A 60-YEAR-OLD woman presented with a 2-day history of severe migrainelike headache, vomiting, and diplopia. Neurologic examination showed bilateral reduction of visual acuity and right cranial nerve VI and oculomotor nerve paresis. A plain-skull x-ray film showed enlargement of the sella turcica and its double floor (Figure 1). A T1-weighted magnetic resonance image showed a large pituitary adenoma (Figure 2) with pronounced suprasellar extension (Figure 2), chiasmatic compression, and right cavernous sinus invasion (Figure 3). The adenoma contained an area of high intensity compatible with intratumoral hemorrhage. Endocrinologic examination demonstrated isolated gonadotropin deficit. After undergoing decompression surgery, the patient's visual acuity and eye movements were much improved; however, gonadotropin deficit persisted.