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.
Pituitary Apoplexy