A Complex Case of Pituitary Apoplexy Mimicking a Stroke: A Case Report With a Review of the Literature

Abstract

Pituitary adenomas, benign tumors originating in the pituitary gland, are classified based on size and hormone activity. Pituitary apoplexy, defined by hemorrhage or infarction of these adenomas, poses a challenge in estimation due to its subtle presentation. It often manifests as sudden, severe headaches, visual disturbances, nausea, and hormone deficiencies. Diagnosis typically involves MRI or, if unavailable, CT scans, alongside hormonal and other laboratory assessments. Here, we present the case of a 71-year-old female patient who was transferred to the hospital for endovascular treatment of a hemorrhagic stroke after presenting with sudden-onset symptoms suggestive of a stroke. Neurological examination revealed rightsided ptosis, diplopia, and bitemporal hemianopsia. The initially performed CT imaging suggested hemorrhagic stroke. Subsequent MRI reviewed pituitary macroadenoma with apoplexy. Immediate surgical management via endoscopic, endonasal, transsphenoidal adenomectomy resulted in gradual symptom improvement. The patient was discharged three days after the procedure with complete symptom improvement and showed no signs of recurrence during regular follow-ups at one and three months postsurgery. This case emphasizes the critical role of accurate imaging in diagnosing and managing patients with pituitary macroadenomas complicated by apoplexy, which can mimic stroke. While CT scans may lack detail, MRI offers precise information. Prompt recognition and evaluation are vital for effective treatment, highlighting the importance of distinguishing between these conditions for optimal patient care.