Presentation
Worsening severe headache with orbital pain.
Patient Data
Un-enhanced CT scan of the brain shows a heterogeneous intrasellar mass with central hyperdensity. No obvious enhancement is demonstrated post intravenous contrast injection.
Pre-contrast T1W of brain demonstrates a circumscribed intrasellar mass with areas of intrinsic hyper intense T1 signal. The mass is heterogeneous on T2W/ FLAIR with hypointense area. The lesion is expanding the sellar and shows suprasellar extension. There is blooming related to blood products on gradient echo image corresponding to hemorrhage. Mild peripheral enhancement is observed.
Case Discussion
Pituitary apoplexy is an acute clinical syndrome caused by necrosis of the pituitary gland. The necrosis may be hemorrhagic or non-hemorrhagic. Clinical manifestations may be variable, though typically include headache, visual deficits, orbital pain and altered mental status. Pre-existing pituitary macroadenoma is usually present (60-90%) but it can occur also in healthy glands in a few isolated cases.
The diagnosis of pituitary apoplexy can be made only when hemorrhagic infarction of the pituitary gland leads to the above mentioned clinical syndrome.
Close differential diagnoses are necrotic/hemorrhagic pituitary macroadenoma and adamantinomatous craniopharyngioma in children.
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