Pituitary apoplexy in the setting of severe headache and unconsciousness
Abstract
Pituitary apoplexy is a rare but life-threatening condition caused by acute ischaemia or haemorrhage within the pituitary gland, often occurring in pre-existing adenomas. We present a case of an unconscious patient with acute headache, initially managed empirically for suspected meningitis. Investigations, such as cerebrospinal fluid analysis, revealed initially xanthochromia, prompting evaluation for subarachnoid haemorrhage. Magnetic resonance imaging and pituitary function testing identified a pituitary macroadenoma with optic chiasm compression and hypopituitarism, leading to successful transsphenoidal resection.This case underscores the importance of including pituitary apoplexy in the differential diagnosis of unconsciousness and severe headache, as it can mimic meningitis or subarachnoid haemorrhage (SAH). While SAH may precipitate apoplexy, xanthochromia can also arise independently from pituitary haemorrhage. Given the risk of rapid clinical deterioration from adrenal insufficiency, clinicians should consider pituitary apoplexy early in the evaluation to facilitate prompt management while also evaluating for other significant differential diagnoses.
Date
2025-05-22
Type
Article
Subject
Collections
Citation
Qureshi M, Thozhuthumparambil KP. Pituitary apoplexy in the setting of severe headache and unconsciousness. BMJ Case Rep. 2025 May 22;18(5):e263585. doi: 10.1136/bcr-2024-263585
Journal / Source Title
BMJ Case Reports
DOI
10.1136/bcr-2024-263585
PMID
40409776
Publisher
BMJ Publishing Group