Pituitary Apoplexy: A MRI Finding Case and Literature Review

Abstract

Introduction: Pituitary apoplexy is an ischemic or hemorrhagic rearrangement within a pituitary adenoma. Pituitary apoplexy is a rare disease that constitutes a diagnosis and therapeutic emergency. Most of the time, apoplexy is the manifestation inaugural of an adenoma unknown, but it can also complicate a known adenoma. All adenomas can be concerned with the occurrence of apoplexy, with an equivalent risk, whether they are secreting or not and whatever the type of secretion. We report the case of a patient in whom the cranio-encephalic MRI enabled to make the diagnosis. Observation: A 57-years-old woman abruptly presented severe cephalodynia, followed by a left visual field defect. The clinical examination revealed an alteration of the consciousness to the type of obstruction and a decrease in left visual acuity is 4/10 th . The cranio-encephalic MRI performed revealed an expansive intrasellar process with suprasellar extension of heterogeneous signal on all the sequences performed alternating hemorrhagic stigmata in the central tumor zone suggesting a macroadenoma having bled, compatible with pituitary apoplexy. She received medical treatment and hormonotherapy, followed by surgical excision. The outcome was satisfactory. Conclusion: Pituitary apoplexy is a rare but serious complication of pituitary adenomas. It is responsible for various neuro-ophthalmologic. Pituitary apoplexy involves the patient's functional and vital prognosis due to acute panhypopituitarism. It is a diagnostic and therapeutic emergency. MRI is a major contribution to diagnosis. Treatment is based on the combination of hormone replacement therapy and trans-sphenoidal tumor excision.

Sudden Headache and Blindness Due to Pituitary (Adenoma) Infarction: A Case Report

“…The 2010 published United Kingdom (UK) national guidelines contain recommendations related to the clinical, endocrinological, and radiological assessments and management to improve the treatment of this rare but potentially life-threatening condition [9]. Urgent surgical decompression of the pituitary gland is required in patients with severe neuro-ophthalmic deficit resulting in blindness [13], yet the role of urgent decompression in patients with a mild symptomatic or without neurological deficit remains controversial, as the physiology of PI is still rather unclear [14]. Nevertheless, a multidisciplinary team is vital for decisions regarding PI that may precipitate as fatal.…”

Pituitary apoplexy producing internal carotid and basilar artery compression: A rare case report

“…Computed tomography scan and brain MRI is the best reference for the diagnosis, but cranio-encephalic MRI is the best reference for the diagnosis of pituitary adenoma and pituitary apoplexy complications. [ 7 19 ] In the present study, brain MRI was done which visualized the tumor and evaluate its extension and made it possible to assess the hemorrhagic process of the pituitary adenoma.…”

“…Most of the time, apoplexy is the expression marking the beginning of an adenoma unknown, but it can also complicate a known adenoma. [ 7 ]…”

“…Most of the time, apoplexy is the expression marking the beginning of an adenoma unknown, but it can also complicate a known adenoma. [7] Apoplexy in the pituitary tumor is uncommon and underdiagnosed entity. The calculated commonness from the epidemiological surveys of the operated patients suggests the incidence of 0.6-12.8.…”