Crisis in the Master Gland: A Case Series of Pituitary Apoplexy
https://doi.org/10.15605/jafes.041.S1
- Author:
Lok Yee Chek
1
;
Wei Wei Ng
1
;
Ijaz binti Hallaj Rahmatullah
1
;
Anilah Abdul Rahim
1
Author Information
1. Hospital Raja Permaisuri Bainun
- Publication Type:Journal Article
- MeSH:
Pituitary Apoplexy
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):97-98
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Pituitary apoplexy is a rare but potentially life-threatening
endocrine emergency caused by hemorrhage or infarction
of the pituitary gland. Its presentation often mimics
other acute neurological conditions, posing diagnostic
and management challenges. We report a case series of
three patients presenting with similar neuro-ophthalmic
complaints but differing in symptom onset and radiological
features.
Cases:The first case was a 25-year-old obese female who
presented with acute headache, fever, and right eye ptosis
with complete ophthalmoplegia for 2 days. Imaging
demonstrated a heterogeneous pituitary macroadenoma
with superimposed hemorrhage. Cortisol, prolactin, and
insulin-like growth factor-1 levels were low. She received
hydrocortisone replacement and underwent left pterional
craniotomy with tumor debulking, resulting in marked
visual improvement.
The second case involved a 59-year-old male who presented
with headache and bilateral blurred vision for 1 week,
followed by acute right-sided ptosis. Imaging showed
a heterogeneous sellar-suprasellar mass compressing
the optic chiasm. He had central hypocortisolism,
hypothyroidism, and hyponatremia. Surgical intervention
was declined, and outpatient follow-up showed stable
neuro-ophthalmic findings.
The third case was a 30-year-old female who presented
with a 2-week history of headache and right-sided blurred
vision with temporal hemianopia. Imaging revealed a
sellar-suprasellar mass with fluid-fluid levels compressing
the optic chiasm. She had central hypocortisolism,
hypothyroidism, and hypogonadism. Hydrocortisone replacement was initiated, followed by transsphenoidal
surgery with tumor debulking. Her vision improved after
the surgery.
Conclusion:Pituitary apoplexy may present with similar clinical features
despite differing onset and radiological characteristics.
Early corticosteroid therapy is essential, while surgical
intervention should be reserved for patients with severe
or progressive neuro-ophthalmic deficits. This case series
highlights the importance of individualized, multidisciplinary management to achieve favorable outcomes.
- Full text:2026080416134904630EP_A140.pdf
