  • Transphenoidal tumour resection done
  • Review 2 months after surgery showed improvement in vision
  • No more headache



Author: radhianahassan