A Rare Case of Pituitary Apoplexy Associated with Middle Cerebral Artery Infarct: A Correlation or Coincidence?
https://doi.org/10.15605/jafes.041.S1
- Author:
Muhammad Fitri Azizi Mat Dait
1
;
Khairul Azmi Ibrahim
1
Author Information
1. Neurology Unit, Medical Department, Hospital Sultanah Nur Zahirah
- Publication Type:Journal Article
- MeSH:
Middle Cerebral Artery;
Pituitary Apoplexy;
Infarction
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):92-93
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Pituitary apoplexy is a rare, life-threatening condition
resulting from hemorrhage or infarction of the pituitary
gland, most commonly in patients with pre-existing
pituitary tumors. It typically presents with a sudden
headache, visual disturbance, ophthalmoplegia, and altered
mental status. An uncommon but serious complication
is ischemic stroke in the middle cerebral artery (MCA) territory, particularly in the absence of direct internal
carotid artery (ICA) compression.
Case:We report a case of a 36-year-old male who presented
with headache, visual impairment, and fever. Initial
computed tomography (CT) brain imaging demonstrated
a heterogeneous sellar lesion with peripheral calcification
measuring 2.4 × 3.2 × 2.7 cm, suggestive of a pituitary mass
with possible apoplexy, without evidence of acute cerebral
infarction. The patient subsequently developed dysarthria,
hemianopia, and reduced consciousness, prompting repeat
neuroimaging. Follow-up CT revealed a large hypodense
area in the right fronto-parieto-temporal region consistent
with ischemic infarction. Magnetic resonance imaging
confirmed an acute infarct in the right MCA territory without
hemorrhagic transformation. A sellar-suprasellar mass
measuring 2.3 × 2.8 × 3.8 cm was identified, consistent with
a pituitary macroadenoma with intratumoral hemorrhage
compressing the optic chiasm, but without direct right ICA
compression. Time-of-flight mineralocorticoid receptor
antagonists demonstrated attenuated flow in the right
ICA (C2–C7), suggesting intracranial ICA thrombosis and
reduced perfusion in the right MCA and its branches.
Laboratory evaluation revealed hyperthyroidism and
hypocortisolism, with no evidence of coagulopathy. The
patient was treated with corticosteroid replacement and
carbimazole and referred for neurosurgical management.
Conclusion:This case highlights a rare association between pituitary
apoplexy and MCA stroke, possibly mediated by
vasospasm, inflammation, or hypercoagulability. More
research is needed to understand this connection and
improve treatment strategies.
- Full text:2026080415120550288EP_A132.pdf
