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Case of the Month

by Dr K C Choy AM (Mal), MBBS, M.Med, FRCR

Answer to Case Of the Month 
Pituitary Apoplexy

Discussion of Findings
The sagittal T1W scan of the brain (Fig.1) showed enlarged sella turcica with an enlarged pituitary gland with a high signal region within the gland. This area is hypointense on the axial T2W scan (Fig.2). These signal characteristics are that of recent haemorrhage where blood products are in the deoxyhaemoglobin and methaemoglobin states.

Fig 3: Coronal T1W with gadolinium

A coronal post gadolinium T1W scan (Fig.3) showed elegantly the presence of a pituitary tumour with suprasellar extension and the draping of the optic chiasma over the gland. The thin rim of enhancing tissue represents the normal pituitary tissue while the hyperintense haematoma can be seen within the almost isointense tumour.

Transphenoidal resection of the mass confirm a haemorrhagic pituitary adenoma.

Pituitary Apoplexy
Pituitary apoplexy is a rare endocrine emergency resulting from hemorrhagic infarction of a pre--existing pituitary tumour. The infarction is thought to be due to rapid growth of tumour outstripping its blood supply. The clinical manifestations of this syndrome are related to rapid expansion of the tumour secondary to hemorrhage with compression of the pituitary gland and the perisellar structures, leading to headache, vomiting, hypopituitarism, visual field defects, and cranial nerve palsies. This may mimic subarachnoid bleed.

Pituitary apoplexy is different from Sheehan's syndrome which is the result of ischaemic infarction of a normal size pituitary gland, leading to hypopituitarism secondary to postpartum hemorrhage and hypotension.
 
About the Author 
Dr K C Choy is currently attached to the Mahkota Medical Centre, Melaka as Consultant Radiologist.
 
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Last Updated:
Monday, 21 February 2011