Pituitary Apoplexy in an Adult Male

Background: The pituitary gland is a major regulator of endocrine function, located at the base of the skull behind the eyes and inferior to the optic chiasm. Pituitary adenomas are noncancerous growths of pituitary tissue. Most pituitary adenomas will arise from the anterior lobe of the pituitary, due in part to the anterior lobe accounting for most of the pituitary’s size. Most are small microadenomas, measuring <1 cm in diameter. Lesions larger than 1 cm are called macroadenomas. Despite popular belief, pituitary adenomas are perhaps not as rare as previously thought, and it is estimated that one in ten people will develop a pituitary adenoma in their life. Because of the pituitary’s endocrine function, some of these growths will produce hormones or hormone precursors. The most common functioning adenoma secretes prolactin and is known as a prolactinoma. Pituitary adenomas which do not produce hormones are termed nonfunctioning adenomas. Pituitary apoplexy is the occurrence of a sudden onset of symptoms due to spontaneous hemorrhage or infarction of the pituitary, usually precipitated by the presence of an adenoma.

Case Study: A 35-year-old male presented to the emergency department, reporting two days of severe headache and nausea. Neurological examination revealed diminished right sided peripheral vision. An abnormally prominent sella turcica was noted on CT scan, which led to follow up magnetic resonance imaging. This revealed moderate pituitary enlargement and heterogeneously hyperintense T1W signal characteristic for hemorrhagic pituitary apoplexy. The patient was observed for several days before a transsphenoidal hypophysectomy was successfully performed. Endocrinology assays done, both preceding and following the surgery, indicated that the adenoma that bled was nonfunctioning. The patient reports a history of an asymptomatic pituitary mass that was incidentally discovered in childhood. The patient was given instructions at that time to follow up with a physician concerning this mass should symptoms arise.

Conclusion: This case presents an example of a benign, nonfunctioning pituitary adenoma with apoplexy to the literature, with endocrinological, histological and radiographic contributions. Given the high prevalence of pituitary adenomas, there should be a strong emphasis on educating physicians about pituitary apoplexy and about adenoma detection methods in patients with endocrinological imbalances related to the pituitary. Raising awareness can result in early detection to promote noninvasive treatments that would avoid potential complications of surgery and the toll of the disease.