Author Affiliations: Departments of Neurology (Drs Flanagan, Leep Hunderfund, and Meissner) and Pathology & Laboratory Medicine (Dr Giannini), Mayo Clinic, Rochester, Minneapolis.
A 63-year-old man presented after being awoken by a severe headache followed by vomiting. Initial neurologic examination was nonlateralizing and showed mild drowsiness. Computed tomography (CT) of the head performed 10 hours after symptom onset revealed a suprasellar mass (Figure 1A). Magnetic resonance imaging (MRI) was performed 24 hours after CT and demonstrated blood in the mass consistent with pituitary apoplexy (Figure 1B and C). Subsequent examinations revealed bitemporal hemianopia confirmed by formal perimetry (Figure 2). Before this presentation, the patient had no symptoms attributable to the pituitary mass. Laboratory testing revealed panhypopituitarism. Hydrocortisone and thyroxine administration was commenced, and transsphenoidal resection of the pituitary was performed. The pathologic examination revealed extensive necrosis consistent with an acutely infarcted pituitary adenoma (Figure 3). By 6 weeks after surgery, the patients' visual field deficit completely resolved, and 1 year later no evidence of residual tumor was seen on repeated neuroimaging. However, persistent pituitary failure required long-term hormone treatment.
Eoin P. Flanagan, Andrea Leep Hunderfund, Caterina Giannini, Irene Meissner. Addition of Magnetic Resonance Imaging to Computed Tomography and Sensitivity to Blood in Pituitary Apoplexy. Arch Neurol. 2011;68(10):1336–1337. doi:10.1001/archneurol.2011.247